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Nielsen BN, Friis SM, Schmiegelow K, Henneberg S, Rømsing J. Evaluation of topical morphine for treatment of oral mucositis in cancer patients. Br J Pain 2021; 15:411-419. [PMID: 34840789 DOI: 10.1177/2049463720975061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Oral mucositis is a painful side effect to chemotherapy. Orally applied opioids may offer analgesia with fewer side effects than systemic opioids. Methods A randomized trial comparing the analgesic effect of a morphine oromucosal solution (OM) to placebo and a positive control group receiving intravenous (IV) morphine as an add-on treatment to morphine patient-controlled analgesia (PCA) in a mixed population of paediatric and adult haematology patients. All patients in the study were equipped with a morphine PCA pump and the participating patients were instructed to use this pump as an escape. Primary outcome was morphine consumption (mg/kg/hour) on the PCA pump. Secondary outcomes included pain intensity difference at rest and when performing oral hygiene, time to first PCA bolus, nutrition intake and adverse events. Findings A total of 60 patients (38 children <18 years) were randomized. Thirty patients were allocated to morphine OM/placebo IV (group MO), 15 patients to placebo OM/morphine IV (group MI) and 15 patients to placebo OM/placebo IV (group P). The median morphine consumption in the MO group (22.7 mcg/kg/hour 95% confidence interval (CI) 19.4-29.4 mcg/kg/hour, p = 0.38) was not significantly different from the placebo group (24.6 mcg/kg/hour 95% CI 16.8-34.4 mcg/kg/hour, p = 0.44) or the MI group (13.7 mcg/kg/hour 95% CI 9.7-37.8 mcg/kg/hour). For the secondary outcomes, the analysis of summed pain intensity difference after the first, third and fourth administrations of study medication indicated a reduction in pain for the MI group compared to the P and MO groups. No serious adverse events were reported. Conclusion The findings indicate that the analgesic effect of peripherally applied morphine is not significantly different from placebo, and parenteral opioids should continue to be the standard of care.
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Affiliation(s)
- Bettina Nygaard Nielsen
- Department of Anaesthesiology, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Susanne Molin Friis
- Paediatric Pain Service, Department of Anaesthesiology, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Paediatrics and Adolescents medicine, The Juliane Marie Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Paediatric Pain Service, Department of Anaesthesiology, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Paediatrics and Adolescents medicine, The Juliane Marie Centre, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Gynecology, Obstetrics and Pediatrics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Steen Henneberg
- Department of Anaesthesiology, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Janne Rømsing
- Department of Drug design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Prakash S, Meena JP, Gupta AK, Bakhshi S, Velpandian T, Pandey RM, Seth R. Ketamine mouthwash versus placebo in the treatment of severe oral mucositis pain in children with cancer: A randomized double-blind placebo-controlled trial. Pediatr Blood Cancer 2020; 67:e28573. [PMID: 32648983 DOI: 10.1002/pbc.28573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND AIMS Oral mucositis (OM) is a common and distressing toxicity in children on chemotherapy. There are a limited number of safe and effective therapeutic options available for OM. Ketamine oral rinse has shown promising results in a few studies in adults. This randomized, double-blind placebo-controlled trial aimed to test the efficacy of ketamine mouthwash in reducing chemotherapy-induced severe OM pain in children. METHODS Children aged 8-18 years with severe OM were randomized to a single dose of ketamine mouthwash (4 mg/mL solution; dose 1 mg/kg) or a placebo. A sample size of 44 patients was determined. Pain score (6-point faces scale) was noted at baseline and 15, 30, 45, 60, 120, 180, and 240 min. The outcome variables were a reduction in pain score, need for rescue medications, and adverse events. RESULTS The baseline characteristics were comparable in the two groups. The mean OM pain at 60 min decreased by 1.64 points (CI 1.13-2.14) in the ketamine group and 1.32 points (CI 0.76-1.87) in the placebo group (P = 0.425), with a group difference of 0.32 points. Rescue pain medication (at 60 min) was required in 13.6% in the ketamine group and 18.2% in the placebo group (P = 1.000). No significant adverse events were observed. CONCLUSIONS Among children on cancer chemotherapy with severe OM, ketamine mouthwash at a dose of 1 mg/kg did not significantly reduce OM pain. It did not decrease the need for rescue pain medications. Further research is warranted to test higher doses of ketamine for a clinically significant effect.
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Affiliation(s)
- Satya Prakash
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Jagdish Prasad Meena
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Aditya Kumar Gupta
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Thirumurthy Velpandian
- Ocular Pharmacology and Pharmacy Division, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Rachna Seth
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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3
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Bunetel L, Tamanai-Shacoori Z, Martin B, Autier B, Guiller A, Bonnaure-Mallet M. Interactions between oral commensal Candida and oral bacterial communities in immunocompromised and healthy children. J Mycol Med 2019; 29:223-232. [PMID: 31235209 DOI: 10.1016/j.mycmed.2019.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/07/2019] [Accepted: 06/07/2019] [Indexed: 01/09/2023]
Abstract
Candida species are usually found as commensal microorganisms in the oral cavity of healthy people. During chemotherapy, cytostatic drugs lead to depletion of the oral flora with the emergence of a dominant bacterial species. The transition from commensal to pathogenic state, further associated with yeast colonization and oral mucositis implies a replacement of the dominant microorganism by Candida albicans. This process goes plausibly through cooperation between C. albicans and bacteria. This study focused on the first step of cooperation between microorganisms isolated from the same oral flora either of leukemic or healthy children. C. albicans isolated from 8/20 children were cultured to display their noninvasive blastosporic yeast form and mixed with their dominant bacteria to study the capacity of planktonic aggregation and the early state of biofilm formation. None of the dominant bacteria opposed the presence of yeast, on the contrary, an interesting cooperation was observed. This behavior is apparently different from that observed when mixing the type strains. In fact, three mutated C. albicans strains display, by their spontaneous ability to form filament, enhanced risks of virulence for leukemic ill carriers. Despite such risks, neither oral nor systemic pathology were observed in ill patients probably because the study was conducted during the first course of chemotherapy and Candida colonization is related to the number of chemotherapeutic cycles. The presence of C. albicans during the initial cycle represents, by its ability to interact with oral bacteria, an actual threat for further cures.
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Affiliation(s)
- L Bunetel
- CNRS, ISCR UMR 6226, université Rennes, 35000 Rennes, France.
| | | | - B Martin
- Inserm U 1241, Inra, université Rennes, 35043 Rennes, France
| | - B Autier
- Centre hospitalier universitaire Rennes, 35033 Rennes, France
| | - A Guiller
- CNRS - UPJV Edysan FRE 3498, université Amiens, 80000 Amiens, France
| | - M Bonnaure-Mallet
- Inserm U 1241, Inra, université Rennes, 35043 Rennes, France; Centre hospitalier universitaire Rennes, 35033 Rennes, France
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4
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Busenhart DM, Erb J, Rigakos G, Eliades T, Papageorgiou SN. Adverse effects of chemotherapy on the teeth and surrounding tissues of children with cancer: A systematic review with meta-analysis. Oral Oncol 2018; 83:64-72. [DOI: 10.1016/j.oraloncology.2018.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 11/29/2022]
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5
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Patıroğlu T, Erdoğ Şahin N, Ünal E, Kendirci M, Karakükcü M, Özdemir MA. Effectiveness of Ankaferd BloodStopper in Prophylaxis and Treatment of Oral Mucositis in Childhood Cancers Evaluated with Plasma Citrulline Levels. Turk J Haematol 2018; 35:85-86. [PMID: 29391340 PMCID: PMC5843785 DOI: 10.4274/tjh.2017.0320] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Türkan Patıroğlu
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology and Oncology, Kayseri, Turkey
| | - Nagihan Erdoğ Şahin
- Erciyes University Faculty of Medicine, Department of Pediatrics, Kayseri, Turkey
| | - Ekrem Ünal
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology and Oncology, Kayseri, Turkey
| | - Mustafa Kendirci
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Metabolism, Kayseri, Turkey
| | - Musa Karakükcü
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology and Oncology, Kayseri, Turkey
| | - Mehmet Akif Özdemir
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology and Oncology, Kayseri, Turkey
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Abstract
A review of the clinical research studies published within the past 5 years revealed that efforts to manage symptoms of cancer and its treatments have not kept pace with new advances in the cure for cancer. Children with cancer continue to experience distressing physical symptoms caused by the disease and treatment. The purpose of this article is to provide a concise overview of the most common symptoms experienced by children with cancer. These symptoms include pain, nausea and vomiting, nutritional concerns, mucositis, and fatigue experienced by the child with cancer. Recommendations for future research are addressed.
