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Jahankhani K, Taghipour N, Nikoonezhad M, Behboudi H, Mehdizadeh M, Kadkhoda D, Hajifathali A, Mosaffa N. Adjuvant therapy with zinc supplementation; anti-inflammatory and anti-oxidative role in multiple myeloma patients receiving autologous hematopoietic stem cell transplantation: a randomized controlled clinical trial. Biometals 2024:10.1007/s10534-024-00630-0. [PMID: 39217594 DOI: 10.1007/s10534-024-00630-0] [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: 02/24/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
Multiple myeloma (MM) patients are often accompanied by heightened levels of oxidative stress, even following bone marrow transplantation. Trace mineral supplements have been found to regulate and inhibit the activity of oxidative radicals and inflammatory factors, which are involved in the pathogenesis of MM. The study sought to evaluate the effectiveness of the supplementation by analyzing changes in oxidative, anti-oxidative, and inflammation markers. Patients were randomly assigned to a zinc or placebo group, with the former receiving 30 mg of zinc or placebo tablets daily for 1 month. Blood samples were collected from the patients on the day of transplantation, 15 days, and 30 days post-transplantation. Real-time PCR was employed to measure the expression of oxidative/antioxidative genes. Furthermore, the protein level of oxidative markers in serum samples was assessed. Finally, serum TNF-α concentrations were measured using the ELISA technique. The expression levels of SOD1, SOD2, and NRF2 genes were significantly higher on days 15 and 30 compared to the control group (P < 0.05), with a greater increase on day 30 (P < 0.05). Conversely, the expression levels of Keap1 and NOX2 genes were lower on day 30 than those of the control group (P < 0.05), with a further decrease from day 15 to day 30 (P < 0.05). The experimental group exhibited a notable reduction in TNF-α cytokine levels on day 30 compared to the control and placebo groups (P < 0.05). All findings were coordinated according to the nutritional questionnaire. Our findings suggest a potential benefit of zinc supplementation in managing the adverse effects of chemotherapy in MM patients, warranting further investigation.
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Affiliation(s)
- Kasra Jahankhani
- Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloofar Taghipour
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Nikoonezhad
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Behboudi
- Faculty of Biology, Medicinal Plants and Drugs Research Institute, Shahid Beheshti University, Tehran, Iran
| | - Mahshid Mehdizadeh
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Dariush Kadkhoda
- Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Hajifathali
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nariman Mosaffa
- Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Amiri Khosroshahi R, Talebi S, Zeraattalab-Motlagh S, Imani H, Rashidi A, Travica N, Mohammadi H. Nutritional interventions for the prevention and treatment of cancer therapy-induced oral mucositis: an umbrella review of systematic reviews and meta-analysis. Nutr Rev 2023; 81:1200-1212. [PMID: 36763701 DOI: 10.1093/nutrit/nuac105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
CONTEXT To date, the efficacy of nutritional interventions on oral mucositis (OM) in patients with cancer, and the quality of this evidence have not been explored. OBJECTIVE The goal of this umbrella review was to provide a comprehensive evaluation of nutritional interventions for patients with cancer with OM, as well as to assess the quality of this evidence. DATA SOURCES Meta-analyses were searched for using PubMed, Scopus, and ISI Web of Science databases until December 2021, with no time restrictions. DATA EXTRACTION Meta-analyses of randomized control trials that evaluated the effects of nutritional interventions on the incidence of OM in patients with cancer had inclusion criteria for this umbrella review. Data extraction, quality assessment of meta-analyses, and primary studies were done independently by 2 authors. The Grading of Recommendations Assessment, Development, and Evaluation technique was used to grade the certainty of evidence. DATA ANALYSIS A total of 26 meta-analyses were included in this umbrella review. The results showed that honey, glutamine, and propolis can reduce the incidence of severe OM, based on moderate evidence quality. In addition, zinc supplementation significantly reduced the incidence of OM, regardless of symptom severity; however, low certainty of the evidence was observed. The effects of vitamin E, curcumin, and probiotics on OM were not statistically significant. CONCLUSION This umbrella review shows that honey, glutamine, and propolis can significantly reduce the incidence of severe OM. These findings need to be confirmed with well-designed, longitudinal randomized controlled trials. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42022301010.
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Affiliation(s)
- Reza Amiri Khosroshahi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepide Talebi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sheida Zeraattalab-Motlagh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Hossein Imani
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirabbas Rashidi
- Hematology-Oncology and BMT Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nikolaj Travica
- Deakin University, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Hamed Mohammadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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Liu X, Zhang W, Chen Y, Rastogi S, Choudhury R. Effectiveness of zinc supplementation on the incidence of oral mucositis during chemotherapy and radiation: A meta‑analysis. Exp Ther Med 2023; 26:347. [PMID: 37383380 PMCID: PMC10294599 DOI: 10.3892/etm.2023.12046] [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: 10/07/2022] [Accepted: 03/15/2023] [Indexed: 06/30/2023] Open
Abstract
Oral mucositis (OM) is a commonly observed and debilitating side effect of chemotherapy and radiation therapy in patients with cancer, especially head and neck cancer. Although there is no proven therapy for the prevention and treatment of OM, zinc supplementation effectively decreases the incidence of OM. This paper provides a current and comprehensive meta-analysis of the efficacy of zinc compared with placebo/control in OM. A systematic literature review was conducted using MEDLINE and Central databases for randomized control trials (RCTs) comparing zinc supplementation (oral or rinse) with placebo/control in patients with various types of cancer undergoing chemotherapy, radiation therapy or combined chemo-radiation. The outcome was OM incidence, independent of the severity. A random-effects model was used to calculate the pooled risk ratio and subgroup analyses were performed. A total of 12 RCTs were included, containing information from 783 patients. A decrease in OM incidence was observed overall when all cancer therapies were considered. However, subgroup analyses showed that zinc did not significantly decrease the incidence of OM when studies were stratified by cancer therapy or scale/criteria used to assess OM. The results of the meta-analysis support the use of zinc supplementation in decreasing OM incidence in patients with cancer receiving chemotherapy or radiation therapy. However, the high heterogeneity between studies and the small number of studies are limitations of the meta-analysis.
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Affiliation(s)
- Xin Liu
- Department of Stomatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing 100071, P.R. China
| | - Weifang Zhang
- Department of Oncology Chemotherapy, Central South University Xiangya School of Medicine Affiliated Haikou People's Hospital, Haikou, Hainan 570208, P.R. China
| | - Yifan Chen
- Department of Outpatient Stomatology, Huzhou Traditional Chinese Medicine Hospital, Zhejiang Chinese Medicinal University, Huzhou, Wuxing, Zhejiang 313000, P.R. China
| | - Sanjay Rastogi
- Deptartment of Oral and Maxillofacial Surgery, Regional Dental College, Guwahati, Assam 781021, India
| | - Rupshikha Choudhury
- Deptartment of Oral and Maxillofacial Surgery, Regional Dental College, Guwahati, Assam 781021, India
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Colella G, Boschetti CE, Vitagliano R, Colella C, Jiao L, King-Smith N, Li C, Nuoh Lau Y, Lai Z, Mohammed AI, Cirillo N. Interventions for the Prevention of Oral Mucositis in Patients Receiving Cancer Treatment: Evidence from Randomised Controlled Trials. Curr Oncol 2023; 30:967-980. [PMID: 36661723 PMCID: PMC9858113 DOI: 10.3390/curroncol30010074] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023] Open
Abstract
Oral mucositis is a common and most debilitating complication associated with cancer therapy. Despite the significant clinical and economic impact of this condition, there is little to offer to patients with oral mucositis, and the medications used in its management are generally only palliative. Given that mucositis is ultimately a predictable and, therefore, potentially preventable condition, in this study we appraised the scientific literature to evaluate effective methods of prevention that have been tested in randomised controlled trials (RCTs). Published high-level evidence shows that multiple preventative methods are potentially effective in the prevention of oral mucositis induced by radiotherapy, chemotherapy, or both. Anti-inflammatory medications (including benzydamine), growth factors and cytokines (including palifermin), cryotherapy, laser-and-light therapy, herbal medicines and supplements, and mucoprotective agents (including oral pilocarpine) showed some degree of efficacy in preventing/reducing the severity of mucositis with most anticancer treatments. Allopurinol was potentially effective in the prevention of radiotherapy-induced oral mucositis; antimicrobial mouthwash and erythropoietin mouthwash were associated with a lower risk of development of severe oral mucositis induced by chemotherapy. The results of our review may assist in highlighting the efficacy and testing the effectiveness of low-cost, safe preventative measures for oral mucositis in cancer patients.
