Implementation of a structured early oral supportive-care pathway and early oral health recovery after oral cancer resection and free-flap reconstruction: a prospective observational cohort study
8 affiliations
- 1Department of Nursing, Tungs’ Taichung MetroHarbor Hospital
- 2Department of Radiation Oncology, Tungs’ Taichung MetroHarbor Hospital
- 3Department of Medical Research, Tungs’ Taichung MetroHarbor Hospital
- 4Department of Nursing, Jenteh Junior College of Medicine, Nursing and Management
- 5Department of Otolaryngology, Tungs’ Taichung MetroHarbor Hospital
- 6Department of Nursing, Hungkuang University
- 7Department of Post-Baccalaureate Medicine, National Chung Hsing University
- 8College of Life Sciences, National Chung Hsing University
Abstract
Background: Patients undergoing oral cancer resection and free-flap reconstruction often have limited capacity for independent oral hygiene during the immediate postoperative period. Standardized bedside oral supportive-care pathways may help organize early postoperative care, but their implementation and accompanying early oral-health recovery have not been well characterized prospectively.
Methods: This prospective, single-center observational cohort study included 36 adults undergoing oral cancer resection with free-flap reconstruction who received a structured early postoperative oral supportive-care pathway beginning on the day of surgery. The primary outcome domains for the present manuscript were pathway implementation, short-term tolerability, and early oral-health recovery from postoperative day 3 (POD3) to POD13. Clindamycin-based and chlorhexidine-based formulations were both used in routine clinical care and were not assigned by the research team; formulation-specific comparisons were secondary and exploratory.
Results: All 36 participants completed both Oral Assessment Scale for Post-Operational Patients with Oral Cancer (OASPOCa) assessments, and 32 (88.9%) were recorded as completing all scheduled daily oral-care sessions in the archived adherence record; four participants had one missed-session record. No clinically significant formulation-related intolerance or discontinuation was recorded. Mean total OASPOCa score decreased from 14.97 (SD 2.79) on POD3 to 11.44 (SD 1.65) on POD13, corresponding to a mean within-participant improvement of 3.53 points (SD 3.15; 95% CI, 2.46–4.59; P < 0.001). At least some participants improved in each of the 10 OASPOCa domains, while others remained unchanged or worsened. In secondary exploratory analyses, the between-formulation difference in mean improvement was 0.39 points (95% CI, −1.78 to 2.55; P = 0.717).
Conclusion: The structured pathway was implemented with high recorded participant-level adherence and was accompanied by multidimensional early oral-health recovery; no clinically significant formulation-related intolerance or discontinuation was recorded. Because oral care began before the first formal assessment and no untreated or usual-care control group was included, the observed change represents temporal postoperative recovery rather than causal pathway efficacy. No clear overall advantage of either routinely used oral-care formulation was demonstrated.
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BibTeX
@article{huang2026implementation,
title = {{Implementation of a structured early oral supportive-care pathway and early oral health recovery after oral cancer resection and free-flap reconstruction: a prospective observational cohort study}},
author = {Tsai-Mei Huang and Yun Chih Chen and Yu-Che Cheng and Chi-Yuan Yeh and Yu-Kang Chang and Mei-Wen Nian and Tsay-I Chiang and Stella Chin-Shaw Tsai},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1981326},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1981326/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Implementation of a structured early oral supportive-care pathway and early oral health recovery after oral cancer resection and free-flap reconstruction: a prospective observational cohort study
AU - Tsai-Mei Huang
AU - Yun Chih Chen
AU - Yu-Che Cheng
AU - Chi-Yuan Yeh
AU - Yu-Kang Chang
AU - Mei-Wen Nian
AU - Tsay-I Chiang
AU - Stella Chin-Shaw Tsai
PY - 2026
DA - 2026/10/20
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1981326
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1981326/full
AB - Background: Patients undergoing oral cancer resection and free-flap reconstruction often have limited capacity for independent oral hygiene during the immediate postoperative period. Standardized bedside oral supportive-care pathways may help organize early postoperative care, but their implementation and accompanying early oral-health recovery have not been well characterized prospectively. Methods: This prospective, single-center observational cohort study included 36 adults undergoing oral cancer resection with free-flap reconstruction who received a structured early postoperative oral supportive-care pathway beginning on the day of surgery. The primary outcome domains for the present manuscript were pathway implementation, short-term tolerability, and early oral-health recovery from postoperative day 3 (POD3) to POD13. Clindamycin-based and chlorhexidine-based formulations were both used in routine clinical care and were not assigned by the research team; formulation-specific comparisons were secondary and exploratory. Results: All 36 participants completed both Oral Assessment Scale for Post-Operational Patients with Oral Cancer (OASPOCa) assessments, and 32 (88.9%) were recorded as completing all scheduled daily oral-care sessions in the archived adherence record; four participants had one missed-session record. No clinically significant formulation-related intolerance or discontinuation was recorded. Mean total OASPOCa score decreased from 14.97 (SD 2.79) on POD3 to 11.44 (SD 1.65) on POD13, corresponding to a mean within-participant improvement of 3.53 points (SD 3.15; 95% CI, 2.46–4.59; P < 0.001). At least some participants improved in each of the 10 OASPOCa domains, while others remained unchanged or worsened. In secondary exploratory analyses, the between-formulation difference in mean improvement was 0.39 points (95% CI, −1.78 to 2.55; P = 0.717). Conclusion: The structured pathway was implemented with high recorded participant-level adherence and was accompanied by multidimensional early oral-health recovery; no clinically significant formulation-related intolerance or discontinuation was recorded. Because oral care began before the first formal assessment and no untreated or usual-care control group was included, the observed change represents temporal postoperative recovery rather than causal pathway efficacy. No clear overall advantage of either routinely used oral-care formulation was demonstrated.
SN - 2234-943X
ER -