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Affiliation(s)
- Marilyn Hockenberry
- Department of Hematology/Oncology, Baylor College of Medicine, Houston TX, USA.
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Moukhlissi M, Aitidir M, Bouamama I, Maani K, Hachim J. [The management of pain in the child with cancer]. Pan Afr Med J 2015; 21:319. [PMID: 26587166 PMCID: PMC4633806 DOI: 10.11604/pamj.2015.21.319.6690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/19/2015] [Indexed: 11/18/2022] Open
Abstract
C'est une étude prospective étalée sur une année (Juin 2007 à Mai 2008) portant sur une série de 140 malades (84 garçons et 56 filles), hospitalisés à l'unité d'hémato-oncologie du service de pédiatrie III à l'hôpital d'enfant de Casablanca. L'objectif de l’étude est de reconnaître la douleur chez l'enfant, l’évaluer en fonction des échelles internationales, et d’ assurer sa prise en charge globale en rapportant l'expérience du service. L’évaluation de la douleur a concerné différentes pathologies cancéreuses: quatre vingt enfants avaient des leucémies aigues lymphoblastiques (57%), 24 enfants présentaient des lymphomes (17%), 10 enfants avaient des neuroblastomes (7%) et 10 autres des néphroblastomes (7%). Parmi les 140 malades évalués, 100 présentaient des douleurs et qui ont fait l'objet de notre étude, donc on peut estimer la prévalence de la douleur ressentie au cours de l'hospitalisation à 71,4%. Plusieurs types d’échelles en fonction de l’âge de l'enfant, et de sa capacité à exprimer par lui-même, ou non, sa douleur, ont été mises à la disposition pour une mesure chiffrée et reproductible mais aussi une base à l'adaptation du traitement antalgique et pour assurer un suivi évolutif sous traitement. Le Traitement anticancéreux reçu par les malades à but curatif: dix malades soit 7,2% ont bénéficié d'une chirurgie curative et une chimiothérapie, cent vingt cinq enfants (89,2%) ont reçu une chimiothérapie seule et cinq malades (3,6%) ont bénéficié d'une association chirurgie, chimiothérapie et radiothérapie. La douleur ressentie avait en lien direct avec la maladie cancéreuse chez 30% des cas (30 enfants), secondaire au traitement anticancéreux chez 30% (30 enfants), et elle était surtout induite par des actes invasifs à visée diagnostique ou thérapeutique chez 40% des cas (40 enfants). Le traitement antalgique a été instauré en fonction de l’évaluation clinique: 67% des patients ont nécessité des antalgiques niveaux I ou II, l'usage des antalgiques niveaux III a eu lieu dans 20% des cas alors que dans 13% des cas le seuil de la douleur n'exigeaient aucun traitement. La prise en charge de la douleur est une étape fondamentale dans le traitement du cancer de l'enfant, elle doit être évaluée dès l’étape diagnostique et surveillée tout au long du traitement.
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Affiliation(s)
- Mohamed Moukhlissi
- Département de Pédiatrie, Unité d'Hémato-Oncologie, CHU Casablanca, Maroc
| | - Malika Aitidir
- Département de Pédiatrie, Unité d'Hémato-Oncologie, CHU Casablanca, Maroc
| | - Imane Bouamama
- Département de Pédiatrie, Unité d'Hémato-Oncologie, CHU Casablanca, Maroc
| | - Khadija Maani
- Département de Pédiatrie, Unité d'Hémato-Oncologie, CHU Casablanca, Maroc
| | - Jamila Hachim
- Département de Pédiatrie, Unité d'Hémato-Oncologie, CHU Casablanca, Maroc
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Lowal KA, Alaizari NA, Tarakji B, Petro W, Hussain KA, Altamimi MAA. DENTAL CONSIDERATIONS FOR LEUKEMIC PEDIATRIC PATIENTS: AN UPDATED REVIEW FOR GENERAL DENTAL PRACTITIONER. Mater Sociomed 2015; 27:359-62. [PMID: 26622207 PMCID: PMC4639337 DOI: 10.5455/msm.2015.27.359-362] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/05/2015] [Indexed: 12/03/2022] Open
Abstract
The early signs of leukemia can usually manifest in the oral cavity due to infiltration of leukemic cells or due to associated decline in normal marrow elements, especially in the acute phase of leukemia, as common lesions at this stage of the disease can be screened and diagnosed by the dentist. Therefore, the dental community should be aware of the oral manifestations of leukemia and oral complications of anticancer treatment. This can eliminate the oral symptoms of the disease and to improve quality of life for these patients. An extensive search in PubMed line using a combination of terms like “leukemia, children, dental, Acute lymphoblastic leukemia, pediatric” for last ten years was made. Reviews and case reports concerned about acute lymphoblastic leukemia in children were all collected and analyzed and data were extracted. Accordingly, the aim of this review is to highlight on the oral presentations of leukemia in children attending dental clinics and the management of its undesirable side effects.
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Affiliation(s)
- Kholoud A Lowal
- Department of Oral Maxillofacial Sciences, Al-Farabi Colleges, Riyadh, Saudi Arabia
| | - Nader Ahmed Alaizari
- Department of Oral Maxillofacial Sciences, Al-Farabi Colleges, Riyadh, Saudi Arabia
| | - Bassel Tarakji
- Department of Oral Maxillofacial Sciences, Al-Farabi Colleges, Riyadh, Saudi Arabia
| | - Waleed Petro
- Department of Oral Maxillofacial Sciences, Al-Farabi Colleges, Riyadh, Saudi Arabia
| | - Khaja Amjad Hussain
- Department of Oral Maxillofacial Sciences, Al-Farabi Colleges, Riyadh, Saudi Arabia
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9
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Shah NC. Current management of mTOR inhibitor-associated stomatitis. BREAST CANCER MANAGEMENT 2015. [DOI: 10.2217/bmt.15.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
mTOR inhibitor-associated stomatitis (mIAS) is an adverse event associated with mTOR inhibitor treatment for advanced cancers. mIAS tends to occur within 2 weeks of treatment start and resolve within weeks of symptom onset. mIAS is usually mild in severity and often self-limiting. Nevertheless, inadequately controlled mIAS can negatively affect patient function and treatment adherence. This review summarizes efficacy and mIAS safety data of mTOR inhibitors, and discusses prevention and treatment of mIAS. Patient cases are used to illustrate important practice points. Although mIAS has been recognized as a cancer treatment-related adverse event only in the last decade, several clinical studies are ongoing. This raises the expectation that management of mIAS in the future will be guided by strong evidence.
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Affiliation(s)
- Nikita C Shah
- Breast Cancer Specialty Section, University of Florida Health Cancer Center – Orlando Health, 1400 South Orange Avenue, MP 760, Orlando, FL 32806, USA
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Tomaževič T, Jazbec J. A double blind randomised placebo controlled study of propolis (bee glue) effectiveness in the treatment of severe oral mucositis in chemotherapy treated children. Complement Ther Med 2013; 21:306-12. [PMID: 23876561 DOI: 10.1016/j.ctim.2013.04.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 02/07/2013] [Accepted: 04/10/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Chemotherapy-induced oral mucositis (OM) is a debilitating side effect. In addition to standard therapy, patients often use complementary and alternative medicine to treat OM. DESIGN Double blind randomised placebo controlled study assessing propolis (bee glue) efficacy for chemotherapy-induced severe OM treatment. SETTING University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia. INTERVENTIONS Paediatric patients undergoing chemotherapy were randomly assigned to propolis (n=19) or placebo groups (n=21). Patients were introduced to a unified oral care protocol and asked to apply propolis or placebo to vestibular mucosa twice daily. Oral mucosa was assessed with the Oral Assessment Guide (OAG) twice a week when the patients were in hospital. Patients were followed for the period of the chemotherapy or for the first 6 months of the chemotherapy. An OAG score of 3 was considered to be severe OM and analysed. MAIN OUTCOME MEASUREMENTS Three dependent variables (a) OM episode frequency, (b) mean number of assessment visits, at which an OAG 3 score was noted, expressing mean OM duration, (c) mean number of OAG 3 scores expressing mean OM severity) were reduced to a single variable using principal component analysis. A new variable (FDS) was used as the dependent variable in ANCOVA model analysis to show the differences between study groups. RESULTS Severe OM was seen in 42% and 48% of patients in the propolis and placebo group, respectively. FDS was not statistically significant between study groups (p=0.59). CONCLUSIONS According to our study results, propolis cannot be recommended for severe OM treatment.
