Oral Health-Related Quality of Life in Pediatric Hematopoietic Cell Transplant Survivors

Abstract

Background: Radiation, chemotherapy, and graft versus host disease (GVHD) associated with HCT can result in oral and dental late effects that persist throughout survivorship. Few studies have documented how these changes affect survivors of pediatric HCT. Aim: Determine the incidence of oral health concerns and their effects on oral health-related quality of life (OHRQoL) among a population aged 2-30 years that underwent HCT as children. Methods: A 21-item survey was sent to 351 patients and their families in one of 3 versions, depending on patient age. Eligible respondents had received an HCT at Seattle Cancer Care Alliance at age <21.0 years, were at least 1 year post-transplant, and had received their HCT within the last 10 years. Results: One hundred and forty-nine (42%) patients returned the survey. Mean patient age at the time of transplant was 9.0 years, mean age at the time of survey was 13.9 years. Health concerns in the last month were reported by 66% of responders. The majority (79.9%) received an allogeneic transplant; 91.9% underwent myeloablative conditioning; 52.4% received TBI as part of their conditioning. The presence of one or more oral health concerns was associated with increased years since transplant (OR= 1.18, 95% CI 1.01-1.37, multivariate analysis). Patients who were older at the time of survey were more likely to report two or more symptoms (OR=1.06, 95% CI 1.01-1.12). For those transplanted <6 years old, patients who received ≥ 12 Gy TBI reported more dental development concerns than those that had no TBI (OR=2.57, 95% CI 0.61,10.83). Most patients who had a diagnosis of oral cGVHD were aware of this, but 10% were not. The majority of respondents (74.5%) reported seeing a dentist at least twice in the last 12 months. Conclusions: Most responding pediatric HCT survivors reported few bothersome oral and dental late effects. Patients may rate their concerns with little severity as they compare them to what they experienced with previous disease treatments. Results indicate adolescents may be more acutely aware of changes in their mouths than younger patients. Future studies should compare OHRQoL reports with clinical findings. The integration of consistent supportive oral care services into HCT care at Seattle Cancer Care Alliance may be positively influencing patients' oral health including their understanding of the value of consistent follow-up dental care.