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Nurhidayah I, Nurhaeni N, Allenidekania A, Gayatri D. A Systematic Review of Experimental Studies on the Impact of Empowerment-Based Interventions on Child and Parent Outcomes in the Pediatric Oncology Setting. J Multidiscip Healthc 2023; 16:3717-3735. [PMID: 38058460 PMCID: PMC10697007 DOI: 10.2147/jmdh.s436394] [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: 09/14/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023] Open
Abstract
Background Cancer has an impact not only on children but also on parents. Parents play the most crucial role in cancer's symptom control and management. However, as the primary caretakers, parents are frequently unprepared or engage in inappropriate behavior when caring for their children. Increasing parents' role through empowerment is critical in pediatric cancer care. Purpose This systematic review aimed to identify the effect of empowerment interventions on parent and child outcomes in pediatric oncology. Methods In this review, studies published between 2013 and 2023 in The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Embase, Medline, and Scopus databases were identified using a search strategy to identify relevant studies that determined empowerment-based intervention for parents in the pediatric oncology. This study used the Joanna Briggs Institute (JBI) critical appraisal tools to assess the quality of the studies. This systematic review followed the recommended reporting items for systematic reviews and meta-analysis (PRISMA) standards. Results Seven studies met the inclusion criteria: four randomized and three non-randomized experimental studies. Children range in age from 1-14 years. The intervention is mostly delivered through face-to-face learning using booklets or modules as a learning tool. The intervention is delivered in 2-6 sessions over 1-8 weeks, lasting 20-45 minutes each. In most studies, the interventions positively affect parents' outcomes (knowledge, caring behavior, distress, care burden, quality of life) and children's outcomes (oral mucositis, gastrointestinal complications, quality of life). The intervention, however, has no significant effect on the coping style. Barriers to implementation include parent-nurse commitment, the retention of parent-nurse participation, and more time spent to provide interventions. Conclusion Our study highlights that empowerment-based interventions positively impact parents and children. These findings suggest that an empowerment-based intervention should be developed to provide better cancer care for a parent and their children. Systematic Review Registration PROSPERO registration number was CRD42023422834.
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Affiliation(s)
- Ikeu Nurhidayah
- Postgraduate Program, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
- Pediatric Nursing Department, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
| | - Nani Nurhaeni
- Pediatric Nursing Department, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | | | - Dewi Gayatri
- Basic Science and Fundamental Nursing Department, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
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Attaran N, Sharma A, Morris M, Dudubo O, Macdonald ME. What are the impacts of oral complications from cancer therapy on the quality of life of children? A protocol to update a scoping review. PLoS One 2023; 18:e0290364. [PMID: 37972049 PMCID: PMC10653535 DOI: 10.1371/journal.pone.0290364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/11/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION Cancer treatments can damage healthy tissues and organs, and leave harmful impacts on cancer survivors, especially on children and adolescents. The oral effects of cancer treatment can occur during or soon after treatment, or months-even years-later. Cancer treatments can also affect the child, psychologically and socially by hindering their speech, eating, sleeping, and social interactions. These effects can have profound impacts on children's quality of life. Building on a previous review published in 2012, this scoping review aims to identify and map the current evidence base underpinning the oral health-related impacts of cancer treatment on the quality of life of children with cancer. METHODOLOGY AND METHODS Our methodology is guided by Arksey and O'Malley's methodological framework for scoping reviews, Levac's additions to the framework, and follows the Joanna Briggs Institute Reviewer's Manual. Five electronic databases and grey literature will be systematically searched using a predefined search strategy. Two reviewers will independently screen the retrieved articles using Rayyan software and chart data from included articles. One of the team's senior research members will act as a third reviewer and make the final decision on disputed documents. We will include literature with a focus on oral health-related quality of life of children undergoing cancer treatments. Following the selection of studies, data will be extracted, synthesized, and reported thematically and the relevant stakeholder's insight will be added to our results.
