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Güneri P, Epstein JB, Bolukbasi G, Spielberger RT. Neutropenic ulcers in oncology: terminology, diagnosis, and management. Support Care Cancer 2023; 31:716. [PMID: 37991547 DOI: 10.1007/s00520-023-08187-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023]
Abstract
Neutropenic ulcerations are characterized by mucosal ulcerations which occur in the presence of neutropenia, suggesting a direct link between neutropenia and mucosal ulceration. An oral ulcer can be labeled as "neutropenic" only if the patients have primary (typically congenital) or secondary neutropenia, and neutropenia is the sole causative factor. Oral mucosal ulcers observed in patients undergoing oncologic therapy may also be termed as "neutropenic ulcers", but the pathogenesis of these oral ulcers more likely involves mucosal events related to trauma, microbial factors, and direct cytotoxicity. In cancer patients, the early appearance of oral ulcers is often attributed to oral mucositis which is a condition primarily caused by the direct mucosal cytotoxicity of chemotherapeutic agents and radiation therapy. Oral ulcers that develop later during or after active cancer therapy may result from intraoral trauma and typically manifest on non-keratinized areas of the oral mucosa which are more susceptible to mucosal damage. In patients undergoing chemotherapy, factors such as disturbances in mucosal barrier function as well as bone marrow suppression lead to reduced neutrophil count and function, and can contribute to the development of oral ulcers. While the etiology of oral ulcers in cancer therapy receiving patients can vary, it is important to emphasize that the host's response plays a crucial role in the progression and repair process of these lesions. This narrative review presents the etiopathogenesis, clinical presentation, and potential management approaches for oral ulcerations in neutropenic patients, with a particular focus on clarifying the usage of the term "neutropenic ulcer" since this term lacks diagnostic specificity and can be misleading in clinical practice regarding the underlying causes and treatment strategies.
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Affiliation(s)
- Pelin Güneri
- Department of Oral and Maxillofacial Radiology, Ege University School of Dentistry, İzmir, Turkey
| | - Joel B Epstein
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
- Cedars Sinai Health System, Los Angeles, CA, USA
| | - Gaye Bolukbasi
- Department of Oral and Maxillofacial Radiology, Ege University School of Dentistry, İzmir, Turkey.
| | - Ricardo T Spielberger
- Department of Hematology and Cellular Therapy, City of Hope Cancer Center, Duarte, CA, USA
- Department of BMT, Southern California Permanente Medical Group, Los Angeles, CA, USA
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Buiret G, Thomas-Danguin T, Feron G. Metallic taste prevalence in patients treated for cancer: a systematic literature review and meta-analysis. Support Care Cancer 2022; 30:5691-5702. [PMID: 35192057 DOI: 10.1007/s00520-022-06904-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 02/09/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Metallic taste (MT) is a taste abnormality often reported by cancer patients. The aim of this systematic review was to exhaustively report MT incidences in cancer patients and to evaluate the risk of bias in the pertinent studies in accordance with a meta-analysis approach. METHODS The research objective was to determine the prevalence of MT in patients treated for cancer. A literature search was conducted using PubMed, Web of Science, and Embase. The authors each screened articles and evaluated the eligibility and individual risk of bias for each article. Then, all of the results were compared. A meta-analysis was conducted on studies that specifically focused on MT evaluation. RESULTS Very few articles have been published on the incidence of MT among taste and smell abnormalities in cancerology (22 of 1674, 1.3%), and the quality of the reports on MT was often low. The most common bias was the methodology used for MT evaluation. Pooling the results of the 22 studies led to an estimated MT incidence in the cancer patient population of 29% (95% CI [0.21; 0.39]) with high and significant heterogeneity observed among the studies. A heterogeneity analysis was performed to identify the causal factors of this heterogeneity. The specific impact of MT on nutritional status (two) and quality of life (five) studies were reported, respectively, and without a specific evaluation of MT. There was no mention of oral health in any of the studies. CONCLUSION Although in clinical practice cancer patients often report MT, its incidence has only been reported in 22 studies, most of which have a moderate to severe risk of bias. Considering the rather high prevalence of MT, more research should be conducted in this field to better identify its causes and mechanisms.
