Mucositis Score Research Articles

Evaluation of oral mucositis level and affecting factors in cancer patients receiving chemotherapy.

This study aimed to evaluate the severity of oral mucositis and the contributing factors among cancer patients undergoing chemotherapy. This study was planned cross-sectional. The study was conducted at a medical oncology clinic between January and July 2022. The sample consisted of 245 patients with cancer receiving chemotherapy. Data were collected using a personal, oral health and disease-related characteristics questionnaire and the World Health Organization Oral Mucositis Assessment Scale by researchers. Intraoral examination of the patients was carried out by researchers. The data were analyzed by independent-sample t-tests, Chi-square tests, paired-sample t-tests, and multivariate logistic regression (p < 0,05). The patients had mean age 62.31 ± 10.70. Patients of 32.7% were with lung cancer. 52%of the patients (n = 128) receiving chemotherapy developed oral mucositis. The independent variables the presence chronic disease(OR:1.85), chemotherapy protocol (OR:3.52) and the dependent variables ECOG performance score (OR:2.25) were variable that affected the development of oral mucositis (p < 0.05). Patients of 35.5% were oral mucositis score of 1. Patients those who had breast cancer, who received doxorubicin or cyclophosphamide chemotherapy protocols, and who had previously developed oral mucositis were found to have a higher rate of oral mucositis (p < 0.05). In addition, oral mucositis was more prevalent in patients with chronic diseases other than cancer (57%), those who used medication continuously (57.2%), those with oral and dental diseases (56.9%), those who had dental check-ups before cancer treatment (79.2%), and those who had information about oral mucositis(70.2%) (p < 0.05). In conclusion, nearly half of the patients (52%, n = 128) receiving chemotherapy developed oral mucositis and of all patients of 35.5% had an oral mucositis score of 1 in the second round of chemotherapy. Patients those who had breast cancer, who received doxorubicin or cyclophosphamide chemotherapy protocols, and who had previously developed oral mucositis were found to have a higher rate of oral mucositis.

Mucositis-associated bloodstream infections in adult haematology patients with fever during neutropenia: risk factors and the impact of mucositis severity

PurposeHaematology patients with high-risk neutropenia are prone to mucosal-barrier injury-associated laboratory-confirmed bloodstream infections (MBI-LCBI). We assessed risk factors for MBI-LCBI including candidaemia in neutropenic haematology patients with fever.MethodsThis prospective observational study was performed in six dedicated haematology units in the Netherlands. Eligible haematology patients had neutropenia < 500/mL for ≥ 7 days and had fever. MBI-LCBIs were classified according to Centers for Disease Control (CDC) definitions and were followed until the end of neutropenia > 500/mL or discharge.ResultsWe included 416 patients from December 2014 until August 2019. We observed 63 MBI-LCBIs. Neither clinical mucositis scores nor the blood level of citrulline at fever onset was associated with MBI-LCBI. In the multivariable analysis, MASCC-score (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.05 to 1.29 per point decrease), intensive chemotherapy (OR 3·81, 95% CI 2.10 to 6.90) and Pichia kudriavzevii (formerly Candida krusei) colonisation (OR 5.40, 95% CI 1.75 to 16.7) were retained as risk factors for MBI-LCBI, while quinolone use seemed protective (OR 0.42, 95% CI 0.20 to 0.92). Citrulline level (OR 1.57, 95% CI 1.07 to 2.31 per µmol/L decrease), active chronic obstructive pulmonary disease (OR 15.4, 95% CI 1.61 to 14.7) and colonisation with fluconazole-resistant Candida (OR 8.54, 95% CI 1.51 to 48.4) were associated with candidaemia.ConclusionIn haematology patients with fever during neutropenia, hypocitrullinaemia at fever onset was associated with candidaemia, but not with bacterial MBI-LCBI. Patients with intensive chemotherapy with a low MASCC-score and colonisation with Pichia kudriavzevii had the highest risk of MBI-LCBI.Trial registrationClinicalTrials.gov (NCT02149329) at 19-NOV-2014.

