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Oropharyngeal problems may affect up to 60% of patients with cancer and can impact greatly on quality of life, both physically and psychologically.
Patients suffering from advanced cancer at any primary site frequently present with symptoms and signs of oral disease. Saliva is a major protector of the tissues of the mouth and cancer patients may have risk factors for developing a dry mouth.
Patients should be specifically questioned about mouth problems and their mouths examined regularly for signs of treatable oral pathology.
Good mouth care is essential for the well-being of debilitated patients in order to prevent problems before they arise and to control unpleasant symptoms.
Routine mouth care as appropriate to patient needs
There are many products available and choice may dictated by patient preference and tolerance. There is some evidence that mucin-based products are better tolerated and more effective than cellulose-based ones (the mucin comes from the stomach of pigs; this may be an issue for some patients). Artificial saliva should ideally be pH neutral.
Please refer to section 12.3.5 Treatment of dry mouth for formulary preparations
Pilocarpine is sometimes used as a treatment for xerostomia. It is associated with side effects. Please seek specialist advice.
See section 12.3.5 Treatment of dry mouth
Other treatment options are available, please seek specialist advice.
Use if nystatin or miconazole not effective or a systemic antifungal is required
Not generally a first line treatment, to be reserved for more resistant infections
Oral suspension oxetacaine 10mg, aluminium hydroxide 200mg, magnesium hydroxide 100mg/5ml, 10ml 8 hourly and at bedtime (unlicensed product, available as a special order from Rosemont)
Sucralfate suspension 1 gram/5ml, 10ml 20 minutes before meals and at bedtime
Protect the ulcerated area
See section 12.3.1 Drugs for oral ulceration and inflammation
Corticosteroids are the mainstay of treatment (but avoid in oral infections)
Prevention:
Treatment: