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Nurhidayah I, Nurhaeni N, Allenidekania A, Gayatri D, Mediani HS. The Effect of Oral Care Intervention in Mucositis Management Among Pediatric Cancer Patients: An Updated Systematic Review. J Multidiscip Healthc 2024; 17:3497-3515. [PMID: 39050692 PMCID: PMC11268750 DOI: 10.2147/jmdh.s467455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/03/2024] [Indexed: 07/27/2024] Open
Abstract
Background Chemotherapy-induced mucositis is inflammation that develops in the oral mucosal due to anticancer treatment. Mucositis has negative consequences that may lead to distress in pediatric patients, resulting in escalated expenses, diminished quality of life, hindrance in cancer therapy, and decreased survival rates. However, despite the numerous methods, oral care protocols are suggested for implementation in the pediatric population despite a lack of high-level evidence studies, particularly regarding which appropriate oral care agents should be administered. Purpose This systematic review aimed to identify the effect of oral care intervention in mucositis management among pediatric cancer patients. Methods Studies were published between 2014 and 2023 from five databases: PubMed, Embase, Medline, ScienceDirect, and Scopus. They were identified using a search strategy to identify relevant studies that identify oral care interventions for managing mucositis in children with cancer. This study used the Joanna Briggs Institute (JBI) critical appraisal tools to assess the quality of the studies and followed the recommended reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Results Eight studies met the inclusion criteria, including seven RCTs and one quasi-experimental study. Oral care interventions involving tooth brushing, mouthwash, and lip care are performed entirely or partially. The frequency of oral care ranges from two to six times daily, and the duration of intervention is from 5 days to six weeks. Oral care interventions using honey, olive oil, Aloe Vera, Andiroba, and salivary enzyme toothpaste are beneficial to lower the severity of mucositis, reduce pain, minimize mucositis duration, and reduce the use of analgesics, but not significantly improve the child's quality of life. However, Caphosol mouthwash did not significantly reduce mucositis. Conclusion Our study highlights that oral care intervention using effective agents integratively, including honey, olive oil, Aloe vera, Andiroba, and salivary enzyme toothpaste, is essential to manage chemotherapy-induced mucositis among children. Systematic Review Registration PROSPERO registration number was CRD42023456278.
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Affiliation(s)
- Ikeu Nurhidayah
- Pediatric Nursing Department, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
- Postgraduate Program, Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
| | - Nani Nurhaeni
- Pediatric Nursing Department, Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
| | | | - Dewi Gayatri
- Basic Science and Fundamental Nursing Department, Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
| | - Henny Suzana Mediani
- Pediatric Nursing Department, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
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Maj M, Tylkowski B, Konopka P, Woźniak-Budych M, Staszak K, Staszak M, Kaźmierski Ł, Bajek A, Jastrzab R. Advancing oral health: Harnessing the potential of chitosan and polyphenols in innovative mouthwash formulation. Biomed Pharmacother 2024; 175:116654. [PMID: 38692066 DOI: 10.1016/j.biopha.2024.116654] [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: 02/04/2024] [Revised: 04/13/2024] [Accepted: 04/24/2024] [Indexed: 05/03/2024] Open
Abstract
This paper explores the therapeutic perspectives of polyphenols and chitosan as potential anticancer agents in the mouthwash formulations. Taking into account the high incidence of squamous cell carcinoma (SCC) among oral cancers, this discussion will concentrate on the potential advantages of these compounds in oral care, focusing on their impact on improving oral health and cancer prevention. According to the data, it appears that the mixture of BACs extract and chitosan may increase the efficiency of the apoptosis of cancer cells while reducing the undesired side effects. The cytotoxicity assays demonstrate a significant reduction in squamous carcinoma cell viability after incubation with BACs extract, with a marked decrease observed over 24-72 hours up to 76%. The anti-cancer properties of the BAC extract are related to luteolin, which is a predominant compound. The addition of 0.025% chitosan reduced the metabolic activity of cancer cells by 37.5%, suggesting a synergistic interaction between the compounds. This research highlights the potential of BACs and chitosan in modulating important molecular targets associated with cancer cell.
