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Ibrahim SS, Hassanein FEA, Zaky HW, Gamal H. Clinical and biochemical assessment of the effect of glutamine in management of radiation induced oral mucositis in patients with head and neck cancer: Randomized controlled clinical trial. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101827. [PMID: 38493953 DOI: 10.1016/j.jormas.2024.101827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/01/2024] [Accepted: 03/14/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND This study aimed to evaluate the effect of oral glutamine suspension on salivary levels of transforming growth factor beta 1 (TGF-β1), a cytokine involved in inflammation and Tumor progression, and the severity of radiation-induced oral mucositis (RIOM) in head and neck cancer patients. This is the first study to investigate the impact of glutamine on TGF-β1 levels in head and neck cancer patients with radiation induced oral mucositis (RIOM). METHODS In this randomized controlled clinical trial, 50 HNC patients were enrolled and received either glutamine oral suspension or maltodextrin as a placebo from the baseline of RIOM to the end of radiotherapy. Salivary TGF-β1 levels were measured at baseline and after treatment. Also, RIOM was assessed using the World Health Organization (WHO) Oral Toxicity Scale, the Oral Mucositis Assessment Scale (OMAS), the Pain Visual Analog Scale (Pain-VAS), the incidence of opioid use, and body mass index (BMI). RESULTS Glutamine significantly reduced salivary TGF-β1 levels and improved RIOM symptoms, such as pain, opioid use, and weight loss. The reduction of TGF-β1 levels was associated with the improvement of RIOM severity. CONCLUSION Glutamine may modulate the inflammatory response and enhance wound healing in RIOM by decreasing salivary TGF-β1 levels. These findings support the use of glutamine as a potential intervention for RIOM and nutritional support for improving radiation sensitivity. TRIAL REGISTRATION This study was registered on clinicalTrials.gov with identifier no. NCT05856188.
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Affiliation(s)
- Suzan S Ibrahim
- Oral Medicine, Periodontology, and Oral Diagnosis, Faculty of Dentistry, Ain Shams University, Cairo, Egypt; Faculty of Oral and Dental medicine, Nahda university, Beni Suef, Egypt
| | - Fatma E A Hassanein
- Oral Medicine, Periodontology, and Oral Diagnosis, Faculty of Dentistry, Ain Shams University, Cairo, Egypt; Faulty of Dentistry, King Salman International University, El-Tur, Egypt.
| | - Hany W Zaky
- Radiation Oncology, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Hadeel Gamal
- Oral Medicine, Periodontology, and Oral Diagnosis, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
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Atwiine F, Kyomya J, Atukunda EC, Isiiko J, Yadesa TM. Prevalence and risk factors of chemotherapy-induced oral mucositis among adult cancer patients at the cancer unit of Mbarara Regional Referral Hospital. Asia Pac J Clin Oncol 2024; 20:354-364. [PMID: 38148289 DOI: 10.1111/ajco.14044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/04/2023] [Accepted: 12/17/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Chemotherapy is a common treatment for cancer, but it is associated with adverse drug reactions like oral mucositis. This condition destroys basal cells in the oral mucosal layer, causing inflammation and ulceration. This can impact the patient's physical, emotional, and psychological well-being, affecting treatment outcomes and quality of life. This study aims to determine the prevalence, severity, and risk factors of chemotherapy-induced oral mucositis among adult cancer patients. METHODS The study was a cross-sectional study conducted among adult cancer patients receiving chemotherapy at the cancer unit of Mbarara Regional Referral Hospital in southwestern Uganda. Data was collected through patient interviews, oral examinations, and patient chart reviews. RESULTS Out of 268 patients, 115 (42.9%) experienced oral mucositis. Grade 2 oral mucositis was the most common (44.3%) followed by grade 1 (35.7%) and grade 3 (20.0%). Independent risk factors of chemotherapy-induced oral mucositis were female gender (Adjusted Odds Ratio (AOR) = 2.19, 95% confidence interval [CI]: 1.27-3.78; p-value = 0.005), poor oral hygiene (AOR = 3.70, 95% CI: 1.51-9.10; p-value = 0.04), and receiving chemotherapy containing an alkylating agent (AOR = 3.17, 95% CI: 1.63-6.19; p-value < 0.001). CONCLUSION The study found that two out of five chemotherapy patients developed oral mucositis, with nearly half being grade 2. The risk factors identified in our study were comparable to those reported in previous studies. Therefore, identification and assessment of cancer patients at high risk for chemotherapy-induced oral mucositis should be routinely done for proper and timely management.
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Affiliation(s)
- Fredrick Atwiine
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Julius Kyomya
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Esther C Atukunda
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - John Isiiko
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
- Cancer Unit, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Tadele Mekuriya Yadesa
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
- Pharm-Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, Kampala International University, Ishaka, Uganda
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Muranaka H, Akinsola R, Billet S, Pandol SJ, Hendifar AE, Bhowmick NA, Gong J. Glutamine Supplementation as an Anticancer Strategy: A Potential Therapeutic Alternative to the Convention. Cancers (Basel) 2024; 16:1057. [PMID: 38473414 PMCID: PMC10930819 DOI: 10.3390/cancers16051057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
Glutamine, a multifaceted nonessential/conditionally essential amino acid integral to cellular metabolism and immune function, holds pivotal importance in the landscape of cancer therapy. This review delves into the intricate dynamics surrounding both glutamine antagonism strategies and glutamine supplementation within the context of cancer treatment, emphasizing the critical role of glutamine metabolism in cancer progression and therapy. Glutamine antagonism, aiming to disrupt tumor growth by targeting critical metabolic pathways, is challenged by the adaptive nature of cancer cells and the complex metabolic microenvironment, potentially compromising its therapeutic efficacy. In contrast, glutamine supplementation supports immune function, improves gut integrity, alleviates treatment-related toxicities, and improves patient well-being. Moreover, recent studies highlighted its contributions to epigenetic regulation within cancer cells and its potential to bolster anti-cancer immune functions. However, glutamine implementation necessitates careful consideration of potential interactions with ongoing treatment regimens and the delicate equilibrium between supporting normal cellular function and promoting tumorigenesis. By critically assessing the implications of both glutamine antagonism strategies and glutamine supplementation, this review aims to offer comprehensive insights into potential therapeutic strategies targeting glutamine metabolism for effective cancer management.
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Affiliation(s)
- Hayato Muranaka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (H.M.); (R.A.); (S.B.); (S.J.P.); (A.E.H.); (N.A.B.)
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Rasaq Akinsola
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (H.M.); (R.A.); (S.B.); (S.J.P.); (A.E.H.); (N.A.B.)
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Sandrine Billet
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (H.M.); (R.A.); (S.B.); (S.J.P.); (A.E.H.); (N.A.B.)
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Stephen J. Pandol
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (H.M.); (R.A.); (S.B.); (S.J.P.); (A.E.H.); (N.A.B.)
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Andrew E. Hendifar
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (H.M.); (R.A.); (S.B.); (S.J.P.); (A.E.H.); (N.A.B.)
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Neil A. Bhowmick
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (H.M.); (R.A.); (S.B.); (S.J.P.); (A.E.H.); (N.A.B.)
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Research, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Jun Gong
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (H.M.); (R.A.); (S.B.); (S.J.P.); (A.E.H.); (N.A.B.)
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Kuba S, Maeda S, Shibata K, Soutome S, Yamanouchi K, Matsumoto M, Tanaka A, Morita M, Hatachi T, Otsubo R, Yano H, Kawashita Y, Sato S, Taniguchi H, Kanetaka K, Umeda M, Nagayasu T, Eguchi S. EFFICACY AND SAFETY OF A DEXAMETHASONE-BASED MOUTHWASH TO PREVENT CHEMOTHERAPY-INDUCED STOMATITIS IN WOMEN WITH BREAST CANCER: A MULTICENTRE, OPEN-LABEL, RANDOMISED PHASE 2 STUDY. J Evid Based Dent Pract 2023; 23:101896. [PMID: 37689451 DOI: 10.1016/j.jebdp.2023.101896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/17/2023] [Accepted: 05/17/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE No standard approach other than oral care is available for preventing chemotherapy-induced stomatitis in patients with breast cancer. In this randomized, controlled phase 2 trial, we aimed to assess the efficacy and safety of a dexamethasone-based mouthwash in preventing chemotherapy-induced stomatitis in patients with early breast cancer. BASIC PROCEDURES Patients with breast cancer scheduled for epirubicin and cyclophosphamide (EC) or docetaxel and cyclophosphamide (TC) therapy were selected and allocated in a 1:1 ratio to the intervention and control groups. The intervention group received chemotherapy, oral care, and a dexamethasone-based mouthwash, whereas the control group received chemotherapy and oral care. The primary endpoint was the incidence of stomatitis. This was a phase 2 study, and the significance level for the analysis of the primary endpoint was set a priori at 0.2. MAIN FINDINGS Data pertaining to 58 patients in the control group and 59 patients in the intervention group were analyzed. Stomatitis incidence was 55% and 38% in the control and intervention groups, respectively (risk ratio, 0.68; 80% confidence interval, 0.52-0.88; P = .052). Stomatitis severity was lower in the intervention group than in the control group (P = .03). The proportion of patients who adhered to the mouthwash regimen was 87% (interquartile range, 67.8%-95.3%). No severe oral infections were observed. PRINCIPAL CONCLUSIONS The dexamethasone-based mouthwash safely reduced stomatitis incidence and severity in patients receiving chemotherapy for early breast cancer. Phase 3 clinical trials are warranted for validating our results.
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Affiliation(s)
- Sayaka Kuba
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Shigeto Maeda
- Department of Breast and Endocrine surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Kenichiro Shibata
- Department of Surgery, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Sakiko Soutome
- Department of Oral Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kosho Yamanouchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Department of Surgery, Shimabara Hospital, Nagasaki, Japan
| | - Megumi Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Aya Tanaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Michi Morita
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Toshiko Hatachi
- Department of Surgery, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan; Department of Breast and Endocrine surgery, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Ryota Otsubo
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Yano
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Department of Surgery, Sasebo City General Hospital, Nagasaki, Japan
| | - Yumiko Kawashita
- Department of Oral Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shuntaro Sato
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Hideki Taniguchi
- Department of Surgery, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Kengo Kanetaka
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Amiri Khosroshahi R, Talebi S, Zeraattalab-Motlagh S, Imani H, Rashidi A, Travica N, Mohammadi H. Nutritional interventions for the prevention and treatment of cancer therapy-induced oral mucositis: an umbrella review of systematic reviews and meta-analysis. Nutr Rev 2023; 81:1200-1212. [PMID: 36763701 DOI: 10.1093/nutrit/nuac105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
CONTEXT To date, the efficacy of nutritional interventions on oral mucositis (OM) in patients with cancer, and the quality of this evidence have not been explored. OBJECTIVE The goal of this umbrella review was to provide a comprehensive evaluation of nutritional interventions for patients with cancer with OM, as well as to assess the quality of this evidence. DATA SOURCES Meta-analyses were searched for using PubMed, Scopus, and ISI Web of Science databases until December 2021, with no time restrictions. DATA EXTRACTION Meta-analyses of randomized control trials that evaluated the effects of nutritional interventions on the incidence of OM in patients with cancer had inclusion criteria for this umbrella review. Data extraction, quality assessment of meta-analyses, and primary studies were done independently by 2 authors. The Grading of Recommendations Assessment, Development, and Evaluation technique was used to grade the certainty of evidence. DATA ANALYSIS A total of 26 meta-analyses were included in this umbrella review. The results showed that honey, glutamine, and propolis can reduce the incidence of severe OM, based on moderate evidence quality. In addition, zinc supplementation significantly reduced the incidence of OM, regardless of symptom severity; however, low certainty of the evidence was observed. The effects of vitamin E, curcumin, and probiotics on OM were not statistically significant. CONCLUSION This umbrella review shows that honey, glutamine, and propolis can significantly reduce the incidence of severe OM. These findings need to be confirmed with well-designed, longitudinal randomized controlled trials. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42022301010.
