AT-A-GLANCE The Seattle Cancer Care Alliance (SCCA) is one of the world’s leading cancer treatment centers. The SCCA Oral Medicine Service helps treat more than 800 cancer patients annually, roughly half of whom are being seen for hematopoietic cell transplantation. SCCA Oral Medicine is a key element of a fully integrated care model producing better health outcomes for patients. SCCA Oral Medicine provides critical patient care before, during and immediately following their cancer treatments, as well as during long-term follow-up. There are many opportunities for local dentists and specialists to collaborate with SCCA Oral Medicine to help stabilize patients’ oral health and enable transplants and other cancer treatments to begin. The clinic can also be a resource for dentists caring for patients who are undergoing cancer treatment and have questions.

Seattle is home to one of the world’s leading cancer treatment centers.

The Seattle Cancer Care Alliance (SCCA) — a joint effort of the Fred Hutchison Cancer Research Center, Seattle Children’s Hospital and University of Washington Medicine — offers patients from the Pacific Northwest, across the country, and around the globe world-class care. This is especially true when it comes to performing bone marrow and stem cell transplants and fighting hematologic malignancies like leukemia and lymphoma.

One key contributor to this admirable success rate is the SCCA Oral Medicine Service. Oral medicine may not have the highest public profile, but its contributions are well-recognized by patients and doctors. They serve about 400 new patients and actively treat more than 800 patients annually.

Dr. David Dean, a clinical assistant professor of oral medicine at the University of Washington, serves as the director of SCCA Oral Medicine Service.

He describes SCCA Oral Medicine, which was founded in 1975 and moved into its current location adjacent to SCCA’s transplant and long-term follow-up services in 2001, as “one of the first outpatient oral medicine services in the world fully integrated with a blood and marrow transplant center.”

A TEAM APPROACH

Multiple specialties within dentistry, including oral medicine, provide supportive care for individuals undergoing cancer treatment. While the providers at SCCA do some work with patients with oral cancers, they serve primarily as integral members of the Alliance team providing supportive care before, during and after transplant and helping to address other complications of cancer therapy. 

Before a transplant procedure, for instance, Dean and his team — which includes three other dentists, a dental hygienist, a dental assistant, patient care coordinators, and a clinic manager — conduct a thorough examination to ensure that the patient’s mouth is as healthy as possible. This is critical, because chemotherapy and radiation treatments can compromise the immune system, making even small infections a serious threat to the patient’s recovery and return to health.

“This is an area where general dentistry helps us greatly,” Dean explains. “We may only have a week or two before their cancer treatment is scheduled, and it’s crucial to get the mouth as stable as possible before that begins.

“With many of these patients coming from other states, not to mention other countries, their local dentists aren’t an option and they might not even know where to start looking for a local dentist.

“We work closely with the UW general practice residency and specialty clinics, but without local dentists making themselves available to do this work, there are times we wouldn’t have the capacity to overcome these timing challenges.”

This team approach has also helped SCCA Oral Medicine Service continue providing care despite the enormous challenges presented by COVID. “We’ve worked working closely with our Infection Prevention Service during the entirety of the pandemic to make sure all of our protocols are in good shape,” he says.

COLLABORATIVE CARE

The Oral Medicine Service continues working closely with patients’ medical teams as they progress through their course of treatment at SCCA. In addition to a variety of infections, one of the more common problems patients encounter is compromised salivary gland function, which can lead to oral discomfort, caries and lost teeth. Mucositis is another issue that generally resolves early but can greatly impact a patient’s nutrition and quality of life while present. Medication-related osteonecrosis of the jaw (MRONJ) can be seen in some patients, particularly those treated for cancers that metastasize to the skeleton.

Graft Vs. Host Disease (GVHD) is another potentially serious complication which can arise in patients who receive transplant cells from a donor. According to Dr. Mary Flowers, SCCA’s director of Long-Term Follow-Up Clinical Services, approximately 35 to 40 percent of patients, depending on the type of procedure, develop GVHD. Of those who do experience GVHD, nearly 80 percent see complications appear in the oral cavity, underscoring the importance of collaboration between the oral medicine clinic and the long-term follow-up (LTFU) program.

