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Ono K, Ueno T, Kido MA, Hitomi S, Naniwa M, Nakatomi C, Yoshimoto RU, Sawada T, Kato T. Recent advances in the treatment of oral ulcerative mucositis from clinical and basic perspectives. J Oral Biosci 2024; 66:504-510. [PMID: 38866365 DOI: 10.1016/j.job.2024.06.002] [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: 04/22/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Oral ulcerative mucositis (OUM) is common in patients with cancer, particularly in those undergoing chemoradiation therapy. The effective management of OUM is crucial for continuous cancer care and patient well-being. Recent studies have advanced our understanding of the causes, leading to clinical trials toward novel treatments. This review focuses on the contemporary therapeutic landscape, and provides the latest insights into the mechanisms of mucosal healing and pain. HIGHLIGHTS Management strategies for OUM in patients with cancer include maintaining good oral hygiene, reducing mucosal irritation against radiation, and using various topical analgesic treatments, including herbal medicines. However, the current management practices have limitations that necessitate the development of more efficacious and novel treatments. Molecular research on transient receptor potential (TRP) channels in the oral mucosa is crucial for understanding the mechanisms of wound healing and pain in patients with OUM. Targeting TRPV3 and TRPV4 can enhance wound healing through re-epithelialization. The suppression of TRPV1, TRPA1, and TRPV4 may be effective in alleviating OUM-induced pain. CONCLUSION Research advancements have improved our understanding and potentially led to novel treatments that offer symptomatic relief. This progress highlights the importance of collaborations between clinical researchers and scientists in the development of innovative therapies.
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Affiliation(s)
- Kentaro Ono
- Division of Physiology, Kyushu Dental University, Fukuoka, Japan.
| | - Takao Ueno
- Dentistry, National Cancer Center Hospital, Tokyo, Japan
| | - Mizuho A Kido
- Department of Anatomy and Physiology, Faculty of Medicine, Saga University, Japan
| | - Suzuro Hitomi
- Department of Physiology, Nihon University School of Dentistry, Tokyo, Japan
| | - Mako Naniwa
- Department of Oral Health Sciences, Kyushu University of Nursing and Social Welfare, Kumamoto, Japan
| | - Chihiro Nakatomi
- Division of Physiology, Kyushu Dental University, Fukuoka, Japan
| | - Reiko U Yoshimoto
- Department of Anatomy and Physiology, Faculty of Medicine, Saga University, Japan
| | - Takeshi Sawada
- Department of Anatomy and Physiology, Faculty of Medicine, Saga University, Japan
| | - Takafumi Kato
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Osaka, Japan
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Zhang L, Luo Y, Long J, Yin Y, Fu Q, Wang L, Patil S. Enhancing Standardized Practices for Oral Mucositis Prevention in Pediatric Hematopoietic Stem Cell Transplantation: A Best Practice Implementation Project. Risk Manag Healthc Policy 2024; 17:1909-1920. [PMID: 39130104 PMCID: PMC11316476 DOI: 10.2147/rmhp.s471877] [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: 04/02/2024] [Accepted: 07/31/2024] [Indexed: 08/13/2024] Open
Abstract
Background Oral mucositis (OM) poses a significant challenge in children undergoing hematopoietic stem cell transplantation (HSCT). There is a gap between clinical practice and the evidence, and nursing practices is not standardized. Objective This study aims to evaluate the effectiveness of applying the evidence for preventing HSCT chemotherapy-induced OM in children and to elevate the nurses' compliance to the evidence. Methods Following the clinical evidence practice application model of the Joanna Briggs Institute (JBI) evidence-Based Care Center. The process included reviewing literature, extracting evidence, identifying gaps, developing audit criteria, conducting a baseline audit, creating an action plan, implementing evidence-based interventions, and assessing outcomes. Results After the evidence implementation, 6 out of 12 audit criteria with poor compliance are significantly improved, with statistically significant differences (P<0.05). The incidence of OM decreases, with a statistically significant difference (66.6% vs 36.7%, P=0.02). The incidence of grade I, II, III, and IV OM also decreases (30% vs 23.3%, 23.3% vs 13.4%, 10% vs 0%, and 3.3% vs 0%). Ultimately, the standardized oral care practice routine and workflows to prevent OM were established. Conclusion Bridging the gap between evidence and clinical practice can standardize nurse behavior, decrease the incidence of OM, and lower the OM severity in children undergoing HSCT.
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Affiliation(s)
- Luyang Zhang
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Yuan Luo
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Jiewen Long
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Yan Yin
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Qin Fu
- Department of Nursing, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Lei Wang
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Sandip Patil
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
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Huang X, Qin X, Huang W, Huang B. The predictive value of hematological inflammatory markers for severe oral mucositis in patients with nasopharyngeal carcinoma during intensity-modulated radiation therapy: A retrospective cohort study. Curr Probl Cancer 2024; 51:101117. [PMID: 38945022 DOI: 10.1016/j.currproblcancer.2024.101117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 05/12/2024] [Accepted: 06/26/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND This study aims to investigate the predictive value of the circulating blood cell count, including neutro-philto-lymphocyte ratio (NLR), platelet-to-lymphocyte (PLR), and thesystemic inflammation index (SII) for the development of severe oral mucositis (SOM) induced by radiation in patients undergoing radiotherapy for nasopharyngeal carcinoma (NPC). METHODS In this retrospective study, 142 NPC patients were screened, and based on mucositis toxicity grade, they were categorized into two groups: SOM and nonSOM. Peripheral blood cell counts were conducted prior to Intensity-Modulated Radiation Therapy (IMRT). Associations between blood cell count, NLR, PLR, SII, and SOM occurrence were examined. RESULTS Revealed elevated NLR and SII levels, along with reduced lymphocyte (LYM), eosinophil (EOS), and basophil (BAS) in patients with SOM. LYM, EOS, BAS, NLR, and SII were effective predictors of the severity of radiation-induced oral mucositis (RIOM) in NPC patients. CONCLUSIONS The occurrence of SOM was strongly linked to the hematological status at the start of Radiation Therapy (RT). Integrating BAS count and NLR into comprehensive risk prediction models could prove valuable for predicting SOM in NPC patients.
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Affiliation(s)
- Xiaoxian Huang
- Clinical Laboratory, Guangxi Orthopaedic Hospital, 32 Xinmin Rd, Nanning, Guangxi 530016, PR China
| | - Xinling Qin
- Department of Radiation Oncology, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Rd, Nanning, Guangxi 530021, PR China; Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, Guangxi 530021, PR China
| | - Weimei Huang
- Department of Radiation Oncology, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Rd, Nanning, Guangxi 530021, PR China; Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, Guangxi 530021, PR China
| | - Ben Huang
- Clinical Laboratory, Guangxi Orthopaedic Hospital, 32 Xinmin Rd, Nanning, Guangxi 530016, PR China.
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Paiva DL, Oliveira VR, Bagnato VS, Simões A. Long-term survival of cancer patients after photobiomodulation therapy for prevention and treatment of oral mucositis. Photodiagnosis Photodyn Ther 2024; 48:104248. [PMID: 38944404 DOI: 10.1016/j.pdpdt.2024.104248] [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: 09/11/2023] [Revised: 05/28/2024] [Accepted: 06/12/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Photobiomodulation therapy (PBMT) has been employed for the prevention and treatment of oral mucositis in patients with head and neck cancer undergoing treatment. However, information about the survival of patients receiving PBMT is still lacking. Therefore, the aim of this study was to correlate the survival of patients who either received or did not receive PBMT, combined with cancer treatments, and to assess whether the number of PBMT sessions had a positive impact on survival. METHODS The records of 751 patients seen at Hospital de Caridade São Vicente de Paulo diagnosed with head and neck cancer, treated by D.L.P., the sole operator of PBMT, between 2000 and 2016, were analyzed. The median survival rates were compared by analyzing diagnostic staging, the combination of cancer treatments, and the number of PBMT sessions. Correlation analyses were performed to assess the interactions between the number of PBMT sessions and survival. RESULTS PBMT increased survival by 55.14 %, from 1.07 (Without PBMT) to 1.66 years (With PBMT) for the total population and more significantly in Group 41 (stages III and IV, radiation therapy/chemotherapy, with more than five PBMT sessions), the median survival value of 1.83 years, which represents a 66.36 % higher survival rate. In all the analyzed populations, the larger number of sessions was associated with better survival. In terms of survival, advanced stages III and IV almost equated with stages I and II in the absence of PBMT. CONCLUSIONS PBMT seems to interfere with the survival of patients with head and neck cancer, corroborating its recommendation for the treatment of mucositis, but further research is needed to investigate possible synergistic effects between PBMT and cancer treatments.
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Affiliation(s)
- Deise Luciane Paiva
- Biomaterials and Oral Biology Department, School of Dentistry, University of São Paulo, Av. Prof. Lineu Prestes, 2227, Cidade Universitária, 05508-000, São Paulo, SP, Brazil.
| | | | - Vanderlei Salvador Bagnato
- São Carlos Institute of Physics, University of São Paulo, Av. Trab. São Carlense,400, Parque Arnold Schimidt,13566-590, São Carlos, Brazil. BME-Texas A&M University - College Station TX USA.
| | - Alyne Simões
- Biomaterials and Oral Biology Department, School of Dentistry (FOUSP-São Paulo), Av. Prof.Lineu Prestes, 2227, Cidade Universitária, 05508-000, São Paulo, SP, Brazil.
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Zuo F, Li T, Chen Y, Wen M, Cao H. Knowledge, attitudes, barriers and practices concerning cancer therapy-associated oral mucositis amongst oncology nurses: A mixed methods systematic review. Asia Pac J Oncol Nurs 2024; 11:100542. [PMID: 39148938 PMCID: PMC11325665 DOI: 10.1016/j.apjon.2024.100542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/17/2024] [Indexed: 08/17/2024] Open
Abstract
Objectives To evaluate oncology nurses' knowledge, attitudes, barriers and practices regarding the prevention and management of cancer therapy-associated oral mucositis. Methods A systematic review was conducted by mixed-methods; searches were conducted in PubMed, EMBASE, Medline, CINAHL, Cochrane Library and Web of Science databases. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed for the systematic review. Searched relevant literature published in English between January 2000 and December 2023. The Mixed Methods Appraisal Tool was used to evaluate the quality of the studies. Results A total of 15 studies were included: 10 cross-sectional studies, 4 non-randomized controlled trials, and one qualitative study. This review provides an overview of the studies: nurses had limited knowledge of cancer therapy-associated oral mucositis; generally positive attitudes towards oral care; there is a slight difference in oral care practices. The main barriers of nurses' prevention and management of cancer therapy-associated oral mucositis were lack of time, lack of knowledge, and lack of staff. Conclusions Our results highlight the importance of training for oncology nurses regarding the management of cancer therapy-associated oral mucositis. It is suggested that oncology nurses should focus on strengthening and continuing education in oral care, adopting evidence-based practice and evaluation systems, implementing institution-specific written standards for oral care protocols, and promoting multidisciplinary team cooperation.
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Affiliation(s)
- Feifei Zuo
- VIP Inpatient Department, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Tong Li
- VIP Inpatient Department, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Ying Chen
- VIP Inpatient Department, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Mianmian Wen
- VIP Inpatient Department, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Huijiao Cao
- VIP Inpatient Department, Sun Yat-Sen University Cancer Center, Guangzhou, China
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Raber-Durlacher JE, Zadik Y, Treister NS, Stempler N, Bruno JS, Epstein JB, Elad S. MASCC/ISOO clinical practice statement: Current understanding on controversies in basic oral care in hemato-oncology and hematopoietic cell transplantation. Support Care Cancer 2024; 32:550. [PMID: 39048882 PMCID: PMC11269443 DOI: 10.1007/s00520-024-08690-1] [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: 06/07/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE A MASCC/ISOO Clinical Practice Statement (CPS) is aimed at generating a concise tool for clinicians, which concentrates on practical information needed for the management of oral complications of cancer patients. This CPS is focused on the current understanding of controversies that may arise while providing basic oral care in hemato-oncology patients and hematopoietic cell transplantation recipients (HCT). The CPS will summarize and elucidate controversies that have appeared in the literature and professional discussions. METHODS This CPS was developed based on a critical evaluation of the literature followed by a structured discussion of a group of leading experts, members of the Oral Care Study Group of MASCC/ISOO. The information is presented in the form of succinct bullets to generate a short manual about the best standard of care. RESULTS Controversies about the use of chlorhexidine (CHX) oral rinse, mechanical dental plaque removal procedures, the need for toothbrush replacement during phases of low blood cell counts, and the use of lidocaine mouthwash for oral pain were identified and discussed. Consensus about the best standard of care was outlined. CONCLUSION The following ratifications are applicable for oral care in hemato-oncology patients and patients undergoing HCT: (1) CHX may reduce the risk of oral infections, although it was not found to reduce the risk of oral mucositis. (2) Toothbrushing and proficient interproximal cleaning should not be discouraged during HCT. (3) Toothbrushes do not need to be replaced daily and are preferred over cleansing swabs. (4) Lidocaine rinse, swish and spit, may be considered to palliate oral mucosal pain if applied in a certain manner.
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Affiliation(s)
- Judith E Raber-Durlacher
- Department of Oral Medicine, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands.
