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ORIGINAL ARTICLE  
Year : 2013  |  Volume : 3  |  Issue : 1  |  Page : 40-43
Knowledge of oral cancer and screening practice of B.Sc. nursing students in Davangere City, India


1 Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune - 18, Maharashtra, India
2 Department of Public Health Dentistry, Coorg Institute of Dental Sciences, Virajpet, India
3 Department of Public Health Dentistry, Indira Gandhi Institute of Dental Sciences, Kothamangalam, India
4 Principal, V S Dental College and Hospital, Bangalore, Karnataka, India
5 College of Dental Sciences, Davangere, India

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Date of Web Publication13-Feb-2014
 

   Abstract 

Background: Oral cancer mainly affects individuals in the 6 th and 7 th decades of life with a history of risk factors like, smoking, tobacco chewing and alcohol consump­tion. Early recognition and referral is essential for higher cure rates and better quality of life. Nursing staff provides the oral health care for patients in hospital. Admission to hospital provides a ''window of opportunity'' for oral cancer screening via an oral health checkup during nursing care.
Objective: To measure awareness of risk factors, clinical signs and screening service for oral cancer among nursing students.
Materials and Methods: A cross-sectional questionnaire survey was conducted in two Nursing Colleges of Davangere city. The questionnaire consisted of 17 closed ended questions. The questionnaire was pre-tested and validated before administering.
Results: Among 300 nursing students, 231 were females and 69 were males. Over 90% thought oral health checkups were important although only 69% performed oral examination regularly; approximately 90% identified smoking and use of tobacco products as a risk factor but very few identified other associated factors like alcohol. Only 55% of the respondents were aware about the most common site of occurrence of oral cancer. Only 49% recognized a non healing ulcer as a sign of oral cancer. Over 90% of the students felt that a nursing student needs more education about screening for oral cancer and were willing to participate in a network to promote early screening for oral cancer.
Conclusion: This study revealed that nurses' awareness of oral cancer risk factors and clinical signs, in the group under study was, however, poor. This study highlights a need for improved education of nurses on oral cancer to make the oral health checkup on admission viable for oral cancer screening.

Keywords: Early detection, nurses, oral cancer, screening

How to cite this article:
Mittal S, Mahuli A, Hiregoudar M, Ramanarayanan S, Mohandas U, Manjunath PG, Natraj CG. Knowledge of oral cancer and screening practice of B.Sc. nursing students in Davangere City, India. J Educ Ethics Dent 2013;3:40-3

How to cite this URL:
Mittal S, Mahuli A, Hiregoudar M, Ramanarayanan S, Mohandas U, Manjunath PG, Natraj CG. Knowledge of oral cancer and screening practice of B.Sc. nursing students in Davangere City, India. J Educ Ethics Dent [serial online] 2013 [cited 2019 Dec 10];3:40-3. Available from: http://www.jeed.in/text.asp?2013/3/1/40/126944



   Introduction Top


In age specific cancer mortality rates in India, oral cancer accounts to 22.9% amongst all cancer mortality in men. [1] Oral cancer mainly affects individuals in the 6 th and 7 th decades of life with a history of risk factors like, smoking, tobacco chewing and alcohol consump­tion. Early recognition and referral is essential for higher cure rates and better quality of life. [2] Despite advances in modern multimodality treatment, the survival rate of oral cancer has only modestly improved to approximately 60% in the recent past. The treatment of oral cancer can produce significant functional impairment in speech, mastication and swallowing, dental health, and even the ability to interact socially. It must be considered among the most debilitating and disfiguring of all cancers. The morbidity of oral cancer treatment is proportional to the stage of disease at diagnosis. Measures to downstage the disease or prevent it will have a significant benefit to society. [2]

Early detection of oral cancer can decrease the morbidity and mortality of this devastating disease. However, in contrast to skin lesions such as melanoma, where visual screening has sensitivity and specificity rates of 93 and 98%, respectively, the visual detection of premalignant oral lesions remains problematic for several reasons. Oral mucosal abnormalities are a common finding in the general population. Without question, the vast majority of these lesions are clinically and biologically benign. However, precancerous and early cancerous lesions are often subtle and rarely demonstrate the clinical characteristics observed in advanced cases: Ulceration, induration, pain, or associated cervical lymphadenopathy. In addition, early lesions are highly heterogeneous in their presentation and may mimic a variety of common benign or reactive conditions. There is a growing realization that some premalignant and early cancerous lesions are lurking within the mucosa but are not readily detectable to the naked eye. [3]

Oral cancer has four cardinal signs which warrant further investigation. These are erythroplakia, leukoplakia, mixed (erythro-leukoplakia), and ulceration. Of these the commonest presenting sign is ulceration. The preponderance of this disease is identified through general medical and dental care. [4],[5],[6] However, there is evidence to suggest general medical practitioner and general dental practitioner lack of awareness contributes to a delay in diagnosis. [5] There is also evidence that the elder generation do not seek dental care. [7] Nursing staff provide oral health care for the patient population in hospital; this is especially true of the vulnerable elderly cohorts who are more likely to suffer from oral cancer. Therefore, admission to hospital provides a ''window of opportunity'' for ''screening'' for this disease. It is of paramount importance that nursing staff should be aware of the risk factors and clinical signs of oral cancer. [8]

Objective

To measure awareness of risk factors, clinical signs and screening service for oral cancer among nursing students.


