New Cancer Clinical Practice Guideline for Severe Jaw Condition Stresses Collaboration Between Dentists and Oncologists

Douglas Peterson DMD, Ph.D., FDS RCSEd, a facutly member in the UConn School of Dental Medicine, in a UConn Health dental clinic on February 27, 2018. (Tina Encarnacion/UConn Health photo)

A new clinical practice guideline that stresses the importance of collaboration between dentists and medical oncologists to prevent, diagnose, and treat medication-related osteonecrosis of the jaw (MRONJ) in cancer patients was recently published by a team of experts, including leadership from UConn School of Dental Medicine faculty Dr. Douglas Peterson.

MRONJ is a severe side effect in patients using drugs to minimize risk for skeletal bone fractures during cancer treatment. These drugs can cause lesions to form in the jaw bone, with failure to heal over a several week timeframe.  The bone lesions can cause significant morbidity for the cancer patient, including pain, decreased quality of life, and need for extensive jaw surgery.

The document, published on July 22, 2019 in the Journal of Clinical Oncology, is a first-in-kind joint MRONJ guideline that has been developed by members of the Multinational Association of Supportive Care in Cancer / International Society of Oral Oncology (MASCC/ISOO) and the American Society of Clinical Oncology (ASCO).  These two organizations are highly impactful in oncology at the international level.

According to the guideline, an ongoing collaboration between the dentist and the oncologist is essential to optimal cancer patient care when it comes to preventing, diagnosing, and treating MRONJ.

Peterson, professor of oral medicine, was recently named chair-elect of ASCO’s Clinical Practice Guidelines Committee, the parent committee that oversees all ASCO guidelines.  Approximately 45,000 oncology professionals are members of ASCO, and represent all oncology subspecialties.  International members comprise approximately one-third of ASCO’s membership, and come from more than 150 countries.  After serving one year as chair-elect, Peterson will become chair of ASCO’s guidelines committee.

“The collaboration between MASCC/ISOO and ASCO to produce this guideline represents the first time these two internationally prominent oncology organizations have partnered to develop this type of information,” said Peterson. “I am delighted to see publication of this guideline come to fruition, and am looking forward to continued development of the next joint oncology guideline that is currently in production.”

To create this guideline, MASCC/ISOO and ASCO convened a multidisciplinary expert panel to evaluate the evidence—including a systematic review of the current literature—and formulate recommendations.

The clinical recommendations in the guideline also include ensuring that MRONJ is diagnosed by a clinician with experience in the management of MRONJ, and taking conservative measures for treating MRONJ whenever possible.

In developing the guideline, Peterson was joined by a team of dental and medical experts from:

Sheba Medical Center, Israel
Tel Aviv University, Israel
Icahn School of Medicine at Mt Sinai, New York, NY
University of Michigan, Ann Arbor, MI
American Society of Clinical Oncology, Alexandria, VA
Hofstra North Shore-LIJ School of Medicine, Hempstead, NY
Stony Brook School of Dental Medicine, Stony Brook, NY
New York Center for Orthognathic and Maxillofacial Surgery, New York, NY
University of Florida College of Dentistry, Gainesville, FL
McMaster University, Canada
Dalhousie University, Canada
Queen Elizabeth II Health Sciences Centre, Canada
Breast Cancer Coalition of Rochester, Rochester, NY
Vanderbilt University, Nashville, TN
University of North Carolina Cancer Care at Nash, Rocky Mount, NC
Case Western Reserve University, Cleveland, OH
Stanford University Medical Center, Stanford, CA
Aarhus University, Denmark
Northern Ontario School of Medicine, Canada.