Management Of Oral Mucositis Research Articles

Photobiomodulation for the prevention and treatment of oral mucositis in patients submitted to hematopoietic stem cell transplantation: health quality evaluation.

To evaluate the quality of oral health care through indicators in patients undergoing hematopoietic stem cell transplantation for the management of oral mucositis. Thirty-five patients were evaluated. Photobiomodulation was performed during the conditioning regimen, 1day, 5days, and 10days after transplantation. Four process indicators and 13 outcome indicators were used to evaluate the effectiveness of the intervention, according to SQUIRE 2.0. All process indicators demonstrated a compliance rate of 100% to the desired standard. Outcome indicators revealed that 66.6% of patients experienced mucositis during at least one follow-up period. A statistically significant increase was observed between periods of 1 and 5days post-transplant, as well as between 1 and 10days post-transplant (p < 0.05), with a predominance of grade I mucositis (p = 0.014). Four patients (16.7%) reported feeling pain, occurring between 5 and 10days after transplantation, with moderate pain being the most prevalent. Oral mucositis did not show a statistically significant association with pain, associated treatments, leukopenia, comorbidities, or type of transplant. The indicators demonstrated their suitability for evaluating oral health in both the prevention and treatment of oral mucositis in these patients. Furthermore, the effectiveness of photobiomodulation in improving the quality of oral health in the patients studied was confirmed.

65 A Multicentre, Three Arm, Phase III Randomized Controlled Trial on the Management of Oral Mucositis in Patients Receiving Radical Radiation for Head and Neck Cancer: An Evaluation of Barrier-Based Treatment

65 A Multicentre, Three Arm, Phase III Randomized Controlled Trial on the Management of Oral Mucositis in Patients Receiving Radical Radiation for Head and Neck Cancer: An Evaluation of Barrier-Based Treatment

Photobiomodulation with light-emitting diode in the management of oral mucositis induced by antineoplastic treatments: a systematic review

Photobiomodulation with light-emitting diode in the management of oral mucositis induced by antineoplastic treatments: a systematic review

Immediate pain alleviation in oral mucositis and other oral ulcerative diseases through photobiomodulation therapy: the preemptive treatment concept.

Photobiomodulation therapy is recommended by multiple international societies for managing oral mucositis. These recommendations are based on extensive evidence. However, the search for an optimal photobiomodulation protocol continues. This mapping review focuses on a novel aspect of photobiomodulation therapy which is the immediate effect on pain levels associated with oral ulcerative conditions. This literature review systematically compiles and evaluates the evidence about oral mucositis, alongside other oral ulcerative conditions, as the protocols that achieved pain relief for these oral conditions may have potential applicability to oral mucositis management. The scientific database used was PubMed. Whereas most of the randomized controlled trials about photobiomodulation therapy for oral mucositis and other ulcerative oral diseases reported delayed pain relief, certain photobiomodulation therapy protocols reported immediate pain relief. The results of this review highlight the concept of preemptive photobiomodulation therapy, in which photobiomodulation therapy is delivered early in the development of oral mucositis throughout the oncotherapy and may achieve immediate pain relief consistently in most of the patients and close to a negligible pain level. Photobiomodulation therapy, as a powerful nonpharmacologic tool for immediate pain relief, has a great beneficial value in patients suffering from oral mucositis and other painful oral ulcerative diseases such as recurrent aphthous stomatitis and chronic graft-versus-host disease.

Phase I study of copaiba aqueous mouthwash in patients with head and neck cancer undergoing radiotherapy.