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Affiliation(s)
- T Tomaževič
- Department of Paediatric and Preventive Dentistry, Medical Faculty of Ljubljana, University of Ljubljana, Slovenia.
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11
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Qutob AF, Gue S, Revesz T, Logan RM, Keefe D. Prevention of oral mucositis in children receiving cancer therapy: A systematic review and evidence-based analysis. Oral Oncol 2013; 49:102-7. [DOI: 10.1016/j.oraloncology.2012.08.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 08/14/2012] [Accepted: 08/15/2012] [Indexed: 10/27/2022]
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12
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Implementation of a hospital oral care protocol and recording of oral mucositis in children receiving cancer treatment. Support Care Cancer 2012; 21:1113-20. [DOI: 10.1007/s00520-012-1633-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 10/14/2012] [Indexed: 11/25/2022]
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13
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Khurana H, Pandey RK, Saksena AK, Kumar A. An evaluation of Vitamin E and Pycnogenol in children suffering from oral mucositis during cancer chemotherapy. Oral Dis 2012; 19:456-64. [PMID: 23078515 DOI: 10.1111/odi.12024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 08/22/2012] [Accepted: 08/27/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of the present study was to evaluate and compare the effectiveness of Vitamin E (E) and Pycnogenol (P) in treatment of Chemotherapy-Related Oral Mucositis (ChROM) in children. MATERIALS AND METHODS A total of 72 children, aged between 6 and 15 years, with ChROM were selected and randomly divided into three groups after assessment of oral mucositis (OM) by WHO grading system. Glycerine (control), E, and P were topically applied in group I, II, and III, respectively, and the prognosis of OM was assessed by functional, objective, and subjective parameters. RESULTS Patients of group II and III showed significant improvement when ChROM was analyzed through scoring systems - WHO grading, Oral Mucositis Assessment Scale (OMAS), and Children's International Mucositis Evaluation Scale (ChIMES) as compared to group I (P < 0.001); however, there was no significant difference between groups II and III. CONCLUSION Both the drugs E and P per se are effective for treatment of OM with P being not effective for the treatment of severe mucositis (grade 4). Combination of E and P and additional agents may be tried for better results.
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Affiliation(s)
- H Khurana
- Department of Pedodontics and Preventive Dentistry, Faculty of Dental Sciences, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India
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14
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Nielsen BN, Aagaard G, Henneberg SW, Schmiegelow K, Hansen SH, Rømsing J. Topical morphine for oral mucositis in children: dose finding and absorption. J Pain Symptom Manage 2012; 44:117-23. [PMID: 22658469 DOI: 10.1016/j.jpainsymman.2011.06.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 06/30/2011] [Accepted: 07/17/2011] [Indexed: 10/28/2022]
Abstract
CONTEXT Systemic opioids for painful chemotherapy-induced oral mucositis in children often result in unsatisfactory pain relief and a high frequency of side effects. Opioids applied topically can produce analgesia by binding to opioid receptors on peripheral terminals of sensory neurons. These receptors are upregulated during inflammation, for example, in oral mucositis. OBJECTIVES The aims of this study were to investigate the dose-response relationship (n=7) and the potential absorption of topical morphine (n=5) across oral mucosa in children with oral mucositis. METHODS The dose-response study was conducted according to a sequential study design (Dixon's Up-and-Down method) for topical morphine doses of 0.025-0.400mg/kg, with the decrease in oral pain score as the primary outcome. To assess potential absorption across oral mucosa after a single dose of topical morphine of 0.050mg/kg, blood samples were drawn and the plasma concentrations of morphine and metabolites were determined by high-pressure liquid chromatography. RESULTS A decrease in oral pain score of ≥36% was achieved in six of seven patients in the dose-response part of the study. Plasma concentrations of morphine and metabolites were well below effective analgesic levels. CONCLUSION No obvious dose-response effect was found for topical morphine doses of 0.025-0.400mg/kg, and topically applied morphine was not absorbed in clinically relevant doses. However, this study was limited by the small number of patients and the allowance of a systemic opioid as rescue medication. Thus, randomized controlled studies are needed to further investigate the analgesic properties of topical morphine.
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Affiliation(s)
- Bettina N Nielsen
- Department of Pharmacology and Pharmacotherapy, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
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15
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Traumeel S in preventing and treating mucositis in young patients undergoing SCT: a report of the Children's Oncology Group. Bone Marrow Transplant 2012; 47:1409-14. [PMID: 22504933 DOI: 10.1038/bmt.2012.30] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Mucositis can be a serious complication of hematopoietic SCT (HSCT). A previous phase II trial in 32 children undergoing HSCT reported a beneficial effect of the homeopathic remedy Traumeel S. The Children's Oncology Group sought to replicate the results in a multi-institutional trial. The study was an international multi-center, double-blind, randomized trial comparing Traumeel with placebo in patients aged 3-25 years undergoing myeloablative HSCT. Traumeel/placebo was started on Day -1 as a five-time daily mouth rinse. Efficacy of the treatment was assessed using the modified Walsh scale for mucositis, scored daily from Day -1 to 20 days after HCST. The main outcome was the sum of Walsh scale scores (area-under-the-curve (AUC)) over this period. Other outcomes included narcotic use, days of total parenteral feeding, days of nasogastric feeding and adverse events. In 181 evaluable patients, there was no statistical difference in mucositis (AUC) in the Traumeel group (76.7) compared with placebo (67.3) (P=0.13). There was a trend towards less narcotic usage in the Traumeel patients. No statistically beneficial effect from Traumeel was demonstrated for mucositis. We could not confirm that Traumeel is an effective treatment for mucositis in children undergoing HSCT.
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16
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Oral mucositis in children suffering from acute lymphoblastic leukaemia. Contemp Oncol (Pozn) 2012; 16:12-5. [PMID: 23788849 PMCID: PMC3687384 DOI: 10.5114/wo.2012.27331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 09/12/2011] [Accepted: 12/02/2011] [Indexed: 11/17/2022] Open
Abstract
Aim of the study Oral mucositis is the most commonly reported side effect observed in neoplastic patients treated with chemotherapy and radiotherapy of the head and neck region as well as in patients who have received a haematopoietic stem cell transplant. The aim of the study was to assess the oral mucosa status in children with acute lymphoblastic leukaemia (ALL) during antineoplastic therapy. Material and methods The clinical examination included 78 children aged 2-18 with ALL. The clinical examination was conducted using the dental preset tray. The condition of the oral mucosa was determined using the WHO scale for oral mucositis. Results In the first period of antineoplastic therapy the pathological lesions of the oral mucosa of the mucositis type were observed among the examined patients. The lesions had various levels of intensity. Pain was found to be the primary symptom of oral mucositis. In this study the following were observed: local erythema of the oral mucosa in 35%, white pseudomembranous lesions in 18%, erosions in 40% and oral ulcerative lesions in 4% of patients who underwent the antineoplastic therapy. Oral mucositis was observed in 3.17% of children after 6 months of chemotherapy. Conclusion Local treatment of oral mucositis with polyantibiotic-antifungal mixture, supporting antifungal systemic treatment, and improving the overall peripheral blood conditions in children suffering from acute lymphoblastic leukaemia improve the condition of the oral mucosa.
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Clinical Update: Prevention and Management of Oral Mucositis in Patients with Cancer. Semin Oncol Nurs 2011; 27:e1-16. [DOI: 10.1016/j.soncn.2011.08.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Otmani N, Alami R, Hessissen L, Mokhtari A, Soulaymani A, Khattab M. Determinants of severe oral mucositis in paediatric cancer patients: a prospective study. Int J Paediatr Dent 2011; 21:210-6. [PMID: 21362073 DOI: 10.1111/j.1365-263x.2011.01113.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To analyse the incidence and the determinants of severe oral mucositis (OM) in young cancer patients treated by standard chemotherapy. METHODS The study was carried out at the Pediatric Hemato-Oncology unit of Children's Hospital of Rabat. Patients under 16 years of age with malignant disease treated by chemotherapy between January 2001 and December 2006 were recorded. RESULTS Consecutive patients (n = 970) with malignant disease were studied. The age ranges from 2 months to 16 years (mean, 6.8 ± 4.1 years). OM occurred in 540 (55.6%) patients, and 17.9% of them encountered severe grades. Mean time to onset of the lesions was 10.5 ± 6.8 (range, 1-22 days) and mean duration was 6.8 ± 3.1 (range, 2-23 days). All chemotherapeutic protocols were associated with OM development (range, 20-100%). Patients with severe OM were more likely to have undifferentiated carcinoma of nasopharyngeal type (RR = 2.6, 95% IC 1.1-6.1), non-Hodgkin lymphoma (RR = 2.1, 95% CI 1.2-2.4) and acute leukaemia (RR = 1.7, 95% CI 1.5-3.6). Methotrexate-based therapies were also associated with the worsening of OM (RR = 1.7, 95% IC 1.2-2.6). CONCLUSION Underlying disease and chemotherapy regimens are the principal risk factors of OM development. This model can help in the identification of patients at risk for adequate preventive and therapeutic measures.
