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  Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 53  |  Issue : 2  |  Page : 256-260
 

Oral health-related quality of life after prosthetic rehabilitation in patients with oral cancer: A longitudinal study with the Liverpool Oral Rehabilitation Questionnaire version 3 and Oral Health Impact Profile-14 questionnaire


Department of Dental and Prosthetic Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India

Date of Web Publication6-Jan-2017

Correspondence Address:
K P Dholam
Department of Dental and Prosthetic Surgery, Tata Memorial Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.197716

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 » Abstract 

Background: Prosthodontic rehabilitation helps to improve the oral health-related quality of life (OHRQOL). The Liverpool Oral Rehabilitation Questionnaire (LORQ) and Oral Health Impact Profile (OHIP) are specific tools that measure OHRQOL. Objective: The primary objective of this study was to assess the impact of oral rehabilitation on patients' OHRQOL following treatment for cancer of oral cavity using LORQ version 3 (LORQv3) and OHIP-14 questionnaire. Secondary objectives were to identify issues specific to oral rehabilitation, patients compliance to prosthetic rehabilitation, the effect of radiation treatment on prosthetic rehabilitation, to achieve meaningful differences over a time before & after prosthetic intervention, to carryout and document specific patient-deprived problem. Methodology: Seventy-five oral cancer patients were studied. Patients were asked to rate their experience of dental problems before fabrication of prosthesis and after 1 year using LORQv3 and OHIP-14. The responses were compared on Likert scale. Results: Patients reported with extreme problems before rehabilitation. After 1 year of prosthetic rehabilitation, there was improvement noticed in all the domain of LORQv3 and OHIP-14. Complete compliance to the use of prosthetic appliances for 1 year study period was noted. In response to the question no. 40 (LORQv3), only 15 patients who belonged to the obturator group, brought to notice the problems which were not addressed in the LORQv3 questionnaire. Conclusion: The study showed that the oral cancer patients coped well and adapted to near normal oral status after prosthetic rehabilitation. This contributed to the improved overall health-related quality of life.


Keywords: Denture, obturators, oral cancer, quality of life, rehabilitation


How to cite this article:
Dholam K P, Chouksey G C, Dugad J. Oral health-related quality of life after prosthetic rehabilitation in patients with oral cancer: A longitudinal study with the Liverpool Oral Rehabilitation Questionnaire version 3 and Oral Health Impact Profile-14 questionnaire. Indian J Cancer 2016;53:256-60

How to cite this URL:
Dholam K P, Chouksey G C, Dugad J. Oral health-related quality of life after prosthetic rehabilitation in patients with oral cancer: A longitudinal study with the Liverpool Oral Rehabilitation Questionnaire version 3 and Oral Health Impact Profile-14 questionnaire. Indian J Cancer [serial online] 2016 [cited 2019 Sep 15];53:256-60. Available from: http://www.indianjcancer.com/text.asp?2016/53/2/256/197716



 » Introduction Top


Treatment modalities of head and neck cancer namely surgery, radiotherapy and chemotherapy lead to severe functional, cosmetic and psychological disturbance in affected patients. Oral rehabilitation after treatment of cancer contributes to restoring the patient to near normal quality of life.[1] There are many questionnaires which assess general treatment outcomes of head and neck cancer patient. The Liverpool Oral Rehabilitation Questionnaire (LORQ) is a recently developed oral health-related quality of life (OHRQOL) questionnaire that deals specifically with oral rehabilitation for patients with head and neck cancers.[2] LORQ was modified further to LORQ version 3 (LORQv3) which has more detailed questions on oral function and patients' dental and prosthetic status.[3]

OHIP has been extensively used within the dental community and shown to be reliable, valid and responsive to change.[3] OHIP measures people's perception of the social impact of oral disorders on their wellbeing.[4] The aim of this index is to provide a comprehensive measure of self-reported dysfunction, discomfort and disability arising from oral conditions. The OHIP-14 is a shorter version of the OHIP-49, but it retains the original conceptual dimensions contained in the OHIP-49.[4],[5]

The purpose of this study is to assess health-related quality of life after prosthetic rehabilitation in oral cancer patients using LORQv3 and OHIP-14.

Objectives

The primary objective of this study was to assess the impact of dental rehabilitation on patients' OHRQOL following treatment for cancer of oral cavity using LORQv3 and OHIP-14 questionnaire. Secondary objectives were to identify issues specific to oral rehabilitation, patients compliance to prosthetic rehabilitation, the effect of radiation treatment on prosthetic rehabilitation. To achieve meaningful differences over a time before and after prosthetic intervention, to carryout and document specific patient-deprived problem.