e24103 Background: Due to the contraindication of low-power laser therapy in the tumor region, the use of copaiba for the management of oral mucositis was proposed, given its anti-inflammatory, antimicrobial and healing properties. This study aimed to evaluate the dose-limiting toxicity/maximum tolerated dose of copaiba aqueous mouthwash solution. Methods: This is a phase I study including patients with cavity or oropharynx cancer (CID-10 C00-C06,10), undergoing radiotherapy alone or associated with chemotherapy. Six successive cohorts were proposed, with a minimum of 3 patients each. The copaiba aqueous mouthwash was used daily starting on the first day of radiotherapy and up to 37 days, associated with Low Power Laser applications (100Mw, 660nm, beam area 0.09842 cm²,1J) in non-tumoral areas. In cohorts 1, 2, and 3, a 10% solution was used, and in cohorts 4, 5, and 6, 15%, 2, 3 and 4 times a day, respectively. Daily assessment was carried out evaluating the presence of oral mucositis lesions (World Health Organization and Oral Mucositis Assessment Scale) and complaints of pain (CTCAE v5.0 and Visual Analogue Pain Scale) and xerostomia (presence or absence). Sialometry was carried out through the collection of unstimulated saliva (by Davies (2002) criteria), once a week. Results: Twenty patients were included (cohort 1 = 5, cohort 2 = 3, cohort 3 = 3, cohort 4 = 3, cohort 5 = 3, cohort 6 = 3) - 1 patient was excluded and 1 discontinued from cohort 1 (due to changes in radiotherapy planning and non-adherence to dentistry appointments). A total of 19 participants used the mouthwash. Most of the participants were women (57.9%), with a median age of 63.2 years, and performance status 1 (84.2%). Most tumors were squamous cell carcinomas (84.2%), 47.4% of them in the palate; 57.9% were staged as IVA. Themedian total radiotherapy dose was 68.0 (60.0-70.0) Gy delivered in 33.0 (30.0-34.5) fractions. Pain in the oral cavity (73.7%) and oropharynx (52.6%) were referred, graded respectively as 4.5 (0.75-7) and 1.5 (0-6). Oral mucositis was classified as grade 3 at most; none of the patients developed grade 4 or had to have radiotherapy interrupted due to toxicity. Ulcerated lesions of oral mucositis developed in the tumor area in 68.4% of patients and non-tumor areas in 84.2%. Patients complained of xerostomia in 73.7% of cases and the median unstimulated sialometry was 0.17mL/min. None of the patients experienced dose-limiting toxicity related to the copaiba solution. Conclusions: Copaiba mouthwash did not trigger dose-limiting toxicity in any of the patients throughout the study, leading to amaximum tolerated dose of 15%, 4 times/day. None of the patients complained of pain or burning related to the use of mouthwash in the absence of oral mucositis lesions, suggesting that it is safe and non-toxic for this use. In this sense, considering the obtained results, the development of a phase II study becomes the next logical step in this research area. Clinical trial information: ID - 34635020.5.0000.5274.

Clinical efficacy and applicability of natural products in the treatment and prevention of radiotherapy-induced oral mucositis: A systematic review.

The aim of this systematic review was to describe the efficacy and acceptability of natural products in the management of oral mucositis caused by radiation. From the day it started to August 7, 2023, a thorough search for randomized controlled trials (RCTs) was carried out among seven databases: the Web of Science, PubMed, Embase, OVID, Scopus, the Cochrane Library and the CINAHL database. Only English-language articles were identified during the search. Using the revised Cochrane risk-of-bias tool, version 2, two researchers screened the articles, collected information on study characteristics, and appraised risks of bias. The data were analyzed and descriptively presented with a narrative synthesis methodology involving the Synthesis Without Meta-Analysis (SWiM) reporting element applied in detail. The PROSPERO registration number of this study is CRD42023476932. Thirty-six clinical trials were included in the study; the included studies included a variety of 20 types of natural products. Honey and Curcuma longa were the most commonly assessed natural products. A total of 2,400 participants reported taking part in therapy with natural products for oral mucositis. Natural products demonstrated substantial efficacy in terms of influencing intensity, incidence, pain score, quality of life, and symptoms such as xerostomia and dysphagia. Except for manuka honey, most natural products were well accepted. Regarding the clinical trials' risk of bias, 2 clinical trials (5.56%) had a high risk of bias, 17 studies (47.2%) had a low risk of bias, and 17 studies (47.2%) were rated with "some concern." Natural remedies work well as alternate treatments for managing oral mucositis caused by radiation therapy. However, additional clinical trials are still needed. The safety of these conventional medications as well as their effectiveness and safety when used in combination with other conventional or naturopathic therapies should be fully examined.

Oral Mucositis Management in Children under Cancer Treatment: A Systematic Review.

