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Bastos Silveira B, Di Carvalho Melo L, Amorim Dos Santos J, Ferreira EB, Reis PED, De Luca Canto G, Acevedo AC, Massignan C, Guerra ENS. Oral manifestations in pediatric patients with leukemia: A systematic review and meta-analysis. J Am Dent Assoc 2024; 155:858-870.e30. [PMID: 39254613 DOI: 10.1016/j.adaj.2024.07.014] [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: 01/23/2024] [Revised: 07/18/2024] [Accepted: 07/29/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND Leukemia is the most common malignancy in pediatric patients, and it has extramedullary involvement. Oral manifestations have been reported in the literature, but to the authors' knowledge, no systematic review has presented the general prevalence of these manifestations. This review aimed to determine the prevalence of oral manifestations in pediatric patients with leukemia. TYPES OF STUDIES REVIEWED The authors conducted a search of PubMed-MEDLINE, Embase, Latin American and Caribbean Health Sciences Literature, Web of Science, and Scopus. Additional searches were carried out in the gray literature and via hand searching of reference lists of included studies. The inclusion criteria were observational studies that investigated the prevalence and occurrence of oral lesions in pediatric patients with leukemia. Two independent reviewers collected data from the selected articles in a prepiloted Excel (Microsoft) spreadsheet. RESULTS From 67 included studies, 79 oral manifestations were reported. The most frequent alteration in children with acute lymphoblastic leukemia during the treatment were caries (81%), with moderate certainty of evidence. The prevalence of gingivitis was 73%, oral mucositis was 50%, and lymphadenopathy was 45%, with very low certainty of evidence. After the therapy, the prevalence of dental anomalies was 61%, and the most common were enamel hypoplasia (40%), dental agenesis (22%), and microdontia (22%), presenting very low certainty of evidence. The high heterogeneity among studies contributed significantly to reduce the certainty of the evidence. PRACTICAL IMPLICATIONS The findings of this study show that pediatric patients with leukemia have oral manifestations predominantly during and after treatment. Health care professionals must be aware of oral manifestations and refer the patients to dentists during the oncological treatment. Thus, the dentist must support pediatric patients with leukemia to help ensure a better quality of life.
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Rodrigues I, Machado V, Lopes LB, Trancoso P, Azul AM, Mendes JJ, Zagalo C, Botelho J. Photobiomodulation therapy on chemo- and radiotherapy induced oral conditions: an umbrella review. BMC Oral Health 2024; 24:1106. [PMID: 39294629 PMCID: PMC11411753 DOI: 10.1186/s12903-024-04793-7] [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: 04/03/2024] [Accepted: 08/22/2024] [Indexed: 09/21/2024] Open
Abstract
OBJECTIVES Photobiomodulation (PBM) is a laser-based therapy used to promote tissue repair, reduce inflammation and pain, and has been extensively studied in chemo- and radiotherapy-induced oral mucositis (OM). This review examines the level of evidence of systematic reviews (SRs) that have investigated PBM in such cases of OM. MATERIALS AND METHODS SRs evaluating PBM for both the treatment and prevention of OM in patients undergoing chemotherapy and/or radiotherapy and published before November 30, 2023, on PubMed, Cochrane, Embase, Web of Science, LILACS, TRIP and Open Grey databases were eligible for inclusion. We assessed the level of methodological and meta-analytic procedures. RESULTS Of the 1201 SRs, 21 that met the inclusion criteria were included. The quality of evidence was assessed using the Assessing the Measurement Tool to Assess Systematic Reviews (AMSTAR2), and the majority was of critically low quality (n = 15, 71.4%) with only 28.5% of low quality. A total of 40 meta-analytic estimates were obtained and analyzed. Approximately 87.5% of the meta-analysis were significant (n = 33), but only one meta-analyses had a strength of "highly suggestive", while the rest were classified as "weak". When analyzing the overlap values, the covered area was 12.14% and the corrected covered area was 7.75%, indicating a moderate overlap. Only 4 SRs had a very high overlap and one had a high overlap. CONCLUSION The efficacy of PBM in the treatment of chemotherapy-induced OM is supported by low to critically low quality SRs and meta-analysis of low strength. This review highlights important areas that need to be addressed in future research on this topic. REGISTRATION CRD42023484013 (PROSPERO).
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Affiliation(s)
- Inês Rodrigues
- Egas Moniz School of Health & Science, Egas Moniz Center for Interdisciplinary Research (CiiEM), Caparica, 2829-511, Portugal
| | - Vanessa Machado
- Egas Moniz School of Health & Science, Egas Moniz Center for Interdisciplinary Research (CiiEM), Caparica, 2829-511, Portugal
| | - Luísa Bandeira Lopes
- Egas Moniz School of Health & Science, Egas Moniz Center for Interdisciplinary Research (CiiEM), Caparica, 2829-511, Portugal
| | - Pedro Trancoso
- Egas Moniz School of Health & Science, Egas Moniz Center for Interdisciplinary Research (CiiEM), Caparica, 2829-511, Portugal
| | - António Mano Azul
- Egas Moniz School of Health & Science, Egas Moniz Center for Interdisciplinary Research (CiiEM), Caparica, 2829-511, Portugal
| | - José João Mendes
- Egas Moniz School of Health & Science, Egas Moniz Center for Interdisciplinary Research (CiiEM), Caparica, 2829-511, Portugal
| | - Carlos Zagalo
- Egas Moniz School of Health & Science, Egas Moniz Center for Interdisciplinary Research (CiiEM), Caparica, 2829-511, Portugal
| | - João Botelho
- Egas Moniz School of Health & Science, Egas Moniz Center for Interdisciplinary Research (CiiEM), Caparica, 2829-511, Portugal.
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Nurhidayah I, Nurhaeni N, Allenidekania A, Gayatri D, Mediani HS. The Effect of Oral Care Intervention in Mucositis Management Among Pediatric Cancer Patients: An Updated Systematic Review. J Multidiscip Healthc 2024; 17:3497-3515. [PMID: 39050692 PMCID: PMC11268750 DOI: 10.2147/jmdh.s467455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/03/2024] [Indexed: 07/27/2024] Open
Abstract
Background Chemotherapy-induced mucositis is inflammation that develops in the oral mucosal due to anticancer treatment. Mucositis has negative consequences that may lead to distress in pediatric patients, resulting in escalated expenses, diminished quality of life, hindrance in cancer therapy, and decreased survival rates. However, despite the numerous methods, oral care protocols are suggested for implementation in the pediatric population despite a lack of high-level evidence studies, particularly regarding which appropriate oral care agents should be administered. Purpose This systematic review aimed to identify the effect of oral care intervention in mucositis management among pediatric cancer patients. Methods Studies were published between 2014 and 2023 from five databases: PubMed, Embase, Medline, ScienceDirect, and Scopus. They were identified using a search strategy to identify relevant studies that identify oral care interventions for managing mucositis in children with cancer. This study used the Joanna Briggs Institute (JBI) critical appraisal tools to assess the quality of the studies and followed the recommended reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Results Eight studies met the inclusion criteria, including seven RCTs and one quasi-experimental study. Oral care interventions involving tooth brushing, mouthwash, and lip care are performed entirely or partially. The frequency of oral care ranges from two to six times daily, and the duration of intervention is from 5 days to six weeks. Oral care interventions using honey, olive oil, Aloe Vera, Andiroba, and salivary enzyme toothpaste are beneficial to lower the severity of mucositis, reduce pain, minimize mucositis duration, and reduce the use of analgesics, but not significantly improve the child's quality of life. However, Caphosol mouthwash did not significantly reduce mucositis. Conclusion Our study highlights that oral care intervention using effective agents integratively, including honey, olive oil, Aloe vera, Andiroba, and salivary enzyme toothpaste, is essential to manage chemotherapy-induced mucositis among children. Systematic Review Registration PROSPERO registration number was CRD42023456278.