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Affiliation(s)
- Małgorzata Maj
- Tissue Engineering Department, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Karlowicza str 24 85-092, Bydgoszcz, Poland
| | - Bartosz Tylkowski
- Eurecat, Centre Tecnològic de Catalunya, Unitat de Tecnologia Química, Marcel·lí Domingo 2, Tarragona 43007, Spain; Department of Clinical Neuropsychology, Faculty of Health Science, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun ul. Sklodowskiej Curie 9, Bydgoszcz 85-094, Poland.
| | - Piotr Konopka
- Faculty of Chemistry, Adam Mickiewicz University, Uniwersytetu Poznanskiego 8, Poznan 61-614, Poland
| | - Marta Woźniak-Budych
- NanoBioMedical Centre, Adam Mickiewicz University, Wszechnicy Piastowskiej 3, Poznan 61-614, Poland
| | - Katarzyna Staszak
- Institute of Technology and Chemical Engineering, Poznan University of Technology, Berdychowo 4, Poznan 60-965, Poland
| | - Maciej Staszak
- Institute of Technology and Chemical Engineering, Poznan University of Technology, Berdychowo 4, Poznan 60-965, Poland
| | - Łukasz Kaźmierski
- Tissue Engineering Department, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Karlowicza str 24 85-092, Bydgoszcz, Poland
| | - Anna Bajek
- Tissue Engineering Department, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Karlowicza str 24 85-092, Bydgoszcz, Poland
| | - Renata Jastrzab
- Faculty of Chemistry, Adam Mickiewicz University, Uniwersytetu Poznanskiego 8, Poznan 61-614, Poland.
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Reuss JM, Alonso-Gamo L, Garcia-Aranda M, Reuss D, Albi M, Albi B, Vilaboa D, Vilaboa B. Oral Mucosa in Cancer Patients-Putting the Pieces Together: A Narrative Review and New Perspectives. Cancers (Basel) 2023; 15:3295. [PMID: 37444405 DOI: 10.3390/cancers15133295] [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: 05/31/2023] [Revised: 06/15/2023] [Accepted: 06/18/2023] [Indexed: 07/15/2023] Open
Abstract
The oral mucosa is a key player in cancer patients and during cancer treatment. The increasing prevalence of cancer and cancer-therapy-associated side effects are behind the major role that oral mucosa plays in oncological patients. Oral mucositis is a debilitating severe complication caused by the early toxicity of chemo and/or radiotherapy that can restrict treatment outcome possibilities, even challenging a patient's survival. It has been referred to as the most feared cancer treatment complication. Predictive variables as to who will be affected, and to what extent, are still unclear. Additionally, oral mucositis is one of the sources of the increasing economic burden of cancer, not only for patients and their families but also for institutions and governments. All efforts should be implemented in the search for new approaches to minimize the apparently ineluctable outburst of oral mucositis during cancer treatment. New perspectives derived from different approaches to explaining the interrelation between oral mucositis and the oral microbiome or the similarities with genitourinary mucosa may help elucidate the biomolecular pathways and mechanisms behind oral mucosa cancer-therapy-related toxicity, and what is more important is its management in order to minimize treatment side effects and provide enhanced cancer support.