Inclusion and exclusion criteria

Patients with good general condition and disease free, after completion of various modalities of treatment for various oral cancers and who needed dental rehabilitation, namely obturators, complete dentures (CDs) and partial dentures (PDs) were included in the study. Uncooperative patients and those with severe complication limiting the scope for rehabilitation, for example, trismus were excluded from the study. Patients with cancers of the oropharynx, salivary glands, nasopharynx, and hypopharynx were not included.


 » Methodology Top


Recruitment of subjects

Seventy-five oral cancer patients who had completed cancer treatment and required prosthetic rehabilitation were randomly selected and included in the study. A disease-free period of 6 months after surgery and 1 year after radiation treatment was considered before considering the patients for oral rehabilitation. The study was conducted between June 2012 and June 2015.

The questionnaire

This study was conducted by questionnaire based interviews by a single investigator. General patient's information and treatment details were recorded. Patients were asked to rate their experience of dental problems before fabrication of prosthesis and after one year of using prosthesis by LORQv3 along with OHIP-14.

The LORQv3 was developed by Pace-Balzan et al.[3] and consists of 40 items divided into two primary sections. The first 17 items assess issues related to oral function, oro-facial appearance and social interaction. The remaining items deal with prostheses and patient denture/prosthetic satisfaction. Items refer to problems or symptoms experienced during the previous week and are rated on a 1–4 Likert scale ranging from never = 1, sometimes = 2, often = 3 and always = 4.[3] Percentage (%) of patients who said “often” or “always” was calculated.

The OHIP-14 developed by Slade and Spencer, assess seven dimensions of impacts of oral conditions on people's OHRQOL including functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability and handicap.[5] The response format on a Likert-type frequency scale was as follows: Very often = 4, fairly often = 3, occasionally = 2, hardly ever = 1, never = 0.[4] Percentage (%) of patients who said “fairly often” or “very often” was calculated.

Statistical analysis

Demographic, clinical, and disease-related variable were presented as frequency (percentage) and mean (standard deviation [SD]), median as appropriate. Two group comparisons were made using Mann–Whitney U-test. Three or more group comparisons were made using Kruskal–Wallis test. Changes in scores were analyzed using Wilcoxon sign rank sum test. The change in the outcome variable recorded at different time points was analyzed using Friedman test. P < 0.05 was considered statistically significant.


 » Results Top


Impact of oral rehabilitation using Liverpool Oral Rehabilitation Questionnaire version 3 and Oral Health Impact Profile-14

Oral cancer patients underwent oral rehabilitation after completion of cancer treatment. A total of 75 patients were included in the study. There were 50 males and 25 females with an age range of 14–77 years (mean 51 year). There were 26 males and 19 females in the obturator group (45) with mean age of 43 years, 15 males and 5 females with mean age of 52 years in the PDs (20) group and 9 males and 1 female with mean age of 62 years in the CDs (10) group.

Only oral cavity cancers were included in the study. Cancer location in the oral cavity were palate (34%), upper alveolus (19%), buccal mucosa (15%), tongue (13%), gingivo-buccal sulcus (7%), lower alveolus (7%), and retromolar trigone (5%). Histopathology of the patients included squamous cell carcinoma (73%), mucoepidermoid carcinoma (5%), adenoid cystic carcinoma (12%), ameloblastoma (1%), and others (8%). Tumor staging seen in this study was T1 in 13%, T2 in 43%, T3 in 4%, and T4 in 39%.

Of 75 patients, 23 (31%) patients underwent surgery, 1 patient (1%) received radiotherapy. The combination treatment of surgery and radiotherapy was done in 28 (37%), surgery and chemotherapy in 2 (3%) surgery, radiotherapy and chemotherapy in 19 (25%) and radiotherapy and chemotherapy was done in 2 (3%) patients.

Out of 45 patients with obturators, only surgery was done in 16 (36%) patients. The combination of surgery and radiotherapy was done in 19 (42%), surgery and chemotherapy in 1 (2%) surgery, radiotherapy and chemotherapy in 9 (20%) patients.

Out of 20 patients with partial denture (PD), only surgery was done in 4 (20%) patients. Combination of surgery and radiotherapy was done in 6 (30%), surgery and chemotherapy in 1 (5%) surgery, radiotherapy and chemotherapy in 8 (40%) and radiotherapy and chemotherapy was done in 1 (5%) patients.

Out of 10 patients with CD, only surgery and radiotherapy was done in 3 (30%) and 1 (10%) patients, respectively. The combination of surgery and radiotherapy was done in 3 (30%), surgery, radiotherapy and chemotherapy in 2 (20%) and radiotherapy and chemotherapy was done in 1 (10%) patients.