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Affiliation(s)
- Ikeu Nurhidayah
- Pediatric Nursing Department, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
- Postgraduate Program, Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
| | - Nani Nurhaeni
- Pediatric Nursing Department, Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
| | | | - Dewi Gayatri
- Basic Science and Fundamental Nursing Department, Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
| | - Henny Suzana Mediani
- Pediatric Nursing Department, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
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Braguês R, Marvão MF, Correia P, Silva RM. Oral Mucositis Management in Children under Cancer Treatment: A Systematic Review. Cancers (Basel) 2024; 16:1548. [PMID: 38672630 PMCID: PMC11048343 DOI: 10.3390/cancers16081548] [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: 03/08/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Children undergoing antineoplastic treatment often present severe side effects due to the dosage and duration of treatments, with oral mucositis emerging as one of the most prevalent and painful inflammatory conditions. There is a growing body of evidence on therapeutic interventions such as cryotherapy, low-level laser therapy, and natural compounds for this condition. The aim of this systematic review was to identify and compare therapies for the management of cancer treatment-induced oral mucositis in pediatric patients. From 2655 articles obtained in initial searches, 39 articles were considered in this systematic review, after applying inclusion/exclusion criteria. Low-level laser therapy, palifermin, honey, and zinc demonstrated reductions in oral mucositis incidence, duration, severity, and pain reported by the patient. Although there are several therapies in place for the prevention and treatment of oral mucositis in children, evidence of their efficacy is still inconclusive to establish accurate clinical protocols.
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Affiliation(s)
- Ricardo Braguês
- Universidade Católica Portuguesa, Faculty of Dental Medicine, 3504-505 Viseu, Portugal; (R.B.); (M.F.M.); (P.C.)
| | - Maria Francisca Marvão
- Universidade Católica Portuguesa, Faculty of Dental Medicine, 3504-505 Viseu, Portugal; (R.B.); (M.F.M.); (P.C.)
| | - Patrícia Correia
- Universidade Católica Portuguesa, Faculty of Dental Medicine, 3504-505 Viseu, Portugal; (R.B.); (M.F.M.); (P.C.)
- Universidade Católica Portuguesa, Center for Interdisciplinary Research in Health (CIIS), 3504-505 Viseu, Portugal
| | - Raquel M. Silva
- Universidade Católica Portuguesa, Faculty of Dental Medicine, 3504-505 Viseu, Portugal; (R.B.); (M.F.M.); (P.C.)
- Universidade Católica Portuguesa, Center for Interdisciplinary Research in Health (CIIS), 3504-505 Viseu, Portugal
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Filetici P, Gallottini SG, Corvaglia A, Amendolea M, Sangiovanni R, Nicoletti F, D'Addona A, Dassatti L. The role of oral microbiota in the development of oral mucositis in pediatric oncology patients treated with antineoplastic drugs: a systematic review. BMC Oral Health 2024; 24:183. [PMID: 38317151 PMCID: PMC10840280 DOI: 10.1186/s12903-024-03938-y] [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: 07/29/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND In the pediatric oncology population, oral mucositis as a consequence of chemotherapy is a highly prevalent complication which strongly affects both the quality of life and treatment possibilities of the patients. Still, the etiopathological mechanisms carrying to its development are not fully understood, although a possible role of oral dysbiosis has been previously investigated with unclear conclusions. The aim of this systematic review was to assess the available evidence on the role of microbiota in the development of oral mucositis. METHODS A systematic literature search was performed following PRISMA guidelines. Three electronic databases were searched up until April 2023 and a following manual search included the reference lists of the included studies and reviews. Studies reporting microbiological and clinical data of pediatric patients treated by antineoplastic drugs were included. RESULTS Thirteen studies met the inclusion criteria, reporting an average mucositis prevalence of 57,6%. Candida albicans infections were frequently observed in studies performing microbiological analysis on oral lesions, in contrast with the low rate detection of the Herpes simplex viruses. Bacterial species such as coagulase-negative Staphylococci and Streptococcus viridans were detected more frequently on lesion sites. Studies reporting a quantitative analysis of the general flora did not show comparable results. Risk of bias assessment among studies was generally considered high or very high. CONCLUSIONS While the specific role of certain microbiological agents, such as Candida albicans, was frequently reported among studies, data regarding the general dynamics of oral microbiota in the development of oral mucositis are lacking in the current literature. Thus, more studies are needed to provide the knowledge required in order to improve protocols for the prevention and treatment of this threatening complication.
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Affiliation(s)
- Pierfrancesco Filetici
- Department of Head and Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy.
- Unit of Oral Surgery and Implantology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy.
| | - Sofia Germana Gallottini
- Department of Head and Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Corvaglia
- Department of Head and Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martina Amendolea
- Department of Head and Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
- Unit of Oral Surgery and Implantology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Roberta Sangiovanni
- Department of Head and Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabrizio Nicoletti
- Department of Head and Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio D'Addona
- Department of Head and Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
- Unit of Oral Surgery and Implantology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Leonardo Dassatti
- Department of Head and Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
- Unit of Oral Surgery and Implantology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
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de Sena ACVP, de Arruda JAA, Bemquerer LM, Pantuzzo ES, Kakehasi FM, Fonseca FP, Fournier BPJ, Abreu LG, Travassos DV, Silva TA. Leukemia/lymphoma oral infiltration and its impact on disease outcomes: A Brazilian study. Oral Dis 2023; 29:2944-2953. [PMID: 36421050 DOI: 10.1111/odi.14452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/24/2022] [Accepted: 11/20/2022] [Indexed: 10/01/2023]
Abstract
OBJECTIVE Oral malignant infiltrations (OMI) are relevant for the diagnosis and prognosis of leukemia/lymphoma. This study analysed the oral health status and OMI of individuals with leukemia/lymphoma. MATERIALS AND METHODS A retrospective analysis (2010-2021) of data from individuals seen at a specialized hospital-based dental service in Brazil. RESULTS A total of 781 cases of leukemia/lymphoma were surveyed. Acute lymphoblastic leukemia (30.1%), acute myeloid leukemia (AML; 26.0%), and non-Hodgkin lymphoma (22.2%) were the most common diagnoses. The first (21.3%) and second (19.3%) decades of life were the most affected. Overall, dental caries (36.7%) and periodontal changes (34.6%) were the most frequent oral conditions. OMI occurred in 25 (3.2%) individuals. Lesions mainly involved the gingiva (80%) and patients diagnosed with AML (64%). Death (p < 0.001) and worse periodontal condition (p = 0.036) were more frequent among adults with OMI than among those without OMI. Death (p = 0.002) was more frequent among paediatric individuals with OMI than among those without OMI. When controlling for underlying disease, no association was observed between OMI and these outcomes. CONCLUSION Oral status of individuals with leukemia, particularly those with acute leukemia or lymphoma, should be closely monitored since one or multiple conditions may occur, including OMI, which may influence disease outcomes.
