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Fear of Progression: a qualitative study of patients treated for oral potentially malignant lesions (OPMD).


Dental School

About the Project

Aim: The main aim of this project would be to establish how many patients having been either treated for OMPD, or with OMPD who opted for a watch and wait policy or having declined treatment, experience feelings of anxiety and fear about the possibility of the disease progressing to a more severe variant or to oral cancer. A secondary aim would be to develop a support network for these patients.

Oral potentially malignant disorders (OPMD) are a group of conditions that has been defined by the WHO in 2017 as “clinical presentations that carry a risk of cancer development in the oral cavity, whether in a clinically definable precursor lesion or in clinically normal mucosa” (Reibel et al 2017, Muler 2016). Although these conditions are associated with an increased statistical risk of malignant change, it is very difficult to predict the outcome for an individual patient. Histologically the lesions have cytologic atypia and distorted epithelial architecture, referred to as oral epithelial dysplasia (OED) graded as mild, moderate or severe (Warnakulasuriya et al 2008, Reibel et al 2017). A meta-analysis estimated that the mean rate of malignant transformation overall was 12.1% (95% CI 8.1%–17.9%), with wide variation among the different studies (0%–36.4%). The estimated mean progression rate of mild/moderate dysplasia was 10.3% and 24.1% for severe (Mehanna et al 2009).

Traditionally, moderate to severe epithelial dysplasia are surgically excised whereas mild dysplasia may or may not be treated surgically. The decision depending, in cases of mild dysplasia, on the clinician’s treatment philosophy and an assessment of both the potential risks of surgery and the practicality of excising the entire lesion and the patient’s choice. Despite the low risk of malignant transformation reported with mild dysplasias there is some suggestion that cases of mild dysplasia should be treated definitively and to discontinue the wait-and-watch approach currently used for milder cases (Dost et al. 2014). However across all grades of dysplasia surgical excision reduces the risk of malignant transformation but does not eliminate the risk completely (Mehanna et al. 2009).

Whilst it is known that patients experience anxiety related to cancer progression (Herschbach and Dinkel 2014) as determined by the Fear of Progression questionnaire (FoP-Q), it is uncertain whether oral pre-cancerous lesions cause similar anxiety. There is some evidence to suggest this the case from studies on patients with potentially malignant cervical lesions (Nagele E et al 2019, Lee Mortensen and Adeler 2015). A study on quality of life in patient with oral leukoplakias, not dysplasias, reported reduced quality of life in comparison with a control group (Ang et al 2019). In our unpublished work we found that 68% of 44 patients who had been treated for OPMD reported fear of progression, unrelated to the severity of dysplasia, and 30% were nervous about their periodic review. This is an important aspect of patient care that has not received much attention and maybe a cause of significant anxiety for patients.

For informal enquiries about the project, contact Dr Michaelina Macluskey ()
For general enquiries about the University of Dundee, contact


QUALIFICATIONS
Applicants must have obtained, or expect to obtain, a first or 2.1 UK honours degree, or equivalent for degrees obtained outside the UK in a relevant discipline.

English language requirement: IELTS (Academic) score must be at least 6.5 (with not less than 5.5 in each of the four components). Other, equivalent qualifications will be accepted. Full details of the University’s English language requirements are available online: http://www.dundee.ac.uk/guides/english-language-requirements.


APPLICATION PROCESS

Step 1: Email Dr Michaelina Macluskey () to (1) send a copy of your CV and (2) discuss your potential application and any practicalities (e.g. suitable start date).

Step 2: After discussion with Dr Macluskey, formal applications can be made via UCAS Postgraduate. When applying, please follow the instructions below:

Apply for the Doctor of Philosophy (PhD) degree in the Dental School: https://digital.ucas.com/coursedisplay/courses/1e6f404e-f563-7944-91e8-2415b17a5347. Select the start date and study mode (full-time/part-time) agreed with the lead supervisor.

In the ‘provider questions’ section of the application form:
- Write the project title and ‘FindAPhD.com’ in the ‘if your application is in response to an advertisement’ box;
- Write the lead supervisor’s name and give brief details of your previous contact with them in the ‘previous contact with the University of Dundee’ box.

In the ‘personal statement’ section of the application form, outline your suitability for the project selected.

Funding Notes

There is no funding attached to this project. The successful applicant will be expected to provide the funding for tuition fees and living expenses, via external sponsorship or self-funding.

References

Ang X.M, Khang Au P.C, Kwok K and Park K.Y. Quality of life with patients with oral leukoplakia. J Oral Path Med. 2019;48 (7):574-580

Dost F, Lê Cao K, Ford P.J, Ades C, Farah C.S. Malignant transformation of oral epithelial dysplasia: a real-world evaluation of histopathologic grading Oral Surg Oral Med Oral Pathol Oral Radiol 2014;117:343-352.

Herschbach P, Dinkel A. Fear of ProgressionU. Goerling (ed.), Psycho-Oncology, Recent Results in Cancer Research 197,DOI: 10.1007/978-3-642-40187-9_2, _ Springer-Verlag Berlin Heidelberg 2014.

Lee Mortensen G, Adeler AL. Qualitative study of women's anxiety and information needs after a diagnosis of cervical dysplasia.Z Gesundh Wiss. 2010 Oct;18(5):473-482. Epub 2010 Mar 31.

Mehanna HM, Rattay T, Smith J, McConkey CC. Treatment and follow-up of oral dysplasiada systematic review and metaanalysis. Head Neck. 2009;31:1600-1609.

Muller S. Oral lichenoid lesions: distinguishing the benign from the deadly. Mod Pathol. 2017;30(s1):54–67.

Nagele E, Trutnovsky G, Greimel E, Dorfer M, Haas J, Reich O. Do different treatment strategies influence women's level of psychosexual distress? Observational cohort study of women with premalignant HPV-associated genital lesions.Eur J Obstet Gynecol Reprod Biol. 2019 May;236:205-209.

Reibel J, Gale N, Hille J, Hunt JL, Lingen M, Muller S, et al. Oral potentially malignant disorders and oral epithelial dysplasia. In: El-Naggar AK, Chan JKC, Grandis JR, Takata T, Slootweg P, editors.

WHO classification of head and neck tumours. 4th ed. Lyon:iaRC; 2017. pp. 112–5.

Warnakulasuriya S, Reibel J, Bouquot J, Dabelsteen E. Oral epithelial dysplasia classification systems: predictive value, utility, weaknesses and scope for improvement. J Oral Pathol Med. 2008;
3:127-133.

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