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Affiliation(s)
- Nona Attaran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Québec, Canada
| | - Apoorva Sharma
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Québec, Canada
| | - Martin Morris
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Québec, Canada
| | - Olawale Dudubo
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Québec, Canada
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Ilic A, Sievers Y, Roser K, Scheinemann K, Michel G. The information needs of relatives of childhood cancer patients and survivors: A systematic review of qualitative evidence. PATIENT EDUCATION AND COUNSELING 2023; 114:107840. [PMID: 37321115 DOI: 10.1016/j.pec.2023.107840] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/25/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To synthesize qualitative research on the information needs of relatives of childhood cancer patients and survivors. METHODS Systematic searches of PubMed, PsycINFO, CINAHL, and Scopus identified relevant literature. Extracted data were combined using thematic synthesis. Methodological quality was assessed using the JBI critical appraisal tool for qualitative research. RESULTS The review included 27 publications, with most research focusing on parents or primary caregivers. Five areas of information needs were identified: treatment, medication, and care; general information about cancer; coping and support; follow-up, late effects, and rehabilitation; and parenting and everyday life. Appropriateness of information depended on health care professionals' aptitude, message characteristics, communication setting, and relatives' personal factors. Preferences for form, sources, and timing for information provision varied. CONCLUSION The review identified information needs, communication barriers, and preferences among caregivers and siblings of childhood cancer patients and survivors, highlighting areas requiring further research and clinical consideration in addressing the identified challenges. PRACTICE IMPLICATIONS Caregivers and siblings have unique but similar information needs regarding childhood cancer. To ensure that these needs are met, health care professionals could use eHealth and mHealth technologies, assess each family member's knowledge, and create a safe and supportive environment for questions and feedback.
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Affiliation(s)
- Anica Ilic
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Yara Sievers
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Katharina Roser
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Katrin Scheinemann
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Center for Pediatric Hematology/Oncology, East Swiss Children's Hospital, St. Gallen, Switzerland; Department of Pediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Canada
| | - Gisela Michel
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
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An exploration of the use of photobiomodulation for management of oral mucositis in children and young people undergoing cancer treatment in the UK. Support Care Cancer 2022; 30:10179-10190. [PMID: 36350380 PMCID: PMC9715443 DOI: 10.1007/s00520-022-07450-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE Oral mucositis affects up to 80% of children and young people (CYP) receiving chemotherapy. This can result in pain, reduced oral intake and, in severe cases, hospitalisation for parental nutrition and pain relief. Photobiomodulation is recommended by multiple bodies for mucositis management for those undergoing cancer treatments. The current use of photobiomodulation within the UK, and the barriers and facilitators to implementation is unknown. METHOD An online mixed-methods survey was administered to representatives from the Children's Cancer and Leukaemia Group (CCLG) between October 2021 and March 2022. This explored: use of photobiomodulation, planned future use, barriers and facilitators to implementation and dental assessment. Quantitative data underwent descriptive statistics. Barriers and facilitators to the implementation of photobiomodulation were analysed using the Theoretical Domains Framework (TDF). RESULTS All UK CCLG centres responded (n = 20, a response rate of 100%). Two units in Scotland were delivering photobiomodulation. A further four units were planning to implement a service. Most units, 65% (n = 13) utilised specialist Paediatric Dentistry services for dental assessment. In the TDF analysis, five domains were most frequently populated: knowledge, skills, environmental context and resources, social influences, and social/professional role and identity. CONCLUSION Photobiomodulation was only available in Scotland in two children's cancer units. Lack of knowledge and skills, and insufficient environmental resources were identified as barriers. Collaboration with paediatric dental services was identified as a facilitator. The establishment of a national network of Paediatric Dentists and Oncologists would promote collaboration to standardise protocols and to address the identified barriers to wider implementation of photobiomodulation.