Effect of an Oral Care Program with Honey on Chemotherapy-related Mucositis among Cancer Patients

Objectives: This study examined the effect of an oral care program with honey on chemotherapy-related mucositis among cancer patients.Methods: In this randomized quasi-experimental study, 34 participants were assigned to either a honey group (n = 17, swish-hold-swallow with acacia honey) or a saline control group (n = 17, mouthwashes with normal saline). The 14-day oral care program comprised a 20-30 minute’s single education session and 1 minute‘s swishing with acacia honey or 3 minutes’ mouthwashes with normal saline solution for 4 times/day (after three meals and before bed time). Mucositis score was assessed at the time of enrollment, day 7, and day 14 using the Oral Assessment Guide. Data were analyzed with repeated measures of ANCOVA and repeated measures of ANOVA with Bonferroni’s correction.Results: There was no significant interaction between groups and follow-up times in the mucositis scores. Within the honey group, there was a significant increment in the mucositis score at day 7 (t = 6.42, &lt;i&gt;p&lt;/i&gt;&lt; 0.001) and a significant decrement at day 14 (t = 11.02, &lt;i&gt;p&lt;/i&gt;&lt; 0.001). In the saline group, there was a significant increment in the mucositis score at day 7 (t = 9.62, &lt;i&gt;p&lt;/i&gt;&lt; 0.001) and a significant decrement at day 14 (t = -10.03, &lt;i&gt;p&lt;/i&gt;&lt; 0.001).Conclusions: A supportive oral care program using honey or saline may be suggested to ameliorate the chemotherapy related mucositis as a safe, feasible, and appropriate care for cancer patients.

Vitamin E ameliorates oral mucositis in gamma-irradiated rats (an in vivo study)

BackgroundRadiation therapy is the primary treatment for neck and head cancer patients; however, it causes the development of oral mucositis accompanied by tissue structure destruction and functional alteration. This study was conducted to evaluate the effect of different doses of vitamin E as a treatment for radiationinduced oral mucositis in rat model.Methods35 male albino rats were randomly divided into five groups: control, untreated radiation mucositis (single dose of 20 Gy), treated radiation mucositis; radiation (single dose of 20 Gy) then vitamin E at doses of 300, 360 and 500 mg/Kg for seven days started 24 h after irradiation. Body weight and food intake were evaluated for each rat. The mucositis score was assessed every day. Rats were sacrificed once at the end of the experiment, and tongue specimens were stained with hematoxylin and eosin, anti P53 and anti Ki67 antibodies.ResultsResults indicated more food intake and less weight reduction in vitamin E treated groups and the contrary for gamma-irradiated group. Additionally, vitamin E delayed the onset and decreased the severity and duration of mucositis. It also restored the histological structure of lingual tongue papillae. Vitamin E treated groups showed a significant higher Ki67 and lower P53 expression as compared to untreated radiation group. The overall improvement increased as vitamin E dose increased. Finally, the amelioration can be attributed to the decreased apoptosis and increased proliferation of cells.ConclusionsVitamin E especially at dose of 500 mg/Kg could be an effective treatment for radiation-induced oral mucositis.

Effect of compound chamomile and lidocaine hydrochloride gel on oropharyngeal complications after the use of laryngeal mask airway with positive pressure ventilation

