Oral Toxicity Scale Research Articles

Clinical and biochemical assessment of the effect of glutamine in management of radiation induced oral mucositis in patients with head and neck cancer: Randomized controlled clinical trial

BackgroundThis study aimed to evaluate the effect of oral glutamine suspension on salivary levels of transforming growth factor beta 1 (TGF-β1), a cytokine involved in inflammation and Tumor progression, and the severity of radiation-induced oral mucositis (RIOM) in head and neck cancer patients. This is the first study to investigate the impact of glutamine on TGF-β1 levels in head and neck cancer patients with radiation induced oral mucositis (RIOM). MethodsIn this randomized controlled clinical trial, 50 HNC patients were enrolled and received either glutamine oral suspension or maltodextrin as a placebo from the baseline of RIOM to the end of radiotherapy. Salivary TGF-β1 levels were measured at baseline and after treatment. Also, RIOM was assessed using the World Health Organization (WHO) Oral Toxicity Scale, the Oral Mucositis Assessment Scale (OMAS), the Pain Visual Analog Scale (Pain-VAS), the incidence of opioid use, and body mass index (BMI). ResultsGlutamine significantly reduced salivary TGF-β1 levels and improved RIOM symptoms, such as pain, opioid use, and weight loss. The reduction of TGF-β1 levels was associated with the improvement of RIOM severity. ConclusionGlutamine may modulate the inflammatory response and enhance wound healing in RIOM by decreasing salivary TGF-β1 levels. These findings support the use of glutamine as a potential intervention for RIOM and nutritional support for improving radiation sensitivity. Trial RegistrationThis study was registered on clinicalTrials.gov with identifier no. NCT05856188.

Study for the prevention of oral mucositis.

TPS12149 Background: Oral mucositis (OM) is a serious complication of cancer treatments characterized by erythema and ulcerations of the mouth. Consequences of OM include pain, diminished functionality, and infections leading to decreased quality of life and discontinuity in therapy. About 20-40% of patients receiving chemotherapy develop OM within 7 days of treatment initiation. Current clinical guidelines recommend prophylactic oral care, cryotherapy, KGF-1, palifermin, and photobiomodulation to prevent OM in specific patient groups. Benzydamine is approved for the prevention of OM in head and neck cancer patients receiving radiotherapy or radio-chemotherapy but has not been well studied for chemotherapy alone. The effectiveness of oral topical treatments is limited by dilution in the saliva and swallowing shortening the duration of their action. Bocaliner is a novel medical device that is hypothesized to enhance the effects of treatments by prolonging the oral retention of topical therapies within the oral cavity. Methods: The Study for the Prevention of Oral Mucositis (SPOM) is a randomized controlled Phase I/II trial that aims to evaluate the efficacy of two different tools (benzydamine mouthwash and Bocaliner) in reducing the incidence and severity of OM in patients undergoing systemic chemotherapy (NCT05338398). A total of 100 adult patients with hematologic malignancies undergoing chemotherapy in a centralized hematology center in Armenia will be randomized into two different treatment groups: saline mouthwash and benzydamine mouthwash (0.15%, 120mL) 3-5 times a day for a total of two weeks. Half of the patients within each group will also randomly receive Bocaliner, which will be placed inside of their mouth immediately after the application of the mouthwash for 20 minutes. Block randomization will be applied with 4 patients per block with 1:1 randomization based on gender, Bocaliner use, and mouthwash type. The primary endpoint is the difference in OM incidence measured by the WHO Oral Toxicity Scale. The secondary endpoints are differences in OM symptoms evaluated using a modified version of the PROMS questionnaire. Safety and tolerability of the medical device will be determined for the Phase I component of the study based on responses to standardized tryout (Day 0) and follow-up questionnaires (Day 14). Other outcomes include the duration and severity of OM. Statistical analysis will explore further clinically meaningful associations between patient data, received therapies, and outcomes. Forty-two patients have already completed the study, while the enrollment of other participants continues and is planned to be completed by the end of 2023. Clinical trial information: NCT05338398 .