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Affiliation(s)
- Ana Carolina Velasco Pondé de Sena
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - José Alcides Almeida de Arruda
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Larissa Marques Bemquerer
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Erika Soares Pantuzzo
- Multiprofessional Integrated Residency in Health, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fabiana Maria Kakehasi
- Department of Paediatrics, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Felipe Paiva Fonseca
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Benjamin P J Fournier
- Department of Oral Biology, Université de Paris, Dental Faculty, Paris, France
- Centre de Recherche des Cordeliers, Université de Paris, Sorbonne Université, Inserm, Laboratory of Molecular Oral Pathophysiology, Paris, France
- AP-HP, Reference Center for Dental Rare Diseases, Rothschild Hospital (ORARES), Paris, France
| | - Lucas Guimarães Abreu
- Department of Child and Adolescent Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Denise Vieira Travassos
- Multiprofessional Integrated Residency in Health, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Social and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Tarcília Aparecida Silva
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Multiprofessional Integrated Residency in Health, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Vieira Nascimento M, Costa FWG, de Oliveira Filho OV, Silva PGDB, de Freitas Pontes KM. Management of Cancer Therapy-Induced Oral Mucositis Using Photobiomodulation Therapy: An Overview of Systematic Reviews. Photobiomodul Photomed Laser Surg 2023; 41:513-538. [PMID: 37788454 DOI: 10.1089/photob.2023.0091] [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: 10/05/2023] Open
Abstract
Objective: To systematically summarize the evidence for photobiomodulation therapy (PBMT) in the prevention and treatment of oral mucositis (OM) in patients undergoing cancer treatment. An electronic search was conducted in 8 databases and grey literature. Background: PBMT is recommended for the management of OM resulting from cancer treatment, with several systematic reviews (SRs) being published in recent years on this topic. Methods: Only SRs with outcomes from clinical trials were included, with no language or year restriction. The AMSTAR 2 tool was used to assess the methodological quality of the SRs. Results: Five thousand eight hundred fifty-six references were found, and 16 were selected for this review. OM prevention and treatment were favorable for PBMT in most studies, with a significant reduction in OM severity. Most studies obtained moderate confidence. Conclusions: PBMT represents an effective strategy in the management of OM, and this evidence is supported by studies with acceptable methodological quality.
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Affiliation(s)
| | | | - Osias Vieira de Oliveira Filho
- Graduate Program in Dentistry, Federal University of Ceará, Fortaleza, Brazil
- College of Dentistry, Christus University, Fortaleza, Brazil
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Arpaci T, Semerci R, Yılmaz P. Nursing care approaches to oral mucositis in pediatric oncology clinics: a cross-sectional study from Türkiye. Support Care Cancer 2023; 31:557. [PMID: 37668773 DOI: 10.1007/s00520-023-08030-9] [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: 03/15/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE It is important to determine the approaches for oral mucositis (OM) care in pediatric oncology clinics to reflect the profile of practices. The aim of this study was to report on current nursing care approaches for OM in Türkiye. METHODS The descriptive, cross-sectional study was conducted with nurse managers in pediatric oncology centers in Türkiye between April and December 2022. The data were obtained online by reaching pediatric oncology nurse managers. The data was collected with the "Oral Mucositis Care Application Form" developed by the researchers based on current literature. RESULTS The study reached approximately 60% (n = 41) of pediatric oncology clinics across Türkiye. Oral assessment of children was mainly conducted by nurses (95.1%), and 53.7% of clinics used the WHO Oral Mucositis Assessment Scale. To prevent OM, oral care routines were performed twice a day (36.6%) using sodium bicarbonate (61%) and 0.9% sodium chloride (26.8%) agents. For oral mucositis management, pharmacological agents included glutamine (oral) (51.2%), chlorhexidine (43.9%), and benzydamine hydrochloride (36.6%), while non-pharmacological agents included black mulberry syrup (41.5%), honey (19.8%), and chewing gum (9.8%). Chlorhexidine and benzydamine hydrochloride were used for all mucositis grades, while glutamine was frequently used for grades 2 and above. CONCLUSIONS The study revealed that the practices related to preventing and managing oral mucositis in pediatric oncology clinics in Türkiye are heterogeneous. These findings will contribute to the existing literature on the multidisciplinary, systematic, and evidence-based approaches used in oral mucositis care in Türkiye.
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Affiliation(s)
- Tuba Arpaci
- Department of Nursing, Faculty of Health Sciences, Karamanoglu Mehmetbey University, Karaman, Turkey.
| | - Remziye Semerci
- Department of Child Health and Disease Nursing, School of Nursing, Koç University, Istanbul, Turkey
| | - Pınar Yılmaz
- Oncology Hospital, Pediatric Oncology Clinic, Hacettepe University, Ankara, Turkey
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Photobiomodulation for Chemotherapy-Induced Oral Mucositis in Pediatric Patients. Biomolecules 2023; 13:biom13030418. [PMID: 36979353 PMCID: PMC10046229 DOI: 10.3390/biom13030418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 02/03/2023] [Accepted: 02/22/2023] [Indexed: 02/25/2023] Open
Abstract
Oral mucositis (OM) is a common side effect in patients undergoing chemotherapy (CT), especially in children due to their rapid epithelial mitotic rate. It has been associated with a significant reduction in life quality since it leads to pain, an inadequate intake of nutrients, an increased risk of opportunistic infections, and interruptions of CT. Photobiomodulation (PMB) with low-level laser therapy (LLLT) has shown faster healing, reduction in pain, and the reduced use of analgesic compared to placebo groups. The purpose of this review is to analyze and compare the existing clinical trials and identify their shortcomings in hope to make future research easier. Using MeSH terms and keywords, the Embase, Medline, and PubMed databases we searched for the period of the last 5 years. We identified a total of 15 clinical trials, with a total of 929 pediatric patients analyzed in this review. We compared different light sources and other laser technique characteristics used in clinical trials such as wavelength, energy and power density, spot size, irradiation time, PBM protocol, and OM evaluation. The main findings show inconsistent laser parameter quotations, differences in the PBM protocol along with a laser application technique, and a lack of clinical trials. Based on that, more studies with a high methodological quality should be conducted in order to provide a unified PBM protocol suitable for the pediatric population.
