Oral Candidosis in Community-Based Patients with Advanced Cancer

Oral candidosis is a significant cause of morbidity in patients with advanced cancer. The objectives of the study were to determine the epidemiology, etiology, clinical features, and microbiological aspects of oral candidosis among community-based patients. The subjects were recruited from hospice day centers in England. The clinical component involved completion of a study questionnaire, assessment of performance status, clinical examination of the oral cavity, measurement of unstimulated whole salivary flow rate, measurement of stimulated whole salivary flow rate, and performance of an oral rinse. Oral swabs were taken from subjects with appearances indicative of oral candidosis. The laboratory component involved standard procedures to isolate, enumerate, and identify yeasts from the clinical specimens. Three hundred ninety patients participated in the study. Two hundred seventy-two (70%) patients had oral yeast carriage, and 51 (13%) patients had combined clinical and microbiological evidence of oral candidosis. On univariate analysis, the presence of oral candidosis was associated with poor Eastern Cooperative Oncology Group performance status, presence of a denture, usage of a systemic corticosteroid, the severity of xerostomia, a low unstimulated whole salivary flow rate, and a low stimulated whole salivary flow rate. Multivariate analysis identified poor Eastern Cooperative Oncology Group performance status, presence of a denture, usage of a systemic corticosteroid, and the severity of xerostomia as being independently associated with the presence of oral candidosis. Oral candidosis is relatively common in community-based patients with advanced cancer. Hence, such patients should be screened for oral candidosis and should also be screened for reversible factors that predispose to oral candidosis, such as poor dental hygiene and salivary gland dysfunction.