How Do You Manage Oral Thrush in Hospice and Palliative Medicine Patients?

By Ruth Lagman, MD, MPH, MBA

As a palliative medicine and hospice physician, I see a lot of oral thrush, or candida of the oropharynx. Symptoms are distressing for patients, and treatment with topical antifungals is also unpleasant. Compliance is often poor because of the unpleasant taste and recommended dosing schedule of four to five times per day. Plus, topical antifungals don’t always work.

We’ve seen that single-dose fluconazole has been effective in patients with HIV, and there was a retrospective study demonstrating its effectiveness in palliative care patients as well.

Given the rise of value-based care and the capitated reimbursement model of hospice care, our team wanted to conduct a prospective observational study to test whether a single dose of 150 mg fluconazole was effective in our hospice and palliative medicine patients and determine if this regimen could be established as standard of care.

We enrolled 57 patients. Over 96 percent of them showed more than 50 percent improvement in signs and symptoms both in number and severity (P < 0.001), and side effects were minimal. We think this is a cost effective treatment that minimizes polypharmacy and drug interactions, and we are implementing this approach for our patients.

Dr. Lagman is a staff physician for the Section of Palliative Medicine and Supportive Oncology.