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Affiliation(s)
- Giuseppe Colella
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Oral and Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Ciro Emiliano Boschetti
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Oral and Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Rita Vitagliano
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Oral and Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Chiara Colella
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Oral and Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Lebei Jiao
- Melbourne Dental School, The University of Melbourne, Carlton, Melbourne, VIC 3053, Australia
| | - Natalie King-Smith
- Melbourne Dental School, The University of Melbourne, Carlton, Melbourne, VIC 3053, Australia
| | - Chong Li
- Melbourne Dental School, The University of Melbourne, Carlton, Melbourne, VIC 3053, Australia
| | - Yii Nuoh Lau
- Melbourne Dental School, The University of Melbourne, Carlton, Melbourne, VIC 3053, Australia
| | - Zacchaeus Lai
- Melbourne Dental School, The University of Melbourne, Carlton, Melbourne, VIC 3053, Australia
| | - Ali Ibrahim Mohammed
- Melbourne Dental School, The University of Melbourne, Carlton, Melbourne, VIC 3053, Australia
| | - Nicola Cirillo
- Melbourne Dental School, The University of Melbourne, Carlton, Melbourne, VIC 3053, Australia
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Li T, Shi L, Wei W, Xu J, Liu Q. The trace that is valuable: serum copper and copper to zinc ratio for survival prediction in younger patients with newly diagnosed acute myeloid leukaemia. BMC Cancer 2023; 23:14. [PMID: 36604732 PMCID: PMC9817254 DOI: 10.1186/s12885-022-10486-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/26/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE No data on predicting the survival of AML patients based on the level of trace elements in the serum have been presented to date. The aims of this prospective cohort study were as follows: (i) to evaluate the serum Cu and Zn levels in people from Northeast China, (ii) to assess the association between the serum Cu level (SCL) and Cu to Zn ratio (SCZR) and clinical and nutrition data, and (iii) to investigate the predictive values of the SCL and SCZR in newly diagnosed de novo AML patients. METHODS A total of 105 newly diagnosed AML patients and 82 healthy controls were recruited. The serum Cu and Zn levels were determined by inductively coupled plasma spectrometry. The associations of SCL and SCZR with the survival of these AML patients were assessed by Cox proportional hazards models. RESULTS Both SCL and SCZR were positively related to the blast percentage of bone marrow and C-reactive protein, negatively related to albumin level and CEBPA double mutation and were significantly associated with worse overall survival and disease-free survival. Meanwhile, patients with higher SCL had worse CTCAE levels, and patients with higher SCZR showed less complete remission during the first course of induction chemotherapy. Moreover, higher SCZR was positively associated with ELN risk stratification, and was negatively associated with haemoglobin level and prognostic nutritional index (PNI). CONCLUSION The SCL and SCZR are associated with long-term survival in patients with newly diagnosed AML undergoing intensive induction and may serve as important predictive biomarkers.
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Affiliation(s)
- Taotao Li
- grid.430605.40000 0004 1758 4110Department of Haematology, the First Hospital of Jilin University, Cancer Center, Changchun, Jilin, China
| | - Liming Shi
- grid.430605.40000 0004 1758 4110Department of Haematology, the First Hospital of Jilin University, Cancer Center, Changchun, Jilin, China
| | - Wei Wei
- grid.263826.b0000 0004 1761 0489Department of Haematology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Jiancheng Xu
- grid.430605.40000 0004 1758 4110Department of Laboratory Medicine, First Hospital of Jilin University, Changchun, China
| | - Qiuju Liu
- grid.430605.40000 0004 1758 4110Department of Haematology, the First Hospital of Jilin University, Cancer Center, Changchun, Jilin, China
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Mohammadi F, Oshvandi K, Kamallan SR, Khazaei S, Ranjbar H, Ahmadi‐Motamayel F, Gillespie M, Jenabi E, Vafaei SY. Effectiveness of sodium bicarbonate and zinc chloride mouthwashes in the treatment of oral mucositis and quality of life in patients with cancer under chemotherapy. Nurs Open 2022; 9:1602-1611. [PMID: 35170247 PMCID: PMC8994952 DOI: 10.1002/nop2.1168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/09/2021] [Accepted: 12/15/2021] [Indexed: 11/29/2022] Open
Abstract
Aim The purpose of the study is to evaluate the effectiveness of sodium bicarbonate and zinc chloride mouthwashes on oral mucositis and quality of life in patients undergoing chemotherapy. Design The present study was a randomized controlled trial study. Methods One hundred forty‐four patients with a cancer diagnosis were randomly assigned into three groups: sodium bicarbonate mouthwash (n = 48), zinc chloride mouthwash (n = 48) and placebo group (n = 48). The severity of mucositis and quality of life were examined blindly at the baseline and 3‐week follow‐up. Results The grade of oral mucositis decreased at the end of the third weeks in the sodium bicarbonate and zinc chloride groups rather than the placebo group (p < .001). The severity of oral mucositis in the sodium bicarbonate and zinc chloride groups decreased from end of the first week until third week (p < .001). In addition, there was significant difference in the severity of oral mucositis among the groups at the end of the second (p = .014) and the third weeks (p < .001). Also, there was a statistically significant difference in quality of life scores between the sodium bicarbonate and zinc chloride mouthwash with the placebo group (p < .001). Conclusion Zinc chloride and sodium bicarbonate mouthwashes were effective in treating and reducing the severity of oral mucositis, and subsequently improving quality of life in patients with cancer under chemotherapy. Therefore, we can recommend zinc chloride and sodium bicarbonate at the beginning of chemotherapy to improve oral health and promoting quality of life in these patients.