Children undergoing antineoplastic treatment often present severe side effects due to the dosage and duration of treatments, with oral mucositis emerging as one of the most prevalent and painful inflammatory conditions. There is a growing body of evidence on therapeutic interventions such as cryotherapy, low-level laser therapy, and natural compounds for this condition. The aim of this systematic review was to identify and compare therapies for the management of cancer treatment-induced oral mucositis in pediatric patients. From 2655 articles obtained in initial searches, 39 articles were considered in this systematic review, after applying inclusion/exclusion criteria. Low-level laser therapy, palifermin, honey, and zinc demonstrated reductions in oral mucositis incidence, duration, severity, and pain reported by the patient. Although there are several therapies in place for the prevention and treatment of oral mucositis in children, evidence of their efficacy is still inconclusive to establish accurate clinical protocols.

Preventive versus curative photobiomodulation for oral mucositis in patients with multiple myeloma undergoing hematopoietic stem cell transplantation: which approach is more effective?

There is increasing evidence that photobiomodulation (PBM) therapy is both an effective and safe approach in hematopoietic stem cell transplantation (HSCT) for both prevention and management of oral mucositis (OM), but its use in clinical practice is still limited and the timing of application is under discussion. The aim of this retrospective study was to evaluate possible differences between patients treated either with preventive or curative PBM therapy. The retrospective case series included 24 patients suffering from multiple myeloma who underwent the same conditioning and transplantation protocol. Patients were treated either with preventive PBM starting from the first day of conditioning up to two days post-HSCT or with curative PBM (starting at OM onset for four consecutive days). OM score, pain, and functional parameters were recorded. All patients developed OM. Preventive PBM was significantly more effective in reducing OM severity (p < 0.0001) and pain (p < 0.0001) post-HSCT than curative PBM. Furthermore, we found a lower number of patients reporting discomfort in all subjective parameters (pain during swallowing, chewing, and speaking) in the preventive PBM group. No adverse events related to PBM therapy were recorded in both groups. The timing for PBM therapy in patients undergoing HSCT is crucial: when started on the first day of conditioning, it significantly reduces both pain and OM severity, providing an important benefit also in subjective oral functions such as speaking, swallowing, and chewing, thus increasing the overall adherence to the oncological therapies.

Unveiling the Multifaceted Management of Oral Mucositis in Cancer Patients: A Narrative Review.

Oral mucositis (OM) is a major and common adverse reaction to cancer treatment, occurring in all patients who undergo radiation therapy or chemotherapy that includes the mucosal areas of the oral and oropharyngeal region. The pathophysiology of OM remains incompletely understood, and there are many unanswered questions about the risk factors for developing OM. Multidisciplinary clinicians and researchers must collaborate to better understand and expand treatment strategies for OM and other inflammatory conditions in oncology. This will lead to the development of more effective treatments and reduce the burden of OM in cancer patients. This article comprehensively reviews the risk factors and patient factors associated with OM, its pathogenesis, clinical presentation, grading, and management.

The place and role of oral microflora in the pathogenesis of oral mucositis in malignant neoplasms (literature review)

Background. Oral mucositis (OM) is one of the most frequent complications of systemic drug therapy of oncological diseases. Clinically, the disease manifests itself in the form of erythema and ulceration of the non-corneating mucous membrane. Although this condition is self-healing, it can affect the conduct of comprehensive antitumor treatment. Currently, the pathophysiological model of the development of OM is supplemented with new data obtained during studies of the oral microflora. Antitumor treatment can lead to changes in the composition of the resident oral microflora and it is quite possible that the changes that occur may affect the development of damage to the oral mucosa. The expansion of knowledge in this area allows researchers to look for new ways to include oral microbiota in OM management strategies.&#x0D; Aim. To summarize and update the accumulated data regarding the role of the oral microbiota in the pathogenesis of OM in patients with malignant neoplasms.&#x0D; Materials and methods. Literature search was performed in Medline, Cochrane Library, Elibrary and Pubmed, including publications demonstrating the current ability to assess the impact of the oral microbiome on OM, as well as developments in this area relating to OM management.&#x0D; Results. In the review the current views on the position of the oral microbiome in the pathogenesis of OM were highlighted and the promising directions for the use of agents influencing the state of the oral microbiota in various strategies to control this disease were emphasised.&#x0D; Conclusion. A better understanding of the pathogenesis of OM and the inclusion of new factors, such as the oral microbiome, into the picture of pathogenesis is likely to enable the formation of more effective management strategies for this disease in the future. This direction seems very promising, and developments in this area show promising results.