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Affiliation(s)
- Naïma Otmani
- Pediatric Hemato-Oncology Unit, Children Hospital, Rabat, Morocco.
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James PJ, Howard RF, Williams DG. The addition of ketamine to a morphine nurse- or patient-controlled analgesia infusion (PCA/NCA) increases analgesic efficacy in children with mucositis pain. Paediatr Anaesth 2010; 20:805-11. [PMID: 20716072 DOI: 10.1111/j.1460-9592.2010.03358.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To assess the efficacy of adding ketamine to morphine nurse- or patient-controlled analgesia (NCA/PCA) infusions in treating mucositis pain in children. BACKGROUND Mucositis pain can be very difficult to control in some patients despite the use of parenteral opioids. In our institution, we have started adding low-dose ketamine to the morphine NCA/PCA in these children in an effort to improve analgesic efficacy. METHODS/MATERIALS The records of all children receiving a morphine/ketamine PCA or NCA for mucositis pain in our institution from 1999 to 2007 were reviewed. At the time of treatment, details of the analgesic management and consumption, pain scores and side effects were prospectively recorded and then entered on to an electronic database. Ketamine was added at a concentration of 20 or 40 microg x kg(-1) per ml with our standard morphine NCA/PCA infusions and protocols being used. RESULTS In 28 patients, there was no difference between average morphine consumption in the 24 h pre and post the addition of ketamine (33.1 (+/-10.7) vs 35.2 (+/-14.3) microg x kg(-1) per hour, P = 0.45) but in those with recorded pain scores (n = 16), the median percentage of pain scores > or =4 was 48% (13-100%) preketamine versus 33% (0-82%) postketamine (P = 0.01). In all patients, there was no change in the rates of nausea and vomiting and pruritus pre and post the addition of ketamine and no other significant side effects were reported. No difference was seen between those who had 20 or 40 microg x kg(-1) per ml of ketamine added. CONCLUSION The addition of ketamine to a morphine NCA/PCA improves analgesic efficacy in children with mucositis pain with no increase in the incidence of side effects.
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Allen G, Logan R, Gue S. Oral Manifestations of Cancer Treatment in Children. Clin J Oncol Nurs 2010; 14:481-90. [DOI: 10.1188/10.cjon.481-490] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Meurman JH, Grönroos L. Oral and dental health care of oral cancer patients: hyposalivation, caries and infections. Oral Oncol 2010; 46:464-7. [PMID: 20308007 DOI: 10.1016/j.oraloncology.2010.02.025] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 02/25/2010] [Indexed: 12/11/2022]
Abstract
Oral cancer and its treatment can cause a variety of problems to patients, also as regards maintaining their daily oral hygiene. Surgery mutilates tissues which may hamper cleaning the teeth and mucosal surfaces. The patient may have complicated reconstructive structures that also need continuous attention. Radiotherapy-induced hyposalivation further complicates the situation and decreases the quality of life. Consequently, dental caries, mucosal diseases such as candidosis and sialadenitis become problematic to treat. Hence every effort should be focused on prevention. In caries prevention intensified fluoride therapy together with dietary counseling is needed. Oral cancer patients also need to be frequently referred to dental hygienists for professional cleaning. Drinking enough daily and moisturizing mucosal surfaces with commercial dry-mouth products, vegetable oils, milk products and respective topical agents need to be individually recommended. In addition, patients with severe dry mouth cases may also benefit from the prescription of pilocarpine tablets. In oral candidosis, the microbiological diagnosis must be confirmed before administration of antifungal drugs in order to avoid the selection pressure to resistant strains.
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Affiliation(s)
- Jukka H Meurman
- Institute of Dentistry, University of Helsinki, Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Finland.
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Challenges of mucositis assessment in children: Expert opinion. Eur J Oncol Nurs 2008; 12:469-75. [DOI: 10.1016/j.ejon.2008.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2008] [Accepted: 05/22/2008] [Indexed: 11/22/2022]
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Cubukçu CE, Sevinir B. Dental health indices of long-term childhood cancer survivors who had oral supervision during treatment: a case-control study. Pediatr Hematol Oncol 2008; 25:638-46. [PMID: 18850476 DOI: 10.1080/08880010802237849] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this case-control study was to compare the dental health of a group of long-term survivors of childhood cancer with that of age- and gender-matched healthy controls. All children who had been progress- and/or disease-free for at least 5 years were selected. Caries indices for permanent dentition (DMF/T) and primary dentition (dmf/t) were calculated. Past data were collected from medical and dental records and read separately by one of the authors. The mean age of the subjects at the initial diagnosis of the disease was 4.3 +/- 0.3 yr (range 0.5-14 yr). The mean time lapse from the cessation of the therapy to the present dental examination was 5.0 +/- 0.7 yr. The study group had significantly (p < .001) more carious lesions in their primary teeth than the control group. The mean dmf/t value was 5.8 +/- 0.6 in the long-term survivors compared to 3.4 +/- 0.2 in the controls. The difference in DMF/T value of those children was statistically insignificant (p > .05) compared to healthy subjects (2.1 +/- 0.6 and 1.6 +/- 0.2, respectively). There was a significant positive correlation between the presence of head and neck radiotherapy (r = 0.427, p < .05), the number of months the child had been on chemotherapy (r = 0.413, p < .01), the number of fluoride gel treatments (r = .361, p < .05), and dmf/t values, separately. Based on the results of this study, our Unit now considers a through semiannual dental examination for every child who will be or has been treated at Pediatric Oncology Department to be mandatory. The focus should be on caries prevention and include dietary counseling, oral hygiene, and fluoride applications if necessary.
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Affiliation(s)
- Ciğdem Elbek Cubukçu
- Pediatric Dental Care Unit, Faculty of Medicine, Uludag University, Bursa, Turkey.
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Abstract
This article is divided into three time periods according to the different phases of cancer treatment: pre, inter, and postcancer therapy. The purpose of dental protocols prior to cancer therapy and the incidence and management of acute and long term oral complications from cancer therapy in the pediatric population are discussed.
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Affiliation(s)
- Catherine H Hong
- Department of Oral Medicine, Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC 28232-2861, USA.
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Avşar A, Elli M, Darka O, Pinarli G. Long-term effects of chemotherapy on caries formation, dental development, and salivary factors in childhood cancer survivors. ACTA ACUST UNITED AC 2007; 104:781-9. [PMID: 17618135 DOI: 10.1016/j.tripleo.2007.02.029] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Revised: 12/07/2006] [Accepted: 02/22/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the long-term effects of chemotherapy on oral health and dental development in childhood cancer survivors (CCS). STUDY DESIGN Ninety-six CCS patients with a mean age of 10.8 years and 96 healthy children of the same age and sex and social background composed the study group. The caries experience of the children was recorded according to the criteria of the World Health Organization, and plaque-gingival status was evaluated according to the Silness-Loe Index. The children were also investigated for stimulated salivary flow rate, buffer capacity, salivary mutans streptococci, and lactobacilli. Disturbances of enamel mineralization were recorded according to the index of developmental defects in dental enamel. Dental development disturbances were diagnosed on panoramic radiographs. RESULTS The caries experience, mutans streptococci, and lactobacilli colonization in CCS children were found significantly higher than in the healthy subjects (P < .05). White/cream colored opacities were the most frequent enamel mineralization disturbances (69.8 %). The occurrence of arrested root development with short V-shaped root malformation was significantly higher in CCS children than in the healthy subjects (P < .05). No statistically significant difference was found between group <or=5 years and >5 years. CONCLUSION This current investigation has shown that CCS children are at an increased risk of caries and developmental dental disturbances.
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Affiliation(s)
- Aysun Avşar
- Department of Pediatric Dentistry, Faculty of Dentistry, University of Ondokuz Mayis, Samsun, Turkey.