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Affiliation(s)
- Fateme Mohammadi
- Department of Pediatric Nursing, Chronic Diseases (Home Care) Research Center and Autism Spectrum Disorders Research CenterDepartment of NursingHamadan University of Medical SciencesHamadanIran
| | - Khodayar Oshvandi
- Department of Medical Surgical NursingSchool of Nursing and Midwifery, Mother and Child Care Research CenterHamadan University of Medical SciencesHamadanIran
| | - Seyed Ramesh Kamallan
- Department of Medical‐Surgical NursingStudent Research CenterHamadan University of Medical SciencesHamadanIran
| | - Salman Khazaei
- Department of EpidemiologyHealth Sciences Research CenterHealth Sciences & Technology Research InstituteHamadan University of Medical SciencesHamadanIran
| | - Hossein Ranjbar
- Department of Hematology and OncologyDepartment of Internal MedicineSchool of MedicineHamadan University of Medical SciencesHamadanIran
| | - Fatemeh Ahmadi‐Motamayel
- Department of Oral and Maxillofacial MedicineSchool of DentistryDental Research CenterHamadan University of Medical SciencesHamadanIran
| | - Mark Gillespie
- School of Health Nursing and MidwiferyUniversity of the West of ScotlandPaisleyScotland
| | - Ensiyeh Jenabi
- Research Assistant Professor of Reproductive Health (By Research)Autism Spectrum disorders Research CenterHamadan University of Medical SciencesHamadanIran
| | - Seyed Yaser Vafaei
- Department of PharmaceuticsDepartment of Pharmaceutics and Pharmaceutical BiotechnologySchool of PharmacyHamadan University of Medical SciencesHamadanIran
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Isozaki AB, Brant JM. Clinical Updates in Mucositis-Related Symptom Management. Semin Oncol Nurs 2022; 38:151252. [DOI: 10.1016/j.soncn.2022.151252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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8
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Hosseini R, Montazerifar F, Shahraki E, Karajibani M, Mokhtari AM, Dashipour AR, Ferns GA, Jalali M. The Effects of Zinc Sulfate Supplementation on Serum Copeptin, C-Reactive Protein and Metabolic Markers in Zinc-Deficient Diabetic Patients on Hemodialysis: A Randomized, Double-Blind, Placebo-Controlled Trial. Biol Trace Elem Res 2022; 200:76-83. [PMID: 33655432 DOI: 10.1007/s12011-021-02649-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/18/2021] [Indexed: 11/25/2022]
Abstract
We aimed to investigate the association between zinc (Zn) supplementation and serum levels of copeptin, high-sensitive C-reactive protein (hs-CRP), glycemic control, anthropometric parameters and renal function in Zn -deficient diabetic hemodialysis patients (DHPs). This randomized, double-blind, placebo-controlled trial (RCT) was conducted on 46 DHPs with Zn-deficiency. The Zn supplement group (n = 21) received a 220-mg/day Zn sulfate capsule (containing 50 mg Zn), and the control group (n = 25) received a placebo capsule (220 mg corn starch), for 8 weeks. Fasting, predialysis blood samples were taken at baseline and after 8 weeks to assess fasting blood glucose (FBG), serum insulin, copeptin, high-sensitive C-reactive protein (hs-CRP), blood urea nitrogen (BUN), creatinine (Cr) concentrations, and homoeostatic model assessment (HOMA-IR) and quantitative insulin-sensitivity check index (QUICKI). Compared to controls, serum copeptin (P < 0.001), hs-CRP (P < 0.001), BUN (P < 0.001), Cr (P < 0.001), Zn (P < 0.001), FBG (P < 0.001) levels, BMI (P < 0.001), and body weight (P < 0.001) were significantly affected following ZnSO4 supplementation for 8 weeks. In contrast, QUICKI (P = 0.57), HOMA-IR (P = 0.60), and serum insulin (P = 0.55) were not affected following Zn supplementation in comparison with patients receiving placebo. Zn sulfate supplementation appears to have favorable effects on serum copeptin and hs-CRP, FBG, and renal function in Zn-deficient DHPs. Iranian Registry of Clinical Trials Identifier: IRCT20190806044461N1.
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Affiliation(s)
- Razieh Hosseini
- Department of Nutrition, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Farzaneh Montazerifar
- Pregnancy Health Research Center, Department of Nutrition, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
| | - Elham Shahraki
- Genetics of Non-Communicable Disease Research Center, Department of Nephrology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mansour Karajibani
- Health Promotion Research Center , Department of Nutrition, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ali Mohammad Mokhtari
- School of Health, Gonabad University of Medical Sciences, Gonabad, Khorasan Razavi, Iran
| | - Ali Reza Dashipour
- Cellular and Molecular Research Center, Department of Food and Technology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Gordon A Ferns
- Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex, UK
| | - Mohammad Jalali
- Nutrition Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Rodríguez-Tomàs E, Baiges-Gaya G, Castañé H, Arenas M, Camps J, Joven J. Trace elements under the spotlight: A powerful nutritional tool in cancer. J Trace Elem Med Biol 2021; 68:126858. [PMID: 34537473 DOI: 10.1016/j.jtemb.2021.126858] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/01/2021] [Accepted: 09/10/2021] [Indexed: 01/31/2023]
Abstract
Cancer is the second leading cause of death worldwide. Research on the relationships between trace elements (TE) and the development of cancer or its prevention is a field that is gaining increasing relevance. This review provides an evaluation of the effects of TE (As, Al, B, Cd, Cr, Cu, F, I, Pb, Li, Mn, Hg, Mo, Ni, Se, Si, Sn, V and Zn) intake and supplementation in cancer risk and prevention, as well as their interactions with oncology treatments. Advancements in the knowledge of TE, their dietary interactions and their main food sources can provide patients with choices that will help them to improve their quality of life and therapy outcomes. This approach could open new opportunities for treatments based on the integration of conventional therapies (chemotherapy, radiotherapy, and immunotherapy) and dietary interventions that provide advanced personalized treatments.
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Affiliation(s)
- Elisabet Rodríguez-Tomàs
- Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, C. Sant Joan s/n, 43201, Reus, Spain; Department of Radiation Oncology, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Av. Doctor Josep Laporte 2, 43204, Reus, Spain
| | - Gerard Baiges-Gaya
- Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, C. Sant Joan s/n, 43201, Reus, Spain
| | - Helena Castañé
- Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, C. Sant Joan s/n, 43201, Reus, Spain
| | - Meritxell Arenas
- Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, C. Sant Joan s/n, 43201, Reus, Spain; Department of Radiation Oncology, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Av. Doctor Josep Laporte 2, 43204, Reus, Spain
| | - Jordi Camps
- Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, C. Sant Joan s/n, 43201, Reus, Spain
| | - Jorge Joven
- Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, C. Sant Joan s/n, 43201, Reus, Spain
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A real-world accuracy of oral mucositis grading in patients undergoing hematopoietic stem cell transplantation. Support Care Cancer 2021; 30:2705-2712. [PMID: 34822004 DOI: 10.1007/s00520-021-06654-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 10/24/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE Oral mucositis is a common complication in patients undergoing hematopoietic stem cell transplantation. Accurate oral mucositis grading is essential for both clinical practice and oral mucositis research. This study aimed to evaluate the accuracy of daily oral mucositis grading by nurses in a tertiary hospital in Australia. METHODS A retrospective study was undertaken to review the daily patient oral assessment record, including diet, pain, erythema, ulceration and the oral mucositis grade based on World Health Organization (WHO) oral mucositis grading scale. The accuracy of the grade was determined by the observations recorded, and reasons for inaccuracy were documented. Any repetition of the same error in the same patient was noted. RESULTS In total, 6841 oral assessments in 373 patients, conducted between 2017 and 2020, were reviewed. A total of 70% (N = 4781) were graded correctly. Of these, 64% (N = 3043) were grade 0. When the grade 0 scores were excluded, the accuracy of grading was reduced to 46% (N = 1738). Common reasons for incorrect grading included: unable to grade due to diet not specified, no ulceration and no pain was scored grade 1, no ulceration was scored as grade 2-4, oral intake was not taken into account, and pain without ulcer was scored 0. A total of 77% of the errors were repeated in the same patient on consecutive days. CONCLUSIONS Our results suggest there is frequent inaccurate evaluation of oral mucositis and a need for nurse training to accurately assess oral mucositis.
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11
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Chung JH, Phalke N, Hastings C, Killilea DW, Feusner JH, Fung EB. Zinc deficiency and its association with treatment-related toxicity in children with cancer. Pediatr Blood Cancer 2021; 68:e29104. [PMID: 34061438 DOI: 10.1002/pbc.29104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/24/2021] [Accepted: 04/27/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Nutritional deficiencies in children with cancer at time of diagnosis and during treatment may negatively affect disease outcome and increase treatment-related toxicity. Yet zinc, an essential nutrient important for supporting immune function and known for reducing diarrheal episodes, is rarely assessed in these children. PROCEDURES Fifty children (1 month to 18 years) with recently diagnosed cancer were enrolled in this study. An age and gender matched control group (n = 50) was also recruited. Plasma and urinary zinc, plasma copper, and C-reactive protein (CRP) levels were measured at baseline, 3, and 6 months following diagnosis. A retrospective review of the toxicity profile was performed in the cohort of children with cancer for the first 4 years after initial diagnosis. RESULTS CRP and plasma copper (both acute-phase reactants) were elevated in patients with cancer compared to controls at baseline, both p < .03. Plasma zinc levels were not significantly different from controls at baseline, but decreased by 11% in the cancer group over 6 months of treatment, 83.2 ± 15.6 to 74.3 ± 14.8 μg/dl, p = .01. Plasma zinc dropped to deficient levels in 35% of cases over the initial 6 months. Zinc deficiency at 6 months was related to an increased incidence of severe diarrhea during 4 years of follow-up, p < .001. CONCLUSIONS Zinc deficiency is an underrecognized problem among patients undergoing treatment for cancer and is associated with severe diarrhea. Further studies are needed to evaluate causes for zinc deficiency, related effects, and a possible role for zinc supplementation.