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Semerci R, Kocaaslan EN. Effect of chewing gum on the management of chemotherapy-induced oral mucositis in children: Systematic review of experimental studies. Eur J Cancer Care (Engl) 2022; 31:e13727. [PMID: 36239087 DOI: 10.1111/ecc.13727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/15/2022] [Accepted: 09/27/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE It was aimed to systematically synthesise the available literature on examining the effect of chewing gum in the management/reduction of chemotherapy-induced oral mucositis in children. METHODS The PRISMA was followed for the systematic review. All published studies obtained from the relevant databases were examined while the research question and inclusion and exclusion criteria were considered. The Joanna Briggs Institute (JBI) critical appraisal tools were used to evaluate the quality of the studies. RESULTS A total of five studies met the inclusion criteria: three randomised controlled trials (RCT) and two quasi-experimental studies with a total of 461 paediatric oncology patients were included. Heterogeneity was found across all studies regarding the application of gum chewing and regarding the effectiveness of gum chewing. Two RTCs and one quasi-experimental study reported that gum chewing is not effective to reduce severe oral mucositis, but effective to reduce moderate and mild oral mucositis, and one RTC reported that gum chewing is not effective to reduce oral mucositis. CONCLUSION Experimental studies particularly randomised controlled trials using rigorous designs, consistent outcome measures, and larger sample sizes are required to determine the efficacy of chewing gum in reducing chemotherapy-induced oral mucositis in paediatric oncology patients. Study was registered in PROSPERO and number was CRD42022328916.
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Affiliation(s)
- Remziye Semerci
- Department of Pediatric Nursing, School of Nursing, Koç University, İstanbul, Turkey
| | - Esra Nur Kocaaslan
- Department of Pediatric Nursing, Trakya University Faculty of Health Sciences, Edirne, Turkey
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Comparison of Side Effects of Nalbuphine and Morphine in the Treatment of Pain in children with Cancer: A Prospective Study. Cancers (Basel) 2022; 14:cancers14153617. [PMID: 35892877 PMCID: PMC9330467 DOI: 10.3390/cancers14153617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 02/01/2023] Open
Abstract
Contemporary pain management regimens in children do not include the use of the middle step of the analgesic ladder, i.e., weak opioids. The aim of this study was to analyse the comparison of side effects and the therapeutic efficacy of morphine and nalbuphine in pain management in children with cancer. We conducted an observational, prospective study and analysed medical records of patients treated at the Clinic of Paediatric Haematology and Oncology of the University Hospital in Wroclaw (Poland), who developed mucositis during treatment. The efficacy and safety of both drugs were analysed, and the efficacy of pain relief and the incidence of adverse effects characteristic of opioid drugs were compared. The cases of 96 of children treated with opioid drugs nalbuphine or morphine were analysed. Nalbuphine therapy was accompanied by a statistically significantly lower incidence of side effects such as skin pruritus, constipation, and micturition disorders compared to morphine (p < 0.05). After the discontinuation of nalbuphine, signs of withdrawal syndrome were much less frequent than after morphine (p < 0.05). In Conclusion, nalbuphine used as a pain killer in children with oncological disorder is a safe drug. It provides stable analgesia in most children. Compared to morphine, the side effects typical of opioid use are less common, and the incidence decreases over time.
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12
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Triarico S, Agresti P, Rinninella E, Mele MC, Romano A, Attinà G, Maurizi P, Mastrangelo S, Ruggiero A. Oral Microbiota during Childhood and Its Role in Chemotherapy-Induced Oral Mucositis in Children with Cancer. Pathogens 2022; 11:pathogens11040448. [PMID: 35456122 PMCID: PMC9025665 DOI: 10.3390/pathogens11040448] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022] Open
Abstract
The human oral cavity harbors the second most abundant microbiota after the gastrointestinal tract, with over 700 species currently identified in the oral microflora. The oral microbiota develops from intrauterine life and after birth is continuously shaped by several influencing factors. The perturbation of the diversity and proportions of species within the oral microbiota leads to dysbiosis and associated increased risk of local and systemic diseases. In children who receive chemotherapy for cancer, oral mucositis is a common and painful side effect that decreases quality of life (QoL) and treatment adherence. The oral microbiota undergoes a substantial dysbiosis as an effect of cancer and its treatment, characterized by lower richness and less diversity. Furthermore, this dysbiosis seems to promote pro-inflammatory cytokine release and pro-apoptotic mediators, enhancing the oral tissue damage. Further studies on the role of the oral microbiota in the pathogenesis of oral mucositis should be performed among children with cancer who receive chemotherapy, to find preventive and protective factors against the pathogenesis of oral mucositis.
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Affiliation(s)
- Silvia Triarico
- UOSD di Oncologia Pediatrica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Argo A. Gemelli 8, 00168 Rome, Italy; (S.T.); (A.R.); (G.A.); (P.M.); (S.M.)
| | - Pierpaolo Agresti
- Scuola di Specializzazione in Pediatria, Università Cattolica del Sacro Cuore, Largo F.sco Vito 1, 00168 Rome, Italy;
| | - Emanuele Rinninella
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (E.R.); (M.C.M.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo F.sco Vito 1, 00168 Rome, Italy
| | - Maria Cristina Mele
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (E.R.); (M.C.M.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo F.sco Vito 1, 00168 Rome, Italy
| | - Alberto Romano
- UOSD di Oncologia Pediatrica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Argo A. Gemelli 8, 00168 Rome, Italy; (S.T.); (A.R.); (G.A.); (P.M.); (S.M.)
| | - Giorgio Attinà
- UOSD di Oncologia Pediatrica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Argo A. Gemelli 8, 00168 Rome, Italy; (S.T.); (A.R.); (G.A.); (P.M.); (S.M.)
| | - Palma Maurizi
- UOSD di Oncologia Pediatrica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Argo A. Gemelli 8, 00168 Rome, Italy; (S.T.); (A.R.); (G.A.); (P.M.); (S.M.)
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Largo F.sco Vito 1, 00168 Rome, Italy
| | - Stefano Mastrangelo
- UOSD di Oncologia Pediatrica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Argo A. Gemelli 8, 00168 Rome, Italy; (S.T.); (A.R.); (G.A.); (P.M.); (S.M.)
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Largo F.sco Vito 1, 00168 Rome, Italy
| | - Antonio Ruggiero
- UOSD di Oncologia Pediatrica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Argo A. Gemelli 8, 00168 Rome, Italy; (S.T.); (A.R.); (G.A.); (P.M.); (S.M.)