Effectiveness of gold nanoparticles in prevention and treatment of oral mucositis in animal models: a systematic review

BackgroundOral mucositis remains a significant complication during cancer therapy with no effective treatment. Gold nanoparticles offer anti-inflammatory, antioxidant properties with low toxicity. This study systematically reviews the literature assessing gold nanoparticles in the management of oral mucositis in animal models.MethodsA literature search was undertaken using MEDLINE, Embase, PubMed, and Web of Science databases, using the format for Systematic Review Centre for Laboratory Animal Experimentation. Prior to the review, the protocol was registered in the systematic review register, PROSPERO (registration no. CRD42021272169). Outcome measures included ulceration, histopathological scores, inflammatory mediators, microbial growth, and pain. Study quality was analysed by SYRCLE risk-of-bias tool.ResultsOnly one study met the inclusion criteria, documenting reduction in ulceration, inflammatory, and oxidative biomarkers. Exposure to AuNPs prevented inflammatory response induced by 5-fluorouracil in oral mucosa of hamsters. However, a high risk of bias necessitates further research.ConclusionThis review identifies a potential therapeutic strategy for prevention and management of oral mucositis. It also provides future direction for gold nanoparticle research in oral mucositis; however, there is lack of sufficient evidence to derive any conclusion. Research with standardized parameters including nanoparticle size, capping agent, surface charge, and appropriate oral mucositis animal models will establish risk–benefit balance and margin of safety for therapeutic use of gold nanoparticles for oral mucositis.

Efficacy of photobiomodulation therapy in the management of oral mucositis in patients with head and neck cancer: A systematic review and meta-analysis of randomized controlled trials.

Numerous studies have examined the effectiveness of photobiomodulation therapy (PBMT) in reducing chemoradiotherapy (CRT)-induced oral mucositis (OM) in patients with head and neck cancer (HNC). Despite this, there is an urgent need to update the meta-analyses on this topic. This meta-analysis aims to explore the impact of PBMT on CRT-induced OM in these patients. We conducted a systematic search in PubMed, Embase, Cochrane, LILACS, and Web of Science from January 2000 to October 2023. This search focused on randomized controlled trials (RCTs) that assessed the effects of PBMT on CRT-induced OM. The study included a total of 14 RCTs encompassing 869 patients with HNC. The incidence of OM in the PBMT group was significantly lower from the second week onwards compared to the control group (RR = 0.49, CI = 0.25-0.97, I2 = 71%, p = 0.04), and this was present until the seventh week (RR = 0.77, CI = 0.61-0.99, I2 = 89%, p = 0.04). Furthermore, the occurrence of severe mucositis in the PBMT group decreased from the third week (RR = 0.51, CI = 0.29-0.90, I2 = 12%, p = 0.02) until the conclusion of the intervention (RR = 0.45, CI = 0.24-0.85, I2 = 80%, p = 0.01). Additionally, PBMT showed beneficial effects in alleviating OM-related pain (WMD = -1.09, 95% CI = -1.38 to -0.880, I2 = 13%, p < 0.00001). The use of He-Ne or InGaAlP lasers with a power range of 10-25 mW demonstrated the most favorable outcomes in preventing and treating OM. PBMT has shown considerable efficacy in reducing the incidence, severity, and pain associated with OM in patients with HNC. Future studies are encouraged to further investigate the most effective parameters for PBMT in the management of OM.