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Affiliation(s)
- Jong H Chung
- Department of Pediatrics, Hematology Oncology, University of California Davis Medical Center, Sacramento, California, USA
| | - Neelam Phalke
- Department of Otolaryngology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | - Caroline Hastings
- Department of Hematology Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - David W Killilea
- Children's Hospital Oakland Research Institute, Oakland, California, USA
| | - James H Feusner
- Department of Hematology Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Ellen B Fung
- Department of Hematology Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA.,Children's Hospital Oakland Research Institute, Oakland, California, USA
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12
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Oshvandi K, Vafaei SY, Kamallan SR, Khazaei S, Ranjbar H, Mohammadi F. Effectiveness of zinc chloride mouthwashes on oral mucositis and weight of patients with cancer undergoing chemotherapy. BMC Oral Health 2021; 21:364. [PMID: 34294072 PMCID: PMC8296564 DOI: 10.1186/s12903-021-01706-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oral mucositis is one of the most emerging and debilitating complications of chemotherapy during the treatment period, which strongly affects the nutritional status and physical and mental condition of these patients. Zinc increased protein synthesis and improved cell membrane stability so passible effective in prevent and treat oral mucositis and promote oral health. Therefore, this study aimed to evaluate the effect of zinc chloride mouthwash on the prevention, incidence, and severity of oral mucositis in cancer patients undergoing chemotherapy. METHODS The present study was a randomized control trial study. 96 patients with a cancer diagnosis selected from one oncology clinic in the west of Iran. Then they assigned randomly to the zinc chloride group and placebo group. The patients in each group should rinse their mouths every 8 h two times and each time 2 min with 7.5 ml from mouthwash. The severity of mucositis and weight loss examined blindly at the baseline and 3-week follow-up. RESULTS The incidence and severity of oral mucositis between groups were significant higher at the end of the second (p < 0.002) and third (p < 0.001) week. The mucositis severity decreased well during the third weeks in the zinc chloride group. The difference in the weight loss was significant higher between the zinc chloride and the placebo group (p < 0.01). CONCLUSION Zinc chloride mouthwash was effective in preventing and reducing the severity of oral mucositis and improving weight in patients undergoing chemotherapy. Trial registration We can therefore recommend more studies examine the effects zinc chloride as preventive care at the beginning of chemotherapy to improve oral health and subsequently preventing weight loss in these patients.
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Affiliation(s)
- Khodayar Oshvandi
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyed Yaser Vafaei
- Department of Pharmaceutics & Pharmaceutical Biotechnology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyed Ramesh Kamallan
- Department of Medical Surgical Nursing, Student Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Salman Khazaei
- Department of Epidemiology, Health Sciences Research Center, Health Sciences and Technology Research Institute, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hossein Ranjbar
- Department of Hematology Oncology, Department of Internal Medicine, School of Medicine, Shahid Beheshti Medical Educational Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fateme Mohammadi
- Department of Pediatric Nursing, Chronic Diseases (Home Care) Research Center and Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
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13
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Hoppe C, Kutschan S, Dörfler J, Büntzel J, Büntzel J, Huebner J. Zinc as a complementary treatment for cancer patients: a systematic review. Clin Exp Med 2021; 21:297-313. [PMID: 33496846 PMCID: PMC8053661 DOI: 10.1007/s10238-020-00677-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/02/2020] [Indexed: 12/17/2022]
Abstract
Zinc is a trace element that plays an important role in the immune system and cell growth. The role of zinc in cancer treatment has been discussed for some time, however without reaching an evidenced-based consensus. Therefore, we aim to critically examine and review existing evidence on the role of zinc during cancer treatment. In January 2019, a systematic search was conducted searching five electronic databases (Embase, Cochrane, PsychINFO, CINAHL and PubMed) to find studies concerning the use, effectiveness and potential harm of zinc therapy on cancer patients. Out of initial 5244 search results, 19 publications concerning 23 studies with 1230 patients were included in this systematic review. The patients treated with zinc were mainly diagnosed with head and neck cancer and underwent chemo-, radio- or concurrent radio-chemotherapy. Interventions included the intake of different amounts of zinc supplements and oral zinc rinses. Outcomes (primary endpoints) investigated were mucositis, xerostomia, dysgeusia, pain, weight, dermatitis and oral intake of nutrients. Secondary endpoints were survival data, quality of life assessments and aspects of fatigue, immune responses and toxicities of zinc. The studies were of moderate quality reporting heterogeneous results. Studies have shown a positive impact on the mucositis after radiotherapy. No protection was seen against mucositis after chemotherapy. There was a trend to reduced loss of taste, less dry mouth and oral pain after zinc substitution. No impact was seen on weight, QoL measurements, fatigue, and survival. The risk of side effects from zinc appears to be relatively small. Zinc could be useful in the prevention of oral toxicities during irradiation. It does not help in chemotherapy-induced side effects.
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Affiliation(s)
- C Hoppe
- Klinik für Innere Medizin II, Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - S Kutschan
- Klinik für Innere Medizin II, Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - J Dörfler
- Klinik für Innere Medizin II, Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - J Büntzel
- Klinik für HNO-Erkrankungen, Kopf-Hals-Chirurgie, Südharz-Klinikum Nordhausen, Dr.-Robert-Koch-Str. 39, 99734, Nordhausen, Germany
| | - J Büntzel
- Klinik für Hämatologie und Medizinische Onkologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Jutta Huebner
- Klinik für Innere Medizin II, Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany.
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14
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Hosseini R, Ferns GA, Sahebkar A, Mirshekar MA, Jalali M. Zinc supplementation is associated with a reduction in serum markers of inflammation and oxidative stress in adults: A systematic review and meta-analysis of randomized controlled trials. Cytokine 2020; 138:155396. [PMID: 33333394 DOI: 10.1016/j.cyto.2020.155396] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/17/2020] [Accepted: 11/30/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Zinc (Zn) is a trace metal that is considered to have an impact on chronic inflammation. However, findings of clinical trials have been inconsistent. The present systematic review and meta-analysis aimed to provide a more robust examination of the evidence on the effectiveness of Zn supplements on markers of inflammation and oxidative stress. METHODS A systematic search in PubMed, Scopus, Web of Science and Cochrane Library was undertaken to identify relevant randomized controlled trials (RCTs) assessing the impact of Zn on inflammation and oxidative stress until 17 August 2020. We applied a random-effects method to obtain effect sizes (ES) and 95% confidence intervals (CIs). Meta-regression was used to detect the potential source of between-study heterogeneity. RESULTS Twenty-one eligible RCTs comprising 1321 participants were included in the meta-analysis. In comparison with the control groups, serum C-reactive protein (CRP) (ES = -0.92 mg/L, 95% CI = [-1.36, -0.48], P < 0.001, I2 = 90.2%), tumor necrosis factor-alpha (TNF-α) (ES = -0.49 pg/mL, 95% CI = [-084, -0.14], P = 0.006, I2 = 34.6%) and malondialdehyde (MDA) (ES = -0.42, 95% CI = [-083, -0.01], P = 0.04, I2 = 76.1%) were significantly reduced in the groups receiving Zn. Serum interleukin 6 (ES = -1.02 pg/mL, 95% CI = [-2.06, 0.02], P = 0.05, I2 = 92.3%) was marginally reduced following Zn supplementation. Moreover, treatment duration was found as the source of inter-study heterogeneity. CONCLUSION This meta-analysis suggests that Zn supplements reduce serum concentrations of markers of inflammation and oxidation: CRP, TNF-α and MDA.