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Affiliation(s)
- Reza Amiri Khosroshahi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepide Talebi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sheida Zeraattalab-Motlagh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Hossein Imani
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirabbas Rashidi
- Hematology-Oncology and BMT Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nikolaj Travica
- Deakin University, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Hamed Mohammadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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Gong J, Osipov A, Lorber J, Tighiouart M, Kwan AK, Muranaka H, Akinsola R, Billet S, Levi A, Abbas A, Davelaar J, Bhowmick N, Hendifar AE. Combination L-Glutamine with Gemcitabine and Nab-Paclitaxel in Treatment-Naïve Advanced Pancreatic Cancer: The Phase I GlutaPanc Study Protocol. Biomedicines 2023; 11:1392. [PMID: 37239063 PMCID: PMC10216251 DOI: 10.3390/biomedicines11051392] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Advanced pancreatic cancer is underscored by progressive therapeutic resistance and a dismal 5-year survival rate of 3%. Preclinical data demonstrated glutamine supplementation, not deprivation, elicited antitumor effects against pancreatic ductal adenocarcinoma (PDAC) alone and in combination with gemcitabine in a dose-dependent manner. The GlutaPanc phase I trial is a single-arm, open-label clinical trial investigating the safety of combination L-glutamine, gemcitabine, and nab-paclitaxel in subjects (n = 16) with untreated, locally advanced unresectable or metastatic pancreatic cancer. Following a 7-day lead-in phase with L-glutamine, the dose-finding phase via Bayesian design begins with treatment cycles lasting 28 days until disease progression, intolerance, or withdrawal. The primary objective is to establish the recommended phase II dose (RP2D) of combination L-glutamine, gemcitabine, and nab-paclitaxel. Secondary objectives include safety of the combination across all dose levels and preliminary evidence of antitumor activity. Exploratory objectives include evaluating changes in plasma metabolites across multiple time points and changes in the stool microbiome pre and post L-glutamine supplementation. If this phase I clinical trial demonstrates the feasibility of L-glutamine in combination with nab-paclitaxel and gemcitabine, we would advance the development of this combination as a first-line systemic option in subjects with metastatic pancreatic cancer, a high-risk subgroup desperately in need of additional therapies.
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Affiliation(s)
- Jun Gong
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Arsen Osipov
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Jeremy Lorber
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Mourad Tighiouart
- Biostatistics and Bioinformatics Research Center, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Albert K. Kwan
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Hayato Muranaka
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Rasaq Akinsola
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Sandrine Billet
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Abrahm Levi
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Anser Abbas
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - John Davelaar
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Neil Bhowmick
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Andrew E. Hendifar
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Colella G, Boschetti CE, Vitagliano R, Colella C, Jiao L, King-Smith N, Li C, Nuoh Lau Y, Lai Z, Mohammed AI, Cirillo N. Interventions for the Prevention of Oral Mucositis in Patients Receiving Cancer Treatment: Evidence from Randomised Controlled Trials. Curr Oncol 2023; 30:967-980. [PMID: 36661723 PMCID: PMC9858113 DOI: 10.3390/curroncol30010074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023] Open
Abstract
Oral mucositis is a common and most debilitating complication associated with cancer therapy. Despite the significant clinical and economic impact of this condition, there is little to offer to patients with oral mucositis, and the medications used in its management are generally only palliative. Given that mucositis is ultimately a predictable and, therefore, potentially preventable condition, in this study we appraised the scientific literature to evaluate effective methods of prevention that have been tested in randomised controlled trials (RCTs). Published high-level evidence shows that multiple preventative methods are potentially effective in the prevention of oral mucositis induced by radiotherapy, chemotherapy, or both. Anti-inflammatory medications (including benzydamine), growth factors and cytokines (including palifermin), cryotherapy, laser-and-light therapy, herbal medicines and supplements, and mucoprotective agents (including oral pilocarpine) showed some degree of efficacy in preventing/reducing the severity of mucositis with most anticancer treatments. Allopurinol was potentially effective in the prevention of radiotherapy-induced oral mucositis; antimicrobial mouthwash and erythropoietin mouthwash were associated with a lower risk of development of severe oral mucositis induced by chemotherapy. The results of our review may assist in highlighting the efficacy and testing the effectiveness of low-cost, safe preventative measures for oral mucositis in cancer patients.
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Affiliation(s)
- Giuseppe Colella
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Oral and Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Ciro Emiliano Boschetti
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Oral and Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Rita Vitagliano
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Oral and Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Chiara Colella
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Oral and Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Lebei Jiao
- Melbourne Dental School, The University of Melbourne, Carlton, Melbourne, VIC 3053, Australia
| | - Natalie King-Smith
- Melbourne Dental School, The University of Melbourne, Carlton, Melbourne, VIC 3053, Australia
| | - Chong Li
- Melbourne Dental School, The University of Melbourne, Carlton, Melbourne, VIC 3053, Australia
| | - Yii Nuoh Lau
- Melbourne Dental School, The University of Melbourne, Carlton, Melbourne, VIC 3053, Australia
| | - Zacchaeus Lai
- Melbourne Dental School, The University of Melbourne, Carlton, Melbourne, VIC 3053, Australia
| | - Ali Ibrahim Mohammed
- Melbourne Dental School, The University of Melbourne, Carlton, Melbourne, VIC 3053, Australia
| | - Nicola Cirillo
- Melbourne Dental School, The University of Melbourne, Carlton, Melbourne, VIC 3053, Australia
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8
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Peng TR, Tsai FP, Wu TW. Effects of various treatments for preventing oral mucositis in cancer patients: A network meta-analysis. PLoS One 2022; 17:e0278102. [PMID: 36480513 PMCID: PMC9731456 DOI: 10.1371/journal.pone.0278102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/09/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Oral mucositis (OM) is a common side effect of chemotherapy and radiotherapy in patients with cancers. The prevention or treatment of OM in cancer patients is crucial in the treatment of cancer. METHODS We searched PubMed, Embase, and Cochrane Library for the randomized control trials (RCTs) of interventions for preventing and treating OM. Network meta-analysis (NMA) was performed to estimate odds ratios (ORs) and 95% confidence intervals (CI) from both direct and indirect evidence. The prespecified primary efficacy outcome was the treatment effect of moderate to severe oral mucositis with 12 interventions. The outcome was moderate to a severe grade of OM. RESULTS This study included 55 RCTs with 3,552 participants. The results showed that honey significantly lowered the risk of chemo/radiotherapy-induced moderate to severe oral mucositis than placebo (OR: 0.01, 95%CI 0.00 to 0.45), followed by lignocaine (OR: 0.07, 95%CI 0.00 to 0.95). The surface under cumulative ranking curve (SUCRA) values for honey were 0.95, followed by lignocaine (SUCRA, 0.81) and benzydamine (SUCRA, 0.78). CONCLUSIONS The honey is effective for patients with cancer undergoing chemotherapy or radiotherapy-induced oral mucositis.
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Affiliation(s)
- Tzu-Rong Peng
- Department of Pharmacy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Fang-Pei Tsai
- Department of Pharmacy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Ta-Wei Wu
- Department of Pharmacy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- * E-mail:
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9
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Mao JJ, Ismaila N, Bao T, Barton D, Ben-Arye E, Garland EL, Greenlee H, Leblanc T, Lee RT, Lopez AM, Loprinzi C, Lyman GH, MacLeod J, Master VA, Ramchandran K, Wagner LI, Walker EM, Bruner DW, Witt CM, Bruera E. Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline. J Clin Oncol 2022; 40:3998-4024. [PMID: 36122322 DOI: 10.1200/jco.22.01357] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The aim of this joint guideline is to provide evidence-based recommendations to practicing physicians and other health care providers on integrative approaches to managing pain in patients with cancer. METHODS The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2021. Outcomes of interest included pain intensity, symptom relief, and adverse events. Expert panel members used this evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 227 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Among adult patients, acupuncture should be recommended for aromatase inhibitor-related joint pain. Acupuncture or reflexology or acupressure may be recommended for general cancer pain or musculoskeletal pain. Hypnosis may be recommended to patients who experience procedural pain. Massage may be recommended to patients experiencing pain during palliative or hospice care. These recommendations are based on an intermediate level of evidence, benefit outweighing risk, and with moderate strength of recommendation. The quality of evidence for other mind-body interventions or natural products for pain is either low or inconclusive. There is insufficient or inconclusive evidence to make recommendations for pediatric patients. More research is needed to better characterize the role of integrative medicine interventions in the care of patients with cancer.Additional information is available at https://integrativeonc.org/practice-guidelines/guidelines and www.asco.org/survivorship-guidelines.
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Affiliation(s)
- Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Ting Bao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Debra Barton
- University of Michigan School of Nursing, Ann Arbor, MI
| | - Eran Ben-Arye
- Lin & Carmel Medical Centers, Clalit Health Services; Technion Faculty of Medicine, Haifa, Israel
| | - Eric L Garland
- College of Social Work, University of Utah, Salt Lake City, UT
| | | | | | - Richard T Lee
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Ana Maria Lopez
- Thomas Jefferson. Sidney Kimmel Cancer Center, Philadelphia, PA
| | | | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jodi MacLeod
- Patient Representative, Memorial Sloan Kettering Integrative Medicine Service, New York, NY
| | - Viraj A Master
- Winship Cancer Institute of Emory University, Atlanta, GA
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10
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Yanagimoto H, Hirooka S, Yamamoto T, Yamaki S, Sekimoto M. Efficacy of Lentinula edodes Mycelia Extract on Chemotherapy-Related Tasted Disorders in Pancreatic Cancer Patients. Nutr Cancer 2022; 75:236-246. [PMID: 35950537 DOI: 10.1080/01635581.2022.2107226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Patients undergoing chemotherapy suffer from taste disorders that affect the quality of life (QOL). In this study, a randomized, double-blind, placebo-controlled trial was conducted to explore the effectiveness of AHCC®, a standardized extract of cultured Lentinula edodes mycelia, for chemotherapy-related adverse events and taste disorders in patients with gastrointestinal cancer. Patients who received chemotherapy were randomized to receive either placebo or AHCC®. The study endpoints were the incidence of anemia and taste disorders assessed with changes in nutritional parameters. Ninety-eight patients with pancreatic ductal adenocarcinoma (PDAC) were enrolled in this study, with 55 patients randomly assigned to the AHCC® group and 43 to the placebo group. The incidence of grades 2-3 anemia in the AHCC® group who were receiving chemotherapy was not significantly different compared to that of the placebo group (Risk difference; -3.1% [95% confidence intervals (CI): -22.8% to 16.9%], p = 0.8392). In the AHCC® group, the occurrence of taste disorders during chemotherapy was significantly lower, and the nutritional parameters were significantly improved compared to those in the placebo group (Risk difference; 28.6% [95% CI: 7.5% to 47.8%], p = 0.0077). AHCC® appears to prevent taste disorders in patients with advanced PDAC who were receiving chemotherapy. AHCC® is expected to enable patients who need chemotherapy to improve nutritional status and their QOL.
