Open AccessQuality of Life Implications of Bisphosphonate‐Associated Osteonecrosis of the Jaw
Author(s) -
Miksad Rebecca Anne,
Lai KuanChi,
Dodson Thomas Benton,
Woo SookBin,
Treister Nathaniel Simon,
Akinyemi Omosalewa,
Bihrle Marian,
Maytal Guy,
August Meredith,
Gazelle G. Scott,
Swan J. Shan
Publication year - 2011
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2010-0183
Subject(s) - medicine , osteonecrosis of the jaw , bisphosphonate , quality of life (healthcare) , bisphosphonate associated osteonecrosis of the jaw , bone density conservation agents , dentistry , osteoporosis , bone density , nursing
Purpose. Potentially debilitating, osteonecrosis of the jaw (ONJ) is an emerging complication of bisphosphonates. However, its effect on quality of life (QoL) is unknown. We determined the ONJ‐related QoL decline in a cancer patient cohort. Patients and Methods. Thirty‐four cancer patients with bisphosphonate‐associated ONJ completed a telephone survey (October 2007 through May 2008). The Oral Health Impact Profile 14 (OHIP) retrospectively assessed participant oral health–related QoL before and after ONJ. Standardized ONJ descriptions were developed in a multidisciplinary, iterative process and were evaluated with three frequently used preference‐based QoL measurement methods on a 0 (death) to 1 (perfect health) scale: Visual Analogue Scale (VAS), Time Trade‐Off (TTO), and EQ‐5D. Results. ONJ significantly ( p < .001) increased OHIP scores (worse QoL) for additive (3.56–16.53) and weighted (7.0–17.5) methods. Seven individual OHIP items significantly increased (Bonferroni correction p < .0035): pain, eating discomfort, self‐consciousness, unsatisfactory diet, interrupted meals, irritability, and decreased life satisfaction. Mean preference‐based QoL values significantly decreased ( p < .001) with worsening ONJ stage (VAS, TTO, and EQ‐5D): no ONJ (0.76, 0.86, 0.82), ONJ stage 1 (0.69, 0.82, 0.78), ONJ stage 2 (0.51, 0.67, 0.55), and ONJ stage 3 (0.37, 0.61, 0.32). As ONJ worsened, EQ‐5D domain scores significantly increased ( p < .001). Pain/discomfort and anxiety/depression contributed most to declining QoL. Conclusions. ONJ significantly affects QoL, a detriment that increases with worsening ONJ. QoL impairments for ONJ stages 2 and 3 are similar to other treatment side effects that influence decision‐making. Bisphosphonate‐associated ONJ QoL is an important consideration for patients, clinicians, and policy makers.