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Affiliation(s)
- Guillaume Buiret
- Service ORL Et Chirurgie Cervicofaciale, Centre Hospitalier de Valence, 179 Boulevard du Maréchal Juin, 26953, Valence, France.
| | - Thierry Thomas-Danguin
- Centre Des Sciences du Goût Et de L'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, 21000, Dijon, France
| | - Gilles Feron
- Centre Des Sciences du Goût Et de L'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, 21000, Dijon, France
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Sakamoto K, Takeda S, Kanekiyo S, Nishiyama M, Kitahara M, Ueno T, Yamamoto S, Yoshino S, Hazama S, Okayama N, Nagano H. Association of tumor necrosis factor-α polymorphism with chemotherapy-induced oral mucositis in patients with esophageal cancer. Mol Clin Oncol 2016; 6:125-129. [PMID: 28123745 DOI: 10.3892/mco.2016.1081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/02/2016] [Indexed: 11/06/2022] Open
Abstract
The purpose of this study was to evaluate the association between tumor necrosis factor (TNF)-α polymorphisms and oral mucositis (OM) from 5-fluorouracil (5-FU) plus cisplatin (CDDP) chemotherapy for esophageal cancer. The rs1799964 polymorphism of TNF-α was genotyped using the tetra-primer amplification refractory mutation system polymerase chain reaction. The experimental group comprised 64 patients who received chemotherapy for esophageal cancer between 1997 and 2004; a total of 106 patients between 2005 and 2013 were investigated as the validation group. Univariate analysis of the experimental group revealed that the TT genotype of TNF-α rs1799964 was significantly higher in patients with grade 1-4 OM compared with the TC/CC genotypes [univariate odds ratio (OR)=4.0; P=0.029]. Similarly, univariate analysis of the validation group revealed that the percentage of the TT genotype was significantly higher in patients with grade 1-4 OM compared with the TC/CC genotypes (OR=2.8; P=0.043). This difference in risk was replicated in the validation cohort. Thus, the TT genotype of TNF-α rs1799964 may be a predictor of chemotherapy-induced OM in patients with esophageal cancer.
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Affiliation(s)
- Kazuhiko Sakamoto
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Shigeru Takeda
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Shinsuke Kanekiyo
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Mitsuo Nishiyama
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Masahiro Kitahara
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Tomio Ueno
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Shigeru Yamamoto
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Shigefumi Yoshino
- Oncology Center, Yamaguchi University Hospital, Ube, Yamaguchi 755-8505, Japan
| | - Shoichi Hazama
- Department of Translational Research and Developmental Therapeutics against Cancer, Yamaguchi University School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Naoko Okayama
- Division of Laboratory, Yamaguchi University Hospital, Ube, Yamaguchi 755-8505, Japan
| | - Hiroaki Nagano
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
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Gilbar P. Review : Taste disturbances during chemotherapy. J Oncol Pharm Pract 2016. [DOI: 10.1177/107815529600200306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. The purpose of this review is to highlight drugs that have been involved in causing taste dys function during cancer chemotherapy and discuss possible management strategies. To illustrate the po tentially damaging consequences that can occur, a case study, describing a taste disturbance with levami sole, is presented. Data sources. A variety of literature sources, including manual and on-line (Medline, IDIS) search ing were used. Taste or taste disorders linked with antineoplastic agents or individual drug names were used as the primary search terms. Study selection. Any articles mentioning taste disturbances during cancer chemotherapy were con sidered. Conclusion. Taste alteration is a poorly re ported and often neglected side effect of drug treat ment. The initial treatment of taste disturbance in volves isolating the cause and correction of any contributing factors. Withdrawal of the offending drug commonly leads to resolution of symptoms. However, if this is inappropriate, management or temporary relief of symptoms often can be achieved. The consequences of taste disturbances can be con siderable, ranging from reduction in a patient's quality of life to cessation of a potentially curative treatment. Pharmacists should be aware of this adverse effect and the possible damaging impact it can have on therapeutic outcome.