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Affiliation(s)
| | - Satoshi Hirooka
- Department of Surgery, Kansai Medical University, Hirakata, Japan
| | | | - So Yamaki
- Department of Surgery, Kansai Medical University, Hirakata, Japan
| | - Mitsugu Sekimoto
- Department of Surgery, Kansai Medical University, Hirakata, Japan
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11
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Paraprobiotics and Postbiotics of Lactobacillus delbrueckii CIDCA 133 Mitigate 5-FU-Induced Intestinal Inflammation. Microorganisms 2022; 10:microorganisms10071418. [PMID: 35889136 PMCID: PMC9324481 DOI: 10.3390/microorganisms10071418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 12/02/2022] Open
Abstract
Intestinal mucositis is a commonly reported side effect in oncology practice. Probiotics are considered an excellent alternative therapeutic approach to this debilitating condition; however, there are safety questions regarding the viable consumption of probiotics in clinical practice due to the risks of systemic infections, especially in immune-compromised patients. The use of heat-killed or cell-free supernatants derived from probiotic strains has been evaluated to minimize these adverse effects. Thus, this work evaluated the anti-inflammatory properties of paraprobiotics (heat-killed) and postbiotics (cell-free supernatant) of the probiotic Lactobacillus delbrueckii CIDCA 133 strain in a mouse model of 5-Fluorouracil drug-induced mucositis. Administration of paraprobiotics and postbiotics reduced the neutrophil cells infiltrating into the small intestinal mucosa and ameliorated the intestinal epithelium architecture damaged by 5-FU. These ameliorative effects were associated with a downregulation of inflammatory markers (Tlr2, Nfkb1, Il12, Il17a, Il1b, Tnf), and upregulation of immunoregulatory Il10 cytokine and the epithelial barrier markers Ocln, Cldn1, 2, 5, Hp and Muc2. Thus, heat-killed L. delbrueckii CIDCA 133 and supernatants derived from this strain were shown to be effective in reducing 5-FU-induced inflammatory damage, demonstrating them to be an alternative approach to the problems arising from the use of live beneficial microorganisms in clinical practice.
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12
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A Narrative Review about Nutritional Management and Prevention of Oral Mucositis in Haematology and Oncology Cancer Patients Undergoing Antineoplastic Treatments. Nutrients 2021; 13:nu13114075. [PMID: 34836330 PMCID: PMC8618139 DOI: 10.3390/nu13114075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 12/22/2022] Open
Abstract
Cancer is a prevalent disease worldwide, and treatments such as radiotherapy and chemotherapy sometimes lead to adverse events. Oral mucositis is one of the most disabling adverse events, and clinical guidelines do not take into account nutritional interventions. The primary endpoint was to gather the evidence about the efficacy of nutritional interventions in the prevention and/or treatment of antineoplastic-induced oral mucositis in oncological patients. A bibliographic review was carried out in the PubMed data base by combining MeSH terms with Boolean operators. Articles were selected based on inclusion and exclusion criteria; 50 final articles were found. Although further evidence is needed, glutamine, honey, and vitamins appear to be good therapeutic options. The rest of the compounds presented controversial or insufficient results, making it difficult to draw conclusions over their utilization as prevention or treatment options. Little evidence is reported about oral mucositis nutritional interventions in spite of them being attainable and affordable compounds. Scarce evidence is shown in paediatric patients compared with adults. Developing higher quality studies and combinations with the compounds researched is necessary for creating a stronger body of evidence.
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13
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NO, way to go: critical amino acids to replenish nitric oxide production in treating mucositis. Curr Opin Support Palliat Care 2021; 15:188-196. [PMID: 34397582 DOI: 10.1097/spc.0000000000000560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW There is still an unmet need for preventive and treatment strategies for chemotherapy-induced and radiotherapy-induced mucositis and its associated systemic inflammatory response (SIR) in cancer patients. Because of citrulline depletion due to cytotoxic therapy, nitric oxide (NO) production can be reduced, limiting its effect in many physiological processes. Restoring NO production could relieve mucositis severity by supporting host damage control mechanisms. Amino acids glutamine, arginine and citrulline are involved in NO production. This review including recent literature of preclinical and clinical studies will discuss the potential benefits of glutamine, arginine and citrulline on mucositis development with focus on NO production. RECENT FINDINGS Mucositis severity is more defined by host response to DNA damage than by DMA damage itself. Citrulline depletion because of afunctional enterocytes could be responsible for NO depletion during cytotoxic therapy. Restoring NO production during cytotoxic therapy could have a beneficial effect on mucositis development. Citrulline seems a more promising NO donor than glutamine or arginine during cytotoxic therapy, although clinical studies in mucositis patients are currently lacking. SUMMARY Glutamine, arginine and citrulline show in-vitro beneficial effects on inflammatory processes involved in mucositis. Translation to the clinic is difficult as demonstrated with use of glutamine and arginine. Citrulline, being the most potent NO donor with excellent oral bio-availability, is very promising as treatment choice for mucositis and its use deserves to be investigated in clinical trials with mucositis patients.
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14
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Karri J, Lachman L, Hanania A, Marathe A, Singh M, Zacharias N, Orhurhu V, Gulati A, Abd-Elsayed A. Radiotherapy-Specific Chronic Pain Syndromes in the Cancer Population: An Evidence-Based Narrative Review. Adv Ther 2021; 38:1425-1446. [PMID: 33570737 DOI: 10.1007/s12325-021-01640-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/27/2021] [Indexed: 12/25/2022]
Abstract
While radiation therapy is increasingly utilized in the treatment paradigm of many solid cancers, the chronic effects of radiation therapies are poorly characterized. Notably, understanding radiation-specific chronic pain syndromes is paramount given that the diagnosis and management of these conditions can serve to prevent long-standing functional impairments, optimize quality of life, and even allow for continued radiotherapy candidacy. These radiation-specific chronic pain phenomena include dermatitis, mucositis, enteritis, connective tissue fibrosis, lymphedema, and neuropathic pain syndromes. It is necessary to maintain a low threshold of suspicion for appropriately diagnosing these conditions as there exists a variance in when these symptoms arise after radiation. However, we present key epidemiological data delineating vulnerable cancer populations for each pain syndrome along with the available evidence for the management for each specific condition.
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Affiliation(s)
- Jay Karri
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Laura Lachman
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Alex Hanania
- Department of Radiation Oncology, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Anuj Marathe
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Mani Singh
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons, New York City, NY, USA
| | - Nicholas Zacharias
- Division of Pain Medicine, Department of Anesthesia, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Vwaire Orhurhu
- Division of Pain Medicine, Department of Anesthesia, University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA
| | - Amitabh Gulati
- Division of Pain Medicine, Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Alaa Abd-Elsayed
- Division of Pain Medicine, Department of Anesthesia, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
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15
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Tang G, Huang W, Zhang L, Wei Z. Role of Glutamine in the Management of Oral Mucositis in Patients with Cancer: A Meta-Analysis of Randomized Controlled Trials. Nutr Cancer 2021; 74:482-495. [PMID: 33605813 DOI: 10.1080/01635581.2021.1889623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
As the effectiveness of glutamine supplementation for oral mucositis (OM) in patients with cancer remains controversial, a comprehensive summary and analysis of available evidence is necessary. The aim of the present meta-analysis was to evaluate the benefits of glutamine supplementation on OM and OM-related adverse reactions in patients with cancer receiving chemotherapy (CT) and/or radiotherapy (RT), using data from randomized controlled trials (RCTs). The PubMed, Embase, Cochrane Library, and Web of Science databases were searched for RCTs on the use of glutamine for treating OM, published until September 11, 2020. Risk ratios (RRs) or standardized mean differences (SMDs) and 95% confidence intervals (CI) were calculated using RevMan 5.3. Fifteen studies with 988 participants were included. Glutamine did not reduce the incidence of OM (RR 0.94), but it reduced the severity of OM (SMD -0.73) and incidence of severe OM (RR 0.41). Additionally, glutamine reduced the incidence of opioid analgesic use (RR 0.84), feeding tube use (RR 0.46), hospitalization (RR 0.39), and treatment interruption (RR 0.49) caused by OM. Glutamine effectively improved OM and reduced OM-related adverse reactions in patients with cancer receiving CT and/or RT.
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Affiliation(s)
- Gang Tang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wang Huang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Linyu Zhang
- Department of Clinical Medicine, Chongqing Medical University, Chongqing, China
| | - Zhengqiang Wei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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16
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Effectiveness of glutamine in the management of oral mucositis in cancer patients: a meta-analysis of randomized controlled trials. Support Care Cancer 2021; 29:4885-4892. [DOI: 10.1007/s00520-021-06060-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/07/2021] [Indexed: 01/08/2023]
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17
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Anderson PM, Lalla RV. Glutamine for Amelioration of Radiation and Chemotherapy Associated Mucositis during Cancer Therapy. Nutrients 2020; 12:nu12061675. [PMID: 32512833 PMCID: PMC7352314 DOI: 10.3390/nu12061675] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 02/07/2023] Open
Abstract
Glutamine is a major dietary amino acid that is both a fuel and nitrogen donor for healing tissues damaged by chemotherapy and radiation. Evidence supports the benefit of oral (enteral) glutamine to reduce symptoms and improve and/or maintain quality of life of cancer patients. Benefits include not only better nutrition, but also decreased mucosal damage (mucositis, stomatitis, pharyngitis, esophagitis, and enteritis). Glutamine supplementation in a high protein diet (10 grams/day) + disaccharides, such as sucrose and/or trehalose, is a combination that increases glutamine uptake by mucosal cells. This increased topical effect can reduce painful mucosal symptoms and ulceration associated with chemotherapy and radiation in the head and neck region, esophagus, stomach and small intestine. Topical and oral glutamine seem to be the preferred routes for this amino acid to promote mucosal healing during and after cancer treatment.