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Yehuda Zadik
- Department of Oral Medicine and Saligman Clinics, Faculty of Dental Medicine, The Hebrew University of Jerusalem, and Hadassah Medical Center, Jerusalem, Israel
| | - Nathaniel S 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
| | - Noa Stempler
- Oral Medicine Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Julia S Bruno
- Molecular Oncology Center-Hospital Sírio-Libanês, São Paulo, Brazil
| | - Joel B Epstein
- Dental Oncology Service, City of Hope Comprehensive Cancer Center, Duarte, CA and Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Sharon Elad
- Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
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Peterson DE, Stout NL, Shulman LN, Perkins J, LeMarier G, Nekhlyudov L. Gaps in Access to Medically Necessary Dental Care for Patients Living With and Beyond Cancer: We Must Do Better. J Clin Oncol 2024; 42:2495-2499. [PMID: 38630949 DOI: 10.1200/jco.24.00162] [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: 01/26/2024] [Revised: 02/23/2024] [Accepted: 03/01/2024] [Indexed: 04/19/2024] Open
Abstract
Delivery of high-quality, evidence-based oral care for those living with and beyond cancer needed!
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Affiliation(s)
- Douglas E Peterson
- Department of Oral & Maxillofacial Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT
| | - Nicole L Stout
- School of Medicine, West Virginia University Cancer Institute, Morgantown, WV
- School of Public Health, West Virginia University, Morgantown, WV
| | - Lawrence N Shulman
- Center for Global Cancer Medicine, Innovation Faculty, Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Jennifer Perkins
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of California San Francisco, San Francisco, CA
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Shirazian S, Mohseni A, Pourshahidi S, Alaeddini M, Etemad-Moghadam S, Vatanpour M. The effect of different parameters of low-level laser used in the treatment of oral mucositis, on the viability and apoptosis of oral squamous cell carcinoma cells: In vitro study. Photochem Photobiol 2024. [PMID: 39032055 DOI: 10.1111/php.13997] [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: 01/14/2024] [Revised: 06/23/2024] [Accepted: 06/26/2024] [Indexed: 07/22/2024]
Abstract
Oral mucositis is a complication of chemo/radiotherapy. To assess the impact of various power levels of diode-laser on the survival and expression of apoptosis-related genes in oral cancer cells, it is crucial to consider the potential existence of malignant cells within the treatment region and the reliance of laser effectiveness on its specific characteristics. Cal-27 cells were cultivated and exposed to a 660 nm-diode-laser at power levels of 20, 40, and 80 mW, alongside non-irradiated control cells. Viability and expression of Bax and Bcl-2 mRNA were assessed with Methyl Thiazolyl Tetrazolium (MTT) and Real-time Polymerase Chain Reaction (RT-PCR), respectively. The results were analyzed using one-way ANOVA and Tukey post-hoc test (p < 0.05). A significant reduction in viability was found only in the 20 mW group compared to controls (p = 0.001). Cell survival was significantly lower in cells receiving 20 mW laser than those treated with 40 and 80 mW (p < 0.05). None of the laser groups showed significant changes in BcL-2, but Bax was significantly lower in cells receiving 40 and 80 mW (p < 0.05), compared to controls. Laser irradiation at 660 nm (2 J/cm2, 30 s) significantly reduced the viability of oral cancer cells when using 20 mW power. These specifications align with the recommendation that the lowest possible laser dose should be applied for treating cancer patients. The exact mechanism of cell death following laser therapy with these specifications requires further investigation.
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Affiliation(s)
- Shiva Shirazian
- Department of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Atieh Mohseni
- Student of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Pourshahidi
- Department of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojgan Alaeddini
- Oral and Maxillofacial Pathology, Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahroo Etemad-Moghadam
- Oral and Maxillofacial Pathology, Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Vatanpour
- Department of Endodontics, Tehran Dental Branch, Islamic Azad University, Tehran, Iran
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Saito Y, Takekuma Y, Takahashi M, Oshino T, Sugawara M. Association of oral mucositis induced by anthracycline-cyclophosphamide and subsequent docetaxel treatment for perioperative breast cancer. Support Care Cancer 2024; 32:513. [PMID: 39001936 DOI: 10.1007/s00520-024-08733-7] [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: 04/09/2024] [Accepted: 07/10/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE Anthracycline-cyclophosphamide followed by docetaxel-containing chemotherapy is effective for perioperative breast cancer treatment. However, these treatments frequently induce oral mucositis (OM), with an incidence ranging from 20 to 50%. The association of OM development between different chemotherapeutic treatments remains unclear. Consequently, this study aimed to compare OM development during docetaxel-containing chemotherapy between patients with and without OM experience during previous anthracycline-cyclophosphamide treatments to assess the association between OM development and treatment regimens. METHODS Seventy-two patients with breast cancer receiving anthracycline-cyclophosphamide followed by docetaxel-containing chemotherapy as a perioperative treatment were categorized into the control (no prior OM experience with anthracycline-cyclophosphamide) and OM-experience (OM development during previous treatment) groups and retrospectively evaluated. The primary endpoint was the incidence of all-grade OM in the first docetaxel-containing chemotherapy cycle. Additionally, the incidences of OM and dysgeusia during all treatment cycles and factors associated with the incidence of OM were evaluated. RESULTS The incidence of all-grade OM in the first cycle was significantly higher in the OM-experience group (54.2%) than in the control group (10.4%; P < 0.0001). Furthermore, its incidence in all treatment cycles was higher in the OM-experience group (66.7%) than in the control group (12.5%, P < 0.0001). However, the incidence of dysgeusia did not differ between the groups. Multivariate logistic regression analysis revealed OM experience during previous anthracycline-cyclophosphamide treatment and concomitant pertuzumab use as independent risk factors for OM development in subsequent docetaxel-containing chemotherapy. CONCLUSION Our study suggests that patients experiencing OM with anthracycline-cyclophosphamide during perioperative breast cancer treatment exhibit symptoms following subsequent docetaxel-containing chemotherapy.
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Affiliation(s)
- Yoshitaka Saito
- Department of Clinical Pharmaceutics & Therapeutics, Faculty of Pharmaceutical Sciences, Hokkaido University of Science, 4-1, Maeda 7-Jo 15-Chome, Teine-Ku, Sapporo, 006-8585, Japan.
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-Jo, Nishi 5-Chome, Kita-Ku, Sapporo, 060-8648, Japan.
| | - Yoh Takekuma
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-Jo, Nishi 5-Chome, Kita-Ku, Sapporo, 060-8648, Japan
| | - Masato Takahashi
- Department of Breast Surgery, Hokkaido University Hospital, Kita 14-Jo, Nishi 5-Chome, Kita-Ku, Sapporo, 060-8648, Japan
| | - Tomohiro Oshino
- Department of Breast Surgery, Hokkaido University Hospital, Kita 14-Jo, Nishi 5-Chome, Kita-Ku, Sapporo, 060-8648, Japan
| | - Mitsuru Sugawara
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-Jo, Nishi 5-Chome, Kita-Ku, Sapporo, 060-8648, Japan
- Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University, Kita 12-Jo, Nishi 6-Chome, Kita-Ku, Sapporo, 060-0812, Japan
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Abdalla-Aslan R, Keegan R, Zadik Y, Yarom N, Elad S. Recent advances in cancer therapy-associated oral mucositis. Oral Dis 2024. [PMID: 38968169 DOI: 10.1111/odi.14999] [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: 04/01/2024] [Revised: 04/25/2024] [Accepted: 05/02/2024] [Indexed: 07/07/2024]
Abstract
Oral mucositis (OM) is a common and debilitating toxicity of cancer treatments - chemotherapy, radiotherapy, hematopoietic cell transplant, or combinations. OM is associated with severe oral pain and has negative impacts on patient function and quality of life. Additionally, OM has accompanying systemic complications that may have critical implications. These local and systemic consequences can alter cancer treatment, and add an economic burden. This review covers the clinical presentation and course of OM, differential diagnosis, clinical and economic impacts, pathogenesis, risk factors, assessment measures, biomarkers and prediction of OM, management, research advances in the development of new drugs and treatments, and big data.
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Affiliation(s)
- Ragda Abdalla-Aslan
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Rebeca Keegan
- General Dentistry, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | - Yehuda Zadik
- Department of Oral Medicine, and Saligman Clinics, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
| | - Noam Yarom
- Oral Medicine Unit, Sheba Medical Center, Tel Hashomer, Israel
- The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Health and medical sciences, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Elad
- Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
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Kubo A, Sakai K, Ueki S, Fujita K. Effect of perioperative oral care on postoperative infections in patients with cancer: A systematic review and meta-analysis. Jpn J Nurs Sci 2024; 21:e12600. [PMID: 38757361 DOI: 10.1111/jjns.12600] [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: 11/09/2023] [Revised: 02/19/2024] [Accepted: 04/08/2024] [Indexed: 05/18/2024]
Abstract
AIM This systematic review aimed to assess the effect of non-pharmacologic perioperative oral hygiene care on reduced incidence of postoperative pneumonia (PP), surgical site infection (SSI), and the length of hospital stay in patients with cancer, and to describe the details of oral hygiene care. METHODS We searched seven databases. Eligibility criteria were based on perioperative oral hygiene care provided by healthcare professionals to patients aged ≥18 years who were surgically treated under general anesthesia and were evaluated for the incidence of PP and SSI. We reported risk ratios (RR) for dichotomous outcomes for PP and SSI using a fixed-effects model of meta-analysis. RESULTS The search resulted in 850 articles, among which two were randomized controlled trials (RCTs) and 21 were observational studies. Most studies indicated that dentists and medical care providers performed a combination of oral cleaning, and oral hygiene instructions. In RCTs, perioperative oral hygiene care significantly reduced the incidence of PP (RR, 0.86; p = .60), while in observational studies, perioperative oral hygiene care significantly reduced the incidence of PP (RR, 0.55; p < .001) and SSI (RR, 0.47; p < .001). The length of hospital stay was also significantly reduced (p < .05). However, the effectiveness of nursing intervention was not clear. CONCLUSIONS Perioperative oral hygiene care implemented by healthcare professionals prevented PP and SSI and reduced length of hospital stays for patients after cancer surgery. As daily perioperative oral hygiene care is performed by nurses, it is necessary to research the effects of oral hygiene by nurses in the future.
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Affiliation(s)
- Aoi Kubo
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kumiko Sakai
- Department of Health Sciences, Graduate School of Medicine, Kyushu university, Fukuoka, Japan
| | - Shingo Ueki
- Department of Health Sciences, Graduate School of Medicine, Kyushu university, Fukuoka, Japan
| | - Kimie Fujita
- Department of Health Sciences, Graduate School of Medicine, Kyushu university, Fukuoka, Japan
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12
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Ardahan Sevgili S, Şenol S. The Effect of Gastrointestinal Mucositis Care Training Given to Pediatric Leukemic Patients and Caregivers on Mucosal Barrier Injury. Cancer Nurs 2024:00002820-990000000-00268. [PMID: 38949311 DOI: 10.1097/ncc.0000000000001385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
BACKGROUND Management of chemotherapy-induced mucosal barrier damage and oral/anal mucositis in leukemia is challenging. OBJECTIVE The aim of this study was to investigate the effect of mucositis care training given to children receiving leukemia treatment and their caregivers on caregiver knowledge and skills, the development of gastrointestinal mucositis in children, the mean oral mucositis area in children, and the mucosal barrier injury laboratory-confirmed bloodstream infection in the clinic. METHODS A stepped-wedge, quasi-experimental, unpaired control group design was used. The participants in the control group were given routine training, and the intervention group members were given mucositis care training in accordance with the guideline recommendations. RESULTS No significant difference was found between groups in developing anal mucositis, but a significant difference in developing oral mucositis was documented, with the mean mucositis area of children being 8.36 ± 3.97 cm2 in the control group and 4.66 ± 2.90 cm2 in the intervention group. The mucosal barrier injury laboratory-confirmed bloodstream infection ratio was 4 per 1000 catheter days in the control group and 3 per 1000 catheter days in the intervention group. CONCLUSION Mucositis care training had a significant positive effect on caregivers' knowledge and skills, the development of oral mucositis, and the mean oral mucositis area in children. However, the training had no effect on the development of anal mucositis or the infection rate in the clinic. IMPLICATIONS FOR PRACTICE Nurses might increase the knowledge and skill levels of caregivers with training on mucositis care, prevent the development of mucositis, and reduce the mean mucositis area. Training might also contribute to the reduction in the infection rate of the clinic.
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Affiliation(s)
- Seda Ardahan Sevgili
- Author Affiliations: Pediatric Nursing Department, Faculty of Nursing, Ege University (Dr Ardahan Sevgili), Izmir; and Department of Pediatric Nursing, Faculty of Health Sciences, Kütahya Health Sciences University (Dr Şenol), Turkey
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13
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Xu X, Zheng X, Lin F, Yu Q, Hou B, Chen Z, Wei X, Qiu L, Wenxia C, Li J, Chen L, Wang Z, Wu H, Lu Z, Zhao J, Liang Y, Zhao J, Pan Y, Pan S, Wang X, Yang D, Ren Y, Yue L, Zhou X. Expert consensus on endodontic therapy for patients with systemic conditions. Int J Oral Sci 2024; 16:45. [PMID: 38886374 PMCID: PMC11183232 DOI: 10.1038/s41368-024-00312-0] [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: 03/07/2024] [Revised: 04/13/2024] [Accepted: 05/10/2024] [Indexed: 06/20/2024] Open
Abstract
The overall health condition of patients significantly affects the diagnosis, treatment, and prognosis of endodontic diseases. A systemic consideration of the patient's overall health along with oral conditions holds the utmost importance in determining the necessity and feasibility of endodontic therapy, as well as selecting appropriate therapeutic approaches. This expert consensus is a collaborative effort by specialists from endodontics and clinical physicians across the nation based on the current clinical evidence, aiming to provide general guidance on clinical procedures, improve patient safety and enhance clinical outcomes of endodontic therapy in patients with compromised overall health.
