Developing an oral health screening tool for an integrated model of care to reduce treatment-related oral morbidity in head and neck cancer survivor

Summary Approximately 62,000 Americans develop head and neck cancer (HNC) each year. Cancer treatments can result in a myriad of changes to the normal function of the oral structures. These treatment-related oral morbidities can persist for the duration of the patient’s life leaving HNC survivors in a state of rapidly

deteriorating oral health. In addition to other barriers to oral care likely experienced by HNC survivors, many of these patients are uninsured and cannot afford dental visits to maintain surveillance of their oral condition. Failure to identify these oral morbidities early can result in expensive, less effective treatments that contribute

to poor quality of life. In response to this shortfall, Dr. Derek Smith (PI) is proposing a career development project which will improve our understanding of the barriers to care and develop the statistical infrastructure required to implement a novel oral care model. The proposed model of care would integrate medical

professionals and their support staff into the oral health team by providing them with a screening tool that allows them to identify patients that are at high risk for oral disease. Dr. Smith is uniquely qualified to pursue this research completing his training as a dentist at Indiana University in 2008 and his PhD in Biostatistics at

Vanderbilt University in 2017. He has participated in numerous research projects and preliminary studies, and has a wealth of experience in clinical dentistry making him an outstanding candidate for this award. Dr. Smith is currently a Research Assistant Professor in the Departments of Biostatistics and Oral Maxillofacial Surgery

at Vanderbilt and has been given protected time, infrastructure, and excellent mentorship to aid in the development of this research plan. The proposed career development plan involves participating in the AT Still University dental public health fellowship program and mentoring on the conduct of patient-centered research.

This development plan is complemented by the mentored research proposal. The model of care Dr. Smith has proposed requires a well-validated screening tool that medical professionals can use to identify patients at high risk for oral morbidity and a data-driven decision rule that helps providers decide when a referral to oral health

professionals is warranted. In Aim 1 of this proposal we will conduct a validation of the Vanderbilt Head and Neck Symptom Survey’s oral subscale by correlating patient reported outcomes with clinician’s findings on exam. Having established validity of the tool, in Aim 2 a screening tool will be developed out of a combination

of items from the VHNSS and other well-validated patient reported outcome measures including the Oral Health Impact Profile. Lastly, for Aim 3 interviews will be conducted with HNC survivors to gain a better understanding of non-financial barriers to oral care in the HNC population. At the completion of this project our

team will have the tools necessary to implement the integrated care model at Vanderbilt, which will improve oral health surveillance and facilitate our future research efforts. !