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Affiliation(s)
- Jose Manuel Reuss
- Department of Postgraduate Prosthodontics, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Laura Alonso-Gamo
- Department of Pediatrics, Hospital Infanta Cristina, 28981 Madrid, Spain
| | - Mariola Garcia-Aranda
- Centro Integral Oncológico Clara Campal, Department of Oncologic Radiotherapy, Hospital Universitario Sanchinarro, 28050 Madrid, Spain
| | - Debora Reuss
- Lecturer Dental School, Universidad San Pablo CEU, 28003 Madrid, Spain
| | - Manuel Albi
- Department of Gynecology and Obstetrics, Quironsalud Group Public Hospitals, 28223 Madrid, Spain
| | - Beatriz Albi
- Department of Gynecology and Obstetrics, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Debora Vilaboa
- Aesthetic Dentistry Department, Universidad San Pablo CEU, 28003 Madrid, Spain
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Hasanah NT, Dewi TS. Holistic Approach of a Leukemic Child Suffering from Oral Mucositis with Coinfections: A Case Report. Int Med Case Rep J 2023; 16:363-369. [PMID: 37333035 PMCID: PMC10274842 DOI: 10.2147/imcrj.s400497] [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: 12/09/2022] [Accepted: 06/07/2023] [Indexed: 06/20/2023] Open
Abstract
Oral mucositis (OM) is a life-threatening side effect of chemo-radiotherapy. OM can provide a portal of entry for many microorganisms as coinfections which potentially generate other oral lesions. This case report describes a holistic approach to obtaining the successful treatment of OM with necrotizing ulcerative stomatitis (NUS) and oral candidiasis as coinfections in pediatric acute lymphoblastic leukemia (ALL). A 2-year-8-month-old boy was referred from the Pediatrics Department at Dr. Hasan Sadikin General Hospital with the chief complaint of canker sore and eating difficulty for the past two weeks. He had undergone the twelfth cycle of the last chemotherapy using methotrexate regimen. Extraoral examination revealed anemic conjunctiva, icteric sclera, and dry lips. Well-defined irregular multiple ulcers covered by yellowish to grayish pseudomembranous were found on the upper and lower labial mucosa, right and left buccal mucosa, tongue, palate, and gingiva. Potassium hydroxide (KOH) examination showed fungi in the oral lesions smear. The established diagnosis was OM with NUS and oral candidiasis as coinfections. Debridement was done using chlorine dioxide-zinc and 0.2% chlorhexidine gluconate. We collaborated with the pediatrician who prescribed ceftazidime, meropenem, and fluconazole, and also with parents. The holistic approach is beneficial and important in improving quality of life and supporting the successful treatment of OM with coinfections.
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Affiliation(s)
- Novia Tri Hasanah
- Oral Medicine Residency Program, Department of Oral Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Tenny Setiani Dewi
- Department of Oral Medicine, Universitas Padjadjaran, Bandung, Indonesia
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Badr LK, El Asmar R, Hakim S, Saad R, Merhi R, Zahreddine A, Muwakkit S. The efficacy of honey or olive oil on the severity of oral mucositis and pain compared to placebo (standard care) in children with leukemia receiving intensive chemotherapy: A randomized controlled trial (RCT). J Pediatr Nurs 2023; 70:e48-e53. [PMID: 36792398 DOI: 10.1016/j.pedn.2022.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 11/28/2022] [Accepted: 12/07/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND Oral mucositis (OM) is a significant complication occurring in approximately 40 to 80% of patients receiving chemotherapy regimens. Although a wide variety of agents have been tested to prevent OM or reduce its severity, none have provided conclusive evidence. OBJECTIVES To determine the efficacy of honey or olive oil on the severity and OM pain in children with leukemia and suffering from OM compared to placebo (standard care) and, to assess which of the two interventions is more beneficial. METHODS A single blind randomized controlled study (RCT) was used to evaluate the effect of Manuka honey or olive oil, in the treatment of chemotherapy-related OM in 42 children with leukemia. The primary outcome was the severity of mucositis, using the World Health Organization (WHO) scale and the secondary outcome was the pain assessed using the Visual analogue scale (VAS). RESULTS Children who received the honey had less severe OM (assessed on the (WHO) scale), p = 0.00 and less pain (assessed on the VAS scale), p = 0.00, compared to the control group. Children who received the olive oil had less pain than the control group, p = 0.00), although not lower than the honey group. CONCLUSION Manuka honey or olive oil can be used as alternative therapies by nurses to children with leukemia and suffering from OM, especially in low and middle-income countries where more expensive therapies may not be available or economical. PRACTICE IMPLICATIONS Pediatric nurses may recommend Manuka honey to treat OM in children with leukemia as it is safe and inexpensive compared to other treatment modalities.