Prevention and Treatment of Oral Mucositis in Pediatric Patients: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Oral mucositis (OM) is a common and serious side effect of cancer treatment. The incidence of chemotherapy-induced OM in pediatric patients can reach up to 91.5% and has a major impact on patients' quality of life. The aim of the study was to assess the efficacy of current interventions and agents for the management of OM in children undergoing chemo/radiotherapy or hematopoietic stem cell transplantation (HSCT). A systematic search of randomized controlled trials (RCTs) was conducted in the MEDLINE and Scopus databases from January 2000 until March 2023. Thirty-four randomized studies meeting the inclusion criteria were identified and five RCTs investigating the efficacy of Low Level Laser Therapy (LLLT) intervention or the agent honey were included in the meta-analysis. The meta-analysis of two RCTs indicated that topical application of honey on oral mucosa was effective in shortening the mean duration of hospital stay in children with severe OM (MD=-4.33, p=0.002). However, LLLT was not found to be effective for the prevention or treatment of OM grade ≥II (RR=0.99, p=0.99). Moreover, the therapeutic application of LLLT did not show significant benefit for lower risk of OM grade ≥II (RR=0.48, p=0.58). Various interventions and agents were examined in the present study for the management of OM. Honey could be a promising candidate for the treatment of OM in pediatric patients. Further high-quality RCTs are required to enhance our findings.

Updates on the potency and mechanism of glutamine supplementation in oral mucositis management: A narrative review

Introduction: Chemotherapy and head-and-neck radiotherapy administered to cancer patients can lead to the development of oral mucositis (OM), a condition characterized by extensive and excruciating damage to the oral mucosal tissues. Glutamine, an essential amino acid, plays a crucial role in various facets of cellular metabolism, particularly in cell proliferation, wound healing, and leukocyte function, and has been reported to have preventive and therapeutic benefits in oral mucositis. Objective: This study aims to comprehensively review current findings on the potential clinical applications and mechanisms of glutamine in the management of oral mucositis. Review: Several studies have demonstrated the efficacy of glutamine supplementation in diminishing the severity of OM and expediting the healing process. This positive effect is attributed to the modulation of inflammation and the stimulation of pro-regenerative activity in keratinocytes and fibroblasts. Furthermore, glutamine intervention enhances the overall nutritional status of patients, reducing the risk of complications commonly observed in cancer patients. Additionally, it plays a pivotal role in preventing or ameliorating the conditions of sarcopenia and lymphopenia. Conclusion: Glutamine supplementation emerges as a promising intervention for the management of oral mucositis in patients undergoing chemotherapy or head-and-neck radiotherapy. Its multifaceted impact, including inflammation modulation, pro-regenerative activity, and improvement in nutritional status, positions glutamine as a valuable component in the comprehensive care of cancer patients experiencing oral mucositis

Türkiye’de Kemoterapi İlişkili Oral Mukozit Yönetimine Yönelik Girişimsel Tipte Yürütülen Hemşirelik Lisansüstü Tezlerinin İncelenmesi

Amaç: Bu araştırma, Türkiye’de kemoterapi ilişkili oral mukozit yönetimine yönelik girişimsel tipte ve hemşirelik alanında yürütülen lisansüstü tezlerinin incelenmesi amacıyla yapılmıştır. Yöntem: Araştırmada doküman analizi yöntemi kullanılmıştır. Veriler, Eylül-Aralık 2022 tarihleri arasında “Yükseköğretim Kurulu Ulusal Tez Merkezi” veri tabanında “kemoterapi”, “oral mukozit”, “hemşirelik” anahtar kelimeleri kullanılarak toplanmıştır. 2007-2022 yılları arasında tamamlanan yirmi altı teze ulaşılmış ve araştırma kriterlerini karşılayan dokuz tez araştırmaya dâhil edilmiştir. Bulgular: İncelenen tezlerin %55,5’i yüksek lisans, %44,4’ü doktora tezidir. Tezlerin çoğunluğu (%44,4) Hemşirelik Anabilim Dalı’nda yürütülmüş olup, tez danışmanlarının uzmanlık alanı (%77,7) İç Hastalıkları Hemşireliği Anabilim Dalı’dır. Yapılan tezlerin çoğunluğu (%44,4) randomize kontrollü deneysel tiptedir. Oral mukozitin değerlendirilmesinde en sık Dünya Sağlık Örgütü Mukozit Değerlendirme Ölçeği’nin (%88,8) kullanıldığı belirlenmiştir. Kemoterapi ilişkili oral mukoziti önlemeye yönelik en sık uygulanan yöntemler karadut şurubu (%33,3) ve kriyoterapi (%33,3)’dir. Sonuç: Yapılan doküman analizi sonucunda, hemşirelik alanındaki lisansüstü tezlerinde karadut şurubu, kriyoterapi, propolisli gargara, klorheksidin, hyalüronik asit ve ankaferd hemostatın kanser bakımında oral mukozitin yönetiminde kullanılabilecek hemşirelik müdahalesi olarak bildirildiği belirlenmiştir.