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Poirée M, Lervat C, Marec-Berard P. [Chemo-induced mucositis in pediatric oncology: Perspectives?]. Bull Cancer 2021; 108:761-770. [PMID: 33933290 DOI: 10.1016/j.bulcan.2021.01.018] [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: 10/19/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 11/16/2022]
Abstract
Mucositis is defined as inflammatory and/or ulcerative lesions of the oral and/or gastrointestinal tract. It occurs in approximately 40% to 50% of adults patients receiving conventional chemotherapy and up to 75% of patients receiving high dose chemotherapy as conditioning for hematopoietic stem cell transplantation. It is a toxic side effect, which strongly impairs quality of life and leads to refractory pain, increasing risk of infection and even therapeutic modifications. Despite improvements made, the management of mucositis remains a challenge and is still not consensual. A multicentric survey of practices concerning the preventive and curative management of chemo-induced mucositis in pediatric oncology department in France was carried out using a standardized questionnaire. Results confirm heterogeneous practices and the small progress made during the last decade. This national survey and an analysis of the recent literature leads to propose guidelines for the prevention and treatment of oral mucositis in children receiving treatment for cancer.
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Affiliation(s)
- Marilyne Poirée
- Hôpital Archet 2, service d'oncohématologie pédiatrique, route Saint-Antoine-de-Ginestière, 06202 Nice, France.
| | - Cyril Lervat
- Centre Oscar-Lambret, unité de pédiatrie, 3, rue Combemale, 59020 Lille cedex, France
| | - Perrine Marec-Berard
- Institut d'hématologie et d'oncologie pédiatrie, centre Léon-Bérard, département d'oncologie pédiatrique, 69008 Lyon, France
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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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Immonen E, Aine L, Nikkilä A, Parikka M, Grönroos M, Vepsäläinen K, Palmu S, Helminen M, Peltomäki T, Lohi O. Randomized controlled and double-blinded study of Caphosol versus saline oral rinses in pediatric patients with cancer. Pediatr Blood Cancer 2020; 67:e28520. [PMID: 32725875 DOI: 10.1002/pbc.28520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/04/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Oral mucositis (OM) is a significant side effect of cancer treatment. The purpose of this study was to compare topically administered Caphosol to saline rinses in the prevention of mucositis in pediatric cancer patients. PROCEDURE A controlled, double-blinded, and randomized clinical crossover study recruited patients between 2 to 17.99 years of age who were diagnosed with a malignancy and were receiving either high-dose methotrexate (≥1 g/m2 ), anthracycline, or cisplatin chemotherapy (NCT0280733). All patients received two 7-day cycles of the mouth rinses; that is, one cycle of Caphosol and one cycle of saline in a randomized order. Oral changes and symptoms were evaluated using the World Health Organisation (WHO) toxicity scale and the Children's International Mucositis Evaluation Scale (ChIMES). The primary endpoint was the frequency and severity of OM and oral symptoms. RESULTS A total of 56 patients were recruited to the study, of whom 45 were randomized with a median age of 6.5 years (range 2.1-17.1 years). No cases of severe OM were observed. Grade ≥ 3 oral symptoms were present at least once in six (13%) patients during the Caphosol cycle and 13 (29%) patients during the saline cycle (P = .12). The peak of symptom scores was evident at around day 4-7 after administration of the chemotherapy with no marked differences between the rinse solutions. Multivariable regression analysis did not indicate a benefit of using Caphosol over the saline solution. CONCLUSIONS No difference in prevention of oral mucositis was observed between the use of Caphosol or saline rinses.
