Nutritional interventions for oral mucositis: a systematic literature review

Comparison of oral zinc supplement and placebo effect in improving the T-cells regeneration in patients undergoing autologous hematopoietic stem cell transplantation: Clinical trial study

BACKGROUND

Immune reconstitution is a significant factor in the success of "hematopoietic stem cell transplantation" (HSCT). Delaying the immune reconstitution increases the risk of infections and relapse after transplantation. T-cell recovery after HSCT is mainly thymus-dependent, and thymic atrophy is associated with various clinical conditions that correlate with HSCT outcomes. Thymus rejuvenation can improve immune reconstitution after transplantation.Zinc (Zn) plays a pivotal role in thymus rejuvenation. Zn deficiency can lead to thymic atrophy, which increases susceptibility to infections. Zn supplementation restores the immune system by increasing thymus output and T-cell repertoire production.We designed this protocol to investigate the effect of oral Zn supplementation on T-cell recovery in patients undergoing HSCT.

METHODS

Forty eligible candidates for autologous-HSCT will be selected. They will be randomly divided into Zn and placebo groups. Subsequently, they will receive 3 Zn or placebo tablets for the first 30 days post-HSCT (+1 to +30), followed by 1 pill or placebo for days (+31 to +90). The copy numbers of "recent thymic emigrants" T cells and "T cell Receptor Excision Circles" (TREC) will be assessed before and after the intervention in peripheral blood mononuclear cells (PBMCs). All patients will be followed up 365 days post-HSCT for relapse and infection.

CONCLUSION

This clinical trial is the first to determine the efficiency of "Zn gluconate" as daily Supplementation in T cell recovery post-HSCT.If successful, an available and inexpensive drug will improve immune system reconstruction after HSCT, reduce the risk of infection, particularly viral infections, and increase patient survival.

The Efficacy of Three Different Oral Hygiene Regimens in Preventing Chemotherapy-Induced Oral Mucositis in Pediatric Patients Receiving Hematopoietic Stem Cell Transplantation

BACKGROUND

Oral mucositis is one of the side effects developed post-hematopoietic stem cell transplant. This retrospective study aimed to assess the efficacy of a mouthwash mixture (lidocaine, sodium alginate, sucralfate, pheniramine) versus hyaluronic acid and a solution of sodium bicarbonate in terms of healing time and weight gain in the treatment of oral mucositis in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation with hemato-oncological malignancies.

METHODS

A total of 171 patients that received chemotherapy for the hematopoietic stem cell transplant were divided into three groups; group 1, treated with a mixed mouthwash of lidocaine, sodium alginate, sucralfate, and pheniramine; group 2, treated with hyaluronic acid; and group 3, treated with an aqueous solution of 5% sodium bicarbonate. Weight and mucositis scale scores derived from medical records of patients.

RESULTS

There was a statistically significant difference in the mucositis scale scores between the groups on the transplant day and days 5, 10, 15 and 20 after the transplantation. At these measurement points, Group 2 (receiving hyaluronic acid) had a lower score, and Group 3 (who received sodium bicarbonate) had a higher score, especially on days 5 and 10 after the transplantation.

CONCLUSION

The results suggest that hyaluronic acid is a more effective treatment option than the other oral care solutions that are frequently used for prophylaxis and treatment of oral mucositis.

Non-pharmacological interventions for chemotherapy-induced diarrhoea and constipation management: A scoping review

PURPOSE

Chemotherapy-induced diarrhoea (CID) and constipation (CIC) are among the most common and severe gastrointestinal symptoms related to chemotherapy. This review aimed to identify and describe the evidence for non-pharmacological interventions for the management of CID and CIC.

METHODS

The scoping review was based on the Joanna Briggs Institute methodology and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Evidence from five databases were included: CINAHL, MEDLINE, Embase, PubMed, and APA PsycInfo. Data were systematically identified, screened, extracted and synthesised narratively to describe the evidence for non-pharmacological interventions and their effects on CID and CIC.

RESULTS

We included 33 studies, of which 18 investigated non-pharmacological interventions for CID management, six for CIC management, and nine for both CID and CIC management. Interventions were categorized into five groups, including (1) digital health interventions, (2) physical therapies, (3) diet and nutrition therapies, (4) education, and (5) multimodal. Diet and nutrition therapies were the most common to report potential effectiveness for CID and CIC outcomes. Most of the interventions were implemented in hospitals under the supervision of healthcare professionals and were investigated in randomised control trials.

CONCLUSIONS

The characteristics of non-pharmacological interventions were diverse, and the outcomes were inconsistent among the same type of interventions. Diet and nutritional interventions show promise but further research is needed to better understand their role and to contribute to the evidence base. Nurses are well placed to assess and monitor for CIC and CID, and also deliver effective non-pharmacological interventions.