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Affiliation(s)
- Xin Xu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xin Zheng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Fei Lin
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Peking University, Beijing, China
| | - Qing Yu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Oral Diseases, Department of Operative Dentistry & Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Benxiang Hou
- Center for Microscope Enhanced Dentistry, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Zhi Chen
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Xi Wei
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Lihong Qiu
- Department of Endodontics, School of Stomatology, China Medical University, Shenyang, China
| | - Chen Wenxia
- College & Hospital of Stomatology, Guangxi Medical University, Nanning, China
| | - Jiyao Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lili Chen
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zuomin Wang
- Department of Stomatology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hongkun Wu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Geriatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhiyue Lu
- Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Jizhi Zhao
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuhong Liang
- Department of Emergency, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Jin Zhao
- Department of Endodontics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yihuai Pan
- Department of Endodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, China
| | - Shuang Pan
- Department of Endodontics, The First Affiliated Hospital of Harbin Medical University & Department of Endodontics, School of Stomatology, Harbin Medical University, Harbin, China
| | - Xiaoyan Wang
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Peking University, Beijing, China
| | - Deqin Yang
- Department of Conservative Dentistry and Endodontics, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Yanfang Ren
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA.
| | - Lin Yue
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Peking University, Beijing, China.
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Sharif H, Hammash M, Anwer W, Hassan N, Seemi T, Sheikh SS. Evaluation of oral health among people with multimorbidity in the marginalized population of Karachi, Pakistan: A multicenter cross-sectional study. J Taibah Univ Med Sci 2024; 19:500-515. [PMID: 38571699 PMCID: PMC10987933 DOI: 10.1016/j.jtumed.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/12/2024] [Accepted: 03/13/2024] [Indexed: 04/05/2024] Open
Abstract
Background Oral health is linked to physical and mental well-being. Oral disease is common among poor and socioeconomically disadvantaged people in developing and industrialized countries. Objectives This study assessed the oral health disease burden among people with multimorbidity in marginalized populations. Methods This cross-sectional study was conducted across 16 locations in the slums of Karachi, Pakistan, to assess oral health disease problems among adults aged 18 to 70 with comorbidity or multimorbidity. The questionnaire covered the socioethnic, demographic, and disease status of people with oral health status. Data analyses were performed using SAS version 9.4. Results Of the 16 designated slum locations, 870 individuals were considered for oral health screening. Gingivitis was highly prevalent, 29% among slum dwellers with multimorbidity of diabetes, hepatitis, and hypertension. Dandasa was widely used as a tooth-cleansing agent in 35% of the study population. By contrast, 45.4% of people showed unsatisfactory oral hygiene conditions. Pathan ethnicity showed the highest prevalence (i.e., 29.8% of dental problems with disease multimorbidity in 26.8% of Baldia Town residents of Karachi). Of the 870 individuals, the highest frequency of dental problems was found in the age group of 18-38 years (28-42.9%) and among female participants (53.8%). Conclusion There is an urgent need for the global enhancement of public health programs, specifically focusing on implementing effective strategies to prevent oral illnesses, promote oral health, and address other chronic diseases in basic healthcare settings. Enhancing oral health poses significant difficulties, especially in less developed nations.
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Affiliation(s)
- Hina Sharif
- Research & Publication Department, SINA Health Education & Welfare Trust, Karachi, Pakistan
- Community Health Sciences Department, the Aga Khan University, Karachi, Pakistan
| | - Muhammad Hammash
- Community Health Sciences Department, the Aga Khan University, Karachi, Pakistan
- Dow University of Health Sciences, Karachi, Pakistan
| | - Wajiha Anwer
- Community Health Sciences Department, the Aga Khan University, Karachi, Pakistan
- Dow University of Health Sciences, Karachi, Pakistan
| | - Nayma Hassan
- Karachi Medical and Dental College, Karachi, Pakistan
| | - Tooba Seemi
- Research & Publication Department, SINA Health Education & Welfare Trust, Karachi, Pakistan
| | - Sana S. Sheikh
- Research & Publication Department, SINA Health Education & Welfare Trust, Karachi, Pakistan
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
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15
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Lim AR, Park W, Moon SJ, Kim MS, Lee S. The trend of dental check-up and prevalence of dental complications following the use of bone modifying agents in patients with metastatic breast and prostate cancer: analysis of data from the Korean National Health Insurance Service. BMC Health Serv Res 2024; 24:412. [PMID: 38566103 PMCID: PMC10988945 DOI: 10.1186/s12913-024-10859-7] [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: 02/27/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Bone-modifying agents (BMA) are key components in the management of cancer patients with bone metastasis. Despite their clinical benefits, the use of BMA is associated with dental adverse events (AEs) including medication-related osteonecrosis of the jaw (MRONJ). This study investigated the frequency of dental surveillance before BMA treatment and the prevalence of dental AEs including MRONJ, after BMA treatment in patients with bone metastasis from breast and prostate cancer using data from the national health insurance system. METHODS Data, including age, cancer diagnosis, administered BMA, and dental AEs during cancer treatment, of patients with bone metastasis from breast and prostate cancer who received at least one infusion of BMA between 2007 and 2019 were extracted from the Korean National Health Insurance Service (KNHIS) dataset. RESULTS Of the 15,357 patients who received BMA, 1,706 patients (11.1%) underwent dental check-ups before BMA treatment. The proportion of patients receiving dental check-up increased from 4.4% in 2007 to 16.7% in 2019. Referral to dentists for a dental check-up was more active in clinics/primary hospitals than general/tertiary hospitals, and medical doctors and urologists actively consulted to dentists than general surgeons, regardless of the patient's health insurance status. After BMA treatment, 508 patients (3.8%) developed dental AEs, including abscess (42.9%), acute periodontitis (29.7%), acute pericoronitis (14.9%), and MRONJ (12.5% of dental AEs cases, 0.5% of total BMA treated patients). CONCLUSIONS Considering the long treatment period in patients with metastatic cancer, coordination between dentists and oncologists is necessary to ensure appropriate dental management before the initiation of BMA.
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Affiliation(s)
- Ah Reum Lim
- Division of Medical Oncology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, 02841, Seoul, Korea
| | - Wonse Park
- Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, Korea
| | - Seok Joo Moon
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Min Sun Kim
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Soohyeon Lee
- Division of Medical Oncology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, 02841, Seoul, Korea.
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16
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Kawakami M, Ueda N, Yamaki K, Aoki K, Wakai N, Tamamoto T, Asakawa I, Kirita T. Effectiveness of intraoral stents in reducing oral adverse events during radiotherapy for maxillary or nasal cavity malignant tumors. Support Care Cancer 2024; 32:150. [PMID: 38329552 DOI: 10.1007/s00520-024-08340-6] [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: 04/05/2023] [Accepted: 01/22/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE Many patients experience oral adverse events during head and neck cancer radiotherapy (RT). The methods of management of such events are under debate. One such technique is the intraoral stent (IOS) technique, which removes normal tissue from the irradiation field. This retrospective study examined the factors associated with the occurrence of oral mucositis (OM) and dysgeusia and the efficacy of IOSs in preventing them. METHODS Twenty-nine patients who underwent RT in the maxilla or nasal cavity between 2016 and 2022 were included. They were investigated for background characteristics, treatment factors (IOS and dose-volume histogram), and oral adverse events (OM and dysgeusia). RESULTS Significant risk factors for the incidence of grade ≥ 2 (Common Terminology Criteria for Adverse Events v5.0) OM were the non-use of IOSs (p = 0.004) and diabetes (p = 0.025). A significant risk factor for the incidence of grade ≥ 1 dysgeusia was concomitant chemotherapy (p = 0.019). The radiation dose to the tongue was significantly lower in the IOS group than in the non-IOS group. CONCLUSION Our findings suggest that the use of an IOS during RT reduces the severity of OM by reducing irradiation to the tongue. Therefore, the use of an IOS is recommended during RT performed in the maxilla or nasal cavity.
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Affiliation(s)
- Mao Kawakami
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, 634-8522, Japan
| | - Nobuhiro Ueda
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, 634-8522, Japan.
| | - Kaori Yamaki
- Department of Radiation Oncology, Nara Medical University, Kashihara, 634-8522, Japan
| | - Kumiko Aoki
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, 634-8522, Japan
| | - Nobuhide Wakai
- Department of Radiation Oncology, Nara Medical University, Kashihara, 634-8522, Japan
| | - Tetsuro Tamamoto
- Department of Radiation Oncology, Nara Medical University, Kashihara, 634-8522, Japan
- Department of Medical Informatics, Nara Medical University Hospital, Kashihara, 634-8522, Japan
| | - Isao Asakawa
- Department of Radiation Oncology, Nara Medical University, Kashihara, 634-8522, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, 634-8522, Japan
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Sajwani AI, AlShdaifat M, Hashi F, Abdelghany E, Alananzeh I. The intersection of oncology and oral health: exploring nurses' insights and practices - a systematic review. Support Care Cancer 2024; 32:138. [PMID: 38289506 PMCID: PMC10827822 DOI: 10.1007/s00520-024-08317-5] [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: 07/06/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE Oral health care for cancer patients is essential but often overlooked. Nurses play a critical role in assessing and managing oral health in this population. This systematic review aims to examine nurses' knowledge, attitudes, and practices regarding oral healthcare in cancer patients. METHODS A systematic review was conducted following the Joanna Briggs Institute methodology. Qualitative and quantitative studies focused on nurses' knowledge, attitudes, and practices in oral healthcare for cancer patients. Seven databases were searched for studies published between January 2000 and January 2023. The primary outcomes of interest were patient satisfaction, quality of life, and nurses' knowledge, attitudes, and practices related to oral healthcare. RESULTS The review identified gaps in nurses' knowledge and training in oral healthcare for cancer patients. Insufficient understanding of oral diagnoses, treatment protocols, and pediatric oral care was noted. Lack of knowledge and skills posed barriers to implementation. Some healthcare providers demonstrated low awareness of oral health recommendations, including the use of fluoridated toothpaste and the need for dental referrals. Referrals to dental services and regular oral assessments were infrequent. Attitudes towards oral healthcare varied, with providers feeling more comfortable in certain areas than others. CONCLUSION Enhancing nurses' knowledge, attitudes, and practices in oral healthcare for cancer patients is crucial. Targeted educational initiatives and interventions are needed to address these gaps. By improving nurses' understanding of oral complications and management approaches, patient outcomes and quality of life can be improved. REGISTRATION PROSPERO International prospective register of systematic reviews, ID: CRD42022368053.
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Affiliation(s)
| | - Mohammad AlShdaifat
- School of Nursing, University of Wollongong Dubai, Dubai, United Arab Emirates
| | - Fatima Hashi
- School of Nursing, University of Wollongong Dubai, Dubai, United Arab Emirates
| | - Eman Abdelghany
- Waist Health Center, Primary Health Care Centers, Sharjah Health Services, Sharjah, United Arab Emirates
| | - Ibrahim Alananzeh
- School of Nursing Faculty of Science, Medicine & Health, University of Wollongong, Dubai, United Arab Emirates.
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Garutti M, Noto C, Pastò B, Cucciniello L, Alajmo M, Casirati A, Pedrazzoli P, Caccialanza R, Puglisi F. Nutritional Management of Oncological Symptoms: A Comprehensive Review. Nutrients 2023; 15:5068. [PMID: 38140327 PMCID: PMC10745914 DOI: 10.3390/nu15245068] [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: 11/01/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Throughout their experience of illness and during the course of treatment, a substantial proportion of cancer patients are prone to develop nutritional and/or metabolic disturbances. Additionally, cancer patients often encounter long-term side effects from therapies, which may lead to impaired digestion, nutrient absorption or bowel motility. Therefore, the preservation and maintenance of an optimal and balanced nutritional status are pivotal to achieving a better prognosis, increasing the tolerance and adherence to cancer therapies and improving the overall quality of life. In this context, personalized nutritional programs are essential for addressing conditions predisposing to weight loss, feeding difficulties, digestion problems and intestinal irregularity, with the goal of promoting adequate nutrient absorption and minimizing the detrimental effects of treatment regimens. The focus of this research is to examine the most common clinical conditions and metabolic changes that cancer patients may experience, including stomatitis, xerostomia, diarrhea, nausea, vomiting, dysphagia, sub-occlusion, dysgeusia, dysosmia, anorexia, and cachexia. Furthermore, we present a pragmatic example of a multidisciplinary workflow that incorporates customized recipes tailored to individual clinical scenarios, all while maintaining the hedonic value of the meals.