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Affiliation(s)
- Peter Gilbar
- Pharmacy Department, Toowoomba Base Hospital, Toowoomba, Australia
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Systematic literature review: xerostomia in advanced cancer patients. Support Care Cancer 2014; 23:881-8. [DOI: 10.1007/s00520-014-2477-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 10/06/2014] [Indexed: 12/21/2022]
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Nikles J, Mitchell GK, Hardy J, Agar M, Senior H, Carmont SA, Schluter PJ, Good P, Vora R, Currow D. Do pilocarpine drops help dry mouth in palliative care patients: a protocol for an aggregated series of n-of-1 trials. BMC Palliat Care 2013; 12:39. [PMID: 24176001 PMCID: PMC3827871 DOI: 10.1186/1472-684x-12-39] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 10/24/2013] [Indexed: 11/29/2022] Open
Abstract
Background It is estimated that 39,000 Australians die from malignant disease yearly. Of these, 60% to 88% of advanced cancer patients suffer xerostomia, the subjective feeling of mouth dryness. Xerostomia has significant physical, social and psychological consequences which compromise function and quality of life. Pilocarpine is one treatment for xerostomia. Most studies have shown some variation in individual response to pilocarpine, in terms of dose used, and timing and extent of response. We will determine a population estimate of the efficacy of pilocarpine drops (6 mg) three times daily compared to placebo in relieving dry mouth in palliative care (PC) patients. A secondary aim is to assess individual patients’ response to pilocarpine and provide reports detailing individual response to patients and their treating clinician. Methods/Design Aggregated n-of-1 trials (3 cycle, double blind, placebo-controlled crossover trials using standardized measures of effect). Individual trials will identify which patients respond to the medication. To produce a population estimate of a treatment effect, the results of all cycles will be aggregated. Discussion Managing dry mouth with treatment supported by the best possible evidence will improve functional status of patients, and improve quality of life for patients and carers. Using n-of-1 trials will accelerate the rate of accumulation of high-grade evidence to support clinical therapies used in PC. Trial registration Australia and New Zealand Clinical Trial Registry Number: 12610000840088.
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Affiliation(s)
- Jane Nikles
- School of Medicine, The University of Queensland, Brisbane, Australia.
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Chen X, Clark JJ, Preisser JS, Naorungroj S, Shuman SK. Dental caries in older adults in the last year of life. J Am Geriatr Soc 2013; 61:1345-50. [PMID: 23865859 PMCID: PMC3743952 DOI: 10.1111/jgs.12363] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine dental caries severity (measured by number of carious teeth) in older adults in the last year of life. DESIGN Cross-sectional study based on dental records. SETTING Community-based geriatric dental clinic. PARTICIPANTS One thousand two hundred sixteen individuals aged 65 and older, including 168 individuals in the last year of life (e.g., individuals died within 1 year after their new-patient examinations). MEASUREMENTS Information on socioeconomic, medical history, medication, functional status, and oral health measures, including number of carious teeth, was abstracted from dental records. End-of-life status was determined using the National Death Index. Propensities of death were calculated using a logistic regression and then adjusted together with mobility and oral care function in the multivariable regression model to examine the effect of end-of-life status on dental caries. RESULTS Caries severity differed in end-of-life participants with different oral care function. Of those needing help with oral care, end-of-life participants had only a slightly higher and nonstatistically significant risk (7.5 vs 6.1, adjusted incidence density ratio (IDR) = 1.12, 95% confidence interval (CI) = 0.85-1.48) of having more carious teeth than those not in the last year of life. On the other hand, caries severity was lower in end-of-life participants without impaired oral care function (IDR = 0.53, 95% CI = 0.30-0.92). CONCLUSION Oral care function modifies the association between caries severity and end-of-life status. Individuals who could maintain oral hygiene independently had a low level of caries at the end of life, however, dental caries had increased before functionally dependent individuals entered their last year of life.
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Affiliation(s)
- Xi Chen
- Department of Dental Ecology, University of North Carolina, Chapel Hill, North Carolina 27599, USA.