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Affiliation(s)
- Egle Immonen
- Tampere Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Ear and Oral Diseases, Tampere University Hospital, Tampere, Finland
| | - Liisa Aine
- Department of Ear and Oral Diseases, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Atte Nikkilä
- Tampere Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mataleena Parikka
- Department of Ear and Oral Diseases, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Marika Grönroos
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Kaisa Vepsäläinen
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Sauli Palmu
- Tampere Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mika Helminen
- Research, Development and Innovation Centre, Tampere University Hospital, Tampere, Finland.,Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
| | - Timo Peltomäki
- Department of Ear and Oral Diseases, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Olli Lohi
- Tampere Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Tays Cancer Centre, Tampere University Hospital, Tampere, Finland
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Alkhouli M, Laflouf M, Alhaddad M. Efficacy of Aloe-Vera Use for Prevention of Chemotherapy-Induced Oral Mucositis in Children with Acute Lymphoblastic Leukemia: A Randomized Controlled Clinical Trial. Compr Child Adolesc Nurs 2020; 44:49-62. [PMID: 32101488 DOI: 10.1080/24694193.2020.1727065] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Oral mucositis can be caused by chemotherapy and can affect a patient's quality of life. Nowadays, to prevent chemotherapy-induced oral mucositis (CIOM) is a crucial point in palliative care centers. This trial aimed to assess the effectiveness of aloe-vera in that concept. The trial was accomplished at Hematology Department of Hospital of Children of Damascus University, Syria. Acute lymphoblastic leukemia (ALL) children were the population from which 26 children were enrolled in the study. They were aged between 3 and 6 years old and were randomly referred according to the intervention into two groups, Aloe-vera (AV) and sodium bicarbonate 5% (13 each). Spongeous sticks were used to help in applying the material on tongue, labial and buccal mucosa, lips, floor of the mouth, and hard palate. Two blinded external examiners evaluated oral mucosa weekly for up to 2 months using the World Health Organization grading scale. Mann-Whitney U test was used to analyze data. According to the observed findings, CIOM degrees were less severe in the aloe-vera group than in the sodium bicarbonate group. Statistically significant difference of occurrence of different CIOM degrees between groups was recorded in the 2nd, 3rd, 4th, and 7th weeks of follow-up period. Moreover, Mann-Whitney U test indicated that patients in the sodium bicarbonate group began CIOM sooner than those in the aloe-vera group with a statistically significant difference (p = .001). These findings show that topical application of aloe-vera solution is effective in the prevention of CIOM in ALL children.
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Affiliation(s)
- Muaaz Alkhouli
- Department of Pediatric Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Mohannad Laflouf
- Department of Pediatric Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Mazen Alhaddad
- Department of Pediatrics, Faculty of Medicine, Damascus University, Damascus, Syria
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Cheng KKF, Ip WY, Lee V, Li CH, Yuen HL, Epstein JB. Measuring Oral Mucositis of Pediatric Patients with Cancer: A Psychometric Evaluation of Chinese Version of the Oral Mucositis Daily Questionnaire. Asia Pac J Oncol Nurs 2017; 4:330-335. [PMID: 28966962 PMCID: PMC5559944 DOI: 10.4103/apjon.apjon_39_17] [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: 03/29/2017] [Accepted: 05/24/2017] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Oral mucositis is a frequent clinical condition that has been shown to affect pediatric cancer patients. Oral Mucositis Daily Questionnaire (OMDQ) is one of the few available patient-reported outcome measures to assess the extent and impact of oral mucositis. The objectives of the study were to translate the Mouth and Throat Soreness-Related Questions of the OMDQ into Chinese (OMDQ MTS-Ch) for children and adolescents aged 6-18 years receiving chemotherapy and to evaluate its psychometric properties. METHODS This was part of a multicenter, prospective cohort study involving two phases. Phase I involved forward-backward translation to fit the cognitive and linguistic age level of the children and adolescents, followed by face and content validation, together with pretesting. In Phase II, which evaluated the internal consistency, test-retest reliability, and discriminant validity, a total of 140 patients completed the OMDQ MTS-Ch for 14 days. RESULTS The OMDQ MTS-Ch had satisfactory face and content validities. The Cronbach's alpha coefficient of the OMDQ MTS-Ch was 0.984. All of the corrected item-total correlations were higher than 0.90. The test-retest intraclass correlation coefficient between consecutive days for the OMDQ MTS-Ch items ranged from 0.576 to 0.983; the only value that was not over 0.70 was that for the paired study days 7 and 8 for the item of talking. The mean area-under-the-curve OMDQ MTS-Ch item scores were significantly different among patients with different degrees of mucositis severity (P < 0.001), supporting the discriminant validity. CONCLUSIONS It has been shown that the OMDQ MTS-Ch has a good level of reliability and discriminant validity and can be completed by children aged ≥6 years and adolescents on a daily basis to measure mucositis and its related functional limitations.