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Largo F.sco Vito 1, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-06-3058203; Fax: +39-06-3052751
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Miranda-Silva W, da Fonseca FP, Gomes AA, Mafra ABB, Rocha V, Fregnani ER. Oral mucositis in paediatric cancer patients undergoing allogeneic hematopoietic stem cell transplantation preventively treated with professional dental care and photobiomodulation: Incidence and risk factors. Int J Paediatr Dent 2022; 32:251-263. [PMID: 34115428 DOI: 10.1111/ipd.12850] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Oral mucositis (OM) is an important side effect related to allogeneic hematopoietic stem cell transplantation (allo-HSCT), and it has been associated with a significative reduction of quality of life. A negative impact of OM in paediatric patients could result in increased use of parenteral feeding and opioids, longer periods of hospitalization, and a higher risk of systemic infection. AIM To investigate the clinical features and clinical outcomes associated with OM development and severity in hematological cancer paediatric patients undergoing allo-HSCT who underwent professional dental care (PDC) and photobiomodulation (PBM) as prophylactic treatment. DESIGN Medical data and OM presentation were retrieved retrospectively from all patients younger than 18 years who received allo-HSCT between 2013 and 2016. The incidence of OM was assessed and graded by two oral medicine specialists following the WHO guidelines, and it was correlated with clinical parameters. RESULTS Forty-nine consecutive paediatric patients were included. OM was diagnosed in 73.5% of patients, and in 36.1% of patients, OM was classified as severe. Acute lymphoblastic leukemia as a primary diagnosis and the use of a myeloablative regimen were associated with OM development. The primary diagnosis and use of total body irradiation (TBI) were associated with aggressive OM. Neither the incidence nor the severity of OM affected the overall survival, whereas only the use of a myeloablative regimen and a high body mass index (BMI) were determinants of lower OM-free survival rates. CONCLUSIONS A myeloablative conditioning and a high BMI were observed to be independent prognostic determinants of a lower OMFS rate. The cluster analysis allowed us to outline patient profiles with greater susceptibility to the development and severity of oral mucositis, which seems to be a useful tool to determine the risk of OM in paediatric patients.
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Affiliation(s)
| | - Felipe Paiva da Fonseca
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Alessandra Araujo Gomes
- Bone Marrow Transplant Unit, Hospital Sírio-Libanês, São Paulo, Brazil.,Pediatric Hematology-Oncology Unit, ITACI/ICR-HCFMUSP, São Paulo, Brazil
| | - Ana Beatriz Bechara Mafra
- Bone Marrow Transplant Unit, Hospital Sírio-Libanês, São Paulo, Brazil.,Pediatric Hematology-Oncology Unit, ITACI/ICR-HCFMUSP, São Paulo, Brazil
| | - Vanderson Rocha
- Bone Marrow Transplant Unit, Hospital Sírio-Libanês, São Paulo, Brazil.,Department of Hematology, Hemotherapy and Cell Therapy, USP, São Paulo, Brazil.,Department of Hematology, NHS-BT, University of Oxford, Oxford, UK
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14
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Zembillas AS, Thomas SM, Rotz SJ, Buhtoiarov IN, Hanna R. Palifermin as primary mucositis prophylaxis in patients with B-cell Non-Hodgkin lymphoma: a case series. Pediatr Hematol Oncol 2022; 39:80-82. [PMID: 34003714 PMCID: PMC8711132 DOI: 10.1080/08880018.2021.1927271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Stefanie M. Thomas
- Department of Pediatric Hematology Oncology and Bone Marrow Transplantation, Cleveland Clinic Children's, Cleveland, OH
| | - Seth J. Rotz
- Department of Pediatric Hematology Oncology and Bone Marrow Transplantation, Cleveland Clinic Children's, Cleveland, OH
| | - Ilia N. Buhtoiarov
- Department of Pediatric Hematology Oncology and Bone Marrow Transplantation, Cleveland Clinic Children's, Cleveland, OH
| | - Rabi Hanna
- Department of Pediatric Hematology Oncology and Bone Marrow Transplantation, Cleveland Clinic Children's, Cleveland, OH
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15
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Walker SM, Selers EL, Jay MA. Intravenous opioids for chemotherapy-induced severe mucositis pain in children: Systematic review and single-center case series of management with patient- or nurse-controlled analgesia (PCA/NCA). Paediatr Anaesth 2022; 32:17-34. [PMID: 34731511 DOI: 10.1111/pan.14324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chemotherapy-induced oral mucositis can result in severe pain. Intravenous (IV) opioids are recommended, but management protocols vary. We systematically reviewed studies reporting IV opioid use for pain related to chemotherapy-induced severe oral mucositis in children and conducted a large single-center case series. METHODS Ovid MEDLINE, PubMed, and Cochrane databases were searched for studies reporting IV opioid duration and/or dose requirements for severe mucositis. Secondly, our pain service database was interrogated to describe episodes of opioid administration by patient- or nurse-controlled analgesia (PCA/NCA) for children with mucositis and cancer treatment-related pain. RESULTS Seventeen studies (six randomized trials, two prospective observational, three retrospective cohort, six retrospective case series) included IV opioid in 618 patients (age 0.3-22.3 years), but reported parameters varied. Mucositis severity and chemotherapy indication influenced IV opioid requirements, with duration ranging from 3 to 68 days and variable dose trajectories (hourly morphine or equivalent 0-97 mcg/kg/h). Our 7-year series included PCA/NCA for 364 episodes of severe mucositis (302 patients; age 0.12-17.2 years). Duration ranged from 1 to 107 days and dose requirements in the first 3 days from 1 to 110 mcg/kg/h morphine. Longer PCA/NCA duration was associated with: higher initial morphine requirements (ρ = 0.46 [95% CI 0.35, 0.57]); subsequent increased pain and need for ketamine co-analgesia (118/364 episodes with opioid/ketamine 13.9 [9.8-22.2] days vs opioid alone 6.0 [3.9-10.8] days; median [IQR]); but not with age or sex. CONCLUSIONS Management of severe mucositis pain can require prolonged IV opioid therapy. Individual and treatment-related variability in analgesic requirements highlight the need for regular review, titration, and management by specialist services.