Objective: To evaluate the effect of compound chamomile and lidocaine hydrochloride gel on oropharyngeal complications after the use of laryngeal mask airway with positive pressure ventilation. Methods: A total of 64 patients undergoing elective surgery under general anesthesia using laryngeal mask airway (LMA) with positive pressure ventilation in Beijing Tongren Hospital Affiliated to Capital Medical University From January to March 2023 were prospectively selected and divided into two groups by the random number table method: normal saline group (n=32), with 18 males and 14 females, aged 28-64 (48.4±10.6) years, and the compound chamomile and lidocaine hydrochloride gel group (chamomile gel group, n=32), with 18 males and 14 females, aged 24-64 (46.3±10.8) years. Patients in both groups received total intravenous anesthesia. Before LMA placement, the front, shoulder and back of LMA were lubricated with normal saline and compound chamomile and lidocaine hydrochloride gel in the normal saline group and the chamomile gel group, respectively. The main outcome measure was the incidence of postoperative oropharyngeal mucosal inflammation at different time points after the removal of the laryngeal mask. Secondary outcome measures included oropharyngeal mucositis score, sore throat score, hoarse voice score, cough score and throat dryness score at different time points after LMA removal, the number of LMA insertion times, time of successful insertion and leakage pressure, as well as stress reactions such as cough and agitation before and after LMA removal, and adverse reactions such as tongue numbness and protective pharyngeal reflex limitation during recovery. Results: The incidence of oropharyngeal mucositis in the chamomile gel group was 25.0% (8/32), 31.3% (10/32), 28.1% (9/32) and 3.1% (1/32) at 0.5, 3, 6 and 24 h after LMA removal, respectively, which were lower than those of normal saline group [53.1% (17/32), 59.4% (19/32), 59.4% (19/32) and 21.9% (7/32)] (all P<0.05). The oropharyngeal mucositis scores of patients in the chamomile gel group were 0 (0, 0.8), 0 (0, 1.0), 0 (0, 1.0) and 0 (0, 0) respectively at 0.5, 3, 6 and 24 h after LMA removal, which were lower than those in the saline group [1.0 (1.0, 1.8), 1.0 (0, 2.0), 1.0 (0, 2.0) and 0 (0, 0)] (all P<0.05). The cough score of the patients in the chamomile gel group was 0 (0, 0) and 0 (0, 0) at 3, 6 h after LMA removal, which were lower than those of the normal saline group [(0, 0) and 0 (0, 0)] (both P<0.05). The throat dryness score of the patients in the chamomile gel group was 0 (0, 1.0) at 3 h after LMA removal, which was lower than that of the normal saline group [1.0 (0.3, 1.0)] (P=0.019). The time of successful LMA insertion in the chamomile gel group was 25.0 (20.3, 29.8) s, which was shorter than that in the saline group [29.0 (25.0, 32.0) s] (P=0.016). There were no significant differences in the number of LMA insertion, leakage pressure, postoperative sore throat and hoarse voice scores between the two groups (all P>0.05). Likewise, there were no stress reactions such as cough and agitation before and after LMA removal, and no adverse reactions such as tongue numbness and limited protective pharyngeal reflex during recovery. Conclusion: Compound chamomile and hydrochloride lidocaine gel can reduce the incidence of postoperative oropharyngeal mucositis, relieve the symptoms of postoperative oropharyngeal mucositis, pharyngeal dryness and cough, and improve the postoperative comfort of patients using the laryngeal mask airway with positive pressure ventilation.

Biobehavioral Influences of Stress and Inflammation on Mucositis in Adolescents and Young Adults with Cancer: Results from a Pilot Study.

Purpose: Chemotherapy-induced mucositis is a prevalent and burdensome toxicity among adolescent and young adults (AYAs) with cancer and impedes the delivery of optimal therapy. Its development is not well understood, but baseline stress and inflammation may be contributory factors. This pilot study evaluates stress and inflammation as risk factors for mucositis, identifies effect size estimates, and evaluates the feasibility of a prospective study to investigate mucositis development. Methods: Thirty AYAs receiving chemotherapy with substantial risk of mucositis completed baseline stress measures, and serum was collected for inflammatory biomarker analysis. Regression and mediation analyses determined the relationship between stress/inflammation and mucositis. Results: Stress appears to be a significant risk factor for incidence of mucositis (odds ratio 1.13, p = 0.125) and predicts total mucositis score (β = 0.281, p = 0.023) as well as peak incidence (β = 0.052, p = 0.018). Baseline levels of interleukin (IL)-1a and epidermal growth factor (EGF) predicted mucositis development, and EGF and IL-8 may mediate the relationship between stress and mucositis. Findings suggest that stress-induced inflammation exacerbates symptom development. Conclusion: Results from this pilot study inform mucositis symptom models, suggesting that psychosocial and physiologic factors are involved in development. Importantly, this pilot study provides initial effect size estimates, including magnitude and direction of relationships, that are essential to informing larger, more robustly powered studies. High enrollment, low attrition, and minimal missing data in this study suggest this model is feasible for research in this population. Importantly, this work is a first step in identifying new risk factors for mucositis and targets for nurse-led interventions to prevent toxicity development.

A Visualized Mortality Prediction Score Model in Hematological Malignancies Patients with Carbapenem-Resistant Organisms Bloodstream Infection.