Window therapeutic of extraoral photobiomodulation for prevention of oral mucositis in HSCT patients: additional arm.

This study aimed to evaluate the efficacy of 1W extraoral photobiomodulation (EOPBM) and to compare with our previous results of 2W EOPBM and intraoral photobiomodulation (IOPBM) protocols in the management of oral mucositis (OM) related to hematopoietic stem cell transplantation (HSCT). A total of 30 patients underwent autologous or allogenic HSCT. Experimental protocol of 1W EOPBM was performed daily beginning in the first day of the conditioning regimen until 5days after transplantation. The application areas included six points on the face and three points on the cervical area. Additional application of IOPBM was performed if patients had ulcered mucositis. Its severity was assessed daily according to WHO (World Health Organization) and NCI (National Cancer Institute) scales. Oral and oropharynx pains were scored daily by visual analogue scale (VAS). The 1W EOPBM protocol was well tolerated without any complaints. Of total, 13 patients were male and 17 were female and the mean age was 49.3years old. Most patients (21 patients - 70%) received autologous HSCT, and 24 patients (80%) underwent myeloablative conditioning (MAC) regime and 6 patients (20%) reduced intensive conditioning regime. Nineteen patients (63.3%) developed OM according to WHO criteria, 3 patients grade I, 10 grade II and 6 grade III. NCI mucositis grades were similar to WHO grades. OM outcomes of 1W EOPBM were similar when compared to our previous groups and no significant differences were observed. No differences were found between pain and the protocols (1W EOPBM, IOPBM and 2W EOPBM). This 1W EOPBM protocol seemed to be as effective as IOPBM and 2W EOPBM in the prevention of OM in HSCT patients. In addition, we might assume that there is a window of application on EOPBM.

Impact of photobiomodulation for prevention of oral mucositis on the quality of life of patients with head and neck cancer: a systematic review.

The aim of this study was to perform a systematic review to evaluate the impact of photobiomodulation therapy (PBMT) for the prevention of oral mucositis (OM) on the quality of life (QoL) of patients with head and neck cancer (HNC) undergoing radiation therapy. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search strategy was performed in five electronic databases (Cochrane, Embase, PubMed, Scopus, and Web of Science). The included studies assessed the QoL of patients undergoing radiation therapy (RT) for HNC and undergoing PBMT for the management of OM. Seven articles met the eligibility criteria. Data extraction was performed in the selected studies including the PBMT parameters (active medium, application procedure, wavelength, fluence, power, irradiance, irradiation time, spot size, energy per point, schedule of irradiation, and total energy). The included studies were qualitatively analyzed, and descriptive analyses were performed. Also, summary results were evaluated for group comparison analysis. All included studies confirmed a decrease in the QoL of the patients that developed OM throughout the RT progress when compared to baseline. Of the informed cases, most of the patients who received PBMT showed grades 1 and 2 OM, while the control group showed more individuals with severe forms of OM (grades 3 and 4). In this sense, patients submitted to PBMT reported better QoL at the end of the treatment compared with the control group. PBMT used for the management of OM preserves the QoL of patients with head and neck cancer.

Effectiveness of Extraoral Photobiomodulation in Management of Oral Mucositis in Head and Neck Cancer Patients Undergoing Radiotherapy: A Multicenter, Randomized, Single-blind Clinical Trial

Effectiveness of Extraoral Photobiomodulation in Management of Oral Mucositis in Head and Neck Cancer Patients Undergoing Radiotherapy: A Multicenter, Randomized, Single-blind Clinical Trial

The roles of health literacy in parents’ honey use and the use of complementary alternative medicine in a Turkish population