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Affiliation(s)
- Lina Kurdahi Badr
- Professor, American University of Beirut, Riad El Solh, PO Box: 11 0236, Beirut 1107 2020, Lebanon.
| | - Rebecca El Asmar
- Clinical Nurse Specialist, Oncology, American University of Beirut Medical center Riad El Solh, PO Box: 11 0236, Beirut 1107 2020, Lebanon.
| | - Sarah Hakim
- Clinical Educator-Clinical and Professional development Center, American University of Beirut Medical Center, Riad El Solh, PO Box: 11 0236, Beirut 1107 2020, Lebanon
| | - Rima Saad
- Clinical nurse specialist, American University of Beirut, Hariri School of Nursing, Riad El Solh, PO Box: 11 0236, Beirut 1107 2020, Lebanon
| | - Roni Merhi
- American University of Beirut Medical center, Riad El Solh, PO Box: 11 0236, Beirut, 1107 2020, Lebanon
| | - Ammar Zahreddine
- Case Manager, Hematology, American University of Beirut Medical center Riad El Solh, PO Box: 11 0236, Beirut 1107 2020, Lebanon.
| | - Samar Muwakkit
- Professor of Clinical Specialty, American University Of Beirut Medical center, Riad El Solh, PO Box: 11 0236, Beirut 1107 2020, Lebanon.
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Ferreira AS, Macedo C, Silva AM, Delerue-Matos C, Costa P, Rodrigues F. Natural Products for the Prevention and Treatment of Oral Mucositis-A Review. Int J Mol Sci 2022; 23:ijms23084385. [PMID: 35457202 PMCID: PMC9030892 DOI: 10.3390/ijms23084385] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 02/06/2023] Open
Abstract
Cancer, a major world public health problem, is associated with chemotherapy treatments whose administration leads to secondary concerns, such as oral mucositis (OM). The OM disorder is characterized by the presence of ulcers in the oral mucosa that cause pain, bleeding, and difficulty in ingesting fluids and solids, or speaking. Bioactive compounds from natural sources have arisen as an effective approach for OM. This review aims to summarize the new potential application of different natural products in the prevention and treatment of OM in comparison to conventional ones, also providing a deep insight into the most recent clinical studies. Natural products, such as Aloe vera, Glycyrrhiza glabra, Camellia sinensis, Calendula officinalis, or honeybee crops, constitute examples of sources of bioactive compounds with pharmacological interest due to their well-reported activities (e.g., antimicrobial, antiviral, anti-inflammatory, analgesic, or wound healing). These activities are associated with the bioactive compounds present in their matrix (such as flavonoids), which are associated with in vivo biological activities and minimal or absent toxicity. Finally, encapsulation has arisen as a future opportunity to preserve the chemical stability and the drug bioa vailability of bioactive compounds and, most importantly, to improve the buccal retention period and the therapeutic effects.
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Affiliation(s)
- Ana Sofia Ferreira
- REQUIMTE/LAQV—Instituto Superior de Engenharia do Porto, Rua Dr. António Bernardino de Almeida 431, 4249-015 Porto, Portugal; (A.S.F.); (C.M.); (A.M.S.); (C.D.-M.)
| | - Catarina Macedo
- REQUIMTE/LAQV—Instituto Superior de Engenharia do Porto, Rua Dr. António Bernardino de Almeida 431, 4249-015 Porto, Portugal; (A.S.F.); (C.M.); (A.M.S.); (C.D.-M.)
| | - Ana Margarida Silva
- REQUIMTE/LAQV—Instituto Superior de Engenharia do Porto, Rua Dr. António Bernardino de Almeida 431, 4249-015 Porto, Portugal; (A.S.F.); (C.M.); (A.M.S.); (C.D.-M.)
| | - Cristina Delerue-Matos
- REQUIMTE/LAQV—Instituto Superior de Engenharia do Porto, Rua Dr. António Bernardino de Almeida 431, 4249-015 Porto, Portugal; (A.S.F.); (C.M.); (A.M.S.); (C.D.-M.)
| | - Paulo Costa
- UCIBIO—Applied Molecular Biosciences Unit, MedTech-Laboratory of Pharmaceutical Technology, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal;
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Francisca Rodrigues
- REQUIMTE/LAQV—Instituto Superior de Engenharia do Porto, Rua Dr. António Bernardino de Almeida 431, 4249-015 Porto, Portugal; (A.S.F.); (C.M.); (A.M.S.); (C.D.-M.)
- Correspondence: ; Tel.: +351-22-83-40-500
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