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Affiliation(s)
- Suellen M Walker
- Developmental Neurosciences Programme (Paediatric Pain Research Group), UCL GOS Institute of Child Health, London, UK.,Department of Paediatric Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Ebony L Selers
- Department of Paediatric Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust, London, UK.,Royal Melbourne Hospital, Parkville, Vic., Australia
| | - Matthew A Jay
- Department of Paediatric Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust, London, UK.,Population, Policy and Practice Research and Teaching Department, UCL GOS Institute of Child Health, London, UK
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- Department of Paediatric Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust, London, UK
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16
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Dharman S, Azima Hanin SM, Smiline Girija AS. Association of salivary microbes with oral mucositis among patients undergoing chemoradiotherapy in head and neck cancer: A hospital-based prospective study. J Int Oral Health 2022. [DOI: 10.4103/jioh.jioh_161_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Shetty SS, Maruthi M, Dhara V, de Arruda JAA, Abreu LG, Mesquita RA, Teixeira AL, Silva TA, Merchant Y. Oral mucositis: Current knowledge and future directions. Dis Mon 2021; 68:101300. [PMID: 34758917 DOI: 10.1016/j.disamonth.2021.101300] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Oral mucositis secondary to head and neck chemoradiation displays a complex molecular pathogenesis involving epithelial and microvascular injury, release of pro-inflammatory cytokines, and host-microbiome communications. These processes lead to oxidative stress and the release of reactive oxygen species that stifle the structural integrity of the oral mucosa, with emergence of erosions and ulcers. The consequences are malnutrition, psychological/psychiatric symptoms, poor quality of life, and occurrence of opportunistic infections. The latter pose a major challenge due to the risk of interruption of anti-neoplastic therapy, tumour recurrence and, ultimately, death. This article aims to present the clinical characteristics, molecular pathogenesis, and an overview of the predisposing factors and current management of oral mucositis. It is anticipated that the future direction of the management of oral mucositis will focus on evidence-based prehabilitation and pre- and per-chemoradiation therapy monitoring.
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Affiliation(s)
- Sameep S Shetty
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, A Constituent of MAHE, Manipal 576104, India.
| | - Meghana Maruthi
- Department of Dental Rehabilitative Oncology, HealthCare Global Enterprises Ltd., Bangalore, India.
| | - Vasantha Dhara
- Consultant Maxillofacial Surgeon, Hyderabad, Telangana, India.
| | - José Alcides Almeida de Arruda
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, room 3202 D, CEP: 31.270-910, Belo Horizonte, Minas Gerais, Brazil.
| | - Lucas Guimarães Abreu
- Department of Child's and Adolescent's Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Ricardo Alves Mesquita
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Antonio Lucio Teixeira
- Faculdade Santa Casa BH, Belo Horizonte, Brazil. Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
| | - Tarcília Aparecida Silva
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, room 3204, CEP: 31.270-910, Belo Horizonte, Minas Gerais, Brazil.
| | - Yash Merchant
- Consultant Maxilofacial Surgeon, Pune, Maharashtra, India.
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18
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Curra M, Gabriel AF, Ferreira MBC, Martins MAT, Brunetto AT, Gregianin LJ, Martins MD. Incidence and risk factors for oral mucositis in pediatric patients receiving chemotherapy. Support Care Cancer 2021; 29:6243-6251. [PMID: 33846825 DOI: 10.1007/s00520-021-06199-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 04/05/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the incidence and risk factors for oral mucositis (OM) in patients with childhood cancer undergoing chemotherapy. METHODS Eight hundred and twenty-nine cycles of chemotherapy were evaluated in 112 patients with childhood cancer undergoing chemotherapy. Chemotherapy protocol, hematological, hepatic, and renal function parameters were collected and compared to presence and severity of OM, as graded by the World Health Organization (WHO) scale. Patients received counseling on oral hygiene and those who presented with OM (grade ≥1) received photobiomodulation therapy (PBMT). RESULTS Age ranged from 0 to 17 years (mean/SD, 8.58 ± 5.05) and fifty-one patients (45.54%) were females. The most common baseline diseases were leukemia (51%) followed by sarcomas (23%) and lymphomas (18%). Eight hundred and twenty-nine cycles of chemotherapy were evaluated, and OM was diagnosed in 527 cycles (63.57%). Higher incidence and severity of OM was observed in protocols using high-dose methotrexate (MTX-HD), MTX-HD cyclophosphamide/doxorubicin combination, and MTX-HD combined with cyclophosphamide (p <0.001). Patients with severe OM had lower levels of leukocytes (p = 0.003), hemoglobin (p = 0.005), platelets (p = 0.034), and higher levels of total bilirubin (p = 0.027), alanine aminotransferase (ALT) (p = 0.001), and creatinine (p = 0.007). CONCLUSION The study contributes to the elucidation of the risk factors for OM in pediatric cancer patients. Chemotherapy protocols using MTX-HD, MTX-HD associated with doxorubicin and cyclophosphamide, and MTX-HD and cyclophosphamide a have higher incidence of severe grades of OM. Other toxicities such as hematological, hepatic, and renal also developed in patients with OM.
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Affiliation(s)
- Marina Curra
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, sala 503, CEP: 90035-003 Santana, Porto Alegre, RS, Brazil
| | - Amanda F Gabriel
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, sala 503, CEP: 90035-003 Santana, Porto Alegre, RS, Brazil
| | - Maria Beatriz C Ferreira
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Marco Antonio T Martins
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, sala 503, CEP: 90035-003 Santana, Porto Alegre, RS, Brazil.,Department of Oral Medicine, Hospital de Clínicas de Porto Alegre (HCPA/UFRGS), Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Lauro J Gregianin
- Department of Pediatric Oncology, Porto Alegre Clínicas Hospital (HCPA/UFRGS), Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Manoela Domingues Martins
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, sala 503, CEP: 90035-003 Santana, Porto Alegre, RS, Brazil. .,Department of Oral Medicine, Hospital de Clínicas de Porto Alegre (HCPA/UFRGS), Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
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de Farias Gabriel A, Silveira FM, Curra M, Schuch LF, Wagner VP, Martins MAT, da Silveira Matte U, Siebert M, Botton MR, Brunetto AT, Gregianin LJ, Martins MD. Risk factors associated with the development of oral mucositis in pediatric oncology patients: Systematic review and meta-analysis. Oral Dis 2021; 28:1068-1084. [PMID: 33774891 DOI: 10.1111/odi.13863] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/02/2021] [Accepted: 03/25/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Oral mucositis (OM) is an acute toxicity related to cancer treatment. This systematic review aimed to identify potential risk factors associated with the development of OM in pediatric cancer patients. METHODS A search was performed in four electronic databases to identify studies that analyzed risk factors for OM in pediatric cancer patients. RESULTS Nineteen articles were included. The incidence of OM ranged from 20% to 80.4%. Chemotherapeutic agents were potential risk factors for OM in eight (42%) studies. Hematological, hepatic, and renal parameters were also considered in eight (42%) studies, while specific individual factors were reported in five (26.3%) studies. Baseline disease, oral microbiota, genetic profile, and biomarkers were reported in four (21.5%) studies each. Meta-analysis showed that groups submitted to high-risk chemotherapy for OM had a 2.79-fold increased risk of OM. CONCLUSIONS Identifying risk factors for OM is essential in order to allow individualized and early prevention treatment.