BackgroundAs a biologically based therapy, honey is used by parents in many parts of the world as a home remedy for their children. While information exists regarding the traditional use of honey for health issues in children, data regarding its relationship with health literacy is lacking. The aims of this study were to determine the use of honey to address children’s health issues among parents of children aged 0–72 months and to explore the relationship between the use of complementary and alternative medicine (CAM) and health literacy.MethodsThe data for this descriptive, cross-sectional study were collected between October and November 2022 via an online survey of 907 parents of children aged 0–72 months. A sociodemographic data collection form, the Holistic Complementary and Alternative Medicine Questionnaire (HCAMQ), and the Turkey Health Literacy Scale-32 (THLS-32) were used to collect the data. A t-test, one-way analysis of variance, and Pearson correlation analysis were used to analyze the data.ResultsThe majority (86.5%) of the parents used honey for their children’s health problems. Among the parents, 83.1% utilized honey as a remedy for alleviating cough symptoms, 10.4% employed it as a treatment for diarrhea, and 14% administered it for the management of oral mucositis. The mean THLS-32 and HCAMQ scores of the parents were 29.39 and 21.31, respectively, and there was a moderate correlation between the parents’ THLS-32 and HCAMQ mean scores (r = 0.662, p < 0.001).ConclusionThis study revealed that a significant proportion of parents who used honey to alleviate their children’s health issues displayed positive attitudes toward complementary and alternative medicine (CAM) while concurrently exhibiting insufficient or limited health literacy levels. Therefore, it is advisable to enhance health literacy regarding the proper and safe utilization of honey, which functions as a biologically based CAM therapy.

Severe Oral Mucositis After Intensity-Modulated Radiation Therapy for Head and Neck Cancer

Oral mucositis (OM) is a common and debilitating adverse effect observed in patients with head and neck cancer (HNC) receiving radiation therapy (RT). Previous studies examining associations between OM and clinical outcomes were performed in the era of 3-dimensional conformal RT planning with low rates of concurrent chemotherapy, and thus may not reflect current practice. To prospectively assess patient-reported OM and identify its associations with clinical outcomes and quality of life. This cohort study performed at a single institution included 702 consecutive patients who underwent definitive or adjuvant intensity-modulated RT (IMRT) for primary HNC from February 9, 2015, to May 27, 2022. Data were analyzed from November 28, 2022, to August 18, 2023. Severity of OM was assessed based on highest reported mouth and throat soreness (MTS) score during radiotherapy according to the Oral Mucositis Weekly Questionnaire-Head and Neck Cancer survey, which was administered weekly during IMRT. Linear mixed models were used to compare mean MTS scores grouped by disease site and chemotherapy regimen. Fisher exact tests and 1-way analysis of variance tests were performed to identify associations between severity of OM and clinical outcomes. Among 576 eligible patients, the median age was 62.5 (IQR, 56.3-69.1) years, and 451 patients (78.3%) were men. In terms of race and ethnicity, 6 patients (1.0%) were American Indian or Alaska Native; 2 (0.3%), Asian; 31 (5.4%), Black; 8 (1.4%), Hispanic or Latino; 509 (88.4%), White; and 28 (4.9%), unknown. The most common treatment site was oropharynx (268 [46.5%]), and most patients received concurrent chemotherapy (464 [80.6%]). By the end of treatment, 360 patients (62.5%) developed severe OM and 568 (98.6%) developed some degree of OM. Linear mixed models found no significant differences in OM between HNC disease sites. Groups with greater highest severity of OM reported had higher rates of measured outcomes (listed respectively by MTS score 0, 1, 2, 3, and 4): feeding tube placement (0%, 3.6% [2 of 56], 6.6% [10 of 152], 14.7% [40 of 272], and 21.6% [19 of 88]; P = .001), hospitalization (12.5% [1 of 8], 10.7% [6 of 56], 15.1% [23 of 152], 23.9% [65 of 272], and 28.4% [25 of 88]; P = .02), opiate use (0%, 19.6% [11 of 56], 42.8%[65 of 152], 61.4% [167 of 272], and 64.8% [57 of 88]; P < .001) and experienced greater weight loss (median, -0.7 [IQR, -1.7 to -0.4] kg; median, 3.9 [IQR, 1.1 to 6.1] kg; median, 5.0 [IQR, 2.2 to 7.7] kg; median, 4.7 [IQR, 2.1 to 7.7] kg; and median, 7.7 [IQR, 2.8 to 10.6] kg; P < .001). In this cohort study of patients with HNC, 62.5% developed severe OM. Higher severity of OM was associated with feeding tube placement, hospitalization, opiate use, and weight loss. Improvements in OM prevention and management are needed.