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Affiliation(s)
- Razieh Hosseini
- Student Research Committee, Department of Nutrition, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Gordon A Ferns
- Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex, UK
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Halal Research Center of IRI, FDA, Tehran, Iran
| | - Mohammad Ali Mirshekar
- Clinical Immunology Research Center, Zahedan University of Medical Sciences, Zahedan, Iran; Department of Physiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohammad Jalali
- Nutrition Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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15
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Anandhi P, Sharief RM, Rahila C. The Benefit of Zinc Sulfate in Oropharyngeal Mucositis during Hyperfractionated Accelerated Concomitant Boost Radiotherapy with Concurrent Cisplatin for Advanced-Stage Oropharyngeal and Hypopharyngeal Cancers. Indian J Palliat Care 2020; 26:437-443. [PMID: 33623304 PMCID: PMC7888420 DOI: 10.4103/ijpc.ijpc_20_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/26/2020] [Indexed: 11/04/2022] Open
Abstract
Background: Radiation-induced oropharyngeal mucositis is a major problem causing widespread clinical symptoms and may interfere with treatment plans, ultimately jeopardizing patient outcome. Zinc supplementation may be considered beneficial in preventing acute toxicity during chemoradiation. Aims and Objective: The aim of the study is to determine the effect of zinc supplementation on radiation-induced oropharyngeal mucositis in Stage III and IV-A oropharynx and hypopharynx cancers treated by hyperfractionated accelerated concomitant boost radiotherapy with weakly cisplatin. The objective behind the study is to know any changes in the onset, duration, and severity of oropharyngeal mucositis by implementation of oral zinc sulfate. Materials and Methods: The study is double-blinded randomized controlled assessment involving 120 patients (60 – control and 60 – experimental) treated with chemoradiation for oropharyngeal and hypopharyngeal cancers. The experimental group received oral zinc sulfate 150 mg once daily during and after treatment, whereas the control group patients were given placebo. The categorical data were analyzed using the Chi-square test and Pearson correlation. The Friedman test was used for comparison of oral mucositis grading between the groups. Results: A statistically significant difference was found in the zinc-supported experimental group showing delay in onset, decrease in severity, and duration of oropharyngeal mucositis. Conclusion: Zinc supplementation could be beneficial in managing oropharyngeal mucositis during chemoradiation of head-and-neck cancers with no untoward side effects.
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Affiliation(s)
- P Anandhi
- Department of Radiation Oncology,Government Arignar Anna Memorial Cancer Institute, Kanchipuram, Tamil Nadu, India.,Affiliated to the Tamil Nadu Dr. MGR Medical University, Kanchipuram, Tamil Nadu, India
| | - Rahamathulla Mudassar Sharief
- Affiliated to the Tamil Nadu Dr. MGR Medical University, Kanchipuram, Tamil Nadu, India.,Department of Dental Surgery, Government Arignar Anna Memorial Cancer Institute, Kanchipuram, Tamil Nadu, India
| | - C Rahila
- Department of Public Health Dentistry, Statistical Analysis, Vivekananda Dental College for Women, Namakkal, Tamil Nadu, India
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16
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Gutiérrez-Vargas R, Villasis-Keever MÁ, Portilla-Robertson J, Ascencio-Montiel ID, Zapata-Tarrés M. Effect of zinc on oropharyngeal mucositis in children with acute leukemia undergoing chemotherapy. Med Oral Patol Oral Cir Bucal 2020; 25:e791-e798. [PMID: 33037810 PMCID: PMC7648919 DOI: 10.4317/medoral.23798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Oropharyngeal mucositis (OM) is one of the main side-effects of oncological therapy. There is no treatment to prevent its occurrence, but some zinc-based therapies have been proven to help in decreasing its intensity. The objective of this study was to determine the effect of zinc in OM in children with acute leukemia in the early stages of oncological treatment.
Material and Methods This quasi-experimental study evaluated OM in 2 groups (control group: conventional hospital management, and experimental group: administration of 50 mg of zinc gluconate daily plus conventional hospital management). OM severity was recorded at a two-month follow-up.
Results Forty-nine patients (26 in the control group and 23 in the experimental group) were included. The mean age of the patients was 11.1 ± 2.7 years; 65.3% had a diagnosis of pre-B acute lymphoblastic leukemia. The incidences of OM in the control group and the experimental group were 46.2% and 26.1%, respectively, but the difference was not significant. Based on a negative binomial regression model, females had, on average, 1.5 more days with OM (p = 0.002), and patients assigned to the experimental group had, on average, 2 less days with OM than the control group (p = 0.001). The pain score was higher in the control group (p = 0.0009), as was the mean score on the WHO scale (p = 0.0012).
Conclusions Zinc facilitated a reduction in the severity and duration of OM; further studies focusing on children are needed to confirm the effects of this trace element. Key words:Oropharyngeal, mucositis, zinc, chemotherapy, children, leukemia.
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Affiliation(s)
- R Gutiérrez-Vargas
- Oncology Department National Institute of Pediatrics, Health Secretary Insurgentes Sur 3700-C, Insurgentes Cuicuilco Coyoacan, Mexico City, 04530
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17
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Shuai T, Tian X, Xu LL, Chen WQ, Pi YP, Zhang L, Wan QQ, Li XE. Oral Glutamine May Have No Clinical Benefits to Prevent Radiation-Induced Oral Mucositis in Adult Patients With Head and Neck Cancer: A Meta-Analysis of Randomized Controlled Trials. Front Nutr 2020; 7:49. [PMID: 32363198 PMCID: PMC7180868 DOI: 10.3389/fnut.2020.00049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/26/2020] [Indexed: 12/30/2022] Open
Abstract
Objectives: The role of oral glutamine for the management of oral mucositis (OM) has not yet been confirmed. The objective of the present study is to further investigate whether oral glutamine is effective in preventing and treating OM among patients with head and neck cancer (HNC) receiving radiotherapy alone or concurrent with chemotherapy. Methods: A systematic search was performed in PubMed, EMBASE, EBSCO, and Cochrane Central Register of Controlled Trials (CENTRAL) to capture all potential citations from the inception to June 2019. Then data extraction and assessment of risk of bias were carried out after selecting the eligible citations. RevMan 5.3 software was used to perform all statistical analyses. Results: Six randomized controlled trials (RCTs) including 441 patients were included in the final analysis. The meta-analysis showed that oral glutamine couldn't significantly decrease the incidence of OM (risk ratio [RR] = 0.98, 95% confidence interval [CI] = 0.94−1.02) and alleviate the development of moderate or severe grade of OM (Moderate-to-severe OM: RR = 0.81, 95% CI = 0.59−1.12; Severe OM: RR = 0.45, 95% CI = 0.13−1.52). But oral glutamine may have the potential to reduce the opioid use (RR = 0.84, 95% CI = 0.71−0.99). The role of oral glutamine in delaying the onset of OM remains uncertain due to conflicting results between quantitative (mean difference [MD] = 4.11 days, 95% CI = 3.49−4.73) and qualitative results. Conclusions: Oral glutamine may have no clinical benefits to prevent or reduce the incidence and severity of radiation-induced OM in patients with HNC receiving radiotherapy alone or concurrent with chemotherapy. It is also uncertain whether oral glutamine can delay the onset of OM. But it may have the potential to relieve the degree of oral pain. Nevertheless, we must cautiously interpret the results because the observed effect size for delay in mucositis start or reduction in opioid use is marginal. Moreover, further RCTs with more rigorous methodology and large-scale are required to enhance the quality of evidence.