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Affiliation(s)
- Amanda de Farias Gabriel
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe Martins Silveira
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Marina Curra
- Department of Oral Pathology, University of Caxias do Sul (UCS), Caxias do Sul, Porto Alegre, Brazil
| | - Lauren Frenzel Schuch
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Vivian Petersen Wagner
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Marco Antonio Trevizani Martins
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Department of Oral Medicine, Hospital de Clínicas de Porto Alegre (HCPA/UFRGS), Porto Alegre, Brazil
| | - Ursula da Silveira Matte
- Molecular and Protein Analysis Unit (UAMP), Hospital de Clínicas de Porto Alegre (HCPA/UFRGS), Porto Alegre, Brazil
| | - Marina Siebert
- Molecular and Protein Analysis Unit (UAMP), Hospital de Clínicas de Porto Alegre (HCPA/UFRGS), Porto Alegre, Brazil
| | - Mariana Rodrigues Botton
- Molecular and Protein Analysis Unit (UAMP), Hospital de Clínicas de Porto Alegre (HCPA/UFRGS), Porto Alegre, Brazil
| | | | - Lauro José Gregianin
- Department of Pediatric Oncology, Porto Alegre Clínicas Hospital (HCPA/UFRGS), Porto Alegre, Brazil
| | - Manoela Domingues Martins
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.,Department of Oral Medicine, Hospital de Clínicas de Porto Alegre (HCPA/UFRGS), Porto Alegre, Brazil
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20
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Valer JB, Curra M, Gabriel ADF, Schmidt TR, Ferreira MBC, Roesler R, Evangelista JMC, Martins MAT, Gregianin L, Martins MD. Oral mucositis in childhood cancer patients receiving high-dose methotrexate: Prevalence, relationship with other toxicities and methotrexate elimination. Int J Paediatr Dent 2021; 31:238-246. [PMID: 32815183 DOI: 10.1111/ipd.12718] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/27/2020] [Accepted: 07/06/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Oral mucositis (OM) is one of the main adverse effects of the chemotherapeutic agent methotrexate (MTX). AIM To evaluate the relationship of OM with MTX metabolism time and other toxicities in childhood, cancer patients receiving high-dose of methotrexate (HD-MTX). DESIGN Seventy-seven childhood patients receiving HD-MTX for treatment of leukaemia, osteosarcoma or lymphoma were evaluated. MTX serum level, hepatic and renal function parameters, and presence and intensity of OM were analysed. RESULTS The patients were submitted to 255 cycles of chemotherapy. OM was diagnosed in 191 (74.9%) cycles. Of these, 119 (46.6%) presented ulcerative lesions. Lymphoma was associated with severe OM (P = .01). OM was associated with higher serum levels of aspartate aminotransferase (P = .006), alanine aminotransferase (P = .04) and creatinine (P = .008). Increase of one unit of total bilirubin and indirect bilirubin associated, respectively, with 11% and 39% higher prevalence of OM. For each increase of one unit of creatinine serum level, it was observed a 37% higher prevalence of OM in patients with lymphoma. No association was found between delayed excretion of MTX and OM development. CONCLUSIONS OM is a prevalent complication of childhood cancer patients receiving HD-MTX. Renal and hepatic toxicity could be considered risk factors for OM, especially in patients with lymphoma.
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Affiliation(s)
- Jéssica Berté Valer
- Department of Oral Pathology and Oral Medicine, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Marina Curra
- Department of Oral Pathology and Oral Medicine, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,School of Dentistry, University of Caxias do Sul, Caxias do Sul, RS, Brazil
| | - Amanda de Farias Gabriel
- Department of Oral Pathology and Oral Medicine, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Tuany Rafaeli Schmidt
- Department of Oral Pathology and Oral Medicine, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Beatriz Cardoso Ferreira
- Full Professor of Pharmacology, Invited Professor, Department of Conservative Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafael Roesler
- Cancer and Neurobiology Laboratory, Experimental Research Center, Porto Alegre Clinical Hospital, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Children's Cancer Institute, Porto Alegre, Brazil
| | | | - Marco Antonio Trevizani Martins
- Department of Oral Pathology and Oral Medicine, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Department of Oral Medicine, Porto Alegre Clinical Hospital (HCPA/UFRGS), Porto Alegre, Brazil
| | - Lauro Gregianin
- Children's Cancer Institute, Porto Alegre, Brazil.,Department of Pediatric Oncology, Porto Alegre Clinicas Hospital (HCPA/UFRGS), Porto Alegre, Brazil.,Pediatric Oncology Service, Porto Alegre Clinical Hospital (HCPA/UFRGS), Porto Alegre, Brazil
| | - Manoela Domingues Martins
- Department of Oral Pathology and Oral Medicine, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Department of Oral Medicine, Porto Alegre Clinical Hospital (HCPA/UFRGS), Porto Alegre, Brazil
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21
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Gupta A, Damania RC, Talati R, O'Riordan MA, Matloub YH, Ahuja SP. Increased Toxicity Among Adolescents and Young Adults Compared with Children Hospitalized with Acute Lymphoblastic Leukemia at Children's Hospitals in the United States. J Adolesc Young Adult Oncol 2021; 10:645-653. [PMID: 33512257 DOI: 10.1089/jayao.2020.0154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Purpose: Adolescent and young adult (AYA) patients (15-39 years old) with acute lymphoblastic leukemia (ALL) have less favorable outcomes and higher treatment-related mortality as compared with older children with ALL. Minimal data exist regarding how well AYA patients tolerate the intensity of chemotherapy at doses and regimens designed for children, and the toxicities suffered by this population at children's hospitals have not been thoroughly characterized. Methods: Pediatric Health Information Systems database was queried to analyze health care outcomes in pediatric (ages 10-14) and AYA patients (ages 15-39) with ALL hospitalized between January 1999 and December 2014. We extracted relevant ICD-9 data for each patient related to grades 3 or 4 toxicities as outlined by the NCI. Results: A total of 5345 hospital admissions met inclusion criteria, representing 4046 unique patients. Of these admissions, 2195 (41.1%) were in the AYA age group, and the remainder were in the 10-14-year-old group. AYA patients had a significantly higher incidence of intensive care unit stay but no difference in median hospital stay nor mortality. AYA patients had increased toxicities in almost every organ system as compared with older children. Conclusions: In this large multicenter US database study, we found an overall increased number of toxicities among AYA patients with ALL in children's hospitals. Compared with children between the ages of 10 and 15, AYA patients developed disproportionately higher toxicities from drugs commonly used in pediatric protocols for ALL. Prospective studies are needed to assess whether dose modifications for certain chemotherapeutics may improve the toxicity profile and health care burden of AYA patients with ALL treated in children's hospitals.