Bloodstream infection (BSI) due to carbapenem-resistant organisms (CROs) has emerged as a worldwide problem associated with high mortality. This study aimed to evaluate the risk factors associated with mortality in HM patients with CROs BSI and to establish a scoring model for early mortality prediction. We conducted a retrospective cohort study at our hematological department from January 2018 to December 2021, including all HM patients with CROs BSI. The outcome measured was death within 30-day of BSI onset. Survivor and non-survivor subgroups were compared to identify predictors of mortality. Univariate and multivariate Cox regression analyses were used to identify prognostic risk factors and develop a nomogram. In total, 150 HM patients were included in the study showing an overall 30-day mortality rate of 56%. Klebsiella pneumonia was the dominant episode. Cox regression analysis showed that pre-infection length of stay was >14 days (score 41), Pitt score >4 (score 100), mucositis (score 41), CAR (The ratio of C-reactive protein to albumin) >8.8 (score 57), early definitive therapy (score 44), and long-duration (score 78) were positive independent risk predictors associated with 30-day mortality, all of which were selected into the nomogram. Furthermore, all patients were divided into the high-risk group (≥160 points) or the low-risk group based on the prediction score model. The mortality of the high-risk group was 8 times more than the low-risk group. Kaplan-Meier analysis showed that empirical polymyxin B therapy was associated with a lower 30-day mortality rate, which was identified as a good prognostic factor in the high-risk group. In comparison, empirical carbapenems and tigecycline were poor prognostic factors in a low-risk group. Our score model can accurately predict 30-day mortality in HM patients with CROs BSI. Early administration of CROs-targeted therapy in the high-risk group is strongly recommended to decrease mortality.

Aspirin Inhibits Carcinogenesis of Intestinal Mucosal Cells in UC Mice Through Inhibiting IL-6/JAK/STAT3 Signaling Pathway and Modulating Apoptosis and Proliferation.

Background:Colorectal cancer is related to ulcerative colitis. This study aimed to investigate the effects of aspirin on non-specific inflammation developing into cancer.Methods:Ulcerative colitis model was generated by administrating azoxymethane/dextran sulfate sodium to mice. Weight, tumor size/amount, and intestinal mucositis scores were analyzed. Inflammatory cell infiltration and atypical hyperplasia were determined with hematoxylin–eosin staining. Immunohistochemical assay was used to detect the proliferating cell nuclear antigen. Interleukin-6 and interleukin-10 were detected using enzyme-linked immunosorbent assay. Signal transducer and activator of transcription 3, phosphorylated-STAT3, cyclin D1, and suppressor of cytokine signaling 3 were examined with western blotting.Results:Aspirin remarkably decreased tumor size/amount compared to those of the ulcerative colitis model group (P < .05). Interleukin-6 was increased and interleukin-10 was decreased in mice of ulcerative colitis model group compared with the control group (P < .05). Aspirin markedly reduced interleukin-6 and enhanced interleukin-10 compared to the ulcerative colitis model group (P < .05) induced Azoxymethane/dextran sulfate sodium inflammation (3 weeks) and atypical hyperplasia (8 weeks). Aspirin predominantly inhibited the “inflammation–atypical hyperplasia–cancer” process and alleviated inflammatory cell infiltration of mice in the ulcerative colitis model group. Aspirin promoted apoptosis and alleviated proliferating cell nuclear antigen of atypical hyperplastic intestinal mucosal cells at 8 weeks post-modeling. The expression of phosphorylated-STAT3, signal transducer and activator of transcription 3, cyclin D1, and suppressor of cytokine signaling 3 was significantly increased in mice of ulcerative colitis model group compared to the control group (P < .05). Aspirin remarkably decreased phosphorylated-STAT3, signal transducer and activator of transcription, and cyclin D1 expression compared with ulcerative colitis model group (P < .05).Conclusion:Aspirin inhibited carcinogenesis of intestinal mucosal cells in the ulcerative colitis model by inhibiting the interleukin-6/Janus kinase/signal transducer and activator of transcription 3 signaling pathway and promoted apoptosis, thereby suppressing proliferation.

Impact of periodontal status on the oral mucositis in patients receiving high-dose chemotherapy.

Oral mucositis (OM) is a frequent complication of cancer treatments. Oral mucositis and periodontal disease have a common inflammatory pattern. The purpose of this study was to evaluate the OM and its association with periodontal status in patients with hematologic malignancies who undergo high-dose chemotherapy. Fifty-five patients who received high-dose chemotherapy were included in the study. Full-mouth periodontal clinical measurements including plaque index (PI), gingival index (GI), clinical attachment level (CAL), and probing depth (PD) values were recorded before the condition chemotherapy regime. OM monitoring was initiated 1day after the chemotherapy and maintained for 20days. Twenty-two of patients (40%) were observed oral mucositis after high-dose chemotherapy. Patients with mucositis had significantly higher GI scores than those who did not have mucositis (p < 0.05). There was a significantly moderate positive correlation between the grade of mucositis and GI scores (p < 0.05). In patients with periodontitis, the incidence of grade 1-2 mucositis was significantly higher than in the healthy group (p < 0.05). In individuals with periodontitis and gingivitis, the healing duration of mucositis was significantly longer than the healthy group (p < 0.05). The results of this study showed that the severity grades of oral mucositis may increase in patients with gingival inflammation. The results also suggest that periodontal diseases may have a significant impact on the duration of oral mucositis. The current study contributes to our understanding of the importance of oral health status in reducing the occurrence, severity, and duration of OM in hematological cancer patients treated with high-dose chemotherapy.