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Affiliation(s)
- Ting Shuai
- Second Dental Center, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xu Tian
- Department of Gastroenterology, Chongqing University Cancer Hospital, Chongqing, China
| | - Ling-Li Xu
- Department of Gastroenterology, Chongqing University Cancer Hospital, Chongqing, China
| | - Wei-Qing Chen
- Department of Gastroenterology, Chongqing University Cancer Hospital, Chongqing, China
| | - Yuan-Ping Pi
- Department of Gastroenterology, Chongqing University Cancer Hospital, Chongqing, China
| | - Lin Zhang
- Department of Nursing, Peking University School and Hospital of Stomatology, Beijing, China
| | - Qiao-Qin Wan
- School of Nursing, Peking University, Beijing, China
| | - Xiu-E Li
- Department of Nursing, Peking University School and Hospital of Stomatology, Beijing, China
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18
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Uwitonze AM, Ojeh N, Murererehe J, Atfi A, Razzaque MS. Zinc Adequacy Is Essential for the Maintenance of Optimal Oral Health. Nutrients 2020; 12:E949. [PMID: 32235426 PMCID: PMC7230687 DOI: 10.3390/nu12040949] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/20/2020] [Accepted: 03/26/2020] [Indexed: 01/19/2023] Open
Abstract
Zinc, a metal found in the Earth's crust, is indispensable for human health. In the human body, around 60% of zinc is present in muscles, 30% in bones, and the remaining 10% in skin, hair, pancreas, kidneys and plasma. An adequate zinc balance is essential for the maintenance of skeletal growth, development and function. It is also necessary for basic cellular functions including enzyme activation, cell signaling and energy metabolism. Inadequate zinc status is associated with a wide variety of systemic disorders including cardiovascular impairment, musculoskeletal dysfunctions and oromaxillary diseases. In this article, we briefly discuss the role of zinc deficiency in the genesis of various oromaxillary diseases, and explain why adequate zinc homeostasis is vital for the maintenance of oral and general health.
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Affiliation(s)
- Anne Marie Uwitonze
- Department of Preventive & Community Dentistry, University of Rwanda College of Medicine & Health Sciences, School of Dentistry, KK 737 St, Kigali, Rwanda
| | - Nkemcho Ojeh
- Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, Bridgetown BB11000, Barbados
| | - Julienne Murererehe
- Department of Preventive & Community Dentistry, University of Rwanda College of Medicine & Health Sciences, School of Dentistry, KK 737 St, Kigali, Rwanda
| | - Azeddine Atfi
- Department of Pathology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Mohammed S. Razzaque
- Department of Preventive & Community Dentistry, University of Rwanda College of Medicine & Health Sciences, School of Dentistry, KK 737 St, Kigali, Rwanda
- College of Advancing & Professional Studies (CAPS), University of Massachusetts Boston (UMB), Boston, MA 02125, USA
- Department of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA 16509, USA
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19
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Rambod M, Pasyar N, Shamsadini M. The effect of foot reflexology on fatigue, pain, and sleep quality in lymphoma patients: A clinical trial. Eur J Oncol Nurs 2019; 43:101678. [DOI: 10.1016/j.ejon.2019.101678] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 09/03/2019] [Accepted: 10/14/2019] [Indexed: 12/30/2022]
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20
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Wang G, Jia L. Herb medicine for relieving radiation induced oral mucositis: A systematic review and meta-analysis protocol. Medicine (Baltimore) 2019; 98:e18337. [PMID: 31852129 PMCID: PMC6922437 DOI: 10.1097/md.0000000000018337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Oral mucositis (OM) is a common and unavoidable side effect in patients suffering from head and neck cancer who are undergoing radiotherapy. It is characterized by unbearable pain, as well as eating and speech disorders. This has serious negative effects on the patients' quality of life and can even reduce radiotherapy tolerance, ultimately resulting in a poor prognosis. At present, many prevention and treatment methods are still in the experimental stage, and the efficacies are controversial. METHODS Four English databases: Medline via pubmed, EMBASE, the Cochrane Library, Web of Science and another 4 Chinese databases: China National Knowledge Infrastructure (CNKI), China Science and Technology Journal database (VIP), Wanfang Database and CBM, will be searched from inception to August 2019. All randomized controlled trials in Chinese and English language will be included. Literature selection, data extraction and quality assessment will be completed by 2 independent authors. The primary outcomes will include the incidence of OM (1-4 grade) and the pain degree. The onset time of OM, the improvement rate for quality of life, and any adverse effects will be evaluated as the secondary outcomes. The data will be synthesized by Review Manager and Stata software. RESULTS This study provides a high-quality synthesis from existing evidence for Chinese herbal medicine in radiotherapy induced OM treatment, according to the criteria: incidence of OM, onset time of OM, status changes in quality of life and adverse events. CONCLUSION This study will provide evidence to help determine whether Chinese herbal medicine is effective and safe for use in the prevention and/or treatment of radiotherapy induced OM. ETHICS AND DISSEMINATION No additional formal ethical recognition or informed consent is required since no primary data collection is involved. The study result will be published in peer-reviewed journals or at related conferences.PROSPERO registration number: PROSPERO CRD42019141900.
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Affiliation(s)
- Gui Wang
- Beijing University of Chinese Medicine
- Department of Oncology of Integrative Chinese and Western Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Liqun Jia
- Department of Oncology of Integrative Chinese and Western Medicine, China-Japan Friendship Hospital, Beijing, China
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21
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Thomsen M, Vitetta L. Zinc deficits, mucositis, and mucosal macrophage perturbation: is there a relationship? Curr Opin Clin Nutr Metab Care 2019; 22:365-370. [PMID: 31335336 DOI: 10.1097/mco.0000000000000588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Mucositis is a common and therapy-limiting adverse effect of cancer treatments including radiotherapy, chemotherapy, and immunotherapy. The optimal zinc formulation, dosage, and timing of administration warrant further research as does the efficacious prevention of febrile mucositis that predisposes to febrile neutropenia. RECENT FINDINGS Metaanalyses concluded that zinc sulfate failed to significantly reduce the incidence or severity of chemotherapy-induced oral mucositis, whereas polaprezinc was associated with a significant reduction. Three new trials were published in 2018. The first trial found that zinc sulfate reduced the incidence and severity of chemotherapy-induced oral mucositis. The second reported that polaprezinc reduced oral mucositis in pediatric patients receiving high-dose chemotherapy for hematopoietic stem cell transplantation. The third trial demonstrated efficacy for a zinc lozenge for postoperative sore throat induced by an endotracheal intubation. SUMMARY Zinc deficits, dietary or induced by cancer, are common in patients with cancer. Febrile mucositis may better describe the condition linking mucositis with febrile neutropenia. Febrile mucositis disrupts treatment and may be life-threatening. A paradigm shift is needed for a more comprehensive understanding of febrile mucositis. Zinc effects on the thymic immunological network and T lymphocytes during chemoradiotherapy regimens also warrant further investigation.
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Affiliation(s)
| | - Luis Vitetta
- The University of Sydney, Sydney Medical School
- Medlab Clinical Ltd., Sydney, New South Wales, Australia
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22
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Pasyar N, Barshan Tashnizi N, Mansouri P, Tahmasebi S. Effect of yoga exercise on the quality of life and upper extremity volume among women with breast cancer related lymphedema: A pilot study. Eur J Oncol Nurs 2019; 42:103-109. [PMID: 31479846 DOI: 10.1016/j.ejon.2019.08.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/05/2019] [Accepted: 08/21/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE This pilot study aimed to evaluate the effect of an 8-weeks-yoga intervention on quality of life and upper extremity edema volume in women with breast cancer related lymphedema. METHODS This was a controlled trial with pre-post design. A total of 40 women with breast cancer related lymphedema were randomly assigned into an intervention or control groups. The intervention group participated in a yoga exercise class for 8 weeks, in a twice a week instructor-led practice and once a week home practice. Outcomes were EORTC QLQ_C30 to measure quality of life, and water displacement volume-meter to measure upper extremity edema volume. The outcomes were evaluated at baseline, 4th and 8th week. Data were analyzed using SPSS. RESULTS Four weeks after the intervention, a significant difference was observed between the groups with respect to role functioning of quality of life (P = 0.03). Eight weeks after the intervention, a significant difference was observed between groups concerning physical and emotional functioning of quality of life (P < 0.05). The changing trend in physical, role, emotional, and cognitive functioning had increased, and in some scales such as fatigue, pain, insomnia, and financial difficulties the scores were reduced in the intervention group. Regarding edema volume, no significant difference was found between both groups on the 4th and 8th week after the intervention (P > 0.05). CONCLUSION As yoga exercise might improve physical, role, and emotional functioning of quality of life as well as reduce fatigue, pain, and insomnia, using this intervention can be suggested amongst women with breast cancer related lymphedema.
