Tratamento oncológico, alterações bucais, perda dentária e mortalidade: um estudo realizado no centro de oncologia de Minas Gerais

Abstract

The present study aims to evaluate the association between the type of oncological treatment and the occurrence of oral alterations and investigate the relationship between tooth loss and all-cause mortality in patients treated at an oncology center of a hospital in southern Minas Gerais in a four-year follow-up. To this end, 399 patients were initially interviewed in that center and later 351 medical records of the total population were analyzed. Outcomes were evaluated through self-report of the following oral changes: xerostomia, halitosis, altered taste, dietary alteration, trismus, mucositis, presence of infection/inflammation. The types of cancer treatment were classified into: chemotherapy, radiotherapy, chemotherapy and radiotherapy, and others. Covariates included socioeconomic status, general and cancer-related health, and oral health. Associations between outcomes and independent variables were tested using bivariate and multiple logistic regression, and the results were expressed as odds ratios (OR) and 95% confidence intervals (95%CI). With regard to the association between the type of cancer treatment and the occurrence of oral alterations, xerostomia (60.15%) and dietary changes (57.64%) were the most prevalent alterations, and patients undergoing chemotherapy (32.58%) or the combination of chemotherapy and radiotherapy (36.34%) were more susceptible to oral diseases. Radiotherapy was not associated with any of the oral alterations, but chemotherapy resulted in higher odds of having altered taste (OR: 2.44; 95%CI: 1.22-4.90). Combined, chemotherapy and radiotherapy were associated with higher odds of altered taste (OR: 3.86; 95%CI: 1.92- 7.75) and the occurrence of mucositis (OR: 2.51; 95%CI: 1, 06-5.94). We used the data obtained from cancer patients when approached, especially those from the oral clinical examination, during which the variable ‘number of teeth’ was accurately verified, while the mortality data from all causes were obtained from hospital records. Covariate adjustment included socioeconomic factors, health-related habits, general health status and oral health. The relationship between all variables and the number of teeth was evaluated using the chi-square test. Kaplan-Meier survival curves were stratified by tooth loss and compared using the log-rank test. The Cox proportional hazards model was applied to calculate hazard ratios (HRs) for the association between tooth loss and mortality after covariate adjustment. Regarding the relationship between tooth loss and all-cause mortality observed in a four-year follow-up, a prospective observational study shows that tooth loss is associated with sex, education, presence of multimorbidity and the use of prosthesis, and that the presence of 20 or more teeth is associated with better survival rates (HR: 0.33; 95%CI: 0.15-0.75). In conclusion, the importance of dental evaluation and follow-up for cancer patients remains evident, both in terms of oral changes resulting from oncological therapies and in terms of tooth loss, with the intention of ensuring the effectiveness of treatment combined with health and quality of the patient's life.