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Abstract
OBJECTIVES To review current evidence that applies to the development of a nursing plan of care for the prevention and treatment of oral mucositis related to cytotoxic therapy. DATA SOURCES Research studies, review articles, evidence-based guidelines, web-based material, and clinical experience. CONCLUSION Although high-level research evidence regarding mucositis is limited, use of multiple types of evidence in developing a structured plan of care facilitates improved patient outcomes and the advancement of the current body of knowledge. IMPLICATIONS FOR NURSING PRACTICE Nurses play a key role in the identification and use of evidence to guide the care of patients at risk for cytotoxic therapy-related oral mucositis.
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Cubukcu CE, Sevinir B. Debridement could be a solution to promote healing of established oral mucositis in children. Eur Arch Paediatr Dent 2007; 8:105-12. [PMID: 17555693 DOI: 10.1007/bf03262578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM The aim of the study was to present a novel approach to promote healing of established oral mucositis and to alleviate symptom clusters in a group of children who were on induction chemotherapy. STUDY DESIGN A clinical prospective study. METHODS Children (40) diagnosed with Grade 3 or 4 oral mucositis were randomly assigned into two groups: In Group I (n=20), accumulated debris on ulcerations was removed (debridement); In Group II (n=20), subjects had no debridement. The condition of oral lesions, speech, lips, teeth, saliva, gingiva, and swallowing ability were examined 3 x week during the study. All subjects received the same oral care regimen. They were well balanced in respect of age, the type of antineoplastic treatment, and the number. RESULTS Debridement promoted resolution and decreased the severity of oral mucositis significantly. Thus, the subjects had less oral discomfort, pain, and nutritional difficulties. STATISTICS The data were entered in the SPSS 13.0 program, and the tests used were Kolmogorov-Smirnov, Shapiro-Wilk, Mann-Whitney, and Spearman's correlation coefficient with a 5% significance level. CONCLUSION Well-controlled, prospective clinical studies related to the management of established oral mucositis will lead to the development of potential interventions and improved patient care.
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Affiliation(s)
- C E Cubukcu
- Dept Paediatric Dental Care, Uludağ University, Medical Faculty, Bursa, Turkey.
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Volpato LER, Silva TC, Oliveira TM, Sakai VT, Machado MAAM. Mucosite bucal rádio e quimioinduzida. ACTA ACUST UNITED AC 2007. [DOI: 10.1590/s0034-72992007000400017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
O aumento da intensidade da quimioterapia e radioterapia no tratamento do câncer tem elevado a incidência de efeitos colaterais, em especial da mucosite bucal. OBJETIVO E MÉTODO: Através de revisão bibliográfica realizou-se atualizar informações quanto à definição, características clínicas, incidência, etiologia, patofisiologia, morbidade associada, prevenção e tratamento dessa manifestação clínica. RESULTADOS: Estudos atuais definem a mucosite bucal como uma inflamação e ulceração dolorosa bastante freqüente na mucosa bucal apresentando formação de pseudomembrana. Sua incidência e severidade são influenciadas por variáveis associadas ao paciente e ao tratamento a que ele é submetido. A mucosite é conseqüência de dois mecanismos maiores: toxicidade direta da terapêutica utilizada sobre a mucosa e mielossupressão gerada pelo tratamento. Sua patofisiologia é composta por quatro fases interdependentes: fase inflamatória/vascular, fase epitelial, fase ulcerativa/bacteriológica e fase de reparação. É considerada fonte potencial de infecções com risco de morte, sendo a principal causa de interrupção de tratamentos antineoplásicos. Algumas intervenções mostraram-se potencialmente efetivas para sua prevenção e tratamento. Entretanto, faz-se necessária a realização de novos estudos clínicos mais bem conduzidos para obtenção de melhor evidência científica acerca do agente terapêutico de escolha para o controle da mucosite bucal, permitindo a realização da quimioterapia e radioterapia do câncer em parâmetros ideais.
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Volpato LER, Silva TC, Oliveira TM, Sakai VT, Machado MAAM. Radiation therapy and chemotherapy-induced oral mucositis. Braz J Otorhinolaryngol 2007; 73:562-8. [PMID: 17923929 PMCID: PMC9444544 DOI: 10.1016/s1808-8694(15)30110-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Accepted: 09/02/2006] [Indexed: 11/24/2022] Open
Abstract
TIncreasing the intensity of radiation therapy and chemotherapy in the management of cancer has increased the incidence of adverse effects, especially oral mucositis. Aim and methods a bibliographical review was conducted on the definition of oral mucositis, its clinical findings, the incidence, its etiology, the pathofisiology, associated morbidity, prevention and treatment. Results current studies define oral mucositis as a very frequent and painful inflammation with ulcers on the oral mucosa that are covered by a pseudo membrane. The incidence and severity of lesions are influenced by patient and treatment variables. Oral mucositis is a result of two major mechanisms: direct toxicity on the mucosa and myelosuppression due to the treatment. Its pathofisiology is composed of four interdependent phases: an initial inflammatory/vascular phase; an epithelial phase; an ulcerative/bacteriological phase; and a healing phase. It is considered a potential source of life-threatening infection and often is a dose-limiting factor in anticancer therapy. Some interventions have been shown to be potentially effective to prevent and treat oral mucositis. Further intensive research through well-structured clinical trials to obtain the best scientific evidence over the standard therapy of oral mucositis is necessary to attain ideal parameters for radiotherapy and chemotherapy.
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de Koning BAE, Philipsen-Geerling B, Hoijer M, Hählen K, Büller HA, Pieters R. Protection against chemotherapy induced mucositis by TGF-beta(2) in childhood cancer patients: results from a randomized cross-over study. Pediatr Blood Cancer 2007; 48:532-9. [PMID: 16767731 DOI: 10.1002/pbc.20910] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Mucositis is one of the most frequent and severe side-effect of chemotherapy in childhood-cancer patients for which there is no prophylaxis available. The efficacy and feasibility of a TGF-beta(2)-enriched feeding for preventing oral and gastro-intestinal-mucositis in childhood-cancer patients were studied. PROCEDURE The study was designed as a two-period cross-over, randomized, double-blinded, placebo, controlled trial. Patients who had a high risk for developing mucositis and who would receive two comparable cycles of chemotherapy were eligible for the study. During one cycle of chemotherapy, TGF-beta(2)-enriched feeding was administered; during the other, a "placebo" (not enriched) feeding was used. WHO toxicity scales of diarrhea, oral mucositis, fever, anal lesions and nausea/vomiting were scored daily. In addition, the incidence of occurrence of blood cultures, antibiotic therapy, and interventions or diagnostics related to mucositis were measured. RESULTS The feasibility of the study was good: 83% of the patients completed two cycles and 86% of the study-feeding was effectively consumed. Administration of TGF-beta(2) was safe as serum TGF-beta(2) did not increase, and renal and liver function were not affected during TGF-beta(2) consumption compared to normal feeding. Differences in toxicity, scored during the whole observation period and the number of days with WHO 3/4 toxicity, were not significantly different between cycles with TGF-beta(2) enriched and normal feeding. CONCLUSIONS TGF-beta(2) administration via feeding is well tolerated and safe. Although this study might have had limitations to show potential benefit of TGF-beta(2), it does not provide evidence that TGF-beta(2) decreases the incidence or degree of mucositis induced by combination chemotherapy in childhood-cancer patients.
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Affiliation(s)
- Barbara A E de Koning
- Department of Pediatric Oncology/Hematology, ErasmusMC-Sophia Children's Hospital, Dr. Molewaterplein, GE Rotterdam, The Netherlands
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Cruz LB, Ribeiro AS, Rech A, Rosa LGN, Castro CG, Brunetto AL. Influence of low-energy laser in the prevention of oral mucositis in children with cancer receiving chemotherapy. Pediatr Blood Cancer 2007; 48:435-40. [PMID: 16862549 DOI: 10.1002/pbc.20943] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study assessed the use of low-energy laser in the prevention or reduction of the severity of oral mucositis. PROCEDURE A randomized clinical trial was carried out. Patients from 3 to 18 years of age treated with chemotherapy or hematopoietic stem-cell transplantation between May, 2003 and February, 2005 were eligible. The intervention group received laser application for 5 days following the start of chemotherapy. The grade of oral mucositis was assessed by the WHO per NCI-CTC common toxicity criteria and the assessments were made on days 1, 8 and 15 by a trained examiner blind to the intervention. RESULTS Sixty patients were evaluable for analysis; thirty-nine (65%) were males, 35 (58%) patients had a diagnosis of leukemia or lymphoma, and 25 (42%) had solid tumors. The mean age was 8.7 +/- 4.3 years. Twenty-nine patients were randomized in the laser group and 31 in the control group. On day 1, no patients presented with mucositis. On day 8, of 20 patients (36%) who developed mucositis, 13 of them were from the laser group and 7 from the control group. On day 15, of 24 patients (41%) who developed mucositis, 13 of them were from the laser group and 11 from the control group. There was no significant difference between groups concerning the grades of mucositis on day 8 (P = 0.234) or on day 15 (P = 0.208). CONCLUSIONS This study showed no evidence of benefit from the prophylactic use of low-energy laser in children and adolescents with cancer treated with chemotherapy when optimal dental and oral care was provided.