Issues specific to oral rehabilitation

Liverpool Oral Rehabilitation Questionnaire version 3

The first 17 items assess issues relating to oral function, oro-facial appearance and social interaction and were applicable to all patients [Table 1]. Prior to rehabilitation, patients in the obturator group scored worse than in complete or partial denture group in all items, i.e., chewing, swallowing, salivation, speech, mouth opening, oro-facial appearance, and social interaction. Patients in the CD group showed better scoring than in the PD group.
Table 1: Data analysis prior to rehabilitation: The first 17 Liverpool Oral Rehabilitation Questionnaire version 3 items assessing issues relating to oral function, oro-facial appearance and social interaction among study groups (obturator, complete denture, partial denture)

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After 1 year [Table 2] of prosthetic rehabilitation, there was statistically significant improvement in all the domains of LORQv3 for patients who had obturators, PD or CD. Although minimal problems persisted during chewing (2% in patients with obturators and 3% in patients with CDs and no problems in the PD group). One percentage patients in the obturator group had problems with swallowing, salivation, and mouth-opening. The problem with speech was seen in 3% and with an oro-facial appearance in 2% of patients who had obturators. No problems were reported in the PD and CD group. Problems with social interaction were noticed in 5% of patients with an obturator, 1% of patients with PD and 2% of patients with CD.
Table 2: Data analysis after 1 year of rehabilitation: The first 17 Liverpool Oral Rehabilitation Questionnaire version 3 items assessing issues relating to oral function, oro-facial appearance and social interaction among study groups (obturator, complete denture, partial denture)

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Amongst the 75 patients, 45 patients in the obturator group and 20 patients in the partial denture group had at least few natural teeth in their upper and lower jaw prior to rehabilitation.

The second part of the LORQv3 [Table 3] assessed the social impact of prostheses and the patient's denture satisfaction. No patient had previous partial and complete dentures or implant retained crowns, bridges or dentures in any of the arches so no scoring was done for pre rehabilitation.
Table 3: Data analysis after 1 year of rehabilitation: Remaining Liverpool Oral Rehabilitation Questionnaire version 3 items dealing with prosthesis and patient satisfaction with these among the study groups (obturator, complete denture, partial denture)

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For items 20–23, after 1 year of prosthetic rehabilitation, though there were no significant differences between the groups for questions on overall patient's satisfaction. It was observed that very few patients with obturators were still embarrassed about conversing, refused dinner invitation and lacked self-confidence because of embarrassment about their dentures. These patients had received radiation [Table 3].

Items 26–39 referred to maxillary and mandibular prosthetic satisfaction. The statistical results of group analysis show that no patients had any complaints at the end of 1 year. However, observation of the data shows that there were very few patients with obturators were dissatisfied and insecured about their dentures. CD wearers complained about food collection under dentures and that they had to take out their dentures while eating. Most of these patients had received radiation treatment. No patients in the PD group had any complaints with maxillary PD [Table 3].

Oral Health Impact Profile-14

In the OHIP-14 questionnaire, before rehabilitation [Table 4], patients in the obturator group scored worse on all items compared with patients in CD or PD group. After 1 year of prosthetic rehabilitation [Table 5], no problems were seen in the domains of psychological disability, social disability, and handicap among all the three groups. There were few patients in the obturator group with the problem in the domain of physical pain (2%) and psychological discomfort (3%).
Table 4: Data analysis prior to rehabilitation using Oral Health Impact Profile-14 among the study groups (obturator, complete denture, partial denture)

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Table 5: Data analysis after 1 year of rehabilitation using Oral Health Impact Profile-14 among the study groups (obturator, complete denture, partial denture)

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Patients compliance to prosthetic rehabilitation

All the 75 patients answered questions on prostheses and the patient's denture satisfaction, thus indicating a complete compliance to the use of prosthetic appliances for 1 year study period.

Differences before and after prosthetic intervention

Patients reported with extreme problems before rehabilitation. After 1 year of prosthetic rehabilitation, there was marked improvement noticed in all the domain of LORQv3 and OHIP-14.

Specific patient-deprived problem

In response to the question no. 40 (LORQv3), only 15 patients who belonged to the obturator group, brought to notice the problems which were not addressed in the LORQv3 questionnaire namely, problems with sucking, drooling of saliva during speech, accumulation of food particles between the teeth, weakening of gums or mucosa following treatment, occlusion of teeth.

Effect of radiation treatment on prosthetic rehabilitation

Fifty radiated patients were compared with 25 nonradiated patients before and after 1 year of oral rehabilitation. The mean and SD scores in all the domains of LORQv3 and OHIP-14 were worse for the radiated patient before the initiation of the prosthetic rehabilitation, i.e., after 1 year of completion of radiation treatment. After 1 year of prosthetic rehabilitation, the scores improved but no difference was seen in mean and SD in both the groups. No statistically significant difference was found between the two groups.