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Affiliation(s)
- Peter M. Anderson
- Cleveland Clinic Pediatric Hematology/Oncology and Bone Marrow Transplant, Pediatric Institute and Taussig Cancer Institute, Cleveland, OH 44195, USA
- Correspondence: ; Tel.: +1-216-308-2706
| | - Rajesh V. Lalla
- UConn Health, School of Dental Medicine, Farmington, CT 06030 USA;
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18
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Prado CM, Purcell SA, Laviano A. Nutrition interventions to treat low muscle mass in cancer. J Cachexia Sarcopenia Muscle 2020; 11:366-380. [PMID: 31916411 PMCID: PMC7113510 DOI: 10.1002/jcsm.12525] [Citation(s) in RCA: 194] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/27/2019] [Accepted: 11/15/2019] [Indexed: 12/20/2022] Open
Abstract
Many patients with cancer experience poor nutritional status, which detrimentally impacts clinical outcomes. Poor nutritional status in cancer is primarily manifested by severe muscle mass (MM) depletion, which may occur at any stage (from curative to palliative) and often co-exists with obesity. The objective of this article was to discuss gaps and opportunities related to the role of nutrition in preventing and reversing low MM in cancer. It also provides a narrative review of relevant nutritional interventions for patients capable of oral intake. The impact of nutrition interventions to prevent/treat low MM in cancer is not well understood, potentially due to the limited number of studies and of clinically viable, accurate body composition assessment tools. Additionally, the type of study designs, inclusion criteria, length of intervention, and choice of nutritional strategies have not been optimal, likely underestimating the anabolic potential of nutrition interventions. Nutrition studies are also often of short duration, and interventions that adapt to the metabolic and behavioural changes during the clinical journey are needed. We discuss energy requirements (25-30 kcal/kg/day) and interventions of protein (1.0-1.5 g/kg/day), branched-chain amino acids (leucine: 2-4 g/day), β-hydroxy β-methylbutyrate (3 g/day), glutamine (0.3 g/kg/day), carnitine (4-6 g/day), creatine (5 g/day), fish oil/eicosapentanoic acid (2.0-2.2 g/day EPA and 1.5 g/day DHA), vitamin/minerals (e.g. vitamin D: 600-800 international units per day), and multimodal approaches (nutrition, exercise, and pharmaceutical) to countermeasure low MM in cancer. Although the evidence is variable by modality type, interventions were generally not specifically studied in the context of cancer. Understanding patients' nutritional requirements could lead to targeted prescriptions to prevent or attenuate low MM in cancer, with the overall aim of minimizing muscle loss during anti-cancer therapy and maximizing muscle anabolism during recovery. It is anticipated that this will, in turn, improve overall health and prognostication including tolerance to treatment and survival. However, oncology-specific interventions with more robust study designs are needed to facilitate these goals.
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Affiliation(s)
- Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Sarah A Purcell
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada.,Division of Endocrinology, Metabolism, and Diabetes, and Division of Nutrition, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Alessandro Laviano
- Department of Translational and Precision Medicine, La Sapienza University, Rome, Italy
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19
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Kuba S, Yamanouchi K, Matsumoto M, Maeda S, Hatachi T, Sakiko S, Kawashita Y, Morita M, Sakimura C, Inamasu E, Shibata K, Otsubo R, Yano H, Nose S, Miyamoto J, Sato S, Kanetaka K, Taniguchi H, Umeda M, Nagayasu T, Eguchi S. Study protocol for efficacy and safety of steroid-containing mouthwash to prevent chemotherapy-induced stomatitis in women with breast cancer: a multicentre, open-label, randomised phase 2 study. BMJ Open 2020; 10:e033446. [PMID: 32060155 PMCID: PMC7045258 DOI: 10.1136/bmjopen-2019-033446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Stomatitis is a frequent adverse event in patients undergoing chemotherapy for breast cancer. Stomatitis can hamper oral nutrition resulting in malnutrition, reduce quality of life and introduce the need for dose reductions and interruption of chemotherapy; however, there is currently no standard approach for preventing chemotherapy-induced stomatitis. We aimed to assess the safety and efficacy of a dexamethasone-based elixir mouthwash for preventing chemotherapy-induced stomatitis in patients with early breast cancer. METHODS AND ANALYSIS In this multicenter, randomised, controlled phase 2 trial, we will randomly assign 120 women with early breast cancer undergoing chemotherapy to use of a dexamethasone-based elixir or standard oral care, to compare their preventive effects on chemotherapy-induced stomatitis. Patients will be assigned in a 1:1 ratio. Patients in the intervention group will receive chemotherapy, oral care and a dexamethasone-based elixir (10 mL 0.1 mg/mL; swish for 2 min and spit, four times daily for 9 weeks), and patients in the control group will receive chemotherapy and oral care. The primary endpoint is the difference in incidence of stomatitis between the two groups. The sample size allows for the detection of a minimum difference of 20% in the incidence of stomatitis between the two groups. Secondary endpoints are severity of stomatitis, duration of stomatitis, completion rate of chemotherapy and adverse events. ETHICS AND DISSEMINATION All participants signed a written consent form, and the study protocol has been reviewed and approved by the Clinical Research Review Board of Nagasaki University (CRB7180001). TRIAL REGISTRATION NUMBER UMIN Clinical Trials Registry (UMIN000030489).
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Affiliation(s)
- Sayaka Kuba
- Surgery, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kosho Yamanouchi
- Surgery, National Hospital Organisation Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Megumi Matsumoto
- Surgical Oncology, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shigeto Maeda
- Surgery, National Hospital Organisation Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Toshiko Hatachi
- Surgery, Japanese Red Cross Nagasaki Atomic Bomb Hospital, Nagasaki, Japan
| | - Soutome Sakiko
- Oral Management Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Yumiko Kawashita
- Oral Management Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Michi Morita
- Surgery, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Chika Sakimura
- Surgery, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan
| | - Eiko Inamasu
- Hakujujikai Sasebo Chuo Hospital, Sasebo, Nagasaki, Japan
| | - Kenichiro Shibata
- Surgery, Japanese Red Cross Nagasaki Atomic Bomb Hospital, Nagasaki, Japan
| | - Ryota Otsubo
- Surgical Oncology, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Yano
- Surgical Oncology, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Seiichi Nose
- Pharmacy, Nagasaki University Hospital, Nagasaki, Japan
| | - Junya Miyamoto
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Shuntaro Sato
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Kengo Kanetaka
- Surgery, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hideki Taniguchi
- Surgery, Japanese Red Cross Nagasaki Atomic Bomb Hospital, Nagasaki, Japan
| | - Masahiro Umeda
- Clinical Oral Oncology, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takeshi Nagayasu
- Surgical Oncology, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Susumu Eguchi
- Surgery, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Nagasaki, Japan
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20
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Efficacy of oral administration of cystine and theanine in colorectal cancer patients undergoing capecitabine-based adjuvant chemotherapy after surgery: a multi-institutional, randomized, double-blinded, placebo-controlled, phase II trial (JORTC-CAM03). Support Care Cancer 2019; 28:3649-3657. [PMID: 31811480 PMCID: PMC7316838 DOI: 10.1007/s00520-019-05205-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/22/2019] [Indexed: 12/01/2022]
Abstract
Purpose Capecitabine-based adjuvant chemotherapy for colorectal cancer patients often causes adverse events (AEs), such as diarrhea, stomatitis, anorexia, and hand-foot syndrome (HFS). Cystine and theanine were reported to attenuate some chemotherapy-associated AEs, and hence are also expected to attenuate capecitabine-induced AEs. Therefore, we aimed to investigate the safety and efficacy of cystine/theanine treatment in colorectal cancer patients undergoing capecitabine-based adjuvant chemotherapy after surgery. Methods A total of 100 colorectal cancer patients treated with capecitabine as an adjuvant chemotherapy after surgery were randomly allocated into the cystine/theanine group (n = 52) or the placebo group (n = 48). The primary endpoint was incidence rate of diarrhea of grade 1 or higher in accordance with the Common Terminology Criteria for AEs (CTCAE) v.4.0, Japanese Clinical Oncology Group (JCOG) version. The secondary endpoints included incidence rates of other AEs (CTCAE v.4.0-JCOG), as well as the incidence rate of HFS according to the HFS grading scale. Results There were no significant differences in capecitabine-induced AEs between the two groups. However, the incidence rate of diarrhea of grade 1 or higher tended to be lower in the cystine/theanine group than the placebo group (18.4% vs. 28.9%, p = 0.169) as well as the incidence rate of HFS of grade 1 or higher (CTCAE v.4.0-JCOG or HFS grading scale) (67.4% vs. 77.8%, p = 0.185, 67.3% vs. 80.0%, p = 0.124, respectively). Conclusion This trial demonstrated that cystine/theanine treatment of colorectal cancer patients undergoing capecitabine-based adjuvant chemotherapy after surgery is safe and has the tendency to reduce the incidence rate of diarrhea or HFS. Trial registration UMIN000024784 Electronic supplementary material The online version of this article (10.1007/s00520-019-05205-1) contains supplementary material, which is available to authorized users.
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21
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Yarom N, Hovan A, Bossi P, Ariyawardana A, Jensen SB, Gobbo M, Saca-Hazboun H, Kandwal A, Majorana A, Ottaviani G, Pentenero M, Nasr NM, Rouleau T, Lucas AS, Treister NS, Zur E, Ranna V, Vaddi A, Cheng KKF, Barasch A, Lalla RV, Elad S. Systematic review of natural and miscellaneous agents for the management of oral mucositis in cancer patients and clinical practice guidelines-part 1: vitamins, minerals, and nutritional supplements. Support Care Cancer 2019; 27:3997-4010. [PMID: 31286229 DOI: 10.1007/s00520-019-04887-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 05/22/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE To update the clinical practice guidelines for the use of natural and miscellaneous agents for the prevention and/or treatment of oral mucositis (OM). METHODS A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer / International Society of Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. The findings were added to the database used to develop the 2014 MASCC/ISOO clinical practice guidelines. Based on the evidence level, the following guidelines were determined: Recommendation, Suggestion, and No Guideline Possible. RESULTS A total of 78 papers were identified within the scope of this section, out of which 29 were included in this part, and were analyzed with 27 previously reviewed studies. A new Suggestion was made for oral glutamine for the prevention of OM in head and neck (H&N) cancer patients receiving radiotherapy with concomitant chemotherapy. The previous Recommendation against the use of parenteral glutamine for the prevention of OM in hematopoietic stem cell transplantation (HSCT) patients was re-established. A previous Suggestion for zinc to prevent OM in H&N cancer patients treated with radiotherapy or chemo-radiotherapy was reversed to No Guideline Possible. No guideline was possible for other interventions. CONCLUSIONS Of the vitamins, minerals, and nutritional supplements studied for the management of OM, the evidence supports a Recommendation against parenteral glutamine in HSCT patients and a Suggestion in favor of oral glutamine in H&N cancer patients for the management of OM.