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Affiliation(s)
- Karis Kin Fong Cheng
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | - Wan Yim Ip
- School of Nursing, Hong Kong Sanatorium and Hospital, Hong Kong, China
| | - Vincent Lee
- Children Cancer Centre, Prince of Wales Hospital, Hong Kong, China
| | - Chak Ho Li
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Hong Kong, China
| | - Hui Leung Yuen
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong, China
| | - Joel B. Epstein
- Division of Otolaryngology and Head and Neck Surgery, City of Hope, CA, USA
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Prevention of gastrointestinal side-effects in paediatric oncology: what are the guidelines? Curr Opin Support Palliat Care 2017; 11:120-124. [PMID: 28333866 DOI: 10.1097/spc.0000000000000264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Gastrointestinal side-effects, particularly with regard to alimentary tract mucositis and chemotherapy-induced nausea and vomiting (CINV), continue to be frequent and debilitating symptomatic conditions among children and adolescents receiving cytotoxic cancer therapy. Further avenues of progress for mucositis and CINV prevention in paediatric oncology setting are warranted. RECENT FINDINGS The current article reviews the major guidelines and literature published in 2016 pertaining to the prevention of mucositis and CINV. Considerable professional organizational efforts have been made to develop consensus-based or evidence-based guidelines that periodically update to define basic standards of mucositis and CINV prevention. There are a few published works in 2016 that may contribute to the emerging evidence on prevention of mucositis and CINV in the paediatric setting for future guideline updates. SUMMARY The concomitant use of 5-HT3 receptor antagonist and dexamethasone are effective to prevent acute and delayed CINV in children who are to receive highly or moderately emetogenic chemotherapy. Optimal control of acute and delayed CINV can prevent anticipatory CINV. Oral care protocols would be beneficial to prevent mucositis in children across all cancer treatment modalities. Cryotherapy or low-level light therapy may be applied to cooperative children undergoing chemotherapy or haematological stem cell transplant conditioning regimens with a high rate of mucositis.
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Treister N, Nieder M, Baggott C, Olson E, Chen L, Dang H, Krailo M, August A, Sung L. Caphosol for prevention of oral mucositis in pediatric myeloablative haematopoietic cell transplantation. Br J Cancer 2016; 116:21-27. [PMID: 27875526 PMCID: PMC5220147 DOI: 10.1038/bjc.2016.380] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/28/2016] [Accepted: 10/24/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The primary objective was to determine whether topically administered Caphosol, rinsed orally four times daily at the initiation of conditioning, reduces the duration of severe oral mucositis (OM) compared with placebo among children and adolescents undergoing haematopoietic cell transplantation (HCT). METHODS This was a Children's Oncology Group multicentre randomised double-blinded placebo-controlled clinical trial. Patients between the ages of 4 and 21 years who were scheduled to undergo myeloablative HCT for any indication were randomised to Caphosol or placebo saline rinses four times daily from initiation of conditioning through day +20. Subjects were assessed daily for OM using the World Health Organisation (WHO) Oral Toxicity Scale, Mouth Pain Categorical Scale (0-10) and the Oral Mucositis Daily Questionnaire (OMDQ). The primary end point was duration of severe OM (WHO ⩾3). RESULTS The study enrolled 220 participants with a median age of 13.7 years (range 4.0-21.9); 163 (74%) received allogeneic HCT. The mean (±s.d.) duration of severe OM was not reduced among Caphosol (4.5±5.0 days) vs placebo (4.5±4.8; P=0.99) recipients. The incidence of severe OM in the Caphosol and placebo arms was 63% (57 out of 91) and 68% (62 out of 91), respectively (P=0.44). There were no significant differences in any of the secondary end points between the groups. CONCLUSIONS Caphosol did not reduce severe OM when compared with placebo among children and adolescents undergoing myeloablative HCT. Studies to identify effective interventions for OM are needed in this population.