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Mahmoud FA, Aktas A, Walsh D, Hullihen B. A Pilot Study of Taste Changes Among Hospice Inpatients With Advanced Cancer. Am J Hosp Palliat Care 2011; 28:487-92. [DOI: 10.1177/1049909111402187] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Identification of taste abnormalities can help understand difficulties in nutrition. We evaluated 15 hospice inpatients with advanced cancer for subjective taste changes. The majority had both subjective and objective taste changes. Most thought all food was tasteless followed by loss of sweet sensation and meat aversion. About half of the participants exhibited anorexia and weight loss with decreased energy intake. Both detection and recognition thresholds for these basic tastes were abnormal for the majority of participants. Reduced sensitivity for sweet and salt taste and altered perception for sour predominated in formal taste testing.
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Affiliation(s)
- Fade A. Mahmoud
- Cleveland Clinic Taussig Cancer Institute, Department of Solid Tumor Oncology, Cleveland, OH, USA
- Cleveland Clinic The Harry R. Horvitz Center for Palliative Medicine and Supportive Oncology, Cleveland, OH, USA
| | - Aynur Aktas
- Cleveland Clinic Taussig Cancer Institute, Department of Solid Tumor Oncology, Cleveland, OH, USA
- Cleveland Clinic The Harry R. Horvitz Center for Palliative Medicine and Supportive Oncology, Cleveland, OH, USA
| | - Declan Walsh
- Cleveland Clinic Taussig Cancer Institute, Department of Solid Tumor Oncology, Cleveland, OH, USA
- Cleveland Clinic The Harry R. Horvitz Center for Palliative Medicine and Supportive Oncology, Cleveland, OH, USA
- St. Christopher’s Hospice, London, UK
| | - Barbara Hullihen
- Cleveland Clinic Taussig Cancer Institute, Department of Solid Tumor Oncology, Cleveland, OH, USA
- Cleveland Clinic The Harry R. Horvitz Center for Palliative Medicine and Supportive Oncology, Cleveland, OH, USA
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Cohn ZJ, Kim A, Huang L, Brand J, Wang H. Lipopolysaccharide-induced inflammation attenuates taste progenitor cell proliferation and shortens the life span of taste bud cells. BMC Neurosci 2010; 11:72. [PMID: 20537148 PMCID: PMC2898829 DOI: 10.1186/1471-2202-11-72] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Accepted: 06/10/2010] [Indexed: 11/18/2022] Open
Abstract
Background The mammalian taste bud, a complex collection of taste sensory cells, supporting cells, and immature basal cells, is the structural unit for detecting taste stimuli in the oral cavity. Even though the cells of the taste bud undergo constant turnover, the structural homeostasis of the bud is maintained by balancing cell proliferation and cell death. Compared with nongustatory lingual epithelial cells, taste cells express higher levels of several inflammatory receptors and signalling proteins. Whether inflammation, an underlying condition in some diseases associated with taste disorders, interferes with taste cell renewal and turnover is unknown. Here we report the effects of lipopolysaccharide (LPS)-induced inflammation on taste progenitor cell proliferation and taste bud cell turnover in mouse taste tissues. Results Intraperitoneal injection of LPS rapidly induced expression of several inflammatory cytokines, including tumor necrosis factor (TNF)-α, interferon (IFN)-γ, and interleukin (IL)-6, in mouse circumvallate and foliate papillae. TNF-α and IFN-γ immunoreactivities were preferentially localized to subsets of cells in taste buds. LPS-induced inflammation significantly reduced the number of 5-bromo-2'-deoxyuridine (BrdU)-labeled newborn taste bud cells 1-3 days after LPS injection, suggesting an inhibition of taste bud cell renewal. BrdU pulse-chase experiments showed that BrdU-labeled taste cells had a shorter average life span in LPS-treated mice than in controls. To investigate whether LPS inhibits taste cell renewal by suppressing taste progenitor cell proliferation, we studied the expression of Ki67, a cell proliferation marker. Quantitative real-time RT-PCR revealed that LPS markedly reduced Ki67 mRNA levels in circumvallate and foliate epithelia. Immunofluorescent staining using anti-Ki67 antibodies showed that LPS decreased the number of Ki67-positive cells in the basal regions surrounding circumvallate taste buds, the niche for taste progenitor cells. PCR array experiments showed that the expression of cyclin B2 and E2F1, two key cell cycle regulators, was markedly downregulated by LPS in the circumvallate and foliate epithelia. Conclusions Our results show that LPS-induced inflammation inhibits taste progenitor cell proliferation and interferes with taste cell renewal. LPS accelerates cell turnover and modestly shortens the average life span of taste cells. These effects of inflammation may contribute to the development of taste disorders associated with infections.