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Affiliation(s)
- Mattia Garutti
- CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy
| | - Claudia Noto
- CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy
- Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Brenno Pastò
- CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy
- Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Linda Cucciniello
- CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy
- Department of Medicine, University of Udine, 33100 Udine, Italy
| | | | - Amanda Casirati
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Paolo Pedrazzoli
- Department of Internal Medicine and Medical Therapy, University of Pavia, 27100 Pavia, Italy
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, 27100 Pavia, Italy
| | - Fabio Puglisi
- CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy
- Department of Medicine, University of Udine, 33100 Udine, Italy
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Bowen J, Cross C. The Role of the Innate Immune Response in Oral Mucositis Pathogenesis. Int J Mol Sci 2023; 24:16314. [PMID: 38003503 PMCID: PMC10670995 DOI: 10.3390/ijms242216314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/11/2023] [Accepted: 11/12/2023] [Indexed: 11/26/2023] Open
Abstract
Oral mucositis (OM) is a significant complication of cancer therapy with limited management strategies. Whilst inflammation is a central feature of destructive and ultimately ulcerative pathology, to date, attempts to mitigate damage via this mechanism have proven limited. A relatively underexamined aspect of OM development is the contribution of elements of the innate immune system. In particular, the role played by barriers, pattern recognition systems, and microbial composition in early damage signaling requires further investigation. As such, this review highlights the innate immune response as a potential focus for research to better understand OM pathogenesis and development of interventions for patients treated with radiotherapy and chemotherapy. Future areas of evaluation include manipulation of microbial-mucosal interactions to alter cytotoxic sensitivity, use of germ-free models, and translation of innate immune-targeted agents interrogated for mucosal injury in other regions of the alimentary canal into OM-based clinical trials.
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Affiliation(s)
- Joanne Bowen
- School of Biomedicine, University of Adelaide, Adelaide 5005, Australia;
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Cueto Urbina A, Guzmán Opazo J, Sagredo Ramírez K, Parra Parra M, López De Blanc S. Association between periodontitis and postoperative complications in hospital medical surgical procedures: a systematic review. REVISTA CIENTÍFICA ODONTOLÓGICA 2023; 11:e177. [PMID: 38312471 PMCID: PMC10831989 DOI: 10.21142/2523-2754-1104-2023-177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/07/2023] [Indexed: 02/06/2024] Open
Abstract
Background Periodontitis is potentially harmful in the perioperative period due to biofilm generating a environment for bacteria to spread and colonize other anatomical areas, which can generate a potential risk of infection, delayed healing, increased morbidity, and even induce avulsion in intubated patients, and subsequent aspiration or ingestion of teeth with increased mobility. Objective Associate the presence of periodontitis and postoperative complications in patients who underwent an in-hospital medical surgical procedure. Methods A systematic review based on studies extracted from PubMed and Scopus was carried out on June 10, 2020, based on the Population, Intervention, Comparison and Result search strategy. As inclusion criteria, the studies had to include all the disaggregated terms of the research question, have a publication date of less than 15 years, and the target population had to have undergone elective hospital medical-surgical interventions. The exclusion criteria corresponded to not presenting an analytical or experimental observational study design, not having made a periodontal clinical diagnosis of the study subjects, and not expressing in the results the presence of postoperative medical-hospital complications. Articles were assessed for quality by supplementing the STROBE guideline and Newcastle Ottawa, for risk of bias by supplementing the STROBE guideline and the Cochrane Collaboration handbook tool. Results A total of 131 articles were obtained, which were subjected to a selection process, resulting in 5 final analytical observational studies. A meta-analysis was performed and determined that periodontitis was a risk factor to postoperative complications after surgical procedures with an OR = 4,76; 95%CI [1,11-20,41]. Conclusions Optimize the guidelines for assessing quality and risk of bias can make their comparison with other studies complex, however it was determined in a statistically significant way that patients with periodontitis have a higher risk of generating postoperative complications after a medical hospital surgery.
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Affiliation(s)
- Alfredo Cueto Urbina
- Public Health Division, School of Dentistry, University of Valparaiso, Chile. , , , Public Health Division School of Dentistry University of Valparaiso Chile
| | - Javiera Guzmán Opazo
- Public Health Division, School of Dentistry, University of Valparaiso, Chile. , , , Public Health Division School of Dentistry University of Valparaiso Chile
| | - Katherine Sagredo Ramírez
- Public Health Division, School of Dentistry, University of Valparaiso, Chile. , , , Public Health Division School of Dentistry University of Valparaiso Chile
| | - Miguel Parra Parra
- Public Health Division, School of Dentistry, University of Valparaiso, Chile. , , , Public Health Division School of Dentistry University of Valparaiso Chile
| | - Silvia López De Blanc
- Department of Oral Pathology and Stomatology, School of Dentistry, National University of Cordoba. Cordoba, Argentina. Universidad Nacional de Córdoba Department of Oral Pathology and Stomatology School of Dentistry National University of Cordoba. Cordoba Argentina
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21
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Dias Gomes da Silva N, Sérgio da Silva Santos P, Carolina Magalhães A, Afonso Rabelo Buzalaf M. Antibacterial, antibiofilm and anticaries effect of BioXtra® mouthrinse for head and neck cancer (HNC) patients under a microcosm biofilm model. Radiother Oncol 2023; 187:109846. [PMID: 37543054 DOI: 10.1016/j.radonc.2023.109846] [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: 01/22/2023] [Revised: 06/30/2023] [Accepted: 07/31/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND AND PURPOSE Considering the lack of studies investigating salivary substitutes to control post-radiation caries for patients with head and neck cancer (HNC), this study aimed to evaluate the antibacterial, antibiofilm, and anticaries effects of BioXtra® on the microcosm biofilm formed on different enamel types (non-irradiated and irradiated) and from distinct saliva sources (control and HNC patients). MATERIALS AND METHODS Non-irradiated and irradiated enamel specimens were treated with BioXtra®, phosphate-buffered-saline (PBS; negative control), or 0.12% chlorhexidine (CHX; positive control) for 1 min. Biofilm was produced from human saliva (healthy participants with normal salivary flow for the control group or irradiated HNC patients with hyposalivation for the HNC group), mixed with McBain saliva, under 0.2% sucrose exposure, daily submitted to the treatments (1 min), for 5 days. Bacterial metabolic activity, biofilm viability, CFU counting, and enamel demineralization were determined. RESULTS BioXtra® significantly reduced the bacterial metabolic activity for both enamel types and the inoculum sources, being more effective for the irradiated enamel or for the saliva from the control group. Similarly, BioXtra® significantly reduced the biofilm viability, the CFU for total microorganisms, mutans streptococci, and lactobacilli, and was able to significantly reduce the mineral loss and the lesion depth compared to PBS. CHX was an effective treatment to significantly reduce all parameters, performing better than BioXtra® and reinforcing its reliable efficiency as a positive control. CONCLUSION Regardless of the enamel type and the inoculum source, BioXtra® presented antibacterial, antibiofilm, and anticaries effects under this experimental model, which should be confirmed in further clinical studies.
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Affiliation(s)
- Natara Dias Gomes da Silva
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Paulo Sérgio da Silva Santos
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Ana Carolina Magalhães
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
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22
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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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23
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Chang AK, Kim BK, Kim AY. The impact of aromatherapy-based oral care on oral conditions, salivary pH, and halitosis in older adults with dementia: Pilot study. Geriatr Nurs 2023; 53:109-115. [PMID: 37536001 DOI: 10.1016/j.gerinurse.2023.07.010] [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: 04/17/2023] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 08/05/2023]
Abstract
Inadequate oral care and poor oral health in older adults are known to increase the risk of dementia. Dementia patients residing in long-term care facilities are especially vulnerable to oral diseases due to their care-resistant behavior. This study aimed to investigate the effects of a 7-day oral care program based on an aroma solution in 58 dementia patients (29 each in the experimental and control groups) admitted to a long-term care hospital in South Korea. The experimental group received oral care with a solution containing peppermint, tea tree, and lemon essential oils, and the control group with a saline solution. The effectiveness of oral care was assessed by the participants' oral condition, salivary pH, and halitosis. The experimental group showed significant improvements (P<.001) in all three outcomes, indicating that oral care with an aroma solution can improve the oral health of older dementia patients residing in long-term care facilities.
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Affiliation(s)
- Ae Kyung Chang
- Professor, College of Nursing Science, Kyung Hee University, Seoul, South Korea
| | - Bo Kyoung Kim
- College of Nursing Science, Kyung Hee University, Seoul, South Korea
| | - Ah Young Kim
- College of Nursing Science, Kyung Hee University, Seoul, South Korea..
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Wang Y, Luo Y, Leng Y, Yang M, Liang T, Niu T. Construction and validation of a risk prediction model for perianal infection in patients with haematological malignancies during chemotherapy: a prospective study in a tertiary hospital in China. BMJ Open 2023; 13:e074196. [PMID: 37597870 PMCID: PMC10441103 DOI: 10.1136/bmjopen-2023-074196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/01/2023] [Indexed: 08/21/2023] Open
Abstract
OBJECTIVES Perianal infection is a serious complication in patients undergoing chemotherapy for haematological malignancies. Therefore, we aimed to develop a predictive model to help medical staff promptly screen patients at a high risk of perianal infection during chemotherapy. DESIGN This was a single-centre prospective observational study. SETTING This study was conducted in a tertiary teaching hospital in Chengdu, China. PARTICIPANTS The study sample comprised 850 patients with haematological malignancies who underwent chemotherapy at the department of haematology or our hospital between January 2021 and June 2022. INTERVENTIONS The included patients were randomly divided into training and validation groups in a 7:3 ratio. Based on the discharge diagnosis, patients with perianal infection were selected as the case group and the other patients were selected as the control group. OUTCOME MEASURE The main outcome measure was the occurrence of perianal infections. RESULTS A predictive model for perianal infections was established. A history of perianal infection, haemorrhoids, constipation and duration of diarrhoea were independent risk factors. The area under the curve of the The area under the receiver operating characteristic (ROC) curve for the training and validation groups were 0.784 (95% CI 0.727 to 0.841) and 0.789 (95% CI 0.818 to 0.885), respectively. Additionally, the model had good calibration in both the training and validation groups with a non-significant Hosmer-Lemeshow test (p=0.999 and 0.482, respectively). CONCLUSIONS The risk prediction model, including a history of perianal infection, history of haemorrhoids, constipation and duration of diarrhoea ≥3 days of perianal infection in patients with haematological malignancies during chemotherapy, has good prediction reliability and can be helpful in guiding clinical medical staff in screening and early intervention of high-risk groups.
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Affiliation(s)
- Yingli Wang
- Department of Hematology, Sichuan University West China Hospital, Chengdu, Sichuan, China
- Sichuan University West China Hospital School of Nursing, Chengdu, Sichuan, China
| | - Yuqin Luo
- Department of Hematology, Sichuan University West China Hospital, Chengdu, Sichuan, China
- Sichuan University West China Hospital School of Nursing, Chengdu, Sichuan, China
| | - Yamei Leng
- Department of Hematology, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Mei Yang
- Department of Hematology, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Taoyun Liang
- Department of Hematology, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Ting Niu
- Department of Hematology, Sichuan University West China Hospital, Chengdu, Sichuan, China
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25
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Martins AFL, Pereira CH, Morais MO, de Sousa-Neto SS, Valadares MC, Freitas NMA, Leles CR, de Mendonça EF. Effects of a mucoadhesive phytomedicine (Curcuma longa L. and Bidens pilosa L.) on radiotherapy-induced oral mucositis and quality of life of patients undergoing head and neck cancer treatment: randomized clinical trial. Support Care Cancer 2023; 31:517. [PMID: 37566179 DOI: 10.1007/s00520-023-07971-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 07/25/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE To assess the effect of a mucoadhesive herbal medicine containing curcuminoids and a glycerinated extract of Bidens pilosa L. (FITOPROT) in association with photobiomodulation (PBM) therapy and a Preventive Oral Care Program (POCP) compared to PBM and POCP in the treatment of radiotherapy (RT)-induced oral mucositis (ROM) and in the quality of life of these patients. METHODS A double-blind clinical trial was performed with head and neck cancer patients undergoing RT or chemoradiotherapy. Participants were randomized into two groups: Group 1 (n=27): PBM and POCP; and Group 2 (n=25): PBM, POCP and FITOPROT. The PBM protocol was daily irradiation, 660 nm, 25mW, 0.25 J/point from the first until the last day of RT. The FITOPROT was used as mouthwash twice a day. ROM was evaluated based on the scales of the World Health Organization and National Cancer Institute. The quality of life was evaluated using the University of Washington Questionnaire, OHIP-14 and Patient-Reported Oral Mucositis Symptom Scale. The MMAS-8 questionnaire was used to evaluated the adherence to POCP and FITOPROT. Data were collected at baseline, 7th, 14th, 21st, and 30th RT sessions. RESULTS No statistical differences were found between the groups for the ROM evaluation. Both groups experienced worsening of the quality of life during the RT. No statistically significant differences between groups were observed for any of the instruments evaluated. CONCLUSION The results suggest that PBM associated with FITOPROT and POCP control the severity of ROM and stabilize the QoL of patients with head and neck cancer. TRIAL REGISTRATION Brazilian Registry of Clinical Trials (ReBEC-RBR-9vddmr; UTN code: U1111-1193-2066), registered in August 8th, 2017.