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Affiliation(s)
- Luciane B Cruz
- Pediatric Oncology Unit, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
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Gandemer V, Le Deley MC, Dollfus C, Auvrignon A, Bonnaure-Mallet M, Duval M, De Lumley L, Hartmann O, Mechinaud F, Sirvent N, Orbach D, Doireau V, Boutard P, Dalle JH, Reguerre Y, Pautard B, Aubier F, Schneider P, Suc A, Couillaut G, Schmitt C. Multicenter randomized trial of chewing gum for preventing oral mucositis in children receiving chemotherapy. J Pediatr Hematol Oncol 2007; 29:86-94. [PMID: 17279004 DOI: 10.1097/mph.0b013e318030a3e4] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The properties of saliva led us to hypothesize that the salivary flow increase induced by gum chewing might protect the oral mucosa from lesions due to cancer chemotherapy. We conducted a multicenter randomized trial to evaluate the efficacy of chewing gum in preventing oral mucositis in 145 children receiving chemotherapy regimens expected to induce WHO grade 3-4 oral mucositis in at least 30% of patients. Patients were allocated at random to standard oral care with or without 5 gum pieces per day. No overall reduction in severe oral mucositis occurred in the gum arm (51%) compared with the standard arm (44%). VIDE, COPADM, and multidrug intensive chemotherapy caused severe oral mucositis in 75% of patients in both arms. In patients receiving less toxic regimens, a decrease in WHO grade 1-4 oral mucositis was noted in the gum arm compared with the standard arm (49% vs. 72%, P=0.03). In the multivariate analysis, the risk of oral mucositis was related only to the type of chemotherapy regimen, suggesting that further strategies for preventing oral mucositis could be mainly based on these criteria.
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Affiliation(s)
- Virginie Gandemer
- Department of Paediatrics, Teaching Hospitals 35203 Rennes Cedex, France.
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Gibson F, Cargill J, Allison J, Begent J, Cole S, Stone J, Lucas V. Establishing content validity of the oral assessment guide in children and young people. Eur J Cancer 2006; 42:1817-25. [PMID: 16872825 DOI: 10.1016/j.ejca.2006.02.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Revised: 02/10/2006] [Accepted: 02/27/2006] [Indexed: 11/21/2022]
Abstract
There is a need for accurate and consistent oral assessment to measure mucosal changes and oral complications associated with cancer therapies. Mucositis is an important and common side effect of cancer therapies that merits the identification of improved health-care interventions. Developing appropriate and reliable oral assessment instruments for use with children is relevant to the evaluation of these interventions. The purpose of this study was to determine the content validity of the oral assessment guide (OAG) in children: an instrument that was designed to objectively assess the physiological changes of the oral cavity following administration of chemotherapy and radiotherapy to adults. This process is considered to be most effective when undertaken systematically. A judgement quantification process was used with health care professionals in paediatric oncology to establish content validity of items (n=9) and instrument (n=10). A revised OAG more pertinent to children and young people was produced in the light of this process.
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Affiliation(s)
- Faith Gibson
- Centre for Nursing and Allied Health Professions Research, 7th Floor Old Building, Great Ormond Street Hospital for Children NHS Trust and Institute of Child Health, Great Ormond Street, London WC1N 3JH, United Kingdom.
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Sixou JL, Aubry-Leuliette A, De Medeiros-Battista O, Lejeune S, Jolivet-Gougeon A, Solhi-Pinsard H, Gandemer V, Barbosa-Rogier M, Bonnaure-Mallet M. Capnocytophaga in the dental plaque of immunocompromised children with cancer. Int J Paediatr Dent 2006; 16:75-80. [PMID: 16430520 DOI: 10.1111/j.1365-263x.2006.00697.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES (i) To compare the prevalence and levels of Capnocytophaga, a known systemic pathogen in immunocompromised patients, in the dental plaque of healthy children and children with cancer, and (ii) to determine the susceptibility of strains isolated from cancer patients to a range of antibiotics. PATIENTS AND METHODS Thirty-one children with cancer undergoing a first course of immunosuppressive chemotherapy and 30 healthy control children were included in the study. Samples were collected on days 0, 7, 14, and 21 of the cure (and equivalent dates in controls). Susceptibility to antibiotics was tested using an agar dilution method and galleries with predefined concentrations of selected antibiotics. RESULTS There was a significant drop in the total anaerobic cultivable flora on day 14 and in the prevalence of Capnocytophaga on days 14 and 21 in the children with cancer. The proportion of Capnocytophaga in the anaerobic flora, however, was high in certain cancer patients. Beta-lactam/beta-lactamase inhibitor combinations, imipenem, clindamycin, and tetracycline were the most effective against Capnocytophaga. CONCLUSION This study showed that Capnocytophaga decreased in prevalence and proportion in the dental plaque of cancer patients during chemotherapy but became predominant in some cases. It is recommended that imipenem or beta-lactam/beta-lactamase inhibitor combinations be used to treat Capnocytophaga bacteraemia.
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Affiliation(s)
- J L Sixou
- Department of Paediatric Dentistry, Rennes Cedex, France.
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Schmid I, Schmitt M, Streiter M, Meilbeck R, Albert MH, Reinhardt D, Stachel D. Parenteral nutrition is not superior to replacement fluid therapy for the supportive treatment of chemotherapy induced oral mucositis in children. Eur J Cancer 2005; 42:205-11. [PMID: 16330203 DOI: 10.1016/j.ejca.2005.09.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Revised: 08/19/2005] [Accepted: 09/27/2005] [Indexed: 10/25/2022]
Abstract
Many paediatric oncology centres apply parenteral nutrition (PN) in children with severe oral mucositis after chemotherapy. However, no convincing data exist to support this treatment strategy. The aim of our study was to elucidate a possible advantage of PN versus intravenous replacement fluid therapy (FT). In a prospective randomized study, 30 children with mucositis WHO grade IV were assigned to receive either PN or intravenous replacement FT. Weight, total body water, fat-free mass (measured by impedance analysis) and peripheral white blood cells were assessed daily. For aspects of quality of life and economics, the length of hospital stay, the incidence of infections, the days on intravenous antibiotics and delay of scheduled chemotherapy were examined. Children with PN gained body weight significantly compared to baseline and to FT due to an augmentation of fat mass while total body water and fat-free mass significantly decreased. In children with FT, body weight remained stable while total body water and fat-free mass significantly increased, thereby loosing fat mass. We observed no differences in recovery of peripheral white blood cells (WBC), incidence of infections, hospitalization time, days on intravenous antibiotics, days on opioid analgesics and delay of the next scheduled chemotherapy cycle. Although children with PN gained weight in form of fat mass, this did not translate into a clinical benefit for the patients such as earlier recovery of WBC counts, shorter hospitalization time, a decreased use of analgesics or less delay of the next scheduled chemotherapy cycle. Our findings therefore do not support the hypothesis that PN is superior to FT when used for less than 10 days for oral mucositis.
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Affiliation(s)
- Irene Schmid
- Kinderklinik and Kinderpoliklinik, Dr. von Haunersches Kinderspital, Ludwig-Maximilians-University Munich, Lindwurmstr. 4, D-80337 Munich, Germany.