Investigation of the protective effect of gel incorporating Eugenia jambolana leaf extract on 5-fluorouracil-induced oral mucositis: an animal study.

The study aimed to evaluate the possible preventive effect of two concentrations (3 and 5% w/w) of Eugenia jambolana (EJ) extract against 5-FU-induced mucositis. Sixteen adult rats were separated into four groups: two control and two preventive groups. Animals in Groups 1, 2, and 3 were injected intraperitoneally with60mg/kg/day of 5-FU on Day 1 followed by 150mg/kg/day on Day 5. The rats in Group 4 (negative control) were given physiological saline at the same times and doses. Furthermore, on the fifth day of the study, the cheek and sublingual mucosa were irritated by external superficial scratches using the tip of an 18-G needle, followed by the application 15µL of 20% acetic acid, after which 3 and 5% EJ w/w gels were applied topically for animals in Groups 2 and 3, respectively. The weight and the mucositis scores were recorded. Antioxidant and anti-inflammatory markers and biochemical tests were analyzed. Significant differences were found between the study groups in weight loss, clinical mucositis scores, mortality rates, and antioxidant and anti-inflammatory parameters. The preventive effect of 3% gel was significant, with no mortality rate, making it an option for preventive strategies.

Comparative randomized trial study about the efficacy of photobiomodulation and curcumin antimicrobial photodynamic therapy as a coadjuvant treatment of oral mucositis in oncologic patients: antimicrobial, analgesic, and degree alteration effect.

As conventional treatments currently available for mucositis are not considerably effective, there is a need to implement an adjuvant protocol for the treatment of oral mucositis in patients undergoing radiotherapy and chemotherapy. To evaluate the effect of photobiomodulation (PBM) and antimicrobial photodynamic therapy (aPDT) mediated by curcumin and blue LED as an adjunct treatment of oral mucositis for oncology patients using chemotherapy and/or radiotherapy. Clinical, randomized study, in a single location, in an oncology service of a general hospital, with a total of 30 patients (over 18years old) with stable oral mucosa lesions in the process of chemotherapy and/or radiotherapy. The patients were divided into 3 groups: control group (treated with nystatin), PBM group (treated with low-level laser therapy), and the aPDT group (treated with 450-nm blue LED and curcumin photosensitizer). The results showed, by means of intra-group comparisons, that the two experimental treatments promoted yeast reduction of the genus Candida in the last two evaluations (21days and 30days), but not in the first two evaluations (7days and 14days). The intra-group comparisons showed that the control and aPDT group showed a significant difference in the degree of mucositis over the four evaluations performed, with the results pointing out that the mucositis worsened in the control group from the 14th day, while reduced in the aPDT group from the 21st day of treatment. A reduction in the degree of mucositis and pain score was observed in the PBM and aPDT groups, with the aPDT group standing out when presenting early clinical improvement in relation to the PBM group and the control group, thus emphasizing its effectiveness within the desired aspects. Regarding the antimicrobial effect, aPDT showed a greater reduction of yeasts of the genus Candida in the tested parameters.

Efficacy of oral cryotherapy versus chewing gum on mucositis in children receiving chemotherapy

Background Oral mucositis is considered one of the most common debilitating and serious complications of cancer treatment. Aim This study aimed to evaluate the effect of oral cryotherapy versus chewing gum on mucositis in children receiving chemotherapy. Patients and method A quasi-experimental design was conducted on a convenient sample of 90 children from both sex with cancer and undergoing chemotherapy, who attended the pediatric outpatient clinics and in-patient pediatric oncology department in Cancer Institute of South Egypt. The children were in the age range from 6 to 18 years, newly diagnosed with cancer and in the induction stage of chemotherapeutic protocol and had a healthy oral mucosa. Tools A structural interview questionnaire dealt with characteristics, clinical data of children, and oral assessment guide. Results More than half of children in the cryotherapy group and one-third of children in the chewing gum group had moderate mucositis compared with 83.3% of children in the control group who had severe mucositis during day 21. Conclusion Using oral cryotherapy with honey flavor and sugar-free gum lead to healthier oral mucosa and lower mucositis score compared with children using only the routine mouth care. Recommendations Provide in-services, up-to-date, regular training programs to improve nurses’ knowledge and practices regarding the use of flavored cryotherapy and chewing gum technique as routine care for children treated with chemotherapy.