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Affiliation(s)
- Nilofar Pasyar
- Community Based Psychiatric Care Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, 7193613119, Shiraz, Iran.
| | | | - Parisa Mansouri
- Community Based Psychiatric Care Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, 7193613119, Shiraz, Iran.
| | - Sedigheh Tahmasebi
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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23
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Yarom N, Hovan A, Bossi P, Ariyawardana A, Jensen SB, Gobbo M, Saca-Hazboun H, Kandwal A, Majorana A, Ottaviani G, Pentenero M, Nasr NM, Rouleau T, Lucas AS, Treister NS, Zur E, Ranna V, Vaddi A, Cheng KKF, Barasch A, Lalla RV, Elad S. Systematic review of natural and miscellaneous agents for the management of oral mucositis in cancer patients and clinical practice guidelines-part 1: vitamins, minerals, and nutritional supplements. Support Care Cancer 2019; 27:3997-4010. [PMID: 31286229 DOI: 10.1007/s00520-019-04887-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 05/22/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE To update the clinical practice guidelines for the use of natural and miscellaneous agents for the prevention and/or treatment of oral mucositis (OM). METHODS A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer / International Society of Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. The findings were added to the database used to develop the 2014 MASCC/ISOO clinical practice guidelines. Based on the evidence level, the following guidelines were determined: Recommendation, Suggestion, and No Guideline Possible. RESULTS A total of 78 papers were identified within the scope of this section, out of which 29 were included in this part, and were analyzed with 27 previously reviewed studies. A new Suggestion was made for oral glutamine for the prevention of OM in head and neck (H&N) cancer patients receiving radiotherapy with concomitant chemotherapy. The previous Recommendation against the use of parenteral glutamine for the prevention of OM in hematopoietic stem cell transplantation (HSCT) patients was re-established. A previous Suggestion for zinc to prevent OM in H&N cancer patients treated with radiotherapy or chemo-radiotherapy was reversed to No Guideline Possible. No guideline was possible for other interventions. CONCLUSIONS Of the vitamins, minerals, and nutritional supplements studied for the management of OM, the evidence supports a Recommendation against parenteral glutamine in HSCT patients and a Suggestion in favor of oral glutamine in H&N cancer patients for the management of OM.
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Affiliation(s)
- Noam Yarom
- Oral Medicine Unit, Sheba Medical Center, Tel Hashomer, Israel. .,School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Allan Hovan
- British Columbia Cancer - Vancouver Centre, Vancouver, Canada
| | - Paolo Bossi
- Medical Oncology, ASST-Spedali Civili, University of Brescia, Brescia, Italy
| | - Anura Ariyawardana
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.,Metro South Oral Health, Queensland Health, Brisbane, Australia
| | - Siri Beier Jensen
- Department of Dentistry and Oral Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Margherita Gobbo
- Division of Oral Medicine and Pathology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Abhishek Kandwal
- Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himayalan University, Dehradun, Uttarakhand, India
| | - Alessandra Majorana
- Department of Medical and Surgical Specialties, Radiological Science and Public Health, Dental School University of Brescia, Brescia, Italy
| | - Giulia Ottaviani
- Division of Oral Medicine and Pathology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Monica Pentenero
- Department of Oncology, Oral Medicine and Oral Oncology Unit, University of Turin, Turin, Italy
| | - Narmin Mohammed Nasr
- Special Needs Dentistry, Dental Services, Directorate General of Health Services-Muscat Governorate, Ministry of Health, Muscat, Oman
| | - Tanya Rouleau
- Dental Oncology Program, Health Sciences North, North East Cancer Center, Sudbury, ON, Canada
| | - Anna Skripnik Lucas
- Medical Oncology Service, Department of Medicine, NYU Langone Perlmutter Cancer Center, New York, NY, USA
| | - Nathaniel Simon Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Eyal Zur
- Compounding Solutions, Tel-Mond, Israel
| | - Vinisha Ranna
- Department of Oral and Maxillofacial Surgery, The Mount Sinai Hospital, New York, NY, 10029, USA
| | - Anusha Vaddi
- Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Karis Kin Fong Cheng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andrei Barasch
- Division of Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Rajesh V Lalla
- Section of Oral Medicine, University of Connecticut School of Dental Medicine, Farmington, CT, USA
| | - Sharon Elad
- Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
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de Menêses AG, Normando AGC, Porto de Toledo I, Reis PED, Guerra ENS. Effects of oral supplementation in the management of oral mucositis in cancer patients: A meta-analysis of randomized clinical trials. J Oral Pathol Med 2019; 49:117-125. [PMID: 31172573 DOI: 10.1111/jop.12901] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/30/2019] [Accepted: 05/30/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the effects of oral supplementation on the management of oral mucositis in patients with cancer undergoing chemo and/or radiation therapy. METHOD This is a systematic review and meta-analysis. The search was performed at 6 databases, and in the gray literature. Methodology of included studies was evaluated by the Cochrane Collaboration Risk of Bias Tool, and evidence quality was assessed by GRADE instrument. RESULTS Twelve randomized clinical trials were included in this review. The oral supplementation used was an oral elemental diet with amino acids and minerals (elental), glutamine, and zinc. The majority of the studies included in this review showed benefits in delaying the occurrence of OM by using glutamine and zinc, and in reducing the severity of OM with glutamine, zinc, and elental in patients receiving chemoradiotherapy. The meta-analysis showed that the risk of oral mucositis in the zinc group was slightly lower than in the control (RR: 0.71, 95% CI: 0.53-0.96, P = 0.02, n = 982) while the glutamine group presented the same risk as the control (RR: 0.91, 95% CI: 0.78-1.05, P = 0.19, n = 314). The evidence quality suggested low confidence for zinc and glutamine studies in the estimated effect from the outcomes assessed. CONCLUSIONS Zinc is a promising strategy in the management of oral mucositis since it delayed the occurrence and reduced its severity. Glutamine and Elental, on the other hand, had no strong evidence in the prevention and/or treatment of oral mucositis in patients with cancer.
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Affiliation(s)
- Amanda Gomes de Menêses
- Interdisciplinary Laboratory of Oncology Research, School of Health Sciences, University of Brasília, Brasília, Brazil
| | | | - Isabela Porto de Toledo
- Laboratory of Oral Histopathology, School of Health Sciences, University of Brasília, Brasília, Brazil.,Brazilian Centre for Evidence Based Research, Department of Dentistry, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Paula Elaine Diniz Reis
- Interdisciplinary Laboratory of Oncology Research, School of Health Sciences, University of Brasília, Brasília, Brazil
| | - Eliete Neves Silva Guerra
- Laboratory of Oral Histopathology, School of Health Sciences, University of Brasília, Brasília, Brazil
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Shuai T, Tian X, Shi B, Chen H, Liu XL, Yi LJ, Chen WQ, Li XE. Prophylaxis With Oral Zinc Sulfate Against Radiation Induced Oral Mucositis in Patients With Head and Neck Cancers: A Systematic Review and Meta-Analysis of Four Randomized Controlled Trials. Front Oncol 2019; 9:165. [PMID: 30967996 PMCID: PMC6438884 DOI: 10.3389/fonc.2019.00165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/25/2019] [Indexed: 12/30/2022] Open
Abstract
Background: Oral mucositis is an inevitable and distressing adverse event patients, who were treated with irradiation for head and neck cancer, face. Although several studies have investigated the potential of oral zinc sulfate in preventing radiation-induced oral mucositis in patients with head and neck cancers, conclusive results have not yet been found. Objective: The aim of the present study is to determine whether oral zinc sulfate is effective in preventing radiation-induced oral mucositis, in patients with head and neck cancers. Methods: We electronically searched all potential citations in PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and EBSCO from their inception to December 2018. After the search and checked literatures, extracted data and appraised risk of bias, RevMan software version 5.3 was used to perform meta-analysis. Results: Four randomized controlled trials (RCTs) involving 162 patients were included. A meta-analysis showed that zinc sulfate did not decrease the incidence (RR [relative risk], 0.97; 95% CI [confidence interval], 0.74–1.28), and did not relieve the moderate and severe grade of radiation induced oral mucositis (moderate and severe oral mucositis: RR, 0.84; 95% CI, 0.14–4.87; severe oral mucositis: RR, 0.43; 95% CI, 0.00–38.98). A qualitative analysis suggested that zinc sulfate was associated with the onset of oral mucositis. Conclusions: Based on limited evidence, zinc sulfate may not have the benefit of prophylaxis against radiation-induced oral mucositis, in patients with head and neck cancers. However, further RCTs with larger sample sizes and more rigorous methodologies are needed to enhance the evidence of these results.
