A report by the Oral Health Foundation in 2022 showed that more than 8,800 people are diagnosed with mouth cancer in the UK annually. The startling reality is that one in 55 men and one in 108 women will develop mouth cancer at some point during their lives.
As dental professionals, we are tasked with screening for early symptoms of the condition in order to facilitate rapid treatment and improve survival rates. We also spend significant time and energy on patient education in the area, aiming to help more people reduce their risk factors and prevent cancer in the first place. Most of our conversations focus on physical signs of the disease, practical lifestyle improvements and the importance of regular dental check-ups. For patients who have received a mouth cancer diagnosis, the dental practitioner’s role involves helping them manage the symptoms of the disease and the side effects of treatment. Those undergoing radiotherapy will need solutions for common issues like dry mouth or difficulty swallowing, for example.
An emotional journey
However, it is important that we also consider the psychological impact of mouth cancer on our patients. Though everyone’s experience will be entirely unique, we can tailor our care according to at least some of the common psychological events associated with oral cancer treatment.
Sadly, one of these is an increased prevalence of anxiety and depression. A study into the mental health of head and neck cancer patients found that 18 per cent were highly distressed during their first oncology appointment, rising to 25 per cent during a follow up appointment. Other research found that people diagnosed with oral cancer were nearly 2.2 times more likely to experience depression compared to those without the condition.
Depressive symptoms may be higher for oral cancer patients who are single, likely due to the lack of access to an immediate support system at home. More serious depressive symptoms have also been reported during and up to three-months postoperative. It is also important to note that selfesteem often decreases after surgical treatment for oral cancer, negatively influencing quality of life for patients of all ages.
Upon interviewing oral cancer patients, one study identified an array of possible cognitive and social outcomes. In addition to anxiety and depression, these included being afraid of the future, as well as feeling lonely and socially avoidant/isolated. Participants also reported on the significant impact of reduced abilities to work and the consequential financial implications. Feelings of helplessness or hopelessness have also been associated with higher rates of depression and anxiety.
Comprehensive support
Coping strategies can have a significant impact on psychological outcomes for patients with oral cancer. An Indian study found that individuals often turned to one of four possibilities – a stead-fast positive attitude, their faith, emotionally unloading on family and friends, or distraction. Other studies have grouped coping strategies according to being either problem-focused or emotion-focused, both of which are important to give a patient the best experience possible.
Dental professionals may, therefore, consider speaking to patients about active coping strategies that help to reduce the stress experienced throughout the oral cancer journey. Of course, we are not psychologists or counsellors and mustn’t try to act as such, but simply giving patients an opportunity to talk about how they’re feeling is important.
As dental care providers, we will also likely witness the much wider implications of mouth cancer. The partners, family members, friends and caregivers involved with someone diagnosed with mouth cancer will require support too. It is widely acknowledged that there is a lack of understanding as to what is required for effective carer support. Dental practitioners are well-placed to ensure that these individuals have the necessary information and tools to look after both their charge’s and their own oral health. Once again, just listening to their story and showing some compassion can go a long way – especially for those who unexpectedly became carers for family members or friends.
A global fight
Despite significant advances in our understanding of the aetiology, development and treatment of mouth cancer in recent years, there is still work to do. In addition to further promoting the importance of early detection for improved survival rates, we must also consider how we can enhance the quality of life for oral cancer patients, before, during and after treatment. This means supporting them with practical solutions to increase both their physical and psychological wellbeing.
References available on request.