Prophylactic management of radiation-induced mucositis using herbal mouthwash in patients with head and neck cancer: an assessor-blinded randomized controlled trial.

Radiation-induced mucositis (RIOM) is one of the most common side effects from head and neck radiotherapy. Several reagents have been introduced to manage the symptom; however, there is still a limited number of effective reagents. Herbal mouthwashes with payayor (Clinacanthus nutans Lindau) and fingerroot (Boesenbergia rotunda) were tested their efficacies in preventing and reducing severity of RIOM in comparison with normal saline with sodium bicarbonate. One hundred twenty patients with head and neck cancer undergoing radiotherapy participated in the study and were randomly assigned into three treatment groups using block randomization method. The participants were assigned one of the three mouthwashes for use throughout their radiotherapy course and were assessed for their mucositis scores from week one to six into their radiotherapy course as well as at one-month follow-up. Body mass index was also measured for comparison of nutritional status. The two mouthwashes were similarly effective in prophylaxis of RIOM in term of severity. The averaged mucositis scores were less than two for all groups. For the onset of RIOM, both herbal mouthwashes could slightly delay the symptom but not statistically significant. Patients' body mass index across the three treatment groups was also comparable. The patients were largely satisfied with all the mouthwashes with no clear preference on any of them. Prophylactic treatment of RIOM using herbal mouthwashes could substitute the current standard of normal saline with bicarbonate. A different formulation of the two herbs could potentially improve the prophylactic outcome. NCT03359187.

Nattokinase crude extract enhances oral mucositis healing

BackgroundNattokinase (NK) is a promising alternative in the prevention and treatment of cardiovascular diseases due to its potent fibrinolytic activity. In this study, we investigated the effect of crude nattokinase extract on the healing of acetic acid-induced oral mucositis in mice.MethodsBacillus subtilis culture media (BSCM) was isolated into the supernatant, named nattokinase crude extract (NCE), and the pellet was named Bacillus subtilis mass (BSM). An oral mucositis model was established in mice by applying 50% glacial acetic acid to the buccal mucosa. According to the treatment conditions, the mice were divided into BSCM, NCE, BSM and phosphate buffered saline (PBS) groups. The weight of the mice, oral mucositis healing score and histopathological examination were used to evaluate the treatment.ResultsFibrinolytic activities of BSCM, NCE and BSM were approximately 8069, 10,800 and 80 U/ml, respectively. The weight gain of mice in the NCE group was significantly different from the PBS group after three days’ treatment (p < 0.05). The oral mucositis score of NCE group was significantly higher than other groups (p < 0.05). The differences in histopathology scores between the NCE and other groups were statistically significant (p < 0.01).ConclusionsNCE could possess remarkable potential to reduce pain and promote oral mucositis healing with minimal safety concerns. In this study, we first report that NCE from the supernatant of Bacillus subtilis can promote the healing of oral mucositis, which extends the application scope of NK.

Improvement of the comfort perception scale in oral mucositis.

The study was conducted to develop a valid and reliable measurement tool for determining the comfort perceptions of patients with oral mucositis. The study was carried out methodologically between April 2017 and October 2019 in outpatient chemotherapy centers and clinics in which malignant patients were treated in a university hospital and educational-research hospital in Erzurum, Turkey of the study sample comprised 380 patients who developed oral mucositis after treatment. A 'Patient Identification Information Form,' draft 'Comfort Perception Scale in Oral Mucositis' and 'General Comfort Scale' were used to collect the study data. Validity and reliability analyses were used when evaluating the data. Percentage, mean, independent groups t-test, Mann-Whitney U test, Kruskal-Wallis test, variance analysis and advanced analyzes were also used. In this study, while the face validity of the scale was obtained, the content validity index was found to be 0.62 Kaiser-Meyer-Olkin value of the scale for explanatory factor analysis was 0.94, and Bartlett's test x2=9142.156 (P<0.05). For the confirmatory factor analysis, the corrected chi-square value was 3.54, the root-mean-square error was 0.082, and the scale structure was confirmed according to these results. As a result, the scale consisted of 31 items and 2 sub-scales. Item-total correlation values ranged from 0.83 to 0.33. As a result of similar scale validity, a significant negative correlation was found between the Comfort Perception Scale in Oral Mucositis and General Comfort Scale scores (P<0.05). The Comfort Perception Scale in Oral Mucositis is a reliable and valid scale. In this study, it was determined that patient comfort was affected according to some variables.