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Djuric M, Hillier-Kolarov V, Belic A, Jankovic L. Mucositis prevention by improved dental care in acute leukemia patients. Support Care Cancer 2005; 14:137-46. [PMID: 16041502 DOI: 10.1007/s00520-005-0867-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Accepted: 06/29/2005] [Indexed: 10/25/2022]
Abstract
GOALS OF WORK The aim of the present study was to evaluate the effects of the intensive dental care protocol in preventing oral complications in acute leukemia patients. PATIENTS AND METHODS Thirty-four patients hospitalized for induction remission therapy for acute leukemia were randomly assigned to one of two groups, whether to receive intensive dental care protocol or not. The intensive dental care group of patients received dental treatment and plaque and calculus removal prior to chemotherapy and supervised oral hygiene measures during chemotherapy. The limited dental care group of patients did not receive prechemotherapy dental care. Groups were comparable in age, sex, and antineoplastic treatment received. Patients were examined after admission to the hospital; at the initiation of the chemotherapy; and 7, 14, 21, and 28 days after initiation of therapy. Positive data about subjective difficulties were taken by anamnesis. Oral hygiene index (OHI) and gingival index (GI) were used to assess the periodontal status of the patients. The severity of mucositis was evaluated according to WHO classification. MAIN RESULTS The results of this study pointed out lower mean values of GI and lower mean values of mucositis score in the intensive dental care group of patients during the whole period of examination. Although the differences in mean values were not statistically significant on most of the examination days, intensive dental care group of patients developed less severe and less painful oral complications compared to the limited dental care group of patients. CONCLUSION We conclude that proper dental care and preventive measures both before and during chemotherapy can be beneficial to these patients.
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Affiliation(s)
- Milanko Djuric
- Clinic for Dentistry, Faculty of Medicine, Hajduk Veljkova 12, 21000, Novi Sad, Serbia and Montenegro.
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Jolivet-Gougeon A, Tamanai-Shacoori Z, Desbordes L, Gandemer V, Sixou JL, Morvan-Graveline N, Cormier M, Bonnaure-Mallet M. Prevalence of oropharyngeal beta-lactamase-producing Capnocytophaga spp. in pediatric oncology patients over a ten-year period. BMC Infect Dis 2005; 5:32. [PMID: 15882453 PMCID: PMC1131902 DOI: 10.1186/1471-2334-5-32] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2004] [Accepted: 05/09/2005] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to evaluate the prevalence of beta-lactamase-producing Capnocytophaga isolates in young children hospitalized in the Pediatric Oncology Department of Hôpital Sud (Rennes, France) over a ten-year period (1993–2002). Methods In neutropenic children, a periodic survey of the oral cavity allows a predictive evaluation of the risk of systemic infections by Capnocytophaga spp. In 449 children with cancer, 3,053 samples were collected by oral swabbing and plated on TBBP agar. The susceptibility of Capnocytophaga isolates to five beta-lactams was determined. Results A total of 440 strains of Capnocytophaga spp. were isolated, 309 (70%) of which were beta-lactamase producers. The beta-lactamase-producing strains were all resistant to cefazolin, 86% to amoxicillin, and 63% to ceftazidime. The proportion of strains resistant to third-generation cephalosporins remained high throughout the ten-year study, while susceptibility to imipenem and amoxicillin combined with clavulanic acid was always conserved. Conclusion These results highlight the risk of antibiotic failure in Capnocytophaga infections and the importance of monitoring immunosuppressed patients and testing for antibiotic susceptibility and beta-lactamase production.
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Affiliation(s)
- Anne Jolivet-Gougeon
- Equipe de Microbiologie, UPRES-EA 1254, Faculté des Sciences Pharmaceutiques et Biologiques, Université de Rennes 1, 2 avenue du Professeur Léon Bernard, 35043 Rennes, France
| | - Zohreh Tamanai-Shacoori
- Equipe de Microbiologie, UPRES-EA 1254, Faculté des Sciences Pharmaceutiques et Biologiques, Université de Rennes 1, 2 avenue du Professeur Léon Bernard, 35043 Rennes, France
| | - Laurent Desbordes
- Equipe de Microbiologie, UPRES-EA 1254, Faculté des Sciences Pharmaceutiques et Biologiques, Université de Rennes 1, 2 avenue du Professeur Léon Bernard, 35043 Rennes, France
| | - Virginie Gandemer
- Pediatric Oncology Department, CHU Hôpital Sud, 16 boulevard de Bulgarie, 35000 Rennes, France
| | - Jean-Louis Sixou
- Equipe de Microbiologie, UPRES-EA 1254, Faculté des Sciences Pharmaceutiques et Biologiques, Université de Rennes 1, 2 avenue du Professeur Léon Bernard, 35043 Rennes, France
| | - Nolwenn Morvan-Graveline
- Equipe de Microbiologie, UPRES-EA 1254, Faculté des Sciences Pharmaceutiques et Biologiques, Université de Rennes 1, 2 avenue du Professeur Léon Bernard, 35043 Rennes, France
| | - Michel Cormier
- Equipe de Microbiologie, UPRES-EA 1254, Faculté des Sciences Pharmaceutiques et Biologiques, Université de Rennes 1, 2 avenue du Professeur Léon Bernard, 35043 Rennes, France
| | - Martine Bonnaure-Mallet
- Equipe de Microbiologie, UPRES-EA 1254, Faculté des Sciences Pharmaceutiques et Biologiques, Université de Rennes 1, 2 avenue du Professeur Léon Bernard, 35043 Rennes, France
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Cheng KKF. Children's acceptance and tolerance of chlorhexidine and benzydamine oral rinses in the treatment of chemotherapy-induced oropharyngeal mucositis. Eur J Oncol Nurs 2004; 8:341-9. [PMID: 15550364 DOI: 10.1016/j.ejon.2004.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Oral care is of great importance in the prevention of chemotherapy-induced oropharyngeal mucositis. Although considerable attention has been given in improving oral care practices, patients' acceptance and tolerance of oral rinses is a continuing problem in oral care. A randomized crossover design was used to determine the relative acceptability and tolerability of chlorhexidine and benzydamine oral rinse agents in children receiving chemotherapy. At the end of the study, each subject was asked to compare these two agents in relation to stinging and taste, as well as his/her perception in reducing mucositis. Thirty-four children aged 6-17 years completed two courses of chemotherapy during which they alternately practiced oral care using chlorhexidine then benzydamine or benzydamine then chlorhexidine. All of the children tolerated the agents well and continued with rinsing throughout the study. Only a few children had to resort to diluting the agents with normal saline or water. Fifty-nine percent of children reported that the stinging associated with benzydamine was more accepted than chlorhexidine. The taste of both these agents was accepted by 50% of children. Approximately 60% of children reported that chlorhexidine was more helpful than benzydamine in reducing mucositis. About 47% and 50% of them preferred chlorhexidine and benzydamine in their subsequent chemotherapy, respectively. In conclusion, chlorhexidine and benzydamine are acceptable and well-tolerated by children over the age 6 years old.
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Affiliation(s)
- K K F Cheng
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, 804A, Esther Lee Building, Shatin, New Territories, Hong Kong.
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Barker GJ, Epstein JB, Williams KB, Gorsky M, Raber-Durlacher JE. Current practice and knowledge of oral care for cancer patients: a survey of supportive health care providers. Support Care Cancer 2004; 13:32-41. [PMID: 15549427 DOI: 10.1007/s00520-004-0691-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2004] [Accepted: 08/10/2004] [Indexed: 12/23/2022]
Abstract
BACKGROUND The Oral Care Study Section of the Multinational Association of Supportive Care in Cancer (MASCC) and the International Society for Oral Oncology (ISOO) conducted a survey on clinical practices of oral/dental management of cancer patients among supportive health care providers. The main purpose was to evaluate the knowledge and current practice for preventing and managing oral side effects associated with intensive chemotherapy (ICT), hematopoietic cell transplant (HCT), and radiation therapy to the head and neck (H&N RT). MATERIALS AND METHODS A questionnaire designed and pretested was sent to 212 MASCC/ISOO members around the world with different dental and medical backgrounds. MAIN RESULTS Seventy-four individuals (35%) responded. The majority of respondents were aware of possible oral complications and provided patients with clinical strategies and recommendations although there was considerable variability among the respondents. Approximately 75% stated that patients were referred for oral/dental care prior to H&N RT and ICT including HCT. However, integrated dental and medical services were reported available in only about 25% of the institutions, and most patients were referred to community-based dental professionals. MAIN CONCLUSIONS The survey represents a first review of current, international oral care practices. It suggests a need to develop evidence-based clinical guidelines to support effective oral/dental interventions and management strategies for this population. Furthermore, strategies for implementation of oral care protocols and better integration of dental and medical services should be developed. Caution in interpreting these findings is urged due to the limited response rate.
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Affiliation(s)
- Gerry J Barker
- Department of Dental Public Health and Behavioral Science School of Dentistry, University of Missouri Kansas City, 650 E 25th Street, Kansas City, MO 64108, USA.