   Materials and Methods Top


A cross sectional questionnaire survey was done. The study was conducted in two randomly selected nursing colleges by lottery method, from 4 nursing colleges of Davangere city. A total of 300 students who were present on the day of data collection, were included in the questionnaire based survey. Second year and third year nursing students were approached and asked to complete the questionnaire in the presence of the researcher.

The pre-designed questionnaire consisted of 17 questions which assessed; oral examination habits, knowledge of oral cancer; its clinical appearance, and risk factors. All the questions used were close-ended. Face and content validity of the questionnaire was done amongst experts from dental and nursing faculty. Informed consent of participants and ethical approval was obtained from the ethical committee of College of Dental Sciences, Davangere.

Statistical analysis

All returned questionnaires were coded and analyzed. Results were expressed as frequency distribution of respondents for each question and were analyzed using the SPSS Version 17 software. Chi-square test was used to analyze the significant differences if any, among the responses given by students of various years of study. P value less than 0.05 was considered statistically significant.


   Results Top


Among 300 nursing students, 77% (n = 231) were females and 23% (n = 69) were males. The students were aged between 17 to 23 years.

91.7% (n = 275) of the respondents thought oral health checks were important although only 53.7% (n = 161) performed this task regularly. 88% (n = 264) of the respondents identified smoking and use of tobacco products as a risk factor but very few identified other associated factors like alcohol, poorly fitting denture, sun exposure and old age as other risk factors. Only 55% (n = 165) of the respondents were aware about the most common site of occurrence of oral cancer. When asked which area of the tongue is most likely to develop oral cancer only 10.3% (n = 31) recognized the lateral borders as the most common site. Out of the total 300 respondents only 6.6% (n = 20) were aware of the correct method for the examination of the tongue. 75.1 % (n = 226) of the respondents were not aware regarding the metastasizing nature of cancers of the oral cavity. Only 17% (n = 51) recognized fixed lymph nodes as indicative of oral cancer metastasis.

Only 48.6% (n = 146) recognized a non-healing ulcer as a sign of oral cancer. 65.8% (n = 198) had not referred patients to a dentist, an ENT specialist or a surgeon for further diagnosis of suspicious oral cancer lesion in the past 12 months. 91% (n = 274) of the students felt that a nursing student needs more education about screening for oral cancer and were willing to participate in a network to promote early screening for oral cancer. [Table 1] shows a summary of the responses to the questionnaire.
Table 1: Responses to the questionnaire

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There was no significant association observed between the year of study and the knowledge, attitude and practice regarding screening of oral cancer tested with Chi-square test.


   Discussion Top


In this changing era specialist nurses are expected to triage, diagnose and treat minor injuries. Recently prescribing, ordering investigations, meeting targets and providing out-of-hours care are some aspects of the changing role of nursing staff. Nursing staff have the opportunity to be fundamental in changing the outcome of patients with undiagnosed oral cancer by recognizing the early signs of the disease. The significance of their role in oral cancer detection has been previously outlined. Interaction with nurses may allow high risk patients to increase their level of awareness and confidence to seek help when required. [8]

91.7% (n = 275) of the respondents thought oral health checkups were important although only 53.7% (n = 161) performed this task regularly. 88% (n = 264) of the respondents identified smoking and use of tobacco products as a risk factor but very few identified other associated factors like alcohol, poorly fitting denture, sun exposure and old age as other risk factors. These findings were consistent with the study conducted by Carter et al. in UK in 2008. [7] This data also parallel work undertaken by Carter LM et al. in 2007 on medical and dental students' awareness of oral cavity carcinoma. [9]

Ninety-one percent (n = 274) of the students felt that a nursing student needs more education about screening for oral cancer and were willing to participate in a network to promote early screening for oral cancer. This highlights a need for continuing medical education, supported by Wardh et al., who used a questionnaire to test nursing and auxiliary nursing staff on oral healthcare. The two groups underwent a four hour teaching program and repeated the questionnaire 2 years later. It was apparent from these results that specific knowledge was not retained thus demonstrating the key to continuous use of the new skill and this aspect should be covered in teaching for reinforcement. [10] This study highlighted weakness in the training of nurses similar to those reported previously by Carter et al. in 2007 involving the training of medical and dental students. [9] In addition, the results in the present study reflect those obtained in a previous study by Carter et al. in 2007 involving general practitioners that identified the need for improved education. [11]

Lack of awareness of oral cancer risk and clinical signs may also prohibit nurses from delivering preventive advice to patients. The results of this study indicate that whilst there is desire to increase patient total care, teaching is required to enhance awareness of oral cancer risk factors and signs. These findings were substantiated in a study by Patton et al. in 2006 where less than 40% of nurse practitioners felt adequately trained to examine patients of oral cancer. [12] There are a few inherent limitation of the study like lack of generalizability beyond the specific school and cohorts involved; it is a cross-sectional study with no ability to link the findings to other factors; the study is merely descriptive with no statistical analysis of associations.