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Affiliation(s)
- Zachary J Cohn
- Monell Chemical Senses Center, Philadelphia, PA 19104-3308, USA
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10
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Hejna M, Köstler WJ, Raderer M, Steger GG, Brodowicz T, Scheithauer W, Wiltschke C, Zielinski CC. Decrease of duration and symptoms in chemotherapy-induced oral mucositis by topical GM-CSF: results of a prospective randomised trial. Eur J Cancer 2001; 37:1994-2002. [PMID: 11597376 DOI: 10.1016/s0959-8049(01)00132-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We have conducted a prospective controlled randomised clinical study testing for the efficacy of topical GM-CSF (molgramostim), as compared to the combined topical use of an antiseptic agent (povidone-iodine) and amphotericin B (AA) in patients with chemotherapy-induced mucositis World Health Organization (WHO) grades I-III. 31 patients (17 females, 14 males) developing oral mucositis following the administration of 5-fluorouracil (5-FU)-based chemotherapy were entered into the present trial. 15 patients were randomised to receive GM-CSF mouthwashes, whereas 16 patients were randomised into the control arm to receive AA. Reported history (P=0.6109) and grading of oral mucositis (2.1+/-0.7, respectively; P=0.9867) were balanced and equally distributed between the two groups. The mean size of lesions of oral mucositis was 1.5+/-0.6 cm (range: 0.7-2.5 cm) in the GM-CSF group and 1.2+/-0.5 cm (range: 0.5-2.5 cm) in the AA group (P=0.08), respectively. The mean number of oral mucositis lesions was 1.9+/-1.1 (range: 1-4) in the GM-CSF group and 2.1+/-1.2 (range: 1-4) in the AA group (P=0.63), respectively. None of the patients had previously received colony stimulating factors either topically or systemically. Treatment for oral mucositis was initiated on day 2.7+/-1.2 (range: day 1-8) after onset of symptoms in the GM-CSF group and on day 1.8+/-1.4 (range: day 1-3; P=0.11) in the AA group. The topical application of GM-CSF resulted in a significantly shorter duration and quicker resolution of oral mucositis, as compared to AA including both, pretreatment plus treatment periods (5.3+/-2.5 versus 8.1+/-1.5 days; P=0.0008) as well as the necessary duration of treatment needed until complete remission of lesions (2.8+/-0.7 versus 6.3+/-1.1 days; P<0.0001). A systemic effect of topical GM-CSF upon the number of peripheral blood leukocytes or granulocytes was excluded. We conclude that the topical application of GM-CSF by mouthwash significantly abbreviated the duration and relieved patients from symptoms of chemotherapy-induced mucositis and was superior to the topical application of AA.