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Affiliation(s)
- Noam Yarom
- Oral Medicine Unit, Sheba Medical Center, Tel Hashomer, Israel. .,School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Allan Hovan
- British Columbia Cancer - Vancouver Centre, Vancouver, Canada
| | - Paolo Bossi
- Medical Oncology, ASST-Spedali Civili, University of Brescia, Brescia, Italy
| | - Anura Ariyawardana
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.,Metro South Oral Health, Queensland Health, Brisbane, Australia
| | - Siri Beier Jensen
- Department of Dentistry and Oral Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Margherita Gobbo
- Division of Oral Medicine and Pathology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Abhishek Kandwal
- Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himayalan University, Dehradun, Uttarakhand, India
| | - Alessandra Majorana
- Department of Medical and Surgical Specialties, Radiological Science and Public Health, Dental School University of Brescia, Brescia, Italy
| | - Giulia Ottaviani
- Division of Oral Medicine and Pathology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Monica Pentenero
- Department of Oncology, Oral Medicine and Oral Oncology Unit, University of Turin, Turin, Italy
| | - Narmin Mohammed Nasr
- Special Needs Dentistry, Dental Services, Directorate General of Health Services-Muscat Governorate, Ministry of Health, Muscat, Oman
| | - Tanya Rouleau
- Dental Oncology Program, Health Sciences North, North East Cancer Center, Sudbury, ON, Canada
| | - Anna Skripnik Lucas
- Medical Oncology Service, Department of Medicine, NYU Langone Perlmutter Cancer Center, New York, NY, USA
| | - Nathaniel Simon Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Eyal Zur
- Compounding Solutions, Tel-Mond, Israel
| | - Vinisha Ranna
- Department of Oral and Maxillofacial Surgery, The Mount Sinai Hospital, New York, NY, 10029, USA
| | - Anusha Vaddi
- Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Karis Kin Fong Cheng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andrei Barasch
- Division of Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Rajesh V Lalla
- Section of Oral Medicine, University of Connecticut School of Dental Medicine, Farmington, CT, USA
| | - Sharon Elad
- Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
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Toyomasu Y, Mochiki E, Yanai M, Suzuki M, Yanoma T, Kimura A, Kogure N, Ogata K, Kuwano H. A prospective pilot study of an elemental nutritional supplement for prevention of oral mucositis during S-1 adjuvant chemotherapy for gastric cancer. Surg Oncol 2019; 29:97-101. [PMID: 31196501 DOI: 10.1016/j.suronc.2019.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/23/2019] [Accepted: 04/08/2019] [Indexed: 12/12/2022]
Abstract
PURPOSES Oral mucositis is one of the most common reasons for discontinuation of S-1 adjuvant chemotherapy after radical gastrectomy. Some studies suggest that nutritional support with amino acids may improve oral mucositis. We conducted a prospective, randomized clinical trial of patients who underwent adjuvant chemotherapy for gastric cancer to examine whether an oral elemental diet prevents chemotherapy associated oral mucositis and body weight loss. METHODS Patients were randomly assigned to a group consuming Elental® (the treatment group, n = 11) or a control diet group (n = 11). Patients in the treatment group consumed one pack of Elental® per day during adjuvant chemotherapy. The primary endpoint was the presence and grade of oral mucositis. Secondary endpoints included adherence to Elental® based on the doses recorded in a diary, changes in nutrition parameters, and frequency and severity of adverse events. RESULTS The incidence of oral mucositis was significantly lower in the treatment group (9.1%) than in the control group (27.3%). The median body weight loss in the treatment group was significantly smaller than that in the control group (P = .015). According to Kaplan-Meier estimates the treatment group was significantly associated with high cumulative S-1 continuation rates (log-rank P = .047). CONCLUSION We conclude that the amino-acid-rich elemental diet Elental® may be useful as a countermeasure for S-1 adjuvant chemotherapy-induced mucositis.
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Affiliation(s)
- Yoshitaka Toyomasu
- Department of General Surgical Science (Surgery I), Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Cnma, Japan; Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, 1981, Kamoda, Kawagoe, Saitama, Japan.
| | - Erito Mochiki
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, 1981, Kamoda, Kawagoe, Saitama, Japan
| | - Mitsuhiro Yanai
- Department of General Surgical Science (Surgery I), Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Cnma, Japan
| | - Masaki Suzuki
- Department of General Surgical Science (Surgery I), Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Cnma, Japan
| | - Toru Yanoma
- Department of General Surgical Science (Surgery I), Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Cnma, Japan
| | - Akiharu Kimura
- Department of General Surgical Science (Surgery I), Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Cnma, Japan
| | - Norimichi Kogure
- Department of General Surgical Science (Surgery I), Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Cnma, Japan
| | - Kyoichi Ogata
- Department of General Surgical Science (Surgery I), Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Cnma, Japan
| | - Hiroyuki Kuwano
- Department of General Surgical Science (Surgery I), Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Cnma, Japan
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Büntzel J, Hübner J, Büntzel J. Komplementärmedizinische Behandlungsansätze bei oraler Mukositis und Xerostomie. DER ONKOLOGE 2019. [DOI: 10.1007/s00761-019-0521-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Thomsen M, Vitetta L. Adjunctive Treatments for the Prevention of Chemotherapy- and Radiotherapy-Induced Mucositis. Integr Cancer Ther 2018; 17:1027-1047. [PMID: 30136590 PMCID: PMC6247548 DOI: 10.1177/1534735418794885] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Chemoradiotherapy-associated mucositis can manifest as
pain, inflammation, dysphagia, diarrhea, weight loss, rectal bleeding, and
infection. Mucositis is a major dose-limiting side effect of chemotherapy,
affecting nutritional intake and oral and intestinal function. Despite several
interventions being available, there is a need for safe and effective
preventative and treatment options for treatment-induced mucositis. The goals of
this review are to discuss interventions based on foods and natural products and
present the research to date. Methods: A narrative literature
review identified 60 clinical studies examining various nutritional compounds
and 20 examining probiotics. 9 studies on probiotics for the prevention of
diarrhea were also assessed on methodological quality and limitations
identified. Results: Several compounds have been posited as useful
adjuvants for cancer treatment–related mucositis. Probiotics demonstrate
efficacy for the prevention and treatment of chemoradiotherapy-induced
gastrointestinal toxicity without significant side effects. Glutamine and
activated charcoal were reported to reduce chemotherapy-induced diarrhea but not
radiation-induced intestinal mucositis. Honey has been reported to decrease
treatment interruptions, weight loss, and delays the onset of oral mucositis.
Zinc, glutamine, and topical vitamin E were demonstrated efficacy for oral
mucositis. Conclusion: There is plausible clinical evidence for the
administration of several adjunctive treatments for the prevention and treatment
of mucositis. Probiotics were reported to reduce the burden of intestinal
mucositis and treatment-induced diarrhea. Activated charcoal and glutamine are
beneficial for chemotherapy-induced diarrhea, whereas the administration of
honey, zinc, and glutamine reduce the risk of developing oral mucositis during
chemotherapy or radiotherapy.
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Affiliation(s)
| | - Luis Vitetta
- 1 University of Sydney, Sydney, New South Wales, Australia.,2 Medlab Clinical Ltd, Sydney, New South Wales, Australia
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25
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Hamaguchi R, Tsuchiya T, Miyata G, Sato T, Takahashi K, Ariyoshi K, Oyamada S, Iwase S. Efficacy of oral administration of cystine and theanine in patients with colorectal cancer undergoing capecitabine-based adjuvant chemotherapy after surgery: study protocol for a multi-institutional, randomised, double-blinded, placebo-controlled, phase II trial. BMJ Open 2018; 8:e021442. [PMID: 30030317 PMCID: PMC6059283 DOI: 10.1136/bmjopen-2017-021442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Although adjuvant capecitabine therapy for patients with colorectal cancer after surgery often causes adverse events (AEs), such as diarrhoea, stomatitis, anorexia and hand-foot syndrome (HFS), there are no standard prevention therapies. Cystine and theanine were reported to attenuate some chemotherapy-associated AEs, and are also expected to attenuate the AEs caused by capecitabine treatment. Therefore, our present study aimed to determine the safety and efficacy of cystine/theanine therapy in patients with colorectal cancer undergoing capecitabine-based adjuvant chemotherapy after surgery. METHODS AND ANALYSIS A multi-institutional, prospective, randomised, double-blinded, placebo-controlled, phase II trial is being planned. Patients with colorectal cancer treated with capecitabine as an adjuvant chemotherapy will be randomised into either the cystine/theanine group (n=50) or placebo group (n=50). Data will be collected during four courses of capecitabine therapy. The primary endpoint will be incidence rate of diarrhoea of grade 1 or higher in accordance with the Common Terminology Criteria for AEs (CTCAE) v.4.0, Japanese Clinical Oncology Group (JCOG) version. The secondary endpoints are incidence rates of other AEs (CTCAE v.4.0-JCOG), scores of the Japanese version of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire module for all patients with cancer (QLQ-C30) and for patients with colorectal cancer (QLQ-CR29), incidence rate of HFS according to the HFS grading scale, protocol adherence, completion rate of four courses of capecitabine therapy and the proportion of completion without delay or dose reduction, time to completion of four courses of capecitabine and total dose of capecitabine. A sample size of 100 patients will be analysed between November 2016 and April 2018. ETHICS AND DISSEMINATION Ethical approval was obtained at all participating institutions. The results of this study will be submitted for publication in international peer-reviewed journals. TRIAL REGISTRATION NUMBER UMIN000024784; Pre-results.
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Affiliation(s)
- Reo Hamaguchi
- Department of Palliative Medicine, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Takashi Tsuchiya
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, Sendai, Japan
| | - Go Miyata
- Department of Gastroenterological Surgery, Iwate Prefectural Central Hospital, Iwate, Japan
| | - Toshihiko Sato
- Department of Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Kenichi Takahashi
- Department of Colorectal Surgery, Tohoku Rosai Hospital, Sendai, Japan
| | - Keisuke Ariyoshi
- Department of Palliative Medicine, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Japanese Organisation for Research and Treatment of Cancer (JORTC), NPO, Tokyo, Japan
| | - Shunsuke Oyamada
- Japanese Organisation for Research and Treatment of Cancer (JORTC), NPO, Tokyo, Japan
| | - Satoru Iwase
- Department of Palliative Medicine, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
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26
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Antioxidant Supplements and Breast Cancer: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2018. [DOI: 10.5812/ijcm.10082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Tanaka Y, Ueno T, Yoshida N, Akutsu Y, Takeuchi H, Baba H, Matsubara H, Kitagawa Y, Yoshida K. The effect of an elemental diet on oral mucositis of esophageal cancer patients treated with DCF chemotherapy: a multi-center prospective feasibility study (EPOC study). Esophagus 2018; 15:239-248. [PMID: 30225745 PMCID: PMC6153973 DOI: 10.1007/s10388-018-0620-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 05/15/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE Oral mucositis (OM) is one of the most uncomfortable adverse events experienced by cancer patients undergoing chemotherapy. Previous reports have revealed that the oral administration of an elemental diet (ED) may prevent OM. However, the incidence of OM has not been accurately determined by specialized diagnostic methods and the effects of an ED on OM remain unclear. We investigated the dose that could feasibly be administered and its effects with regard to the suppression of OM in esophageal cancer patients undergoing chemotherapy. METHODS We performed a prospective multi-center feasibility study of the administration of an ED (160 g/day) with 2 cycles of docetaxel/cisplatin/5-FU (DCF) chemotherapy. We assessed compliance to the ED for 49 days and the incidence of OM according to the amount of the ED that was orally administered. The incidence of OM was graded by a dental specialist who was experienced in dental oncology using a central OM review system. RESULTS Fourteen of 20 patients (70%) were able to complete the orally administered ED (160 g/day) during the course of chemotherapy. Three patients (15%) could not take the ED orally for 9, 14, and 21 days, respectively, while 1 patient (5%) took the ED orally at an average dose of 80 g/day for 35 days. The remaining 2 patients (10%) could not take the 80 g/day dose for 11 and 12 days, respectively. The incidence of grade ≥ 2 OM in the ED completion group (15.4%, 2 of 13 patients) was significantly lower than that in the non-completion group (66.7%, 4 of 6 patients) (p = 0.046). CONCLUSIONS An ED might be a one of the test treatment to reduce the incidence of OM in esophageal cancer patients treated with DCF and should be evaluated in further randomized study. CLINICAL TRIAL The date of submission: Dec 08th, 2017.
