Incorporating oral care into cancer treatment

Xi Chen left the University of Iowa in 2023.  He enjoyed his eight years there, but Iowa City’s small size made finding enough participants for his research difficult, he said.

“I struggled with recruitment for my research,” he said. “I couldn’t sleep. It was so stressful. I needed to find another place with a large medical center but a bigger population.”

He joined the faculty of The Ohio State University’s College of Dentistry the same year, as an associate professor. In addition, Chen brought his research to the university’s Geriatric Oncology Dental Clinic.

Carroll Ann Trotman, dean of the College of Dentistry, said that Chen was recruited to the College of Dentistry to provide expertise in geriatric dentistry and end-of-life care. 

“His work provides a unique opportunity to develop a program to integrate dental professionals to function as part of the cancer or palliative team to provide on-site assessment and counsel patients,” she said. “Bringing oral symptom management into the medical team addresses the many access barriers that cancer patients face.”

Cancer treatment can cause or exacerbate problems in the mouth, which can make eating painful, Chen said. This in turn can leave patients weaker and less able to tolerate their treatment.

“Literature shows that up to 98% of patients undergoing cancer therapy experience at least one oral health side effect,” Chen said.

The ability to eat and enjoy food is something that palliative care physicians consider regularly.

“In the palliative care community, we spend a lot of time talking about food,” said Julia Agne, Chen’s colleague and a physician specializing in palliative care at The James Cancer Hospital and Solove Research Institute. “Whenever you’re facing an illness like cancer, the desire to eat can be impacted by so many aspects of the disease. It’s very fitting that we partner with the College of Dentistry because one of the first experiences of food is when it enters your mouth. … If you’re unable to chew it, if you’re unable to eat without pain, the experience of food completely changes.”

Chen’s goal is to develop several new initiatives in the Geriatric Oncology Dental Clinic, including public outreach programs. A lack of information is one of the major barriers to receiving care, he said.

“Patients may be under the wrong impression that all these complications are an inevitable part of cancer therapy and there’s not much we can do about that,” he said. “With that wrong impression, they may not report their symptoms.”

Another barrier, that Chen has witnessed firsthand, is differing concerns among care providers. Often, if a patient’s illness is severe, oral care is not prioritized.

Even if patients he has seen in the past were able to see a dentist, their disease state was often not factored into their oral care, he said.

“Our study shows that their treatment was not modified based on their prognosis and life expectancy. They receive the usual care just like their healthy counterparts,” he said. “This made me wonder whether the current treatment really addresses patient’s goal of oral care.”

Chen’s research on this topic is innovative, Agne said.

“This is a unique interdisciplinary approach,” she said. “A lot of palliative care research is focused on the relationship between palliative care physicians and mental health providers. I haven’t seen a collaboration between dentistry and palliative care.”

Chen hopes to fully integrate his work into The James, and Agne is looking forward to further collaborations.

 “I’m really excited,” she said. “This is a completely unexplored realm: dentistry and palliative care. We spend a lot of time in palliative care thinking about what medication we can give to fix a symptom. Dr. Chen is providing another layer [of support].”

The ability to work with colleagues like Agne is just one of the reasons Chen is glad he became a Buckeye.

“I’m so happy to relocate to Ohio State,” he said. “It helped me identify the great potential to expand and translate my research into practice. … Maybe all of this can be used to improve patient care.”