Although nurses do receive oral healthcare training as part of their curriculum, this is most often not taught by a specialist in that area. It is therefore appropriate that medical or dental staff that have specialist interests in this area; oral medicine specialists, oral and maxillofacial surgeons, otorhinolaryngologists, plastic surgeons, specialist nurses in these areas, specialist oncology nurses, dentists, dental hygienists, dental therapists or oral health educators could in future train nursing staff on oral healthcare including oral cancer awareness. It is essential to include adequate training in the nursing curriculum as clinical observation and oral examination by nurses may prove effective in improving survival rates for oral cancer. [8],[11],[14]


   Conclusion Top


This study revealed that, nursing students in Davangere regarded an oral health checkup as important; however, their awareness of oral cancer risk factors and clinical signs was poor. This study highlights a need for improved education of nurses on oral cancer to make them well oriented toward screening of oral cancer on admission.

Programs aimed at educating the nursing students regarding oral cancer screening can have a tremendous impact on the knowledge of nursing students in Davangere city. The present survey thus indicates that educational programs and campaigns should be organized to improve and/or enhance the nursing student's awareness of the teeth. Hopefully, more emphasis would be laid on oral cancer risk factors and screening in the nursing curriculum. As early diagnosis can make big difference in oral cancer prevention and management.

 
   References Top

1.Dikshit R, Gupta PC, Ramasundarahettige C, Gajalakshmi V, Aleksandrowic I, Radwe R, et al. Cancer mortality in India: A nationally representative survey. Lancet 2012;379:1807-16.  Back to cited text no. 1
    
2.Kuriakose MA, Sharan R. Oral Cancer Prevention. Oral Maxillofac Surg Clin N Am 2006;18:493-511.  Back to cited text no. 2
    
3.Lingen MW. Oral cancer screening aids: Where is the science? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:153-4.  Back to cited text no. 3
[PUBMED]    
4.Scully C, Malamos D, Levers BG, Porter SR, Prime SS. Sources and patterns of referrals of oral cancer role of general practi­tioners. Br Med J 1986;293:599-60l.  Back to cited text no. 4
    
5.Schnetler JF. Oral cancer diagnosis and delays in referral. Br J Oral Maxillofac Surg 1992;30:210-3.  Back to cited text no. 5
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6.Greenwood M, Lowry RJ. Primary care clinicians' knowledge of oral cancer: A study of dentists and doctors in the North East of England. Br Dent J 2001;191:510-2.  Back to cited text no. 6
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7.Haughney MG, Devennie JC, Macpherson LM, Mason DK. Integration of primary care dental and medical services: A three year study. Br Dent J 1998;184:343-7.  Back to cited text no. 7
    
8.Carter LM, Harris AT, Kavi VP, Johnson S, Kanatas A. Oral cancer awareness amongst hospital nursing staff: A pilot study. BMC Oral Health 2009;9:4.  Back to cited text no. 8
    
9.Carter LM, Ogden GR. Oral cancer awareness of undergraduate medical and dental students. BMC Med Educ 2007;7:44.  Back to cited text no. 9
    
10.Wardh I, Paulsson G, Fridlund B. Nursing staff's understanding of oral health care for patients with cancer diagnoses: An intervention study. J Clin Nurs 2009;18:799-806.  Back to cited text no. 10
    
11.Carter LM, Ogden GR. Oral cancer awareness of general medical and general dental practitioners. Br Dent J 2007;203:248-9.  Back to cited text no. 11
    
12.Patton LL, Ashe TE, Elter JR, Southerland JH, Strauss RP. Adequacy of training in oral cancer prevention and screening as self-assessed by physicians, nurse practitioners, and dental health professionals. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:758-64.  Back to cited text no. 12
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13.Meng XD, Porter CK, Li Q, Tomar SL. Florida nurse practitioners' attitudes and practices regarding oral cancer prevention and early detection. J Am Acad Nurse Pract 2007;19:688-75.  Back to cited text no. 13
    
14.Monteiro LS, Salazar F, Pacheco J, Warnakulasuriya S. Oral cancer awareness and knowledge in the City of Valongo, Portugal. Int J Dent 2012;2012:376838.  Back to cited text no. 14
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Correspondence Address:
Simpy Mittal
Assistant Professor, Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Pimpri, Pune - 411018
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-7761.126944

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