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Affiliation(s)
- Nathaniel 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
| | - Michael Nieder
- Blood and Marrow Transplant Department, Moffitt Cancer Center, Tampa, FL and Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Christina Baggott
- Pediatric Hematology-Oncology, Stanford Medical Center, Stanford, CA, USA
| | - Ellen Olson
- Aflac Cancer and Blood Disorders Service, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Lu Chen
- Children's Oncology Group, Monrovia, CA, USA
| | - Ha Dang
- Children's Oncology Group, Monrovia, CA, USA.,Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mark Krailo
- Children's Oncology Group, Monrovia, CA, USA.,Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Sposito AMP, Silva-Rodrigues FM, Sparapani VDC, Pfeifer LI, de Lima RAG, Nascimento LC. Coping Strategies Used by Hospitalized Children With Cancer Undergoing Chemotherapy. J Nurs Scholarsh 2015; 47:143-51. [DOI: 10.1111/jnu.12126] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Amanda Mota Pacciulio Sposito
- Rho Upsilon , Occupational Therapist, Clinical Hospital at Ribeirão Preto Medical School; University of São Paulo; São Paulo Brazil
| | - Fernanda Machado Silva-Rodrigues
- Assistant Professor, Nursing in Child, Adolescent, and Woman's Health Department; Faculdade de Ciências Médicas da Santa Casa de São Paulo - FCMSCSP; São Paulo Brazil
| | - Valéria de Cássia Sparapani
- Rho Upsilon , Pediatric Nurse, University of São Paulo at Ribeirao Preto College of Nursing; WHO Collaborating Centre for Nursing Research Development; São Paulo Brazil
| | - Luzia Iara Pfeifer
- Assistant Professor, Department of Neuroscience and Behavioral Sciences, Division of Occupational Therapy, Ribeirão Preto Medical School; University of São Paulo; Brazil
| | - Regina Aparecida Garcia de Lima
- Rho Upsilon , Full Professor, Department of Maternal-Infant and Public Health Nursing at Ribeirão Preto College of Nursing; University of São Paulo, and WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto; São Paulo Brazil
| | - Lucila Castanheira Nascimento
- Rho Upsilon , Associate Professor, Department of Maternal-Infant and Public Health Nursing at Ribeirão Preto College of Nursing; University of São Paulo, Brazil, and WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto; São Paulo Brazil
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Kamsvåg‐Magnusson T, Thorsell‐Cederberg J, Svanberg A, von Essen L, Arvidson J, Mellgren K, Toporski J, Ljungman G. Parents and children's perceptions of distress related to oral mucositis during haematopoietic stem cell transplantation. Acta Paediatr 2014; 103:630-6. [PMID: 24612395 PMCID: PMC4286779 DOI: 10.1111/apa.12627] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 12/19/2013] [Accepted: 03/05/2014] [Indexed: 11/28/2022]
Abstract
AIM Oral mucositis is a common and debilitating side effect of haematopoietic stem cell transplantation. Our study investigated parents' and children's experiences of oral mucositis treatment and whether the parents' perceptions accurately reflected the children's views. METHODS We analysed 71 questionnaires completed by the parents of children who had undergone haematopoietic stem cell transplantation, together with 38 questionnaires completed by children who were 7 years of age or over. RESULTS The parent proxy and child self-reports showed good to excellent agreement. For example, 86% of the parents and 83% of the children reported oral pain and 44% of the parents and 47% of the children reported difficulty swallowing often or very often. The majority of the parents (61%) were satisfied with the pain treatment that had been given to their child. However, the treatment provided for oral mucositis was not altogether consistent. CONCLUSION Oral mucositis affected the majority of the children undergoing haematopoietic stem cell transplantation, causing considerable pain and discomfort. The parent proxy reports proved to be reliable and are an important supplement to child self-reports on symptoms related to oral mucositis. But there is a clear need to establish more evidence-based care for children suffering from oral mucositis.