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Rubenstein EB, Peterson DE, Schubert M, Keefe D, McGuire D, Epstein J, Elting LS, Fox PC, Cooksley C, Sonis ST. Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis. Cancer 2004; 100:2026-46. [PMID: 15108223 DOI: 10.1002/cncr.20163] [Citation(s) in RCA: 477] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Oral and gastrointestinal (GI) mucositis can affect up to 100% of patients undergoing high-dose chemotherapy and hematopoietic stem cell transplantation, 80% of patients with malignancies of the head and neck receiving radiotherapy, and a wide range of patients receiving chemotherapy. Alimentary track mucositis increases mortality and morbidity and contributes to rising health care costs. Consequently, the Multinational Association of Supportive Care in Cancer and the International Society for Oral Oncology assembled an expert panel to evaluate the literature and to create evidence-based guidelines for preventing, evaluating, and treating mucositis. METHODS Thirty-six panelists reviewed literature published between January 1966 and May 2002. An initial meeting in January 2002 produced a preliminary draft of guidelines that was reviewed at a second meeting the same year. Thereafter, a writing committee produced a report on mucositis pathogenesis, epidemiology, and scoring (also included in this issue), as well as clinical practice guidelines. RESULTS Panelists created recommendations from higher levels of evidence and suggestions when evidence was of a lower level and there was a consensus regarding the interpretation of the evidence by the panel. Panelists identified gaps in evidence that made it impossible to recommend or not recommend use of specific agents. CONCLUSIONS Oral/GI mucositis is a common side effect of many anticancer therapies. Evidence-based clinical practice guidelines are presented as a benchmark for clinicians to use for routine care of appropriate patients and as a springboard to challenge clinical investigators to conduct high-quality trials geared toward areas in which data are either lacking or conflicting.
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Affiliation(s)
- Edward B Rubenstein
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Cheng KKF, Chang AM, Yuen MP. Prevention of oral mucositis in paediatric patients treated with chemotherapy. Eur J Cancer 2004; 40:1208-16. [PMID: 15110885 DOI: 10.1016/j.ejca.2003.10.023] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2002] [Revised: 07/24/2003] [Accepted: 10/21/2003] [Indexed: 11/18/2022]
Abstract
This study compared the efficacy of two protocols for oral care using either chlorhexidine or benzydamine as oral rinses to alleviate mucositis in children undergoing chemotherapy. Eligible participants were randomised to receive either protocol for 3 weeks in a two-period crossover design. The occurrence of ulcerative lesions and severity of mucositis were measured at baseline and twice weekly, using the modified Oral Assessment Guide (OAG). Data were continuously analysed by plotting them directly on predefined sequential charts. According to this sequential analysis, the study could be terminated at the 34th within subject comparison, with a statistically significant reduction in ulcerative lesions (P<0.05) and severity of mucositis (P<0.05) in children on the chlorhexidine protocol. These findings suggest that chlorhexidine together with oral care might be helpful in alleviating mucositis when given prophylactically to children on chemotherapy, but the therapeutic benefit needs to be confirmed in a larger trial.
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Affiliation(s)
- K K F Cheng
- Nethersole School of Nursing, Faculty of Medicine, Room 804A, Esther Lee Building, Chung Chi College, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
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42
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Belfield PM, Dwyer AA. Oral complications of childhood cancer and its treatment. Eur J Cancer 2004; 40:1035-41; discussion 1042-4. [PMID: 15093579 DOI: 10.1016/j.ejca.2003.09.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2003] [Revised: 09/19/2003] [Accepted: 09/29/2003] [Indexed: 10/26/2022]
Affiliation(s)
- P M Belfield
- Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Cheng KKF, Chang AM. Palliation of Oral Mucositis Symptoms in Pediatric Patients Treated With Cancer Chemotherapy. Cancer Nurs 2003; 26:476-84. [PMID: 15022979 DOI: 10.1097/00002820-200312000-00007] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This prospective randomized 2-period crossover study aimed at comparing the efficacy of 2 oral care protocols differing in the type of mouthwashes: chlorhexidine versus benzydamine in alleviating oral mucositis symptoms for children undergoing chemotherapy. Forty subjects were randomly allocated to receive either chlorhexidine first then benzydamine protocols or benzydamine first then chlorhexidine protocols. Each protocol was started on the first day of chemotherapy and continued for 21 days. Subjects were evaluated in intervals of 3 to 4 days using the World Health Organization (WHO) grading for mucositis and 10-cm visual analogue scale for oral symptoms evaluations. Among 34 evaluable subjects, 26% and 48% of them using chlorhexidine and benzydamine had WHO grade II mucositis, respectively (P < .05). The results revealed a significant difference in mean area under the curve (AUC) of mouth pain (1.35 +/- 2.26 versus 3.09 +/- 3.21) (P = .05), and a trend of a lessening of mean AUC of difficulty in eating/chewing (2.49 +/- 3.74 versus 2.71 +/- 4.1) (P = .82) and swallowing (1.34 +/- 3.31 versus 1.91 +/- 4.03) (P = .53) for subjects receiving chlorhexidine compared to those receiving benzydamine. In conclusion, chlorhexidine may be helpful in palliating mucositis symptoms for children in chemotherapy. The beneficial effect, however, is small and needs to be confirmed in a larger trial.
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Affiliation(s)
- K K F Cheng
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
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Cheng KK, Molassiotis A, Chang AM, Wai WC, Cheung SS. Evaluation of an oral care protocol intervention in the prevention of chemotherapy-induced oral mucositis in paediatric cancer patients. Eur J Cancer 2001; 37:2056-63. [PMID: 11597384 DOI: 10.1016/s0959-8049(01)00098-3] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Oral mucositis is the most frequent and severe complication of chemotherapy in children with cancer that can aggravate the child's clinical condition and increase the risk of infection. This prospective comparative study was designed to determine the effectiveness of a preventive oral care protocol in reducing chemotherapy-induced oral mucositis in children with cancer. During an 8-month period, 42 children aged 6 to 17 years with haematological malignancies or solid tumours were evaluated. The 21 children who were included in the first 4-month period of the study constituted the control group. Another 21 children were enrolled in the subsequent 4 months and were assigned to the experimental group, in which they were given an oral care protocol intervention. The oral care protocol consisted of tooth brushing, 0.2% chlorhexidine mouth rinse and 0.9% saline rinse. Children in both groups were evaluated twice a week for 3 weeks. The incidence of ulcerative lesions, severity of oral mucositis and the related pain intensity were used as the main outcome variables. A 38% reduction in the incidence of ulcerative mucositis was found in children using the oral care protocol compared with children in the control group. The severity of oral mucositis (P=0.000002) and the related pain (P=0.0001) were significantly reduced with the intervention. These results support the preventive use of the oral care protocol in paediatric cancer patients who undergo chemotherapy for cancer treatment.
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Affiliation(s)
- K K Cheng
- Department of Nursing, 6/F, New Teaching Block, Chung Chi College, Chinese University of Hong Kong, Shatin, Hong Kong.
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Bunetel L, Tricot-Doleux S, Agnani G, Bonnaure-Mallet M. In vitro evaluation of the retention of three species of pathogenic microorganisms by three different types of toothbrush. ORAL MICROBIOLOGY AND IMMUNOLOGY 2000; 15:313-6. [PMID: 11154423 DOI: 10.1034/j.1399-302x.2000.150508.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The retention and survival of microorganisms on toothbrushes pose a threat of recontamination for certain patients at risk. In order to measure the influence of brush design and optimize the choice of toothbrush model for complementary studies, the in vitro retention of three microbial species (Porphyromonas gingivalis ATCC 33277, Streptococcus mutans ATCC 25175 and Candida albicans ATCC 26555) was evaluated for three types of toothbrush. Two series of standardized experiments were carried out for each brush and microorganism. The first series tested the retention of the microorganisms on the head portion of the brush, while the second measured retention on the head of the brush and the part of the handle inserted in the mouth during brushing. For each series, the microorganisms were counted at T0 and T24 (after storage of the brushes at room temperature for 24 h). Depending on the microorganism studied, from 0.2% to 2% of the initial inoculum was retained on the brush. The number detected increased with the size of the exposed area. After 24 h, P. gingivalis and S. mutans were found on only one type of brush. C. albicans survived on all three. These results confirm that microorganisms can quickly colonize toothbrushes.
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Affiliation(s)
- L Bunetel
- Equipe de Biologie Buccale, Université de Rennes 1, France
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