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Affiliation(s)
- Ting Shuai
- Department of Nursing, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xu Tian
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing University Cancer Hospital, Chongqing, China
| | - Bing Shi
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing University Cancer Hospital, Chongqing, China
| | - Hui Chen
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing University Cancer Hospital, Chongqing, China
| | - Xiao-Ling Liu
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing University Cancer Hospital, Chongqing, China
| | - Li-Juan Yi
- Department of Nursing, Hunan Traditional Chinese Medical College, Zhuzhou, China
| | - Wei-Qing Chen
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing University Cancer Hospital, Chongqing, China
| | - Xiu-E Li
- Department of Nursing, Peking University School and Hospital of Stomatology, Beijing, China
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Tian X, Liu XL, Pi YP, Chen H, Chen WQ. Oral Zinc Sulfate for Prevention and Treatment of Chemotherapy-Induced Oral Mucositis: A Meta-Analysis of Five Randomized Controlled Trials. Front Oncol 2018; 8:484. [PMID: 30510915 PMCID: PMC6252385 DOI: 10.3389/fonc.2018.00484] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/09/2018] [Indexed: 12/30/2022] Open
Abstract
Chemotherapy-induced oral mucositis is an extremely serious complication faced by cancer patients. The role of oral zinc sulfate in preventing and treating chemotherapy-induced oral mucositis remains a subject of debate. The aim of this systematic review is to assess the potential of oral zinc sulfate to alleviate this morbid condition. A systematic search was conducted electronically in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) to capture all potential randomized controlled trials investigating efficacy and safety of oral zinc sulfate in prevention and treatment of chemotherapy-induced oral mucositis, and the retrieval time was limited from their inception to April 2018. We assigned two independent investigators to perform a search, screen citations, extract information, and evaluate the risk of bias in all included trials. Subsequently, the RevMan 5.3 software was utilized to perform all statistical analyses. We included five eligible studies involving 352 patients. Meta-analysis based on limited data revealed that oral zinc sulfate failed to decrease the incidence of chemotherapy-induced oral mucositis (RR [relative risk] = 0.52, 95% CI [confidence interval] = 0.17–1.64) as well as relieve chemotherapy-induced oral mucositits grade (RR = 0.62, 95% CI = 0.11–3.56; RR = 0.70, 95% CI = 0.29–1.71). Moreover, qualitative analyses also suggested that oral zinc sulfate was not associated with reduced oral pain intensity, delayed onset of chemotherapy-induced oral mucositis, decreased adverse events, or improved quality of life compared with control regimes. Oral zinc sulfate may not provide clinical benefits in preventing or reducing incidence, severity, or pain intensity of chemotherapy-induced oral mucositis in cancer patients. However, more studies with large-scale and rigorous methods are warranted for the purpose of further investigating efficacy and safety of oral zinc sulfate for this pathologic condition due to the presence of limitations.
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Affiliation(s)
- Xu Tian
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Department of Gastroenterology, Chongqing Cancer Institute, Chongqing University Cancer Hospital, Chongqing, China.,Editorial Office, TMR Integrative Nursing, TMR Publishing Group, Tianjin, China
| | - Xiao-Ling Liu
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Department of Gastroenterology, Chongqing Cancer Institute, Chongqing University Cancer Hospital, Chongqing, China
| | - Yuan-Ping Pi
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, Department of Nursing, Chongqing Cancer Institute, Chongqing University Cancer Hospital, Chongqing, China
| | - Hui Chen
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Department of Gastroenterology, Chongqing Cancer Institute, Chongqing University Cancer Hospital, Chongqing, China
| | - Wei-Qing Chen
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Department of Gastroenterology, Chongqing Cancer Institute, Chongqing University Cancer Hospital, Chongqing, China
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27
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Shuai T, Yi LJ, Tian X, Chen WQ, Chen H, Li XE. Prophylaxis with oral zinc sulfate against radiation-induced oropharyngeal mucositis in patients with head and neck cancer: Protocol for a meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018; 97:e13310. [PMID: 30508920 PMCID: PMC6283232 DOI: 10.1097/md.0000000000013310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Oropharyngeal mucositis is considered to be an inevitable and the most troubling side effect of head and neck irradiation, which is caused by the direct toxic action of radiation on oral mucosa. Several randomized controlled trials (RCTs) have investigated the efficacy of zinc sulfate in prevention of radiation-induced oropharyngeal mucositis in patients with head and neck cancer. However, the definite conclusions have not been confirmed. The systematic review and meta-analysis will be performed to comprehensively evaluate whether zinc sulfate is effective in prevention of radiation-induced oropharyngeal mucositis in patients with head and neck cancer. METHODS Relevant information will be identified by a comprehensive search of the following electronic databases: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and EBSCO from their inception to October 2018. Only RCTs which evaluated whether zinc sulfate is effective in prevention of radiation-induced oropharyngeal mucositis in patients with head and neck cancer will be eligible. Two independent investigators will be assigned to search literature, screen information, extract data, and appraise the risk of bias. The primary investigator will use Revman 5.3 software to perform all statistical analyses. We designed this systematic review and meta-analysis on June 5. 2018, and expect to complete the full-text on December 20, 2018. RESULTS This protocol has been registered with a unique identifier of CRD42018108533. We will submit this systematic review and meta-analysis to a peer-reviewed journal. Meanwhile, we also will dissemination the whole findings in topic-related conferences. CONCLUSION As the first systematic review and metaanalysis, the present study will elucidate current evidence of the role of oral zinc for the prevention and treatment of radiation-induced oropharyngeal mucositis in the head and neck cancer.
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Affiliation(s)
- Ting Shuai
- Department of Nursing, Peking University of Stomatology Hospital, Beijing
| | - Li-Juan Yi
- Department of Nursing, Hunan Traditional Chinese Medical College, Zhuzhou
| | - Xu Tian
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital & Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Wei-Qing Chen
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital & Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Hui Chen
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital & Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Xiu-E Li
- Department of Nursing, Peking University of Stomatology Hospital, Beijing
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28
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Tian X, Chen WQ, Liu XL, Pi YP, Chen H. Efficacy and safety of oral zinc sulfate in the prevention of chemotherapy-induced oral mucositis: Protocol for a meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018; 97:e10839. [PMID: 29794779 PMCID: PMC6392683 DOI: 10.1097/md.0000000000010839] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Oral mucositis has been an extremely serious complication resulted from cytotoxic effects of the chemotherapy among cancer patients. Several randomized controlled trials investigated the efficacy of zinc sulfate in prevention of this morbid condition among cancer patients undergoing chemotherapy, however conclusive findings has not yet been generated. This systematic review will assess the efficacy and safety of oral zinc sulfate for chemotherapy-induced oral mucositis. METHODS We will electronically search all potential citations in PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) from their inception to April 2018. The randomized controlled trials, which investigated the efficacy of oral zinc sulfate for chemotherapy-induced oral mucositis will be considered. We will assign 2 independent investigators to perform search, screen citations, extract data, and appraise risk of bias. And then, the primary investigator will adopt RevMan 5.3 software to complete all statistical analyses. ETHICS AND DISSEMINATION The findings from this systematic review and meta-analysis will be submitted to a peer-reviewed journal for publication. Moreover, we will disseminate all results in any topic-related conference. REGISTRATION NUMBER This protocol has been registered with a number of CRD42018093605.
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Affiliation(s)
- Xu Tian
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment
| | - Wei-Qing Chen
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Xiao-Ling Liu
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment
| | - Yuan-Ping Pi
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Hui Chen
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment
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