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Affiliation(s)
- Tove Kamsvåg‐Magnusson
- Department of Women's and Children's HealthPaediatrics oncologyUppsala UniversityUppsalaSweden
| | | | | | - Louise von Essen
- Department of Public Health and Caring SciencesPsychosocial Oncology and Supportive CareUppsala UniversityUppsalaSweden
| | - Johan Arvidson
- Department of Women's and Children's HealthPaediatrics oncologyUppsala UniversityUppsalaSweden
| | - Karin Mellgren
- Department of PediatricsInstitute for Clinical SciencesUniversity of GothenburgGothenburgSweden
| | - Jacek Toporski
- Department of Clinical Sciences, Pediatric Oncology and HematologyUniversity of LundLundSweden
| | - Gustaf Ljungman
- Department of Women's and Children's HealthPaediatrics oncologyUppsala UniversityUppsalaSweden
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Impact of oral mucositis on short-term clinical outcomes in paediatric and adolescent patients undergoing chemotherapy. Support Care Cancer 2013; 21:2145-52. [PMID: 23471538 DOI: 10.1007/s00520-013-1772-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 02/20/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this study is to determine the burden of the peak severity of oral mucositis and severity over time on selected clinical outcomes in paediatric and adolescent patients receiving chemotherapy. PATIENTS AND METHODS A multicentre study enrolled 140 patients between the ages of 6 and 18 years, who had been treated with chemotherapy and completed the self-report Mouth and Throat Soreness-related questions of the Oral Mucositis Daily Questionnaire for 14 days. Clinical data were collected from patients' medical records during the first 14 days after starting chemotherapy. RESULTS Forty-one percent developed oral mucositis. Multiple linear regression analysis revealed that oral mucositis was significantly associated with an increased loss of baseline body weight, after controlling for nausea/vomiting (β = 0.34, p = 0.002). Multiple logistic regression analysis showed that severe mucositis was significantly associated with a higher probability of fluid replacement, after controlling for nausea/vomiting (adjusted OR = 12.8; 95 % CI = 2.7-61.0; p = 0.001). In addition, severe mucositis was significantly associated with a higher probability of fever, after controlling for neutropoenia (adjusted OR = 5.4; 95 % CI = 1.8-15.4; p = 0.002). No difference was observed for oral or systemic infections among the subgroups. About 5 % of the patients with oral mucositis had delays in chemotherapy (≤ 7 days). None of the patients had dose modification or unplanned hospitalization due to oral mucositis. The associations of peak severity and overall oral mucositis with adverse clinical outcomes in paediatric and adolescent patients were equivalent. CONCLUSION Oral mucositis is associated with negative effects on clinical outcomes.
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Oral mucositis in pediatric and adolescent patients undergoing chemotherapy: the impact of symptoms on quality of life. Support Care Cancer 2011; 20:2335-42. [PMID: 22167295 DOI: 10.1007/s00520-011-1343-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 11/29/2011] [Indexed: 12/30/2022]
Abstract
GOALS OF WORK This study sought to characterize the range of oral symptoms and affect upon quality of life reported by pediatric and adolescent patients in relation to the severity of oral mucositis and symptom burden during chemotherapy. PATIENTS AND METHODS A multicenter study included 140 patients between 6 and 18 years of age who had been treated with chemotherapy. Participants completed the self-report Mouth and Throat Soreness-related Questions of the Oral Mucositis Daily Questionnaire (OMDQ) for 14 days and the Oral Mucositis-specific Quality of Life Measure (OMQoL) at baseline, day 7, and day 14. MAIN RESULTS The incidences of non-severe and severe mucositis were 23% (n = 32) and 18% (n = 25), respectively. The symptoms reported by the patients with oral mucositis were related to eating (82.4%), swallowing (78.9%), drinking (75.4%), sleeping (71.9%), and talking (43.9%). Approximately 39% (22 out of 57) of patients with mucositis reported at least two simultaneous symptoms resulting from oral mucositis. About a quarter of them (25%, 14 out of 57) reported having all five symptoms concurrently. The mean area under curve (AUC) scores for symptom severity were significantly higher in the severe