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TOPIC: The impact of Long Term Illness - Managing the side effects

The impact of Long Term Illness - Managing the side effects 1 month, 1 week ago #1

With the escalating prevalence and financial impact of Long Term Illness are we creating an increasing clinical need for products to address the side effects of treatment? For example medication, cancer treatment, auto-immune diseases, Stroke and Parkinsons (amongst others) cause the side effect of Xerostomia (dry mouth), this is a condition which if left unchecked can exacerbate a person’s health concerns & severely impact quality of life.

One particular example cited is that within the treatment of certain cancers (head and neck most commonly) Xerostomia can cause an increase in dental caries, impacting on recovery and increasing the risk of major complications post treatment.

What are we doing to manage the side effects of the treatment of long term illness & is Xerostomia a mostly hidden health concern?
Last Edit: 4 days ago by Kauser Aslam.

Re: The impact of Long Term Illness - Managing the side effects 3 weeks, 4 days ago #2

Xerostomia is often ignored as patients feel it is 'just one more complaint' that they don't want to burden their clinician with, unaware that this condition and its symptoms can be controlled. By addressing the issues & prescribing an artificial saliva Clinicians can help their patients continue their medication plan, allow them to eat more comfortably, and increase sleep which in itself will help with coping strategies.

Re: The impact of Long Term Illness - Managing the side effects 2 weeks, 2 days ago #3

It is not just dental caries that affects the quality of life is it?

That aside, I agree a much ignored side effect of not only various cancer therapies but also medications; Many health professionals are ignorant of this (xerostomia) and fail to give the correct advice when patients do raise the issue. Patients may complain of feeling dry and increasing ulceration in the oral cavity yet many may advise the use of a chlorohexidine containing mouthwash which invariably will worsen the situation.

Re: The impact of Long Term Illness - Managing the side effects 3 days, 22 hours ago #4

In my role as a palliative care nurse this common symptom is not a hidden one but a very common one therefore all our patients have an initial oral assessment and ongoing regular follow up assessments eg looking at dryness ability to swallow inflammation pain thrush taste disturbance then individual strategies are discussed with the patient such as oral cleansing routine sucking sweets/gum to stimulate saliva saliva stimulant spray/oral gel or salivix pastille a lip salves and treatment of any oral thrush anything that can be done to improve a patients ability to enjoy food and drink is vital to improve quality of life.

Re: The impact of Long Term Illness - Managing the side effects 3 days, 21 hours ago #5

Xerostomia could indeed be a hidden health issue in patients who are unable to communicate fully with nursing staff, for instance, patients with Parkinson’s or MS. For this reason, if one of our patients appears to be having difficulty eating or drinking, we check their oral health and inform the medical team if we feel there are any problems. Similarly, we take seriously any comments from patients who complain of a sore mouth and taste disturbance and appropriate medication is prescribed promptly by the medical team.

Re: The impact of Long Term Illness - Managing the side effects 1 day, 16 hours ago #6

Great posts by very caring individuals; I am a dental hygienist and have become really interested in xerostomia from a well-being point of view rather than a "dental" perspective. I say this but I still always take a view to the prevention of dental disease especially given that reduced saliva flow will increase caries incidence and the risk of periodontal disease. These patients do not need more problems.

It is perhaps not in palliative care that the problem arises though? It seems that in the primary care setting "lip service" (pardon the pun) is paid to patients reporting dry mouth to their GPs and little is known or done about it; over 1000 medicines in the BNF will reduce saliva flow and it really can not be much fun for the patients suffering and we obviously do not get to see some of these patients with less than 50% of the population attending the dentist regularly then many are missed by us and the patient never gets the correct advice to help them prevent dental disease....

Simple strategies work

Re: The impact of Long Term Illness - Managing the side effects 22 hours, 23 minutes ago #7

Working in palliative care we often face side effects from long term illness. For example, dry mouth we obviously implement frequent mouthcare as tolerated and sometimes use artificial saliva/ and saliva stimulants such as vitamin c or pilocarpine eye drops. We often use medications off label with the patients informed consent. There are many other examples such as Ondansetron for itch. A useful book that may help is Symptom Management in Advanced Cancer 4th edition. Twycorss/Wilcock/Toller. (Palliative drugs.com.).
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