Efficacy of Nutrients in Reducing the Symptoms of Radiation Induced Oral Mucositis in a Hamster Model

Radiation-induced oral mucositis (RIOM) is a painful, dose-limiting toxicity in cancer therapy. RIOM was induced by radiation on the left buccal pouch mucosa of Golden Syrian hamsters (n = 8/group). Animals were treated topically with polyphenols (Curcumin or Quercetin) or amino acids/metabolite mixtures (Alanyl-Glutamine or Arginine + Glutamine + β-Hydroxy β-methylbutyric acid (Arg/Gln/HMB)) for over 20 day. Progression of RIOM was assessed using a standard visual scoring six-point scale, for differences in severity of mucositis (score ≥3) (Chi-square analysis) and in the daily group scores (Mann-Whitney rank sum test). Compared to the controls, there was a significant reduction in number of days with severe RIOM (score ≥3) in the treatment groups: Curcumin (50 μg/ml) = 17%; Control = 38.5%, p < 0.001; Quercetin (50 μg/ml) = 27.6% and Quercetin (100 μg/ml) = 25%; Control = 41.3%, p = 0.007 and p = 0.001, respectively; Arg/Gln/HMB (50 mg/ml) = 31.9%; Control = 50.0%, p = 0.040. In addition, Curcumin (50 μg/ml), Quercetin (100 μg/ml) and Arg/Gln/HMB (100 mg/ml) groups had lower mucositis scores (≥3) on at least two consecutive time points over the course of the study than their respective controls. There were no significant group differences in deaths or body weight. This study demonstrates the potential benefits of topical application of either plant polyphenols or amino acid/metabolite mixtures in addressing severity and progression of RIOM.

Radiotherapy of tongue cancer using an intraoral stent: a pilot study

AbstractAim:The aim was to evaluate the feasibility of an intraoral stent (10 and 20 mm thickness) in radiotherapy of tongue cancer, and to measure the reduction in acute mucositis in the palate.Materials and method:There were six patients in the intervention group, and seven patients in the control group. Target coverage was measured by the minimum dose covering 98% of the clinical target volume (CTV). Data were collected from the planning CT and daily cone-beam computer tomography (CBCT).Results:The 10 and 20 mm stent yielded a mean distance of 26 and 36 mm, respectively, between the tongue and the hard palate. We found comparable dose coverage of the CTV in the treatment plan, and on the CBCT. The stent reduced mean dose to the hard palate by 61.0% (p = 0.002). Dose to the soft palate was not reduced (p = 0.18). Average Common Terminology Criteria for Adverse Events (CTCAE) mucositis scores of the hard palate were 0 and 0.8 in the intervention and control group, respectively. The mucositis scores of the soft palate were 1.2 and 1.8.Findings:Use of an intraoral stent substantially reduced the dose to the hard palate. CTV coverage was maintained. We did not find any significant reduction in visually scored radiation-induced mucositis.

Effect of Honey-Lemon Spray Versus Benzydamine Hydrochloride Spray on Radiation-Induced Acute Oral Mucositis in Head and Neck Cancer Patients: A Pilot, Randomized, Double-Blind, Active-Controlled Clinical Trial.

Introduction: Oral mucositis (OM) is the most prevalent side effect in patients with head and neck cancer (HNC). It causes an obvious decrease in quality of life (QoL) in these patients, so different medications have been recommended for OM, however, without optimal response. This randomized trial aimed to assess the effects of a honey-lemon spray compared with benzydamine hydrochloride in prevention of radiation-induced OM in patients with HNC. Materials and Methods: Forty-six patients with HNC received external beam radiotherapy for 5 days per week. Patients were randomized to treatment with either benzydamine hydrochloride spray or honey-lemon spray for 5 weeks and continued for 1 week after the end of treatment. The oral cavity was examined weekly, with a score given to each site based on the degree of mucositis using a 4-point scale, and a mean mucositis score was calculated as the primary outcome. Occurrence of OM, pain, QoL, and adverse effects were defined as secondary outcomes. Patients, therapists, and outcome assessors were blinded to group allocation. Results: No significant group differences occurred in the mucositis score, pain, or QoL. Mucositis occurrence rates were higher in the benzydamine hydrochloride group compared with the honey-lemon group (hazard ratio = 2.1, 95% confidence interval: 1.1 to 4.2). Two patients in the honey-lemon group had mild nausea and burning throat; no adverse effects occurred in the benzydamine hydrochloride group. Conclusions: There were no significant group differences in mucositis severity between patients treated with honey-lemon spray and benzydamine hydrochloride. The potential preventive effects of honey-lemon spray need to be confirmed in further trials. The trial registration number is IRCT20161024030467N1.