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Affiliation(s)
- Yoshihiro Tanaka
- 0000 0004 0370 4927grid.256342.4Department of Surgical Oncology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu 501-1194 Japan
| | - Takao Ueno
- 0000 0001 2168 5385grid.272242.3Dental Division of National Cancer Center, Tokyo, Japan
| | - Naoya Yoshida
- 0000 0001 0660 6749grid.274841.cDepartment of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasunori Akutsu
- 0000 0004 0370 1101grid.136304.3Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroya Takeuchi
- 0000 0004 1936 9959grid.26091.3cDepartment of Surgery, Graduate School of Medicine, Keio University, Tokyo, Japan
| | - Hideo Baba
- 0000 0001 0660 6749grid.274841.cDepartment of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hisahiro Matsubara
- 0000 0004 0370 1101grid.136304.3Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuko Kitagawa
- 0000 0004 1936 9959grid.26091.3cDepartment of Surgery, Graduate School of Medicine, Keio University, Tokyo, Japan
| | - Kazuhiro Yoshida
- 0000 0004 0370 4927grid.256342.4Department of Surgical Oncology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu 501-1194 Japan
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Lopez-Vaquero D, Gutierrez-Bayard L, Rodriguez-Ruiz JA, Saldaña-Valderas M, Infante-Cossio P. Double-blind randomized study of oral glutamine on the management of radio/chemotherapy-induced mucositis and dermatitis in head and neck cancer. Mol Clin Oncol 2017; 6:931-936. [PMID: 28588793 PMCID: PMC5451869 DOI: 10.3892/mco.2017.1238] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/30/2017] [Indexed: 01/17/2023] Open
Abstract
This randomized clinical trial was designed to determine whether glutamine administration was effective in reducing the incidence and severity of mucositis and dermatitis induced by radiotherapy (RT) or chemoradiotherapy (CHRT) in patients with head and neck cancer (HNC). Fifty patients were randomized to receive orally either L-Glutamine or placebo (25 patients in each arm). In the glutamine-treated group, 10 g of oral glutamine was administered three times daily. The primary endpoint was to compare the appearance of clinical mucositis between groups at the 6th week, according to the Common Terminology Criteria for Adverse Events. Secondary endpoints were: Functional mucositis, mucositis onset, cervicofacial dermatitis, pain, weight loss and assessment of quality of life (according to the M.D. Anderson Symptom Inventory-Head and Neck). In total, 76 and 87.5% developed clinical mucositis in the glutamine and placebo group, respectively. The incidence and severity grade of mucositis at the 6th week did not exhibit statistically significantly differences between the two groups, although it had a higher value in the placebo group. Significant reduction of dermatitis incidence (P=0.038) and severity (P=0.032) was found in the glutamine group. There were no differences in other outcomes such as pain, weight loss and mucositis onset, in treatment parameters including concomitant chemotherapy, radiation dose and previous surgery, or in quality of life. The present study revealed that glutamine provided slight clinical effects compared with placebo in terms of reducing oral mucositis induced by RT or CHRT in patients with HNC at the 6th week; however, the results were not statistically significant. Although the findings suggested a significant benefit in reducing the incidence and severity of dermatitis, further confirmatory studies are required.
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Affiliation(s)
- David Lopez-Vaquero
- Department of Oral and Maxillofacial Surgery, Donostia University Hospital, 20014 San Sebastian, Spain
| | - Lucia Gutierrez-Bayard
- Department of Radiation Oncology, Puerta del Mar University Hospital, 11009 Cadiz, Spain
| | | | | | - Pedro Infante-Cossio
- Department of Surgery, School of Medicine, University of Seville, 41009 Seville, Spain
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29
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Maria OM, Eliopoulos N, Muanza T. Radiation-Induced Oral Mucositis. Front Oncol 2017; 7:89. [PMID: 28589080 PMCID: PMC5439125 DOI: 10.3389/fonc.2017.00089] [Citation(s) in RCA: 205] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 04/21/2017] [Indexed: 01/11/2023] Open
Abstract
Radiation-induced oral mucositis (RIOM) is a major dose-limiting toxicity in head and neck cancer patients. It is a normal tissue injury caused by radiation/radiotherapy (RT), which has marked adverse effects on patient quality of life and cancer therapy continuity. It is a challenge for radiation oncologists since it leads to cancer therapy interruption, poor local tumor control, and changes in dose fractionation. RIOM occurs in 100% of altered fractionation radiotherapy head and neck cancer patients. In the United Sates, its economic cost was estimated to reach 17,000.00 USD per patient with head and neck cancers. This review will discuss RIOM definition, epidemiology, impact and side effects, pathogenesis, scoring scales, diagnosis, differential diagnosis, prevention, and treatment.
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Affiliation(s)
- Osama Muhammad Maria
- Faculty of Medicine, Experimental Medicine Department, McGill University, Montreal, QC, Canada
- Radiation Oncology Department, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Nicoletta Eliopoulos
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Faculty of Medicine, Surgery Department, McGill University, Montreal, QC, Canada
| | - Thierry Muanza
- Faculty of Medicine, Experimental Medicine Department, McGill University, Montreal, QC, Canada
- Radiation Oncology Department, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Oncology Department, McGill University, Montreal, QC, Canada
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30
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Greenlee H, DuPont-Reyes MJ, Balneaves LG, Carlson LE, Cohen MR, Deng G, Johnson JA, Mumber M, Seely D, Zick SM, Boyce LM, Tripathy D. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin 2017; 67:194-232. [PMID: 28436999 PMCID: PMC5892208 DOI: 10.3322/caac.21397] [Citation(s) in RCA: 407] [Impact Index Per Article: 58.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Answer questions and earn CME/CNE Patients with breast cancer commonly use complementary and integrative therapies as supportive care during cancer treatment and to manage treatment-related side effects. However, evidence supporting the use of such therapies in the oncology setting is limited. This report provides updated clinical practice guidelines from the Society for Integrative Oncology on the use of integrative therapies for specific clinical indications during and after breast cancer treatment, including anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Clinical practice guidelines are based on a systematic literature review from 1990 through 2015. Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-L-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy due to a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related side effects. In summary, there is a growing body of evidence supporting the use of integrative therapies, especially mind-body therapies, as effective supportive care strategies during breast cancer treatment. Many integrative practices, however, remain understudied, with insufficient evidence to be definitively recommended or avoided. CA Cancer J Clin 2017;67:194-232. © 2017 American Cancer Society.
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Affiliation(s)
- Heather Greenlee
- Assistant Professor, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
- Member, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY
| | - Melissa J DuPont-Reyes
- Doctoral Fellow, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Lynda G Balneaves
- Associate Professor, College of Nursing, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
| | - Linda E Carlson
- Professor, Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Misha R Cohen
- Adjunct Professor, American College of Traditional Chinese Medicine at California Institute of Integral Studies, San Francisco, CA
- Clinic Director, Chicken Soup Chinese Medicine, San Francisco, CA
| | - Gary Deng
- Medical Director, Integrative Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jillian A Johnson
- Post-Doctoral Scholar, Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA
| | | | - Dugald Seely
- Executive Director, Ottawa Integrative Cancer Center, Ottawa, ON, Canada
- Executive Director of Research, Canadian College of Naturopathic Medicine, Toronto, ON, Canada
| | - Suzanna M Zick
- Research Associate Professor, Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI
- Research Associate Professor, Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Lindsay M Boyce
- Research Informationist, Memorial Sloan Kettering Library, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Debu Tripathy
- Professor, Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Abstract
Absolute lymphocyte count (ALC) recovery rapidly occurring at 14 days after start of chemotherapy for osteosarcoma and Ewing sarcoma is a good prognostic factor. Conversely, lymphopenia is associated with significantly decreased sarcoma survival. Clearly, the immune system can contribute towards better survival from sarcoma. This chapter will describe treatment and host factors that influence immune function and how effective local control and systemic interventions of sarcoma therapy can cause inflammation and/or immune suppression but are currently the standard of care. Preclinical and clinical efforts to enhance immune function against sarcoma will be reviewed. Interventions to enhance immune function against sarcoma have included regional therapy (surgery, cryoablation, radiofrequency ablation, electroporation, and radiotherapy), cytokines, macrophage activators (mifamurtide), vaccines, natural killer (NK) cells, T cell receptor (TCR) and chimeric antigen receptor (CAR) T cells, and efforts to decrease inflammation. The latter is particularly important because of new knowledge about factors influencing expression of checkpoint inhibitory molecules, PD1 and CTLA-4, in the tumor microenvironment. Since these molecules can now be blocked using anti-PD1 and anti-CTLA-4 antibodies, how to translate this knowledge into more effective immune therapies in the future as well as how to augment effectiveness of current interventions (e.g., radiotherapy) is a challenge. Barriers to implementing this knowledge include cost of agents that release immune checkpoint blockade and coordination of cost-effective outpatient sarcoma treatment. Information on how to research clinical trial eligibility criteria and how to access current immune therapy trials against sarcoma are shared, too.
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Affiliation(s)
- Peter M Anderson
- Department of Pediatric Hematology/Oncology/BMT, Cleveland Clinic S20, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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Evaluation of efficacy of Caphosol in prevention and alleviation of acute side effects in patients treated with radiotherapy for head and neck cancers. Contemp Oncol (Pozn) 2016; 20:389-393. [PMID: 28373821 PMCID: PMC5371706 DOI: 10.5114/wo.2016.64600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 01/14/2016] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY Oral mucositis is a common side effect of the oral mucosa due to anticancer therapy, especially for head and neck cancer. Caphosol is indicated for dryness of the mouth and oropharynx and treatment of mucositis due to irradiation or high-dose chemotherapy. The aim of the study was to evaluate the efficacy of Caphosol in preventing and alleviating mucositis due to radiotherapy in the head and neck region. MATERIAL AND METHODS Caphosol was used from the beginning of the irradiation and for two weeks more after the treatment was completed. Mucositis, xerostomia, and dysphagia were scored by radiotherapists. Subjective evaluation was made by patients. Caphosol was assessed in a non-blinded, matched clinical study. Each treatment arm consisted of 50 patients. The groups were similar. The only difference in the management protocol between the treatment arms was the use of Caphosol in the experimental arm. RESULTS A statistically significant difference in mean severity of early irradiation-induced side effects between the studied groups was observed with respect to: mucositis in the clinical target volume (CTV) area, mucositis in the increased dose (boost) area, dysphagia and xerostomia (p < 0.001 for all reactions). In the group of patients who used Caphosol, the mucositis was less intense, both in the CTV and in the boost area. CONCLUSIONS The use of Caphosol reduces the severity of acute mucositis, dysphagia and xerostomia, exerting a positive effect on comfort in the oral cavity in patients irradiated for head and neck tumors.
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Tort S, Acartürk F. Preparation and characterization of electrospun nanofibers containing glutamine. Carbohydr Polym 2016; 152:802-814. [DOI: 10.1016/j.carbpol.2016.07.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/24/2016] [Accepted: 07/07/2016] [Indexed: 01/16/2023]
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Ishikawa T, Yasuda T, Doi T, Okayama T, Sakamoto N, Gen Y, Dohi O, Yoshida N, Kamada K, Uchiyama K, Handa O, Takagi T, Konishi H, Yagi N, Kokura S, Naito Y, Itoh Y. The amino acid-rich elemental diet Elental® preserves lean body mass during chemo- or chemoradiotherapy for esophageal cancer. Oncol Rep 2016; 36:1093-100. [PMID: 27374272 DOI: 10.3892/or.2016.4877] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/16/2016] [Indexed: 11/06/2022] Open
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Chaveli-López B, Bagán-Sebastián JV. Treatment of oral mucositis due to chemotherapy. J Clin Exp Dent 2016; 8:e201-9. [PMID: 27034762 PMCID: PMC4808317 DOI: 10.4317/jced.52917] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/08/2016] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The management of oral mucositis is a challenge, due to its complex biological nature. Over the last 10 years, different strategies have been developed for the management of oral mucositis caused by chemotherapy in cancer patients. MATERIAL AND METHODS An exhaustive search was made of the PubMed-Medline, Cochrane Library and Scopus databases, crossing the key words "oral mucositis", "prevention" and "treatment" with the terms "chemotherapy" and "radiotherapy" by means of the boolean operators "AND" and "NOT". A total of 268 articles were obtained, of which 96 met the inclusion criteria. RESULTS Several interventions for the prevention of oral mucositis, such as oral hygiene protocols, amifostine, benzidamine, calcium phosphate, cryotherapy and iseganan, among others, were found to yield only limited benefits. Other studies have reported a decrease in the appearance and severity of mucositis with the use of cytoprotectors (sucralfate, oral glutamine, hyaluronic acid), growth factors, topical polyvinylpyrrolidone, and low power laser irradiation. CONCLUSIONS Very few interventions of confirmed efficacy are available for the management of oral mucositis due to chemotherapy. However, according to the reviewed literature, the use of palifermin, cryotherapy and low power laser offers benefits, reducing the incidence and severity of oral mucositis - though further studies are needed to confirm the results obtained. KEY WORDS Chemotherapy-Induced Oral Mucositis Treatment.