 » Discussion Top


In this study, sample consisted of only oral cancer patients who had undergone prosthodontic treatment at our hospital. In this group of patients, oral consideration and prosthodontic needs vary considerably as compared to the other cancer patients and general dental patients. Oral cancer patients have very specific needs that are beyond the needs of most other patients diagnosed with other types of cancer.[6]

Three other studies [7],[8],{9} compared patients wearing removable partial and CDs. One study compared denture satisfaction in CD wearers with RPD wearers. CD wearers were more satisfied with speech, mastication, and retention of the maxillary denture while RPD wearers were more satisfied with retention and comfort of wearing mandibular dentures.[7] The second study was a longitudinal clinical trial assessing the impact of implant-retained dentures on patients' perceived outcome using the OHIP-49 and a denture satisfaction questionnaire. Baseline satisfaction with maxillary dentures was higher than for mandibular dentures in edentulous patients.[8] In the third study, patients were grouped into group CD (patients wearing complete dentures in both the arches); group COMB (patients wearing a combination of CDs in one arch opposed by either an RPD or no denture in the other) and group PD (patients wearing, at most, RPDs in one or both arches). The results of the study showed that patients wearing CDs in one or both arches generally scored worse for oral function and mandibular denture problems/satisfaction than patients wearing RPDs.[1]

As with previous studies,[2],[3] it appeared that the LORQv3 was acceptable to patients, with few items omitted. Item 17 (difficulty opening mouth) was the most frequently omitted item, probably as a result of its location at the top of page 2 of the LORQv3 questionnaire. Hence in previous studies by Pace-Balzan et al., less response rate was achieved.[1],[3] However, in this study, 100% response rate was achieved as this study was conducted by questionnaire-based interviews which were conducted by a single investigator.

The shortcoming of this study was that the study sample consisted of heterogeneous group of oral cancer patients, with different types of oral cancer, who received different treatment modalities for oral cancer with different types of prosthetic rehabilitation. Due to the disparity in occurrence and treatment of the lesion having a homogenous group of patients was not possible. Hence, an attempt for subjective analysis of OHRQOL was done in oral cancer patients who received CD, PDs and obturators.

The main advantage of this study was its longitudinal design and, hence, the ability to measure responsiveness over time. Shortcomings of lack of rehabilitation improved considerably after 1 year of prosthetic rehabilitation. Patients were comfortable with most of the aspects dental rehabilitation, i.e. function, psychological. Although nominal shortcomings persisted in obturator and CD as compared to PD. Total compliance to use of prosthesis was observed. Although the scores were worse for radiated patient before rehabilitation, there were no statistical differences seen between radiated and nonradiated group after 1 year of rehabilitation.


 » Conclusion Top


This subjective analysis using LORQv3 and OHIP showed that inspite of altered anatomy following resection and reconstruction, compromised physiology following chemo-radiation, the oral cancer patients coped well and adapted to near normal oral status after prosthetic rehabilitation. This showed improved QOL after one year of dental rehabilitaion.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 » References Top

1.
Pace-Balzan A, Butterworth CJ, Dawson LJ, Lowe D, Rogers SN. The further development and validation of the Liverpool Oral Rehabilitation Questionnaire (LORQ) version 3: A cross-sectional survey of patients referred to a dental hospital for removable prostheses replacement. J Prosthet Dent 2008;99:233-42.  Back to cited text no. 1
    
2.
Pace-Balzan A, Cawood JI, Howell R, Lowe D, Rogers SN. The Liverpool Oral Rehabilitation Questionnaire: A pilot study. J Oral Rehabil 2004;31:609-17.  Back to cited text no. 2
    
3.
Pace-Balzan A, Cawood JI, Howell R, Butterworth CJ, Lowe D, Rogers SN. The further development and validation of the Liverpool Oral Rehabilitation Questionnaire: A cross-sectional survey of patients attending for oral rehabilitation and general dental practice. Int J Oral Maxillofac Surg 2006;35:72-8.  Back to cited text no. 3
    
4.
Slade GD. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol 1997;25:284-90.  Back to cited text no. 4
    
5.
Slade GD, Spencer AJ. Development and evaluation of the Oral Health Impact Profile. Community Dent Health 1994;11:3-11.  Back to cited text no. 5
    
6.
Peker K, Ozdemir-Karatas M, Balik A, Kürklü E, Uysal O, Rogers SN. Validation of the Turkish version of the Liverpool Oral Rehabilitation Questionnaire version 3 (LORQv3) in prosthetically rehabilitated patients with head and neck cancer. BMC Oral Health 2014;14:129.  Back to cited text no. 6
    
7.
Celebic A, Knezovic-Zlataric D. A comparison of patient's satisfaction between complete and partial removable denture wearers. J Dent 2003;31:445-51.  Back to cited text no. 7
    
8.
Allen PF, McMillan AS. A longitudinal study of quality of life outcomes in older adults requesting implant prostheses and complete removable dentures. Clin Oral Implants Res 2003;14:173-9.  Back to cited text no. 8
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]

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