To Assess Effectiveness of Topical Application of Pure Honey on Radiation Induced Mucositis in Cancer Patients Undergoing Radiotherapy

Introduction: Mucositis is an inflammatory illness that affects the mouth’s mucous membranes. It could be the result of an infection or an indication of something more serious. Oncology nurses play a crucial role in improving patient outcomes related to oral mucositis. Honey has long been used to prevent and cure oral mucositis. Aim: The aim of the study to assess effectiveness of topical application of pure honey on radiation induced mucositis in cancer patients undergoing radiotherapy. Material and Methods: The style adopted for the study is true experimental design with two group pre-tests with the experimental analysis approach was wont to judge the effectiveness of topical applications of pure honey on radiation evoked mucositis patients. This study was conducted in GSL Cancer hospital Rajahmundry. The sample size consisted of sixty patients suffering type oral mucositis patients who are admitted in GSL cancer hospital at Rajahmundry. Sample random sampling technique was used for the choice of sample. Knowledge was collected by mistreatment WHO mucositis assessment scales &amp; one observation check list to assess the grade of radiation induced mucositis in patients. Modified WHO oral mucositis assessment scale. Data were analysed using descriptive and inferential statistics. Result: The results of this study showed that, oral mucositis score of experimental and control groups mean were 9.73 and1.7 respectively. The standard deviation was 0.927 and 14.55 respectively. Hence calculated t’ value 2.66 is greater than tabulated‘t’ value 2, ‘p’ value is 0.0101 shows that there was a significant oral mucositis scores between post test scores in both experimental and control groups. Applications of pure honey was effective. Conclusion: The findings of the study concluded that, the application of pure honey was effective on radiation induced mucositis in cancer patients undergoing radiotherapy and the level of mucositis is decrease.

Anakinra: efficacy in the management of fever during neutropenia and mucositis in autologous stem cell transplantation (AFFECT-2)\u2014study protocol for a multicenter randomized double-blind placebo-controlled trial

BackgroundSince decades, fever and infections have been the most important complications of intensive chemotherapy and hematopoietic stem cell transplantation (HSCT) in the treatment of hematologic malignancies. Neutropenia has long been considered to be the most important risk factor for these complications. However, recent studies have shown that not neutropenia, but the development of mucositis is the most important cause of these complications. Currently, limited options for the prevention and treatment of mucositis are available, of which most are only supportive. The pro-inflammatory cytokine interleukin-1 (IL-1) plays a crucial role in the pathogenesis of mucositis. Pre-clinical studies of chemotherapy-induced mucositis have shown that recombinant human IL-1 receptor antagonist anakinra significantly ameliorated intestinal mucositis. In our pilot study AFFECT-1, we examined the safety and maximal tolerated dose of anakinra in patients with multiple myeloma, treated with high-dose melphalan (HDM) and autologous HSCT, selecting a dose of 300 mg daily for the phase IIb trial. The aim of the AFFECT-2 study is to determine the efficacy of anakinra in preventing fever during neutropenia (FN) and mucositis in this study population.Methods/designA multicenter, randomized, placebo-controlled, double-blind phase IIb trial will be conducted. Ninety patients with multiple myeloma scheduled for treatment with HDM and autologous HSCT will be included. Patients will be randomized between intravenous treatment with anakinra (300 mg) or placebo. Each group will be treated from day − 2 (day of HDM; day 0 is HSCT) up until day + 12. Outcome measures will be assessed at baseline, during admission, at discharge or day + 30, at day + 90, and + 1 year. The primary outcome will be reduction of FN. Secondary outcome measures include mucositis scores, bloodstream infections, citrulline levels, quality of life, and fatigue severity.DiscussionThe AFFECT-2 trial will examine the efficacy of anakinra in the management of fever during neutropenia and mucositis in patients with multiple myeloma treated with HDM and autologous HSCT. The results of this study may provide a new treatment option for these important complications. Also, this study will give us more insight in the pathophysiology of mucositis, including the role of IL-1 and the role of the microbiota in mucositis.Trial registrationClinicaltrials.gov NCT04099901. Registered on September 23, 2019. EudraCT: 2018-005046-10.