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Affiliation(s)
- Allisson Filipe Lopes Martins
- Universidade Evangélica de Goiás, Dentistry School, Av. Universitária, s/n-Cidade Universitária, Goiás, Anápolis, CEP 75083-515, Brazil
| | - Carlos Henrique Pereira
- Araujo Jorge Cancer Hospital, R. 239, 206-Setor Universitário, Goiás, Goiânia, CEP 74175-120, Brazil
| | - Marília Oliveira Morais
- Araujo Jorge Cancer Hospital, R. 239, 206-Setor Universitário, Goiás, Goiânia, CEP 74175-120, Brazil
| | - Sebastião Silvério de Sousa-Neto
- Laboratory of Oral Pathology, School of Dentistry, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiás, Goiânia, CEP 74605-220, Brazil
| | - Marize Campos Valadares
- Laboratory of Pharmacology and Cellular Toxicology, Pharmacy Faculty, Universidade Federal de Goiás 5ª Avenida Esquina com Rua 240, s/n-Setor Universitário, Goiás, Goiânia, CEP 74605-170, Brazil
| | - Nilceana Maya Aires Freitas
- Department of Radiotherapy, Araujo Jorge Cancer Hospital, R. 239, 206-Setor Universitário, Goiás, Goiânia, CEP 74175-120, Brazil
| | - Cláudio Rodrigues Leles
- Department of Prevention and Oral Rehabilitation, School of Dentistry, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n-Setor Universitário, Goiás, Goiânia, CEP 74605-220, Brazil
| | - Elismauro Francisco de Mendonça
- Department of Oral Pathology, School of Dentistry, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil.
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26
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Kara H, Arikan F, Kartoz F, Korcum Sahin AF. A Prospective Study of Nurse-Led Oral Mucositis Management: Impact on Health Outcomes of Patients Receiving Radiotherapy for Head and Neck Cancer and Lung Cancer. Semin Oncol Nurs 2023; 39:151440. [PMID: 37188584 DOI: 10.1016/j.soncn.2023.151440] [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: 11/11/2022] [Revised: 03/28/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES The study aimed to evaluate the impact of nurse-led mucositis management on the health outcomes of patients receiving radiotherapy for head and neck cancer and lung cancer. The study adopted a holistic approach that involved the patient in the care process by screening, providing education and counseling about mucositis management and integrating it into daily life by the radiotherapy nurse. DATA SOURCES In this prospective, longitudinal cohort study, 27 patients were assessed and monitored through use of the WHO Oral Toxicity Scale and Oral Mucositis Follow-up Form and educated on mucositis during their radiotherapy through use of the Mucositis Prevention and Care Guide. At the end of radiotherapy, an evaluation of the radiotherapy process was performed. In this study, each patient was followed for 6 weeks from the start of radiotherapy. CONCLUSION The worst clinical data for oral mucositis and its variables emerged at week 6 of treatment. While the Nutrition Risk Screening score increased over time, weight decreased was observed to decrease. The mean stress level was 4.74 ± 0.33 in the first week and 5.77 ± 0.35 in the last week. It was observed that 88.9% of the patients showed good compliance with the treatment. IMPLICATIONS FOR NURSING PRACTICE Nurse-led mucositis management contributes to better patient outcomes during the radiotherapy process. Such an approach improves oral care management in patients receiving radiotherapy for head and neck and lung cancer, demonstrating its positive impact on additional patient-focused outcomes.
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Affiliation(s)
- Hava Kara
- Nurse Educator, PhD Student, Akdeniz University Hospital, Antalya, Turkey
| | - Fatma Arikan
- Faculty of Nursing, Akdeniz University, Antalya, Turkey.
| | - Funda Kartoz
- Department of Radiation Oncology, Akdeniz University Hospital, Antalya, Turkey
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27
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Lv J, Liao S, Li B, Pan L, Wang R. Scheduling radiotherapy for patients with nasopharyngeal carcinoma in the corresponding time window can reduce radiation-induced oral mucositis: A randomized, prospective study. Cancer Med 2023; 12:16032-16040. [PMID: 37537945 PMCID: PMC10469752 DOI: 10.1002/cam4.6252] [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: 06/12/2022] [Revised: 05/27/2023] [Accepted: 06/02/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND To explore a new method to reduce radiation-induced oral mucositis by scheduling radiotherapy for patients with nasopharyngeal carcinoma (NPC) in the corresponding time window of the cycle of oral mucosal cells. METHODS Eighty-two NPC patients were randomly divided into a day group (n = 41) and a night group (n = 41). The radiotherapy was scheduled at noon (11:30-15:30) for the day group, while at night (19:00-23:00) for the night group. Oral mucositis and oral pain were recorded in both groups after each radiotherapy fraction. The short-term efficacy of primary tumor regression, weight loss, and bone marrow suppression was recorded. RESULTS The incidence of Grade 2 oral mucositis was 87.8% (36/41) and 63.4% (26/41) in the night group and day group, respectively (p = 0.010). The incidence of Grade 3 oral mucositis was 65.9% (27/41) and 22.0% (9/41) in the night group and day group, respectively (p < 0.001). The mean number of radiotherapy for patients to develop Grade 2 oral mucositis was 15.67 ± 5.05 and 20.92 ± 6.21 in the night group and day group, respectively. The incidence of Grade 2 oral pain was 48.8% (20/41) and 22.0% (9/41) in the night group and day group, respectively (p = 0.011). There were no significant differences in tumor regression, weight loss, and bone marrow suppression between the two groups. CONCLUSION By scheduling radiotherapy based on the corresponding time window of the cycle of oral mucosal cells, the severity of oral mucositis in NPC patients was reduced.
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Affiliation(s)
- Jun Lv
- Department of RadiotherapyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Shibin Liao
- Department of RadiotherapyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Bo Li
- Department of RadiotherapyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Linjiang Pan
- Department of RadiotherapyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Rensheng Wang
- Department of RadiotherapyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
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28
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Gobbi MF, Ferreira MH, de Carvalho DLC, Silva GBL, Macari KSM, Neves LDJ, Santos PSDS, Junior LAVS, Melo WR, Antunes HS, De Macedo LD, Eduardo FDP, Bezinelli LM. Dental consensus on HSCT - Part II: dental Care during HSCT. Hematol Transfus Cell Ther 2023; 45:368-378. [PMID: 37321878 PMCID: PMC10499574 DOI: 10.1016/j.htct.2023.04.003] [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: 03/24/2023] [Accepted: 04/17/2023] [Indexed: 06/17/2023] Open
Abstract
During the state of immune vulnerability in hematopoietic stem cell transplantation (HSCT), the patient has an increased risk of developing a vast number of complications, including severe problems in the oral cavity. These situations require professional oral care to act in the diagnosis and treatment of these conditions, as well as to develop prevention protocols to minimize patient's complications. Oral mucositis, opportunistic infections, bleeding, specific microbiota, taste, and salivary alterations are complications that can occur during HSCT and interfere with various aspects, such as pain control, oral intake, nutrition, bacteremia and sepsis, days of hospitalization and morbidity. Several guidelines have been published to address the role of professional oral care during the HSCT, we describe a consensus regarding these recommendations.
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Affiliation(s)
| | | | | | - Geisa Badauy Lauria Silva
- Serviço de Odontologia do Hospital Aráujo Jorge/Associação de Combate ao Câncer em Goiás, Goiânia, Goiás, Brazil
| | - Karina Silva Moreira Macari
- Departamento de Odontologia, Hospital de Câncer Infantojuvenil de Barretos do Hospital de Amor, Barretos, SP, Brazil
| | - Lilian de Jesus Neves
- Departamento de Odontologia, Hospital de Câncer Infantojuvenil de Barretos do Hospital de Amor, Barretos, SP, Brazil
| | - Paulo Sérgio da Silva Santos
- Departamento de Cirurgia, Estomatologia, Patologia e Radiologia da Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, Brazil
| | | | | | | | - Leandro Dorigan De Macedo
- Serviço de Odontologia e Estomatologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Brazil; Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Brazil
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29
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Saito Y, Takekuma Y, Takeshita T, Oshino T, Sugawara M. Impact of systemic dexamethasone dosage on docetaxel-induced oral mucositis in patients with breast cancer. Sci Rep 2023; 13:10169. [PMID: 37349388 PMCID: PMC10287713 DOI: 10.1038/s41598-023-37285-9] [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: 02/21/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023] Open
Abstract
Oral mucositis (OM) is a common adverse effect of docetaxel-containing treatment. This study aimed to assess whether dexamethasone (DEX) dose-dependently attenuates docetaxel-induced OM and dysgeusia. We retrospectively analyzed medical records of patients with breast cancer receiving docetaxel-containing regimens at Hokkaido University Hospital between June 2015 and June 2022. The patients were divided into low-dose and high-dose groups (DEX 4 or 8 mg/day on days 2-4, respectively), and incidence of OM and dysgeusia, and risk factor(s) for OM incidence were evaluated. The incidence of all-grade OM in the first cycle was 57.8% in the low-dose group and 19.2% in the high-dose group (P = 0.0002), which met our primary endpoint. The incidence of OM in all treatment cycles was also significantly lowered by DEX-dose increase (P = 0.01). In contrast, the incidence of dysgeusia was similar between the two groups in the first and all cycles (P = 0.50 and P = 0.28, respectively). These results were also confirmed in a propensity score-matched population. Multivariate logistic regression analysis also suggested that lower DEX dosage was a singular risk factor for all-grade OM incidence. In conclusion, our study suggests that DEX dose-dependently reduces the incidence of OM in docetaxel-containing regimens for breast cancer treatment.
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Affiliation(s)
- Yoshitaka Saito
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan
| | - Yoh Takekuma
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan
| | - Takashi Takeshita
- Department of Breast Surgery, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan
| | - Tomohiro Oshino
- Department of Breast Surgery, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan
| | - Mitsuru Sugawara
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan.
- Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University, Kita 12-jo, Nishi 6-chome, Kita-ku, Sapporo, 060-0812, Japan.
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30
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Bruno JS, Al-Qadami GH, Laheij AMGA, Bossi P, Fregnani ER, Wardill HR. From Pathogenesis to Intervention: The Importance of the Microbiome in Oral Mucositis. Int J Mol Sci 2023; 24:ijms24098274. [PMID: 37175980 PMCID: PMC10179181 DOI: 10.3390/ijms24098274] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/11/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Oral mucositis (OM) is a common and impactful toxicity of standard cancer therapy, affecting up to 80% of patients. Its aetiology centres on the initial destruction of epithelial cells and the increase in inflammatory signals. These changes in the oral mucosa create a hostile environment for resident microbes, with oral infections co-occurring with OM, especially at sites of ulceration. Increasing evidence suggests that oral microbiome changes occur beyond opportunistic infection, with a growing appreciation for the potential role of the microbiome in OM development and severity. This review collects the latest articles indexed in the PubMed electronic database which analyse the bacterial shift through 16S rRNA gene sequencing methodology in cancer patients under treatment with oral mucositis. The aims are to assess whether changes in the oral and gut microbiome causally contribute to oral mucositis or if they are simply a consequence of the mucosal injury. Further, we explore the emerging role of a patient's microbial fingerprint in OM development and prediction. The maintenance of resident bacteria via microbial target therapy is under constant improvement and should be considered in the OM treatment.
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Affiliation(s)
- Julia S Bruno
- Instituto de Ensino e Pesquisa, Hospital Sírio-Libanês, São Paulo 01308-060, Brazil
| | - Ghanyah H Al-Qadami
- School of Biomedicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5005, Australia
| | - Alexa M G A Laheij
- Department of Oral Medicine, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
- Department of Preventive Dentistry, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
- Department of Oral Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, 1081 LA Amsterdam, The Netherlands
| | - Paolo Bossi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy
| | - Eduardo R Fregnani
- Instituto de Ensino e Pesquisa, Hospital Sírio-Libanês, São Paulo 01308-060, Brazil
| | - Hannah R Wardill
- School of Biomedicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5005, Australia
- The Supportive Oncology Research Group, Precision Cancer Medicine Theme, The South Australian Health and Medical Research Institute, Adelaide 5000, Australia
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31
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Nunes Duarte AC, Barbosa AN, Saito CPB, Paula EVD, Saito D. Oral mucositis and microbial status in acute lymphoblastic leukemia subjects undergoing high-dose chemotherapy. BRAZILIAN JOURNAL OF ORAL SCIENCES 2023. [DOI: 10.20396/bjos.v22i00.8667697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Aim: To assess oral microbial status in patients with acute lymphoblastic leukemia (ALL) undergoing high-dose chemotherapy and to unravel possible associations between nosocomial pathogens and the establishment of chemotherapy-induced oral mucositis (CIOM). Methods: Oral mucosa, saliva, and peripheral blood samples were collected from 46 ALL subjects one day prior to chemotherapy (D0) and 2 weeks after treatment initiation (D14). Clinical intraoral inspection was performed by a single practitioner, with mucositis classification performed according to the WHO oral toxicity scale. Blood components were quantified by automatic flow cytometry, while oral Staphylococcus aureus and Pseudomonas aeruginosa were detected by Polymerase Chain Reaction with species-specific primers. Associations among bacteria and clinical findings were determined by Fisher’s Exact test, longitudinal bacterial changes by paired Macnemar, and correlations among blood parameters and mucositis status or bacteria via Mann-Whitney. Results: S. aureus displayed higher detection rates at D14 (p < 0.05) and was positively associated with mucositis, adoption of a non-solid diet (all p < 0.001), nausea and fever (all p < 0.05). Conversely, P. aeruginosa did not correlate to CIOM clinical parameters. At the systemic standpoint, lower hemoglobin levels associated with CIOM and fever events (all p < 0.01). Conclusion: The study evidences S. aureus as a potential pathogen in ALL-CIOM, reaffirming microbial control as an important preventive measure during high-dose immunosuppressive therapy. The weight of non-white-blood-cell parameters should be validated as novel CIOM biomarkers in prospective research.