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Affiliation(s)
- M Hejna
- Department of Medicine I, Division of Oncology, University Hospital, 18-20 Waehringer Guertel, A-1090, Vienna, Austria
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11
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Oberbaum M, Yaniv I, Ben-Gal Y, Stein J, Ben-Zvi N, Freedman LS, Branski D. A randomized, controlled clinical trial of the homeopathic medication TRAUMEEL S in the treatment of chemotherapy-induced stomatitis in children undergoing stem cell transplantation. Cancer 2001; 92:684-90. [PMID: 11505416 DOI: 10.1002/1097-0142(20010801)92:3<684::aid-cncr1371>3.0.co;2-#] [Citation(s) in RCA: 150] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Stomatitis is a common consequence of chemotherapy and a condition for which there is little effective treatment. Although the management of patients with other chemotherapy-related toxicities has improved in recent years, the incidence of stomatitis is increasing because of more intensive treatment and is often a dose limiting factor in chemotherapy. The authors assessed the efficacy of a homeopathic remedy, TRAUMEEL S(R), in the management of chemotherapy-induced stomatitis in children undergoing bone marrow transplantation. METHODS A randomized, placebo-controlled, double-blind clinical trial was conducted in 32 patients ages 3-25 years who had undergone allogeneic (16 patients) or autologous (16 patients) stem cell transplantation. Of the 30 evaluable patients, 15 were assigned placebo, and 15 were assigned TRAUMEEL S both as a mouth rinse, administered five times daily from 2 days after transplantation for a minimum of 14 days, or until at least 2 days after all signs of stomatitis were absent. Stomatitis scores were evaluated according to the World Health Organization grading system for mucositis. RESULTS A total of five patients (33%) in the TRAUMEEL S treatment group did not develop stomatitis compared with only one patient (7%) in the placebo group. Stomatitis worsened in only 7 patients (47%) in the TRAUMEEL S treatment group compared with 14 patients (93%) in the placebo group. The mean area under the curve stomatitis scores were 10.4 in the TRAUMEEL S treatment group and 24.3 in the placebo group. This difference was statistically significant (P < 0.01). CONCLUSIONS This study indicates that TRAUMEEL S may reduce significantly the severity and duration of chemotherapy-induced stomatitis in children undergoing bone marrow transplantation.
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Affiliation(s)
- M Oberbaum
- The Institute of Research on Complementary Medicine, The Center of Integrated Complementary Medicine, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem 91031, Israel.
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Godder KT, Henslee-Downey PJ. Colony-Stimulating Factors in Stem Cell Transplantation: Effect on Quality of Life. ACTA ACUST UNITED AC 2001; 10:215-28. [PMID: 11359669 DOI: 10.1089/15258160151134881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Health-related quality of life (QOL) is poorest during the immediate post-transplantation period, but the impact of medical interventions during this period has not been studied. Colony-stimulating factors (CSFs), which are used to minimize short-term negative outcomes, might be expected to improve QOL; however, little is published about their impact on QOL during this period. We conducted a MEDLINE search to identify studies reporting on outcomes of stem cell transplantation (SCT) affected by the CSFs, mainly sargramostim and filgrastim. End points studied were: mucositis, incidence and type of infection, duration of hospitalization, time to myeloid engraftment, and quantity and quality of harvested cells. To impute the impact of CSFs on QOL post-SCT, we also reviewed the association between QOL and CSF outcomes in other circumstances. Data suggest that both CSFs improve QOL in the early autologous or allogeneic post-bone marrow transplantation period. Poor QOL caused by infection and increased length of hospital stay is expected to be improved by sargramostim. Time to myeloid engraftment, when negatively affecting QOL, is expected to be improved with both CSFs; however, the time to myeloid engraftment is consistently shorter with filgrastim. Current prospective trials designed to study the effects of CSFs in the immediate post-SCT period should collect QOL data.
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Affiliation(s)
- K T Godder
- Division of Transplantation Medicine, Palmetto Richland Memorial Hospital and University of South Carolina, Columbia, SC 29203, USA.
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Abstract
Oral complications are common among patients with advanced cancer, though relatively little research has been undertaken in this field. This review article discusses the common problem of xerostomia among the terminally ill, together with an overview of oral candidosis, oral viral infections, chemotherapy- and radiotherapy-associated mucositis, and alterations in taste sensation among those with advanced cancer. Suggested management regimes, based on the limited clinical trial data available, are provided where appropriate.
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Affiliation(s)
- M P Sweeney
- University of Glasgow Dental School, Glasgow, Scotland
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de Conno F, Ripamonti C, Sbanotto A, Saita L, Zecca E, Ventafridda V. The pharmacological management of cancer pain. Part II: The role of opioid drugs in adults and children. Ann Oncol 1993; 4:267-76. [PMID: 8100145 DOI: 10.1093/oxfordjournals.annonc.a058481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- F de Conno
- Palliative Care Division, National Cancer Institute, Milan, Italy
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