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Affiliation(s)
- Begonya Chaveli-López
- DDS. Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - José V Bagán-Sebastián
- MD, DDS, PhD. Head of the Department of Stomatology and Maxillofacial Surgery. Chairman of Oral Medicine. University of Valencia, Spain
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Khemissa F, Mineur L, Amsellem C, Assenat E, Ramdani M, Bachmann P, Janiszewski C, Cristiani I, Collin F, Courraud J, de Forges H, Dechelotte P, Senesse P. A phase III study evaluating oral glutamine and transforming growth factor-beta 2 on chemotherapy-induced toxicity in patients with digestive neoplasm. Dig Liver Dis 2016; 48:327-32. [PMID: 26776879 DOI: 10.1016/j.dld.2015.11.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/13/2015] [Accepted: 11/20/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with gastrointestinal (GI) cancer are exposed to cachexia, which is highly correlated with chemotherapy-induced side effects. Research suggests that specific immunonutrients could prevent such toxicities. AIMS The primary objective of this phase III study was to evaluate the efficacy of glutamine and transforming growth factor-β2 (TGF-β2) in the prevention of grade 3-4 non-hematological toxicities induced by chemotherapy in patients with GI cancer. PATIENTS AND METHODS We designed a double-blind, randomized, controlled and multicenter trial stratified according to center, type of chemotherapy, presence of cachexia, and age. Patients were randomized to receive either Clinutren Protect(®) (CP) or a control isocaloric diet (without TGF-β2 or glutamine). RESULTS Between November 2007 and October 2011, 210 patients were enrolled in the study, of which 201 were included in the intention-to-treat analysis. Grade 3-4 non-hematological toxicities were not significantly different between the CP and control groups when evaluated by univariate and multivariate analyses. Likewise, no difference was observed regarding grade 3-4 hematological toxicities or reasons for treatment interruption. CONCLUSION This randomized study does not support the hypothesis that oral glutamine and TGF-β2 supplementation is effective to reduce grade 3 or 4 non-hematological toxicities induced by chemotherapy in patients with GI neoplasm.
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Affiliation(s)
- Faïza Khemissa
- Gastroenterology Department, Centre Hospitalier de Perpignan, Perpignan, France
| | - Laurent Mineur
- Digestive Oncology and Radiotherapy Unit, Institut Sainte Catherine, Avignon Cedex 9, Avignon, France
| | - Caroline Amsellem
- Nutrition Department, INSERM U1073, Institut de Recherche et d'Innovation Biomédicale, Université de Rouen, Rouen, France
| | - Eric Assenat
- Department of Clinical Nutrition and Gastroenterology, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Mohamed Ramdani
- Gastroenterology Department, Centre Hospitalier de Béziers, Béziers, France
| | - Patrick Bachmann
- Department of Clinical Nutrition, Centre Léon Bérard, Lyon, France
| | - Chloé Janiszewski
- Clinical Research Department, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | | | - Fideline Collin
- Clinical Research Department, Centre Hospitalier de Perpignan, Perpignan, France
| | - Julie Courraud
- Clinical Research Department, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Hélène de Forges
- Clinical Research Department, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Pierre Dechelotte
- Nutrition Department, INSERM U1073, Institut de Recherche et d'Innovation Biomédicale, Université de Rouen, Rouen, France
| | - Pierre Senesse
- Department of Clinical Nutrition and Gastroenterology, Institut régional du Cancer de Montpellier (ICM), Montpellier, France; SIRIC Montpellier Cancer, Institut régional du Cancer de Montpellier (ICM), Montpellier, France; Epsylon Laboratory, EA 4556 Dynamics of Human Abilities & Health Behaviors, Université de Montpellier, Montpellier, France.
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Manzi NDM, Silveira RCDCP, dos Reis PED. Prophylaxis for mucositis induced by ambulatory chemotherapy: systematic review. J Adv Nurs 2015; 72:735-46. [PMID: 26626711 DOI: 10.1111/jan.12867] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2015] [Indexed: 02/01/2023]
Abstract
AIM The aim of this study was to perform a systematic review of clinical trials covering interventions used as prophylaxis for oral mucositis induced by ambulatory antineoplastic chemotherapy. BACKGROUND Oral mucositis in patients undergoing chemotherapy is a side effect that can impact the quality of treatment and can interfere with eating and therapeutic adherence. DESIGN Quantitative systematic review. DATA SOURCES Relevant databases were searched, from January 2002-July 2013, by using the combination of the keywords mucositis, stomatitis, neoplasms, antineoplastic agents, drug therapy, prevention and control and chemotherapy. REVIEW METHODS Two researchers independently read the titles and abstracts from every cross-reference. The quality of the included studies was analysed by the Jadad Scale and the Cochrane Collaboration Risk of Bias Tool. Data were extracted from the selected studies with a data collection form developed specifically for this purpose. RESULTS Of the 23 controlled clinical trials that were identified in this study, five articles evaluated the use of oral cryotherapy to prevent oral mucositis and three studies analysed the prophylactic use of glutamine. Interventions of protocols for oral care, palifermin, allopurinol and chlorhexidine were evaluated by two articles each. Interventions of zinc sulphate, amifostine, chewing gum, sucralfate, recombination human intestinal trefoil factor, kefir and vitamin E were evaluated by one article each. CONCLUSION There is strong evidence that cryotherapy can prevent oral mucositis arising from ambulatory treatment with 5-flurouracil chemotherapy. Other interventions, although showing positive results in preventing oral mucositis, require further study to confirm their conclusions.
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Alleviating gastro-intestinal symptoms and concerns by integrating patient-tailored complementary medicine in supportive cancer care. Clin Nutr 2015; 34:1215-23. [DOI: 10.1016/j.clnu.2014.12.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 12/14/2014] [Accepted: 12/16/2014] [Indexed: 01/04/2023]
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Banava S, Houshyari M, Safaie T. The effect of casein phosphopeptide amorphous calcium phosphate fluoride paste (CPP-ACPF) on oral and salivary conditions of patients undergoing chemotherapy: A randomized controlled clinical trial. Electron Physician 2015; 7:1535-41. [PMID: 26767110 PMCID: PMC4700902 DOI: 10.19082/1535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/14/2015] [Indexed: 11/20/2022] Open
Abstract
Background Oral and saliva conditions of patients undergoing chemotherapy is often affected by the medication they receive. Up to now, no appropriate medication that possesses the positive effects of chemotherapy without presenting oral complications has been introduced. Objective The aim of this study was to assess the clinical effects of CPP-ACPF paste on the oral and salivary status of patients undergoing chemotherapy. Methods From October 2013 to April 2014, 20 patients in chemotherapy treatment plans and who met the inclusion criteria enrolled in this randomized parallel single-blind controlled clinical trial in Shohada-e-Tajrish Hospital in Tehran, Iran. Patients were divided into two groups: 1) patients received their daily medication of cancer therapy center (group 1, control); 2) patients applied CPP-ACPF Crème (MI paste plus, GC USA) twice a day as instructed (group 2). The baseline status of oral conditions of patients (mucositis, dry mouth, infection, diminished tasting sense, difficulty in food intake, burning sensation of mucosa, saliva and dental plaque pH, rest and stimulated saliva, buffering capacity of saliva) were recorded and reevaluated after 21 and 42 days. The data were analyzed with a Mann-Whitney U-test. Results A total of 20 patients were allocated randomly to groups 1 and 2. The Mann-Whitney U-test showed that application of CPP-ACPF paste twice daily did not cause any significant difference in oral complication of the subject group compared with the control group (p>0.05). Among salivary signs, resting and stimulated saliva rates and saliva buffering capacity had significantly altered in the CPP-ACPF group in day 21 and 42 in comparison with those of the control group (p<0.05). Conclusion Application of CPP-ACPF paste before and during chemotherapy can improve the salivary status of patients undergoing this treatment.
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Affiliation(s)
- Sepideh Banava
- DDS, M.Sc. in Restorative Dentistry and Dental Materials, Assistant Professor, Islamic Azad University, Dental Branch, Tehran, Iran
| | - Mohammad Houshyari
- Assistant Professor, Shohada-e-Tajrish Hospital, Department of Radiation Oncology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Sayles C, Hickerson SC, Bhat RR, Hall J, Garey KW, Trivedi MV. Oral Glutamine in Preventing Treatment-Related Mucositis in Adult Patients With Cancer. Nutr Clin Pract 2015; 31:171-9. [DOI: 10.1177/0884533615611857] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Caitlin Sayles
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
| | - Stephen C. Hickerson
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
| | - Raksha R. Bhat
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
| | - Jacob Hall
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kevin W. Garey
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
| | - Meghana V. Trivedi
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
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Greenlee H, Balneaves LG, Carlson LE, Cohen M, Deng G, Hershman D, Mumber M, Perlmutter J, Seely D, Sen A, Zick SM, Tripathy D. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr 2015; 2014:346-58. [PMID: 25749602 DOI: 10.1093/jncimonographs/lgu041] [Citation(s) in RCA: 163] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The majority of breast cancer patients use complementary and/or integrative therapies during and beyond cancer treatment to manage symptoms, prevent toxicities, and improve quality of life. Practice guidelines are needed to inform clinicians and patients about safe and effective therapies. METHODS Following the Institute of Medicine's guideline development process, a systematic review identified randomized controlled trials testing the use of integrative therapies for supportive care in patients receiving breast cancer treatment. Trials were included if the majority of participants had breast cancer and/or breast cancer patient results were reported separately, and outcomes were clinically relevant. Recommendations were organized by outcome and graded based upon a modified version of the US Preventive Services Task Force grading system. RESULTS The search (January 1, 1990-December 31, 2013) identified 4900 articles, of which 203 were eligible for analysis. Meditation, yoga, and relaxation with imagery are recommended for routine use for common conditions, including anxiety and mood disorders (Grade A). Stress management, yoga, massage, music therapy, energy conservation, and meditation are recommended for stress reduction, anxiety, depression, fatigue, and quality of life (Grade B). Many interventions (n = 32) had weaker evidence of benefit (Grade C). Some interventions (n = 7) were deemed unlikely to provide any benefit (Grade D). Notably, only one intervention, acetyl-l-carnitine for the prevention of taxane-induced neuropathy, was identified as likely harmful (Grade H) as it was found to increase neuropathy. The majority of intervention/modality combinations (n = 138) did not have sufficient evidence to form specific recommendations (Grade I). CONCLUSIONS Specific integrative therapies can be recommended as evidence-based supportive care options during breast cancer treatment. Most integrative therapies require further investigation via well-designed controlled trials with meaningful outcomes.