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32
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Skarf LM, Jones KF, Meyerson JL, Abrahm JL. Pharmacologic Pain Management: What Radiation Oncologists Should Know. Semin Radiat Oncol 2023; 33:93-103. [PMID: 36990640 DOI: 10.1016/j.semradonc.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Individuals with cancer experience a host of symptoms, especially when the malignancy is advanced. Pain occurs from the cancer itself or related treatments. Undertreated pain contributes to patient suffering and lack of engagement in cancer-directed therapies. Adequate pain management includes thorough assessment; treatment by radiotherapists or anesthesia pain specialists; anti-inflammatory medications, oral or intravenous opioid analgesics, and topical agents; and attention to the emotional and functional effects of pain, which may involve social workers, psychologists, speech therapists, nutritionists, physiatrists and palliative medicine providers. This review discusses typical pain syndromes arising in cancer patients undergoing radiotherapy and provides concrete recommendations for pain assessment and pharmacologic treatment.
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Affiliation(s)
- Lara Michal Skarf
- Section of Palliative Care, VA Boston Healthcare System, Harvard Medical School, Boston, MA.
| | - Katie Fitzgerald Jones
- Boston College William F. Connell School of Nursing and VA Boston Health Care System, Boston, MA
| | - Jordana L Meyerson
- Section of Palliative Care, VA Boston Healthcare System, Harvard Medical School, Boston, MA
| | - Janet L Abrahm
- Department of Psychosocial Oncology and Palliative Care, Division of Adult Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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Zwicker P, Freitag M, Heidel FH, Kocher T, Kramer A. Antiseptic efficacy of two mouth rinses in the oral cavity to identify a suitable rinsing solution in radiation- or chemotherapy induced mucositis. BMC Oral Health 2023; 23:176. [PMID: 36966298 PMCID: PMC10040117 DOI: 10.1186/s12903-023-02884-5] [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: 11/23/2022] [Accepted: 03/14/2023] [Indexed: 03/27/2023] Open
Abstract
OBJECTIVES Oral mucositis caused by intensive cancer chemotherapy or radiotherapy frequently results in pronounced damage of the oral mucosa leading to painful oral hygiene. To support oral care, antimicrobial effective mouth rinses may be used. Thus, the efficacy of a hypochlorite-based mouth rinse (Granudacyn®), assumed to be highly biocompatible because of the compounds being part of the natural pathogen defense, as possible antiseptic agent in case of oral mucositis was compared to that of an octenidine based antiseptic mouth rinse (Octenidol® md). MATERIALS AND METHODS The study was conducted as monocentric, controlled, randomized, blind cross over comparative study on 20 volunteers. As a proof of principle, we performed the study on orally healthy subjects and not cancer patients. The efficacy was determined as reduction of colony forming units (cfu) on buccal mucosa as well as in saliva. After mouth rinsing for 30 s, samples were taken after 1 min, 15 min, 30 and 60 min. The lg-reduction was calculated as difference between lg-values of cfu pre- and post-treatment. RESULTS Both antiseptic mouth rinses induced a significant reduction of cfu on buccal mucosa and in saliva 1 min after mouth rinsing. The effect persisted up to 60 min. The octenidine based rinse was significantly superior to the hypochlorite-based rinse up to the last sample 60 min after rinsing. However, the known cytotoxicity of octenidine argues against its application. CONCLUSION Within the limits of this study, due to its antiseptic efficacy, the hypochlorite-based rinse Granudacyn® can be regarded appropriate to support the oral hygiene in patients with a sensitive oral mucosa during an aggressive cancer chemotherapy and radiation treatment in case of oral mucositis.
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Affiliation(s)
- Paula Zwicker
- Institute of Hygiene and Environmental Medicine, Ferdinand-Sauerbruch-Str, University Medicine Greifswald, D-17475, Greifswald, Germany.
| | - Marcus Freitag
- Institute of Hygiene and Environmental Medicine, Ferdinand-Sauerbruch-Str, University Medicine Greifswald, D-17475, Greifswald, Germany
| | - Florian H Heidel
- Internal Medicine C, Ferdinand-Sauerbruch-Str, University Medicine Greifswald, D-17475, Greifswald, Germany
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Fleischmannstr. 4, D-17475, Greifswald, Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, Ferdinand-Sauerbruch-Str, University Medicine Greifswald, D-17475, Greifswald, Germany
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Lanzetti J, Finotti F, Savarino M, Gassino G, Dell’Acqua A, Erovigni FM. Management of Oral Hygiene in Head-Neck Cancer Patients Undergoing Oncological Surgery and Radiotherapy: A Systematic Review. Dent J (Basel) 2023; 11:83. [PMID: 36975580 PMCID: PMC10046982 DOI: 10.3390/dj11030083] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND In the literature, among oral health prevention programs dedicated to cancer patients, a wide heterogeneity is evident. The purpose of this work is to analyze the available scientific evidence for the treatment of head and neck cancer (HNC) patients undergoing resective surgery and radiotherapy and to draw up a diversified oral hygiene protocol during oncological therapy. METHODS PubMed was used as database. Studies published from 2017 to September 2022 were analyzed. Studies investigating the effectiveness of the preventive procedures carried out by the dental professionals in HNC patients undergoing postoperative adjuvant therapy have been taken into account. RESULTS The application of the search string on PubMed allowed the selection of 7184 articles. The systematic selection of articles led to the inclusion of 26 articles in this review, including 22 RCTs, 3 observational studies, and 1 controlled clinical study. Articles were divided according to the debated topic: the management of radiation-induced mucositis, xerostomia, the efficacy of an oral infection prevention protocol, and the prevention of radiation-induced caries. CONCLUSIONS Dental hygienists are fundamental figures in the management of patients undergoing oncological surgery of the maxillofacial district. They help the patient prevent and manage the sequelae of oncological therapy, obtaining a clear improvement in the quality of life.
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Affiliation(s)
- Jacopo Lanzetti
- Dental School, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
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Bledsaw K, Prudowsky ZD, Yang E, Harriehausen CX, Robins J, DeJean J, Staton S, Campbell JR, Davis AL, George A, Steffin D, Stevens AM. A Novel Oncodental Collaborative Team: Integrating Expertise for Central Line-Associated Bloodstream Infection Prevention in Pediatric Oncology Patients. JCO Oncol Pract 2023; 19:e25-e32. [PMID: 36137251 DOI: 10.1200/op.22.00302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Pediatric oncology and bone marrow transplant patients are at high risk of infection, and limitations to dental expertise among medical providers render patients vulnerable to central line-associated bloodstream infections from oral pathogens. Traditionally, oral health maintenance relied on patients and bedside nurses; however, routine methods are often suboptimal to prevent central line-associated bloodstream infection in high-risk patients. Limited overlap of medical and dental expertise, and limited dental resources in typical oncology units, prevent optimal oral care for children with cancer, requiring novel solutions to better integrate specialties. METHODS Here, we outline the creation of a novel Pediatric oncodental team to address oral-systemic infection prevention strategies for high-risk patients. RESULTS Our oncology and dental teams created a systematic approach for increasing oral surveillance and treatment in select high-risk patients. Supervised pediatric dental residents participated in scheduled oncology rounds, and a permanent oral health educator with a background in dental hygiene was also hired as a dedicated dental professional within our oncology department. CONCLUSION Our pediatric oncodental team aims to sustain optimal oral complication prevention strategies to reduce the risk of infection, provide education on the significance of the oral-systemic link in cancer care, and improve access and continuity of care.
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Affiliation(s)
- Kandice Bledsaw
- Texas Children's Cancer and Hematology Centers, Houston, TX.,Quality & Outcomes Management, Texas Children's Hospital, Houston, TX
| | - Zachary D Prudowsky
- Texas Children's Cancer and Hematology Centers, Houston, TX.,Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Esther Yang
- Department of Pediatrics, Baylor College of Medicine, Houston, TX.,Department of Dentistry, Texas Children's Hospital, Houston, TX
| | - Claudia X Harriehausen
- Department of Pediatrics, Baylor College of Medicine, Houston, TX.,Department of Dentistry, Texas Children's Hospital, Houston, TX
| | - Jenell Robins
- Texas Children's Cancer and Hematology Centers, Houston, TX.,Department of Pediatrics, Baylor College of Medicine, Houston, TX.,Department of Dentistry, Texas Children's Hospital, Houston, TX
| | - Janet DeJean
- Texas Children's Cancer and Hematology Centers, Houston, TX
| | - Sharon Staton
- Texas Children's Cancer and Hematology Centers, Houston, TX
| | - Judith R Campbell
- Department of Pediatrics, Baylor College of Medicine, Houston, TX.,Department of Infectious Diseases, Texas Children's Hospital, Houston, TX.,Center for Infection Prevention & Control, Texas Children's Hospital, Houston, TX
| | - Andrea L Davis
- Center for Infection Prevention & Control, Texas Children's Hospital, Houston, TX
| | - Anil George
- Texas Children's Cancer and Hematology Centers, Houston, TX.,Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - David Steffin
- Texas Children's Cancer and Hematology Centers, Houston, TX.,Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Alexandra M Stevens
- Texas Children's Cancer and Hematology Centers, Houston, TX.,Department of Pediatrics, Baylor College of Medicine, Houston, TX
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Skallsjö K, von Bültzingslöwen I, Hasséus B, Johansson JE, Öhman J, Raber-Durlacher JE, Huysmans MCDNJM, Laheij AMGA, van Leeuwen SJM, Hovan AJ, Garming Legert K, Nguyen HM, Turk PJ, Rozema FR, Blijlevens NMA, Brennan MT. Oral health in patients scheduled for hematopoietic stem cell transplantation in the Orastem study. PLoS One 2023; 18:e0285615. [PMID: 37200298 DOI: 10.1371/journal.pone.0285615] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/26/2023] [Indexed: 05/20/2023] Open
Abstract
Despite advances in transplant medicine, prevalence of complications after hematopoietic stem cell transplantation (HSCT) remains high. The impact of pre-HSCT oral health factors on the incidence and severity of complications post-HSCT is poorly understood. The aim of this prospective, observational study was to analyze oral health in patients planned for HSCT. Patients ≥18 years requiring HSCT were included from five sites between 2011-2018. General health, oral findings and patient-reported symptoms were registered in 272 patients. Oral symptoms around disease onset were reported by 43 patients (15.9%) and 153 patients (58.8%) reported oral complications during previous chemotherapy. One third of patients experienced oral symptoms at the oral examination before conditioning regimen and HSCT. In total, 124 (46.1%) patients had dental caries, 63 (29.0%) had ≥one tooth with deep periodontal pockets, 147 (75.0%) had ≥one tooth with bleeding on probing. Apical periodontitis was observed in almost 1/4 and partially impacted teeth in 17 (6.3%) patients. Oral mucosal lesions were observed in 84 patients (30.9%). A total of 45 (17.4%) of 259 patients had at least one acute issue to be managed prior to HSCT. In conclusion, oral symptoms and manifestations of oral disease were prevalent in patients planned for HSCT. The extent of oral and acute dental diseases calls for general oral screening of patients pre-HSCT.
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Affiliation(s)
- Kristina Skallsjö
- Department of Oral medicine and Pathology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Inger von Bültzingslöwen
- Department of Oral Microbiology and Immunology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bengt Hasséus
- Department of Oral medicine and Pathology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan-Erik Johansson
- Department of Hematology and Coagulation, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jenny Öhman
- Department of Oral medicine and Pathology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Judith E Raber-Durlacher
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Alexa M G A Laheij
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Stephanie J M van Leeuwen
- Department of Dentistry, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Allan J Hovan
- Oral Oncology and Dentistry, British Columbia Cancer, Vancouver, British Columbia, Canada
| | | | - Hieu M Nguyen
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, United States of America
| | - Philip J Turk
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Frederik R Rozema
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Nicole M A Blijlevens
- Department of Hematology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Michael T Brennan
- Department of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, United States of America
- Department of Otolaryngology/Head and Neck Surgery, Wake Forest University School of Medicine, Wake Forest, North Carolina, United States of America
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Protective Role of Natural Compounds under Radiation-Induced Injury. Nutrients 2022; 14:nu14245374. [PMID: 36558533 PMCID: PMC9786992 DOI: 10.3390/nu14245374] [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: 11/11/2022] [Revised: 12/05/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
In recent years, evidence has shown the potential therapeutic effects of different natural compounds for the prevention and treatment of radiotherapy-induced mucositis (RIOM). RIOM represents one of the most frequent side effects associated with anti-neoplastic treatments affecting patients' quality of life and treatment response due to radiation therapy discontinuation. The innate radio-protective ability of natural products obtained from plants is in part due to the numerous antioxidants possessed as a part of their normal secondary metabolic processes. However, oxygen presence is a key point for radiation efficacy on cancer cells. The aim of this review is to describe the most recent evidence on radiation-induced injury and the emerging protective role of natural compounds in preventing and treating this specific damage without compromising treatment efficacy.