Flowers oversees the LTFU treatment program for SCCA. It is one of the largest such programs anywhere, maintaining contact with more than 6,200 patients.

“We stay in contact with some patients for 20 years or more after their bone marrow or stem cell transplants,” she says. “We see patients periodically for consultations as needed, and they have access to our networks and to additional information. Some of this contact is provided electronically or through telemedicine. And if the patient consents, we send them follow-up health questionnaires which are important for research into new therapies.”

According to Flowers, cancer treatment often changes a person’s perspectives on life. 
“They and their families are so grateful for the care they received, knowing that they wouldn’t be here without these life-saving procedures. That’s one of the reasons we hold reunions for transplant patients once every two or three years,” she says, adding that the next reunion will be held this July. 

This long-term commitment to their patients is another hallmark of SCCA treatment, and oral medicine is a big part of that process.

The integration between medicine and oral medicine is a key factor in their success rates, says Flowers. “Dr. Dean is a wonderful collaborator. Sometimes it’s hard to get people to understand how important this type of treatment is when they’re not directly involved in providing it.

“Before the clinic became such an integral part of our treatment services, we didn’t even know if and how the oral cavity was affected by some of these complications. Now they have helped us diagnose many complications and have published guidelines based on the work being done here. They’ve been adopted by cancer treatment centers in the US and around the world.”

A LEGACY OF CARE

Dean insists he and the entire team are simply building on the legacy of Dr. Mark Schubert, the SCCA Oral Medicine Service’s founder and original director, who retired last year.

“Mark was such a great mentor,” Dean says. “He had the original vision for the service and for over 40 years helped create what we have today.”

Schubert’s efforts to establish the SCCA Oral Medicine Service began as periodic consultation with hematology - oncology teams, offering his expertise to help them understand oral health issues arising in their patients. Schubert encouraged these interchanges and eventually established the service as a forum for research and documentation of oral health complications in cancer treatment.

Schubert and his close collaborator Michele Lloid (RDH, MS), who joined him in 1984, expanded oral medicine’s role from a consulting service to today’s fully integrated model supporting the clinical and research missions of SCCA.

“I’d decided I wanted to go into oral medicine,” Dean recalls. “I was drawn to the complex diagnostic puzzles and the soft tissue issues you deal with in oral medicine.”
Dean began talking with Schubert as a potential advisor for his graduate work in oral medicine. During those conversations, Schubert asked Dean whether he’d ever considered working with patients with complex medical conditions. (He hadn’t.) But one thing led to another, with Schubert overseeing Dean’s thesis, becoming his mentor, recruiting him to SCCA Oral Medicine, and eventually turning over its leadership.



“I simply fell in love with the unique and complex oral medicine challenges we deal with, and with the patients themselves,” Dean says. “It’s rewarding work. Working with the folks here at SCCA is the best thing I’ve ever done.”

Dean sees many opportunities for collaboration between the SCCA Oral Medicine Service and general dentistry.

“There are many things that a general dentist can help with, but some may also have questions when treating patients going through cancer therapy. I hope that these dentists will use us as resource if they have questions or need a second opinion.”
But Dean recognizes that collaboration is a two-way street. 

“When we have limited time to ensure that a patient’s mouth is absolutely stable to allow them to proceed to transplant, we might need to find a dentist, an oral surgeon or an endodontist to do that work in short order. We couldn’t meet these patients’ needs without dentists who are willing to give of their time and expertise.”

With that in mind, Dean hopes other dentists will consider supporting SCCA Oral Medicine’s work.

“If you have any interest or feel a calling to help patients going through or preparing to go through cancer therapy, I hope you will be available to provide services when needed.” 

HOW YOU CAN HELP

Any dentist interested in supporting the SCCA Oral Medicine Clinic’s work with cancer patients should call (206) 606-1333 and speak with Dr. Dean or clinic manager Mikki Burns.

Additionally, a fund has been established to support patients without resources who require pre-transplant dental care. Any donations to this fund should be made out to the UW Foundation and sent to:

UW Dentistry Advancement
BOX 357137
Seattle, WA 98195-7137

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This article originally appeared in the Fall 2020 Issue of WSDA News.