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Affiliation(s)
- Ajay Gupta
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Rahul C Damania
- Division of Pediatric Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Ravi Talati
- Division of Hematology, Oncology, and Blood and Marrow Transplant, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Mary Ann O'Riordan
- Women's & Children's Services, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
| | - Yousif H Matloub
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sanjay P Ahuja
- Division of Pediatric Hematology/Oncology, Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
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MASCC/ISOO clinical practice guidelines for the management of mucositis: sub-analysis of current interventions for the management of oral mucositis in pediatric cancer patients. Support Care Cancer 2020; 29:3539-3562. [PMID: 33156403 DOI: 10.1007/s00520-020-05803-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this sub-analysis was to highlight the MASCC/ISOO clinical practice guidelines for the management of oral mucositis (OM) in pediatric patients and to present unique considerations in this patient population. METHODS This sub-analysis of the pediatric patient population is based on the systematic review conducted by the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISSO) published in 2019/2020. Studies were scored and assigned a level of evidence based on previously published criteria. Data regarding adverse effects and compliance was collected from the original publications. RESULTS A total of 45 papers were included and assessed in this sub-analysis, including 21 randomized controlled trials (RCTs). Chewing gum was demonstrated to be not effective in preventing OM in pediatric cancer patients in 2 RCTs. The efficacy of all other interventions could not be determined based on the available literature. CONCLUSION There is limited or conflicting evidence about interventions for the management of OM in pediatric cancer patients, except for chewing gum which was ineffective for prevention. Therefore, currently, data from adult studies may need to be extrapolated for the management of pediatric patients. Honey and photobiomodulation therapy in this patient population had encouraging potential. Implementation of a basic oral care protocol is advised amid lack of high level of evidence studies.
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Impact of Saliva and Cariogenic Microbiota on the Chemotherapy-Induced Oral Mucositis in Oncopediatric Patients: A Preliminary Longitudinal Study. Int J Dent 2020; 2020:1243953. [PMID: 33163075 PMCID: PMC7605952 DOI: 10.1155/2020/1243953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/14/2020] [Indexed: 12/13/2022] Open
Abstract
This study aims to evaluate the salivary parameters and cariogenic microbiota of pediatric oncological patients and their correlation with severe oral mucositis (SOM). A preliminary longitudinal study included patients in the age range from 4 to 18 years (n = 26), with diagnosis of primary cancer, who were followed up before and after time intervals of two, five, and ten weeks of induction chemotherapy. Oral mucosa examinations were performed by means of the modified Oral Assessment Guide (OAG) by calibrated examiners (κ > 0.70). Saliva analysis (unstimulated saliva flow (USF), clinical saliva viscosity (CSV), and pH) and microbiological (total Streptococcus (TS) and Streptococcus of the mutans group (SMG)) tests were performed using unstimulated saliva. The data were analyzed by the Wilcoxon and Spearman Correlation tests (α = 5%). The patients were predominantly of the female sex (n = 15; 57.7%), adolescents (n = 15; 57.7%), and patients with hematological tumors (n = 21; 80.8%). SOM was more frequent in the tenth week (n = 7; 28.6%). The values of USF, CSV, pH, TS, and SMG were not changed by the institution of chemotherapy (p > 0.05). These values were correlated with SOM and the time, TS and SMG, and CSV and SMG. The salivary and microbiological parameters investigated did not influence the severity of oral mucositis in the pediatric patients oncological..
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Prophylactic photobiomodulation therapy using 660 nm diode laser for oral mucositis in paediatric patients under chemotherapy: 5-year experience from a Brazilian referral service. Lasers Med Sci 2020; 35:1857-1866. [PMID: 32535807 DOI: 10.1007/s10103-020-03060-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/01/2020] [Indexed: 12/22/2022]
Abstract
The use of photobiomodulation therapy (PBMT) in the prevention of oral mucositis (OM) in paediatric care has increased. In this article, we report data of paediatric oncology/haematopoietic stem cell transplantation (HSCT) patients treated with PBMT to prevent chemotherapy-induced OM. A retrospective study was conducted at a Brazilian referral service. Prophylactic PBMT was used in children and adolescents (≤ 17 years) following the protocol: InGaAIP, 660 nm, 100 mW, 2 J, 3.33 W/cm2, and 20 s per point. Demographic data and OM severity scores were assessed. A regression model tested the association between OM with prophylactic PBMT and antineoplastic therapy. A total of 148 individuals who had undergone 358 chemotherapy cycles were analysed. A higher occurrence of OM was observed in HSCT and osteosarcoma (OS) patients. Except for HSCT, OM was associated with methotrexate (MTX) use in all disease groups. PBMT significantly reduced OM severity in acute lymphoblastic leukaemia (ALL) and OS patients. OM grade was 3.16 and 5.45 times higher among individuals with ALL and OS, who had not undergone prophylactic PBMT compared with those who had undergone prophylactic PBMT (p < 0.001). PBMT prevented chemotherapy-induced OM. Individuals who used MTX and did not undergo prophylactic PBMT were at increased risk of OM.
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Wang G, Jia L. Herb medicine for relieving radiation induced oral mucositis: A systematic review and meta-analysis protocol. Medicine (Baltimore) 2019; 98:e18337. [PMID: 31852129 PMCID: PMC6922437 DOI: 10.1097/md.0000000000018337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Oral mucositis (OM) is a common and unavoidable side effect in patients suffering from head and neck cancer who are undergoing radiotherapy. It is characterized by unbearable pain, as well as eating and speech disorders. This has serious negative effects on the patients' quality of life and can even reduce radiotherapy tolerance, ultimately resulting in a poor prognosis. At present, many prevention and treatment methods are still in the experimental stage, and the efficacies are controversial. METHODS Four English databases: Medline via pubmed, EMBASE, the Cochrane Library, Web of Science and another 4 Chinese databases: China National Knowledge Infrastructure (CNKI), China Science and Technology Journal database (VIP), Wanfang Database and CBM, will be searched from inception to August 2019. All randomized controlled trials in Chinese and English language will be included. Literature selection, data extraction and quality assessment will be completed by 2 independent authors. The primary outcomes will include the incidence of OM (1-4 grade) and the pain degree. The onset time of OM, the improvement rate for quality of life, and any adverse effects will be evaluated as the secondary outcomes. The data will be synthesized by Review Manager and Stata software. RESULTS This study provides a high-quality synthesis from existing evidence for Chinese herbal medicine in radiotherapy induced OM treatment, according to the criteria: incidence of OM, onset time of OM, status changes in quality of life and adverse events. CONCLUSION This study will provide evidence to help determine whether Chinese herbal medicine is effective and safe for use in the prevention and/or treatment of radiotherapy induced OM. ETHICS AND DISSEMINATION No additional formal ethical recognition or informed consent is required since no primary data collection is involved. The study result will be published in peer-reviewed journals or at related conferences.PROSPERO registration number: PROSPERO CRD42019141900.
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Affiliation(s)
- Gui Wang
- Beijing University of Chinese Medicine
- Department of Oncology of Integrative Chinese and Western Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Liqun Jia
- Department of Oncology of Integrative Chinese and Western Medicine, China-Japan Friendship Hospital, Beijing, China
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