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Effect of synbiotic mouthwash on oral mucositis induced by radiotherapy in oral cancer patients: a double-blind randomized clinical trial. Support Care Cancer 2022; 31:31. [PMID: 36517616 DOI: 10.1007/s00520-022-07521-5] [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: 11/18/2021] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Considering the complex pathobiology of oral mucositis, especially in oral cancer patients, the prevention and treatment of oral mucositis in patients undergoing radiotherapy remains an essential and clinically crucial unmet need. The present study aims to investigate and compare the effects of synbiotic mouthwash with normal saline mouthwash on the prevention and control of radiotherapy-induced oral mucositis in oral cancer patients. METHODS Double-blind, randomized clinical trial (RCT) performed on 64 oral cancer patients who underwent radiotherapy (IRCT20201106049288N1, registration date: 2020-12-23). Patients were divided randomly into the case (32 subjects) and control (32 subjects) groups. All patients underwent intensity-modulated radiotherapy and received 6000 cGY of radiotherapy in 34 fractions. All patients received the usual treatment for mucositis, but in the case group, synbiotic mouthwash was prescribed and in the control group, normal saline mouthwash was prescribed from a day before the start to the end of radiotherapy treatment. Patients were monitored every session for 6 weeks to check the progression, oral involvement severity, and mucositis grade. RESULTS The case group showed a significant reduction in the oral mucositis severity. The mucositis grade in the case group from the 7th session of oral examination was significantly lower than the control (p < 0.05), and this significant difference persisted until the last session of oral examination. Incidence rates of severe oral mucositis (grade 3) during the treatment period were 11.59% in the case and 36.45% in control (p < 0.001). CONCLUSION Synbiotic mouthwash significantly reduces and prevents oral mucositis intensity in oral cancer patients undergoing radiotherapy.
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Sardo AVN, Andrade MF, Figueiredo A, Rosin FCP, Corrêa L, Zezell DM. Does Photobiomodulation Affects CK10 and CK14 in Oral Mucositis Radioinduced Repair? Int J Mol Sci 2022; 23:ijms232415611. [PMID: 36555260 PMCID: PMC9779304 DOI: 10.3390/ijms232415611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 12/14/2022] Open
Abstract
The mechanisms of action of photobiomodulation (PBM) in oral mucositis (OM) are not completely elucidated. To enlighten the role of PBM in the evolution of epithelial maturity in OM ulcers, the present study evaluated the effect of PBM with red (λ) wavelength of 660 nanometers (nm) and infrared of 780 nm in radio-induced OM wounds on the tongue of rats, eight and twenty days after irradiation with single dose of 20 Gy. The percentage area corresponding to positive staining for cytokeratin 10 (CK10) and 14 (CK14) proteins was evaluated in the epithelial area of the lesions, using an immunohistochemical technique (IHC), 8 and 20 days after the induction of lesions, and compared with an untreated control group. CK10 was significantly more expressed in the group treated with 660 nm PBM. CK14 did not show quantitative differences between the groups evaluated. However, whereas in the groups treated with PBM, CK14 was already restricted to the basal layer of the epithelium, as expected in healthy epithelia, in control group it was also expressed in upper layers of the epithelium. In this work, PBM was able to improve epithelial maturity of the repaired OM wound, especially in the 660 nm group.
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Affiliation(s)
- Ariane Venzon Naia Sardo
- Center for Lasers and Applications, Instituto de Pesquisas Energeticas e Nucelares IPEN-CNEN, São Paulo CEP 05508-000, SP, Brazil
| | - Maíra Franco Andrade
- Center for Lasers and Applications, Instituto de Pesquisas Energeticas e Nucelares IPEN-CNEN, São Paulo CEP 05508-000, SP, Brazil
| | - Anaeliza Figueiredo
- School of Dentistry, University of São Paulo, São Paulo CEP 05508-000, SP, Brazil
| | | | - Luciana Corrêa
- School of Dentistry, University of São Paulo, São Paulo CEP 05508-000, SP, Brazil
| | - Denise Maria Zezell
- Center for Lasers and Applications, Instituto de Pesquisas Energeticas e Nucelares IPEN-CNEN, São Paulo CEP 05508-000, SP, Brazil
- Correspondence:
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40
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Wang J, Liang J, He M, Xie Q, Wu Q, Shen G, Zhu B, Yu J, Yu L, Tan X, Wei L, Ren J, Lv Y, Deng L, Yin Q, Zhou H, Wu W, Zhang M, Yang W, Qiao M, Shu R, Xia Z, Li Z, Huang Z, Hu W, Wang L, Liu Z, Pi G, Ren H, Ji Y, Liu Z, Qi X, Chen P, Shao L, Chen F, Xu X, Chen W, Wang Q, Guo Z. Chinese expert consensus on intestinal microecology and management of digestive tract complications related to tumor treatment (version 2022). J Cancer Res Ther 2022; 18:1835-1844. [PMID: 36647940 DOI: 10.4103/jcrt.jcrt_1444_22] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The human gut microbiota represents a complex ecosystem that is composed of bacteria, fungi, viruses, and archaea. It affects many physiological functions including metabolism, inflammation, and the immune response. The gut microbiota also plays a role in preventing infection. Chemotherapy disrupts an organism's microbiome, increasing the risk of microbial invasive infection; therefore, restoring the gut microbiota composition is one potential strategy to reduce this risk. The gut microbiome can develop colonization resistance, in which pathogenic bacteria and other competing microorganisms are destroyed through attacks on bacterial cell walls by bacteriocins, antimicrobial peptides, and other proteins produced by symbiotic bacteria. There is also a direct way. For example, Escherichia coli colonized in the human body competes with pathogenic Escherichia coli 0157 for proline, which shows that symbiotic bacteria compete with pathogens for resources and niches, thus improving the host's ability to resist pathogenic bacteria. Increased attention has been given to the impact of microecological changes in the digestive tract on tumor treatment. After 2019, the global pandemic of novel coronavirus disease 2019 (COVID-19), the development of novel tumor-targeting drugs, immune checkpoint inhibitors, and the increased prevalence of antimicrobial resistance have posed serious challenges and threats to public health. Currently, it is becoming increasingly important to manage the adverse effects and complications after chemotherapy. Gastrointestinal reactions are a common clinical presentation in patients with solid and hematologic tumors after chemotherapy, which increases the treatment risks of patients and affects treatment efficacy and prognosis. Gastrointestinal symptoms after chemotherapy range from nausea, vomiting, and anorexia to severe oral and intestinal mucositis, abdominal pain, diarrhea, and constipation, which are often closely associated with the dose and toxicity of chemotherapeutic drugs. It is particularly important to profile the gastrointestinal microecological flora and monitor the impact of antibiotics in older patients, low immune function, neutropenia, and bone marrow suppression, especially in complex clinical situations involving special pathogenic microbial infections (such as clostridioides difficile, multidrug-resistant Escherichia coli, carbapenem-resistant bacteria, and norovirus).
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Affiliation(s)
- Jun Wang
- Department of Hematology, Hongkong University Shenzhen Hospital, Shenzhen, China
| | - Jing Liang
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Mingxin He
- Institute of Infection, Immunology and Tumor Microenvironment, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Medical College, Wuhan University of Science and Technology, Wuhan, China
| | - Qi Xie
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Qingming Wu
- Institute of Infection, Immunology and Tumor Microenvironment, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Medical College, Wuhan University of Science and Technology, Wuhan, China
| | - Guanxin Shen
- Department of Immunology, Basic Medical School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Baoli Zhu
- Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Jun Yu
- Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, CUHK-Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong, China
| | - Li Yu
- Department of Hematology and Oncology, International Cancer Center, Shenzhen Key Laboratory, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen University Health Science Center, Xueyuan AVE 1098, Shenzhen, China
| | - Xiaohua Tan
- Department of Oncology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
| | - Lanlan Wei
- Department of Oncology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
| | - Jun Ren
- Department of Medical Oncology, Fudan University Pudong Medical Center, Shanghai, China
| | - Youyong Lv
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Lijuan Deng
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Qian Yin
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Zhou
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Wu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Min Zhang
- Hubei Medical Evaluation and Continuing Education Office, Wuhan, China
| | - Wenyan Yang
- Shangdong First Medical Univrsity and Shangdong Academy of Medical Sciences, Jinan, China
| | - Mingqiang Qiao
- The Key Laboratory of Molecular Microbiology and Technology, Ministry of Education, College of Life Sciences, Nankai University, Tianjin; School of Life Science, Shanxi University, Taiyuan, China
| | - Rong Shu
- Department of Anesthesiology, the third People's Hospital of Hubei Province, Wuhan, China
| | - Zhongjun Xia
- Medical Department, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Zhiming Li
- Medical Department, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Ziming Huang
- Hubei Maternal and Child Health Care Hospital, Wuhan, China
| | - Weiguo Hu
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Liang Wang
- Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhi Liu
- Department of Biotechnology, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Guoliang Pi
- Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua Ren
- National Cancer Center/National Clinical Research Cancer for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Yong Ji
- National Cancer Center/National Clinical Research Cancer for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Zhe Liu
- Medical College, Tianjin University, China
| | - Xiaofei Qi
- Department of Hematology, The First Affiliated Hospital of Soochow University; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Collaborative Innovation Center of Hematology, Suzhou, China
| | - Peng Chen
- Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Liang Shao
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Feng Chen
- Department of Orthopedics, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaojun Xu
- Department of Hematology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Weiqing Chen
- Chongqing University Cancer Hospital, Chongqing, China
| | - Qiang Wang
- Institute of Infection, Immunology and Tumor Microenvironment, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Medical College, Wuhan University of Science and Technology, Wuhan, China
| | - Zhi Guo
- Department of Hematology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
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Impact of systemic dexamethasone administration on oral mucositis induced by anthracycline-containing regimens in breast cancer treatment. Sci Rep 2022; 12:12587. [PMID: 35869165 PMCID: PMC9307799 DOI: 10.1038/s41598-022-16935-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/18/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractOral mucositis (OM) is one of the most common complications associated with chemotherapy. Here, we evaluated whether systemic dexamethasone (DEX) dosage in prophylactic antiemetics affected the incidence of OM in anthracycline-containing regimens. Patients receiving anthracycline-containing regimens for breast cancer were divided into high- and low-DEX dose groups and retrospectively evaluated. The incidence of all-grade OM in the first cycle in the high- and low-dose groups was 27.3% and 53.5%, respectively, and was significantly lowered by increasing the DEX dose (P < 0.01); thus, the study met its primary endpoint. The result in all treatment cycles was also significant (P = 0.02). In contrast, the incidence of dysgeusia was similar between the high- and low-dose groups in the first and all cycles (13.6% and 16.3% in the first cycle [P = 0.79] and 27.3% and 34.9% in all cycles [P = 0.42], respectively). Multivariate analysis revealed that low DEX dosage was an independent risk factor for all-grade OM development. In conclusion, our study suggests that DEX attenuates OM in anthracycline-containing regimens for breast cancer treatment in a dose-dependent manner. Further evaluation of OM prophylaxis, including DEX administration, is required for better control.
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Clinicians’ experience with topical benzydamine and morphine for the management of oral mucositis: adverse effects and barriers. Support Care Cancer 2022; 30:10255-10262. [DOI: 10.1007/s00520-022-07443-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 10/30/2022] [Indexed: 11/11/2022]
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Comparison of methods for the handling of metallic dental restorations before head and neck radiotherapy. Support Care Cancer 2022; 30:10285-10290. [PMID: 36239800 DOI: 10.1007/s00520-022-07406-7] [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: 07/12/2022] [Accepted: 10/10/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE During head and neck radiotherapy, backscatter from metallic dental restorations (MDRs) causes oral mucositis. Currently, two MDR handling methods are used: the replacement of MDRs with provisional restorations (MDR removal) and fabrication of dental spacers before radiotherapy. We compared the effects of these two methods on the incidence of oral mucositis during head and neck radiotherapy. METHODS We enrolled 76 patients with MDRs who underwent radiotherapy for head and neck cancer between April 2016 and March 2020. We set grade 2 oral mucositis as an outcome. After adjustment of all covariates using the propensity score (PS), we analyzed the data using a Cox proportional hazards model. In addition, subgroup analysis was performed by stratifying the data into quintiles based on the PS. RESULTS For the incidence of grade 2 oral mucositis due to head and neck radiotherapy, the hazard ratio for the MDR removal group relative to the dental spacer group was 0.344 (95% confidence interval, 0.121-0.980; P = 0.046). Subgroup analysis showed that the hazard ratio for the MDR removal group was 0.339 (95% confidence interval, 0.122-0.943; P = 0.038). CONCLUSION The results suggest that MDR replacement is superior to dental spacer fabrication in reducing the incidence of oral mucositis during head and neck radiotherapy, although MDR removal carries several associated risks.