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Affiliation(s)
- Heather Greenlee
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT).
| | - Lynda G Balneaves
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Linda E Carlson
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Misha Cohen
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Gary Deng
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Dawn Hershman
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Matthew Mumber
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Jane Perlmutter
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Dugald Seely
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Ananda Sen
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Suzanna M Zick
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Debu Tripathy
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
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Ogata Y, Ishibashi N, Yamaguchi K, Uchida S, Kamei H, Nakayama G, Hirakawa H, Tanigawa M, Akagi Y. Preventive effects of amino-acid-rich elemental diet Elental® on chemotherapy-induced oral mucositis in patients with colorectal cancer: a prospective pilot study. Support Care Cancer 2015; 24:783-789. [PMID: 26266658 PMCID: PMC4689768 DOI: 10.1007/s00520-015-2844-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 07/06/2015] [Indexed: 02/06/2023]
Abstract
Purpose The prospective pilot study was designed to evaluate the preventive effects of amino-acid-rich elemental diet (ED), Elental®, on chemotherapy-induced oral mucositis in patients with colorectal cancer. The factors influencing its efficacy are also investigated. Methods A total of 22 eligible patients with colorectal cancer experiencing grade 1–3 oral mucositis during treatment with fluorouracil-based chemotherapy entered the current study. Their average age was 67 years. There were 10 male and 12 female. The PS was 0 in the majority of patients. Patients received two courses of the same chemotherapy regimen and Elental® concurrently after recovery to grade 0 or 1 oral mucositis. Results FOLFOX6 + bevacizumab in 8 patients, FOLFIRI + bevacizumab in 8 patients, FOLFIRI + panitumumab in 1 patient, FOLFIRI in 1 patient, XELOX + bevacizumab in 2 patients, and S-1 + cetuximab in 2 patients were used as first-line (16 cases) or as second-line (6 cases) chemotherapy. Dose reduction of 5-fluorouracil (5-FU) or oral fluoropyrimidine was performed in the 2 patients achieving grade 3 oral mucositis and in the 3 patients achieving grade 2 oral mucositis. The maximum grade of oral mucositis decreased in 18 of the 22 patients during the first treatment course with Elental® (p = 0.0002) and in 20 of the 22 patients in the second course (p < 0.0001). Multivariate analyses found that the dose reduction in 5-FU or oral fluoropyrimidine, ED intake, and the prior administration of ED were each a significant factor for the preventive efficacy on oral mucositis. Conclusion The amino-acid-rich elemental diet Elental® may be useful as a countermeasure for 5-FU-based chemotherapy-induced oral mucositis in patients with colorectal cancer.
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Affiliation(s)
- Yutaka Ogata
- Department of Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, 839-0863, Japan.
| | - Nobuya Ishibashi
- Department of Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, 839-0863, Japan
| | - Keizou Yamaguchi
- Department of Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, 839-0863, Japan
| | - Shinji Uchida
- Department of Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, 839-0863, Japan
| | - Hideki Kamei
- Department of Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, 839-0863, Japan
| | - Goichi Nakayama
- Department of Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, 839-0863, Japan
| | - Hiroaki Hirakawa
- Department of Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, 839-0863, Japan
| | - Masahiko Tanigawa
- Department of Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, 839-0863, Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University School of Medicine, Kurume, 830-0011, Japan
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Elemental diet plus glutamine for the prevention of mucositis in esophageal cancer patients receiving chemotherapy: a feasibility study. Support Care Cancer 2015; 24:933-941. [PMID: 26266659 PMCID: PMC4689762 DOI: 10.1007/s00520-015-2864-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 07/27/2015] [Indexed: 01/15/2023]
Abstract
PURPOSE We investigated the effect of glutamine (Gln) and an elemental diet (ED) on chemotherapy-induced oral mucositis in esophageal cancer patients. METHODS Thirty patients were randomized to the control group (no treatment: n = 10), Gln group (oral intake of 8910 mg Gln/day: n = 10), or Gln plus ED group (total oral intake of 8862 mg Gln/day, including the Gln in ED: n = 10). Oral administration of Gln and ED began 1 week before chemotherapy and continued during treatment. Oral mucositis was evaluated during 2 cycles of chemotherapy using Common Terminology Criteria for Adverse Events v3.0. RESULTS The incidence of grade ≥2 oral mucositis was 60 % in the control group, 70 % in the Gln group, and 10 % in the Gln plus ED group. Gln plus ED showed a significant preventive effect on the development and severity of oral mucositis. By multivariate analysis, Gln plus ED and cancer stage were independent factors affecting chemotherapy-induced oral mucositis. The percentage of change in body weight and diamine oxidase activity from before chemotherapy was higher in the Gln plus ED group than in the control group. CONCLUSIONS Oral administration of Gln plus ED may prevent chemotherapy-induced oral mucositis in esophageal cancer patients.
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Mallick S, Benson R, Rath GK. Radiation induced oral mucositis: a review of current literature on prevention and management. Eur Arch Otorhinolaryngol 2015; 273:2285-93. [DOI: 10.1007/s00405-015-3694-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 06/17/2015] [Indexed: 10/23/2022]
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Azman M, Mohd Yunus MR, Sulaiman S, Syed Omar SN. Enteral glutamine supplementation in surgical patients with head and neck malignancy: A randomized controlled trial. Head Neck 2015; 37:1799-807. [DOI: 10.1002/hed.23839] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2014] [Indexed: 11/11/2022] Open
Affiliation(s)
- Mawaddah Azman
- Department of Otorhinolaryngology; Universiti Kebangsaan Malaysia; Kuala Lumpur Malaysia
| | - Mohd Razif Mohd Yunus
- Department of Otorhinolaryngology; Universiti Kebangsaan Malaysia; Kuala Lumpur Malaysia
| | - Suhaina Sulaiman
- School of Healthcare Sciences, Faculty of Health Sciences; Universiti Kebangsaan; Malaysia
| | - Syed Nabil Syed Omar
- Department of Oral and Maxillofacial Surgery; Universiti Kebangsaan Malaysia; Kuala Lumpur Malaysia
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Leggett S, Koczwara B, Miller M. The Impact of Complementary and Alternative Medicines on Cancer Symptoms, Treatment Side Effects, Quality of Life, and Survival in Women With Breast Cancer—A Systematic Review. Nutr Cancer 2015; 67:373-91. [DOI: 10.1080/01635581.2015.1004731] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- S. Leggett
- Flinders University, Adelaide, Australia
| | | | - M. Miller
- Flinders University, Adelaide, Australia
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Eilers J, Harris D, Henry K, Johnson LA. Evidence-Based Interventions for Cancer Treatment-Related Mucositis: Putting Evidence Into Practice. Clin J Oncol Nurs 2014; 18 Suppl:80-96. [DOI: 10.1188/14.cjon.s3.80-96] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Chaveli-López B. Oral toxicity produced by chemotherapy: A systematic review. J Clin Exp Dent 2014; 6:e81-90. [PMID: 24596641 PMCID: PMC3935911 DOI: 10.4317/jced.51337] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 10/17/2013] [Indexed: 12/03/2022] Open
Abstract
Introduction: Antineoplastic chemotherapy remains one of the most widely used management strategies in cancer, either alone or in combination with other types of treatment. The main inconvenience of chemotherapy is its lack of selectivity, since it acts upon both tumor cells and rapidly multiplying normal cells such as bone marrow cells, hair follicle cells and oral and gastrointestinal mucosal cells.
Material and method: An exhaustive search was made of the main oral toxic effects of chemotherapy in the PubMed-Medline, Cochrane Library and Scopus databases. A total of 1293 articles were identified, of which 333 met the study inclusion criteria.
Results: The toxic effects of chemotherapy at oral mucosal level comprise mucositis, osteonecrosis of the jaws secondary to bisphosphonate use, susceptibility to infections, dental alterations, salivary and neurological disorders, dysgeusia and bleeding tendency. These complications have a negative impact upon patient quality of life, and in some cases can prove life-threatening.
Conclusions: Evaluation of patient oral and dental health is essential before administering chemotherapy, in order to minimize the risk of oral and systemic complications of such treatment.
Key words:Chemotherapy, oral complications, dental, saliva and osteonecrosis jaw.
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49
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Oral complications and management strategies for patients undergoing cancer therapy. ScientificWorldJournal 2014; 2014:581795. [PMID: 24511293 PMCID: PMC3910370 DOI: 10.1155/2014/581795] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 12/19/2013] [Indexed: 12/22/2022] Open
Abstract
With cancer survival rate climbing up over the past three decades, quality of life for cancer patients has become an issue of major concern. Oral health plays an important part in one's overall quality of life. However, oral health status can be severely hampered by side effects of cancer therapies including surgery, chemotherapy, radiotherapy, and hematopoietic stem cell transplantation. Moreover, prevention and treatment of these complications are often overlooked in clinical practice. The present paper aims at drawing health care professionals' attention to oral complications associated with cancer therapy by giving a comprehensive review. Brief comments on contemporary cancer therapies will be given first, followed by detailed description of oral complications associated with cancer therapy. Finally, a summary of preventive strategies and treatment options for common oral complications including oral mucositis, oral infections, xerostomia, and dysgeusia will be given.
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50
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Ben-Arye E, Polliack A, Schiff E, Tadmor T, Samuels N. Advising patients on the use of non-herbal nutritional supplements during cancer therapy: a need for doctor-patient communication. J Pain Symptom Manage 2013; 46:887-96. [PMID: 23707384 DOI: 10.1016/j.jpainsymman.2013.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 02/01/2013] [Accepted: 02/18/2013] [Indexed: 12/23/2022]
Abstract
CONTEXT Many cancer patients are using non-herbal nutritional supplements (NHNS), often without informing their oncologists. OBJECTIVES To review the literature and summarize the beneficial effects and safety of NHNS in the prevention and reduction of treatment-related symptoms. METHODS Databases were searched for randomized, controlled clinical trials (Jadad score ≥ 2) using AltHealthWatch, Cochrane Database of Systematic Reviews, Embase, MEDLINE, Memorial Sloan-Kettering Integrative Medicine Service Database, Natural Standard Database, and PubMed. The key words searched were the following: alternative and/or complementary medicine, nutritional and/or dietary supplements, quality of life, symptoms and/or side effects, specific toxicities (e.g., neuropathy, mucositis), and specific supplements (e.g., vitamin E, glutamine, etc.). RESULTS A number of NHNS products were found to be effective. The incidence and severity of peripheral sensory neuropathy associated with taxane-agents such as paclitaxel can be reduced with vitamin E, glutamine, and acetyl-L-carnitine. Vitamin E and glutamine also have been shown to reduce oral mucositis resulting from radiation and chemotherapy, and glutamine and probiotics can reduce chemotherapy-induced diarrhea. CONCLUSION There is a need to develop an open and nonjudgmental dialogue between oncologists and cancer patients, addressing the needs of the patient while dealing with issues related to the efficacy and safety of these products. Referral of patients to an integrative medicine consultant may help achieve these goals, providing both parties with the option of reaching an informed and respectful decision about treatment.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Haifa, Israel; Complementary and Traditional Medicine Unit, Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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