mucositis group (mean 0.95 to 1.21; 95% CI 0.76 to 1.34) compared with the non-severe (mean 0.50 to 1.06; 95% CI 0.35 to 1.30) and the without mucositis (mean 0 to 0.09; 95% CI 0 to 0.12) groups (p < 0.001). Wald's method generated two clusters: a low-symptom group (n = 102; 72.9%) and a high-symptom group (n = 38; 27.1%). The high-symptom group reported significantly lower mean AUC OMQoL subscale scores (mean 62.2 to 79.2; 95% CI 55.9 to 88.2 versus mean 93.1 to 97.1; 95% CI 91.7 to 98.3, respectively; p < 0.001) and higher mean AUC distress score (mean 1.9 ± 0.5; 95% CI 1.7 to 2 versus mean 1.1 ± 0.2; 95% CI 1.1 to 1.1, respectively; p < 0.001) than the low-symptom group. Swallowing and sleeping had the strongest standardized coefficients in OMQoL subscale scores (swallowing: -0.321 to -0.767; sleeping: -0.406 to -0.773), as well as distress scores (0.468 and 0.557, respectively). CONCLUSIONS Severe oral mucositis is a common cause of morbidity in pediatric and adolescent patients undergoing chemotherapy. High-symptom burden due to mucositis may have profound impacts on patient quality of life and levels of psychological distress.
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Abstract
OBJECTIVE We aimed to review the pain management in 100 episodes of severe mucositis in children and determine the incidence of associated side effects. BACKGROUND Mucositis is a painful, debilitating condition affecting the alimentary mucosa and occurs following many anticancer treatments. Severe pain associated with mucositis may necessitate reductions, delays or termination of anticancer therapy and so intravenous morphine, preferably by patient-controlled analgesia (PCA) is the treatment of choice. METHODS Retrospective review of consecutive episodes of mucositis in children requiring intravenous opioid analgesia over a 3-year period (May 2006-April 2009). RESULTS In 24/92 (26%) of cases, morphine PCA provided insufficient pain relief and children required adjuvant ketamine therapy. These children had rapidly increasing morphine requirements approaching 1000 mcg/kg/day by day 2 (more than double compared with children on morphine alone), were more likely to be female, and tended to be older (median [IQR] age 12 [6-12] years vs 7 [3-14] years). The addition of ketamine to the morphine PCA appears to be associated with reduced morphine consumption, improved pain scores, causing minimal side effects and no hallucinations. CONCLUSIONS Children with severe mucositis who have escalating morphine requirements may benefit from the addition of ketamine to their morphine PCA.
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Cheng KKF, Lee V, Li CH, Goggins W, Thompson DR, Yuen HL, Epstein JB. Incidence and risk factors of oral mucositis in paediatric and adolescent patients undergoing chemotherapy. Oral Oncol 2011; 47:153-62. [DOI: 10.1016/j.oraloncology.2010.11.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 11/29/2010] [Accepted: 11/29/2010] [Indexed: 11/29/2022]
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Abstract
PURPOSE OF REVIEW Oral health is an integral part of the overall health of children. Pediatricians must be competent in issues of oral health and disease if they are to fulfill their role as professionals dedicated to the health of children. This review will update pediatricians on the epidemiology of child oral disease, highlight the importance of good oral health in special populations of children, and examine the role pediatricians can play in maintaining children's oral health. RECENT FINDINGS Dental caries continues to be a common chronic disease of childhood and has increased in the youngest age groups. Oral disease has implications beyond the mouth and can cause significant problems for children with other chronic diseases. Pediatricians receive very little education on oral health during their medical training and numerous barriers exist to incorporating oral health into practice. Despite these facts, opportunities exist to both increase knowledge and overcome the barriers to incorporating oral health into daily practice. Collaboration with other child health professionals to improve children's oral health will make the job of the pediatrician easier. SUMMARY Pediatricians have an opportunity to increase their knowledge of children's oral health, incorporate it into their daily clinical routine, and improve the overall health of children.
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