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Jasiewicz F, Qurban Z, Hughes C. Treatment-induced mucositis in oncology. Br J Hosp Med (Lond) 2022; 83:1-8. [DOI: 10.12968/hmed.2022.0324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Almost all cancer therapies lead to a wide array of side effects, owing to the disruption of normal physiological processes and alteration of immunological responses. Of these, mucositis is one of the most commonly encountered side effects, presenting in about 20–40% of all patients receiving chemotherapy and 80% of those being treated with radiotherapy for head and neck malignancies. This article provides a brief introduction and comprehensive overview of the various treatment modalities used in managing this complication. The key to management is a multidisciplinary approach, revolving around pain control, oral hygiene, nutritional support and management of superimposed infection. The scarcity of therapeutic options for prevention or treatment of mucositis has resulted in clinical difficulty in controlling it, which, in turn, seriously affects the patient's quality of life and cancer management, contributing to patient morbidity and mortality.
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Affiliation(s)
- Francis Jasiewicz
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Zeeshan Qurban
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Christopher Hughes
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
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Gündogdu F, Sayar S. Oncology nursing practices in the management of chemotherapy-related oral mucositis in accordance with evidence-based guidelines: a descriptive and cross-sectional study. Support Care Cancer 2022; 30:9549-9557. [DOI: 10.1007/s00520-022-07361-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/10/2022] [Indexed: 11/29/2022]
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Mazzetti T, Sergio da Silva Santos P, Spindola Antunes H, Fernandes Montagner A, Hélène van de Sande F, Timm Maske T. Required time for pre-oncological dental management - A rapid review of the literature. Oral Oncol 2022; 134:106116. [PMID: 36115328 DOI: 10.1016/j.oraloncology.2022.106116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 10/31/2022]
Abstract
This study identified the scientific literature comparing the influence of different times in which dental procedures were performed before the oncological treatments (radiotherapy and/or chemotherapy) on the risk of oral complications development. MEDLINE/PubMed and Embase databases were searched, and articles were selected by title, abstract and full-text assessment. The search identified 2,356 articles and three retrospective observational studies were included. Data were collected and analyzed according to the dental procedure, the time before oncological treatment, and oral complications. Risk of bias (ROBINS) and certainty of evidence (GRADE) were evaluated. Pairwise meta-analyses were performed from dental extractions (Exo) data according to the time which were performed and ORN development using a random-effect model (RR and 95 % CI, p < 0.05). meta-analyses showed a higher risk of ORN development in patients with Exo performed < 2 weeks before oncological treatment than in those who Exo was performed > 2 weeks ≤ 1 month before oncological therapy (RR 1.29; 95 % CI 1.12-1.48; p < 0.01). There was a higher prevalence of oral mucositis (OM) in patients who received periodontal treatment ≤ 3 weeks before oncological therapy than those who received dental procedures > 3 weeks ≤ 6 months before. Although the risk of bias ranged from serious to critical, with very low certainty of evidence, the findings suggest that dental extractions should be performed within > 2 weeks before oncological treatment to avoid ORN complications. More studies are needed to conclude the appropriate time to perform dental procedures to decrease other associated oral complications. (CRD42021272652).
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Affiliation(s)
- Thais Mazzetti
- Graduate Program in Dentistry, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil.
| | - Paulo Sergio da Silva Santos
- Department of Surgery, Stomatology, Pathology, and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil.
| | | | | | | | - Tamires Timm Maske
- Department of Preventive and Community Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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da Silva NDG, de Paiva PRB, Magalhães TVM, Braga AS, Santos PSDS, Henrique-Silva F, Magalhães AC, Buzalaf MAR. Effect of experimental and commercial artificial saliva formulations on the activity and viability of microcosm biofilm and on enamel demineralization for irradiated patients with head and neck cancer (HNC). BIOFOULING 2022; 38:674-686. [PMID: 36154759 DOI: 10.1080/08927014.2022.2111258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/14/2022] [Accepted: 08/02/2022] [Indexed: 06/16/2023]
Abstract
The effect of different artificial saliva formulations on biofilm activity and viability, and on enamel demineralization for head and neck cancer (HNC) patients was evaluated. Irradiated enamel samples were treated (1 min) with BioXtra® or with experimental formulations containing carboxymethylcellulose plus inorganic constituents alone (AS) or containing 0.1 mg mL-1 CaneCPI-5 (AS + Cane), 1.0 mg mL-1 hemoglobin (AS + Hb) or combination of both (AS + Cane + Hb). Phosphate-buffered-saline and chlorhexidine (0.12%) were negative and positive control, respectively. Biofilm was produced from the saliva of five male HNC patients, under 0.2% sucrose exposure for 5 days, and daily treated with the formulations (1 min). No significant effects were observed for the different experimental treatments. BioXtra® significantly reduced lactobacilli, demonstrating antibacterial potential for this group. Chlorhexidine was an effective treatment to significantly reduce all parameters, being an important antimicrobial and anticaries agent. Future in vitro studies must be performed using a new approach for the design of the experimental formulations.
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Affiliation(s)
- Natara Dias Gomes da Silva
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Pedro Renato Bodo de Paiva
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | | | - Aline Silva Braga
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Paulo Sérgio da Silva Santos
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Flávio Henrique-Silva
- Department of Genetics and Evolution, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Ana Carolina Magalhães
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
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Mauceri R, Coniglio R, Abbinante A, Carcieri P, Tomassi D, Panzarella V, Di Fede O, Bertoldo F, Fusco V, Bedogni A, Campisi G. The preventive care of medication-related osteonecrosis of the jaw (MRONJ): a position paper by Italian experts for dental hygienists. Support Care Cancer 2022; 30:6429-6440. [PMID: 35292850 PMCID: PMC9213300 DOI: 10.1007/s00520-022-06940-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/25/2022] [Indexed: 02/01/2023]
Abstract
PURPOSE The prevention and early diagnosis of medication-related osteonecrosis of the jaw (MRONJ) is fundamental to reducing the incidence and progression of MRONJ. Many in the field believe that dental hygienists should play an integral role in primary and secondary MRONJ prevention. However, to date, very few publications in the literature have proposed standardised MRONJ protocols, which are dedicated to dental hygienists. The aim of this study was to provide guidance to the health care providers managing MRONJ. METHODS The expert opinion in this study was developed by dental hygienists from the main Italian technical-scientific associations (Italian Dental Hygienists Association, AIDI and National Union of Dental Hygienists, UNID) and authors of the latest Italian recommendations regarding MRONJ from the field of dentistry and maxillofacial surgery. RESULTS The oral care protocol outlined in this position paper is focused on the role of dental hygienist in patients at risk or affected by MRONJ, and it regards 3 main issues: primary prevention, secondary prevention and supporting the treatment of MRONJ. Each issue contains easy-to-apply indications and procedures, as described by the authors, regarding the role of the dental hygienist. CONCLUSION Referring to the main issues under consideration (primary prevention, secondary prevention and the treatment of MRONJ), a clinical examination of periodontal tissue is critical in preventing MRONJ. It is the opinion of the authors of this study that the application of a periodontal screening score is fundamental in defining personalised strategies for patients at risk of MRONJ. By means of these basic procedures, a protocol for assisting the health care provider and the presentation of a practical approach for patients at risk or affected by MRONJ are described in this study.
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Affiliation(s)
- Rodolfo Mauceri
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Via L. Giuffrè 5, 90127, Palermo, PA, Italy.
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy.
- Department of Dental Surgery, Faculty of Dental Surgery, University of Malta, Msida, Malta.
| | - Rita Coniglio
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Via L. Giuffrè 5, 90127, Palermo, PA, Italy
| | - Antonia Abbinante
- Italian Dental Hygienists Association - AIDI, Aosta, Italy
- Department of Interdisciplinary Medicine, Complex Operating Unit of Odontostomatology, Aldo Moro University of Bari, Bari, Italy
| | - Paola Carcieri
- Department of Surgical Sciences, CIR-Dental School, Oral Medicine Section, University of Turin, Turin, Italy
- CIR-Dental School, Oral Prevention and Community Dentistry, University of Turin, Turin, Italy
| | - Domenico Tomassi
- Catholic University of Rome, Rome, Italy
- National Union of Dental Hygienists - UNID, Rome, Italy
| | - Vera Panzarella
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Via L. Giuffrè 5, 90127, Palermo, PA, Italy
| | - Olga Di Fede
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Via L. Giuffrè 5, 90127, Palermo, PA, Italy
| | | | - Vittorio Fusco
- Oncology Unit, Azienda Ospedaliera Di Alessandria SS, Antonio e Biagio E Cesare Arrigo, Alessandria, Italy
| | - Alberto Bedogni
- Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padua, Padua, Italy
| | - Giuseppina Campisi
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Via L. Giuffrè 5, 90127, Palermo, PA, Italy
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Bezerra PMM, Vieira TI, Dos Santos FG, Ribeiro ILA, de Sousa SA, Valença AMG. The impact of oral health education on the incidence and severity of oral mucositis in pediatric cancer patients: a systematic review and meta-analysis. Support Care Cancer 2022; 30:8819-8829. [PMID: 35915339 DOI: 10.1007/s00520-022-07296-9] [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: 02/17/2022] [Accepted: 07/22/2022] [Indexed: 10/16/2022]
Abstract
Oral health education is an effective measure to prevent oral mucositis (OM) by improving self-management and effectively engaging patients in their health care. This systematic review aimed to determine the impact of oral health education interventions on the incidence and severity of OM. Bibliographical searches were carried out by two independent examiners in Medline, Scopus, Web of Science, Cochrane Library, Virtual Health Library, and SIGLE, until June 2022. The eligibility criteria were based on the PICO strategy, considering studies with pediatric oncology patients, aged 0 to 19 years, who had attended oral health education activities and had been examined for the incidence and/or severity of OM. Data were extracted for qualitative synthesis and organized in spreadsheets. The quality assessment of the selected studies was performed using the ROBINS-I tool. Meta-analysis was based on the group frequencies of OM ulcerative lesions, adopting a significance level of 5%. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to define the certainty of the evidence. The primary search retrieved 1827 articles. After removing duplicate records and screening titles and abstracts for eligibility, a total of 21 articles were selected for full-text analysis. Of these, seven eligible studies were included for data extraction and qualitative synthesis, while four studies were selected for quantitative synthesis. All studies had a longitudinal design; three performed a before-after comparison and four were controlled studies. OM was assessed by the following scales: OAG, WHO, ChIMES, and WCCNR. While data analysis of the selected studies was heterogeneous, the implementation of oral health education strategies was found to reduce the incidence and severity of OM during the follow-up period. The meta-analysis showed a favorable outcome for the educational intervention. The likelihood of patients attending oral health education activities to manifest OM ulcerative lesions was significantly lower (P = 0.002) than that of the control. The GRADE analysis presented a low certainty of the evidence. To conclude, oral health education interventions improved OM outcomes in pediatric oncology patients with a low quality of evidence.
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Affiliation(s)
| | - Thiago Isidro Vieira
- Postgraduate Program in Dentistry, Federal University of Paraíba, 58051-900, João Pessoa PB, Brazil
| | - Fabio Gomes Dos Santos
- Postgraduate Program in Dentistry, Federal University of Paraíba, 58051-900, João Pessoa PB, Brazil
| | | | - Simone Alves de Sousa
- Postgraduate Program in Dentistry, Federal University of Paraíba, 58051-900, João Pessoa PB, Brazil
| | - Ana Maria Gondim Valença
- Postgraduate Program in Dentistry, Federal University of Paraíba, 58051-900, João Pessoa PB, Brazil
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Shayani A, Aravena PC, Rodríguez-Salinas C, Escobar-Silva P, Diocares-Monsálvez Y, Angulo-Gutiérrez C, Rivera C. Chemotherapy as a risk factor for caries and gingivitis in children with acute lymphoblastic leukemia: A retrospective cohort study. Int J Paediatr Dent 2022; 32:538-545. [PMID: 34653279 DOI: 10.1111/ipd.12932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/11/2021] [Accepted: 09/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dental and oral anomalies are among the most common long-term side effects of childhood cancer therapy. AIM To evaluate chemotherapy as a risk factor for caries lesions and gingivitis in children with acute lymphoblastic leukemia (ALL) treated with the ALL IC-BFM 2009 chemotherapy protocol. DESIGN A retrospective cohort study was designed. Clinical records of 23 paediatric patients with ALL exposed to chemotherapy in the Regional Hospital in Valdivia, Chile, and 46 unexposed patients assessed every 3 months for 24 months were analyzed. The data on gender, age, index of the number of decayed, missing, or filled teeth, and the presence of gingivitis were recorded (Mann-Whitney U test and logistic regression analysis, p ≤ .05). RESULTS A significantly greater frequency of gingivitis (69.57%; p < .002) and a mean of new caries lesions were observed in children treated with chemotherapy than in the unexposed children (p < .01). The chemotherapy protocol presented a relative risk of 2.15 (95% CI = 1.22 - 2.66; p = .01) for new caries lesions and 2.29 (95% CI = 1.76 - 3.82; p = .002) for gingivitis. CONCLUSION The ALL IC-BFM 2009 chemotherapy protocol in patients with ALL is a risk factor for new caries lesions and gingivitis.
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Affiliation(s)
- Anis Shayani
- School of Dentistry, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
| | | | | | - Pamela Escobar-Silva
- School of Dentistry, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
| | | | | | - César Rivera
- Oral Medicine and Pathology Research Group, Department of Basic Biomedical Sciences, Faculty of Health Sciences, Universidad de Talca, Talca, Chile
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