Fred Hutch Oral Medicine Service at MASCC/ISOO
The Multinational Association of Supportive Care (MASCC) and the International Society of Oral Oncology (ISOO) will hold its annual meeting June 26-28 in Seattle. The Fred Hutch Oral Medicine Service team will be there presenting their recent research findings.
They are studying the oral microbiome to answer the question, "Why do some patients develop more severe and painful mouth sores (oral mucositis) after receiving a bone marrow transplant compared to others?" and found that those patients who had higher levels of a specific mouth bacterium, Oribacterium asaccharolyticum, before bone marrow transplant were more likely to develop severe oral mucositis.
“This bacterium was more common in men and in people with higher levels of uric acid in their blood, which we think may be helping the bacterium survive in the mouth,” said Hakan Gem, DDS, MSD, who is the presenting author. “Our findings suggest that this microbe may play a key role in exacerbating the severity of oral mucositis following bone marrow transplantation. This is exciting for both patients and providers, as it opens the door to new therapeutic targets for preventing a common and serious complication of BMT.”
What's something people might not expect about the oral medicine team and the work that you do?
Burns: Most people I talk with, including employees and patients, are surprised to learn that Fred Hutch has a dental department. We are one of the few regional cancer centers that offers oral medicine services. Patients will travel from other parts of the West Coast and even as far away as North Carolina for our specialized oncology oral care.
Dean: Oral oncology is not widely known. It's really multidisciplinary, which surprises people in both dentistry and medicine.
What type of research is your team currently involved in?
Dean: Current research in our service is focused on the oral health impact of chronic oral GVHD and the influence of the oral microbiome on oral mucositis. We are currently working to design a project on the potential influence of oral/periodontal bacteria on risk for chronic GVHD.
Members of our group are (and have recently been) involved in clinical practice statements and systematic reviews related to medication-related osteonecrosis of the jaw, immunotherapy-related adverse events impacting oral health, dental care for patients with advanced cancers, social eating in the context of oncology and oral impact of EGFR inhibitors.
What's your favorite part of the work you do?
Burns: The holistic approach to cancer care and being a part of a bigger multidisciplinary team.
Dean: The patients. They're kind, wonderful people who are so appreciative of the attention and support they receive. The problem-solving is fun, too. I gravitate toward solving mysteries and figuring out the best way to help. I like the complexity of it all.
Are there any patients in particular that have stuck out to you?
Dean: There was a younger man who I saw for many years post-transplant for aplastic anemia. He had severe oral GVHD. We were close enough in age and interests that we'd spend time catching up. He'd give me recommendations on where to go for the best lemon pepper wings in the city and show me travel pictures.
Another patient had an incredibly dry, even blunt, sense of humor. He always told me exactly what he thought. We worked together for years, through really hard times and better times. He showed me pictures of his dog and shared how proud he was of his daughter in high school. We were so in sync in clinic we regularly joked about our "bromance". His sister started coming when he was in hospice care. I absolutely loved him and think about him all the time.
What's an accomplishment you are most proud of for your team?
Burns: I am proud of the way our team supports patients. When we work with transplant patients, we behave similarly to a concierge service. We determine what dental work is needed for patients to safely undergo transplant, then coordinate an appointment with an appropriate outside dental resource to get that work done. We provide a warm handoff to that clinic, consultation with the treating dentist, and follow up to ensure work is completed and the patient is clear for transplant.
Dean: Our team does an outstanding job connecting people with resources quickly, especially those who don't have a dentist or dental insurance. We also played a part in advocating for pre-transplant dental care coverage through Medicare and Medicaid. It happened with a random email, and soon we were talking to folks at the Leukemia & Lymphoma Society and other national organizations. I'm proud to have played a small part in that.