Case Study of Korean Medical Treatment for Major Aphthous Oral Ulcers

Objective: This case study reports on the results of the Korean medical treatment of a major aphthous oral ulcer patient.Methods: A 19-year-old male Korean patient with a major aphthous oral ulcer received acupuncture, herbal medicine, and moxibustion for three weeks in a hospital.Results: After treatment, changes were observed in the numeric rating scale (NRS) from 8 to 5, World Health Organization oral toxicity scale (WHO OTS) from grades 3 to 2, oral perception guide from 11 to 15, and Oral Health Impact Profile-14 (OHIP-14) from 19 to 34.Conclusion: It is worth examining the progress of Korean medical treatment for a major aphthous oral ulcer patient.

A Prospective Study of Nurse-Led Oral Mucositis Management: Impact on Health Outcomes of Patients Receiving Radiotherapy for Head and Neck Cancer and Lung Cancer

ObjectivesThe study aimed to evaluate the impact of nurse-led mucositis management on the health outcomes of patients receiving radiotherapy for head and neck cancer and lung cancer. The study adopted a holistic approach that involved the patient in the care process by screening, providing education and counseling about mucositis management and integrating it into daily life by the radiotherapy nurse. Data SourcesIn this prospective, longitudinal cohort study, 27 patients were assessed and monitored through use of the WHO Oral Toxicity Scale and Oral Mucositis Follow-up Form and educated on mucositis during their radiotherapy through use of the Mucositis Prevention and Care Guide. At the end of radiotherapy, an evaluation of the radiotherapy process was performed. In this study, each patient was followed for 6 weeks from the start of radiotherapy. ConclusionThe worst clinical data for oral mucositis and its variables emerged at week 6 of treatment. While the Nutrition Risk Screening score increased over time, weight decreased was observed to decrease. The mean stress level was 4.74 ± 0.33 in the first week and 5.77 ± 0.35 in the last week. It was observed that 88.9% of the patients showed good compliance with the treatment. Implications for Nursing PracticeNurse-led mucositis management contributes to better patient outcomes during the radiotherapy process. Such an approach improves oral care management in patients receiving radiotherapy for head and neck and lung cancer, demonstrating its positive impact on additional patient-focused outcomes.

Oral mucositis and microbial status in acute lymphoblastic leukemia subjects undergoing high-dose chemotherapy

Aim: To assess oral microbial status in patients with acute lymphoblastic leukemia (ALL) undergoing high-dose chemotherapy and to unravel possible associations between nosocomial pathogens and the establishment of chemotherapy-induced oral mucositis (CIOM). Methods: Oral mucosa, saliva, and peripheral blood samples were collected from 46 ALL subjects one day prior to chemotherapy (D0) and 2 weeks after treatment initiation (D14). Clinical intraoral inspection was performed by a single practitioner, with mucositis classification performed according to the WHO oral toxicity scale. Blood components were quantified by automatic flow cytometry, while oral Staphylococcus aureus and Pseudomonas aeruginosa were detected by Polymerase Chain Reaction with species-specific primers. Associations among bacteria and clinical findings were determined by Fisher’s Exact test, longitudinal bacterial changes by paired Macnemar, and correlations among blood parameters and mucositis status or bacteria via Mann-Whitney. Results: S. aureus displayed higher detection rates at D14 (p < 0.05) and was positively associated with mucositis, adoption of a non-solid diet (all p < 0.001), nausea and fever (all p < 0.05). Conversely, P. aeruginosa did not correlate to CIOM clinical parameters. At the systemic standpoint, lower hemoglobin levels associated with CIOM and fever events (all p < 0.01). Conclusion: The study evidences S. aureus as a potential pathogen in ALL-CIOM, reaffirming microbial control as an important preventive measure during high-dose immunosuppressive therapy. The weight of non-white-blood-cell parameters should be validated as novel CIOM biomarkers in prospective research.

Efficacy of Propolis in the Prevention of Oral Mucositis in Patients Undergoing High-Dose Chemotherapy: A Randomized Controlled Trial.

Oral mucositis is one of the most common symptoms in adults with a hematological cancer who are receiving high-dose chemotherapy. Propolis is a complementary and alternative method used to prevent oral mucositis in these patients. The aim of this study was to determine the efficacy of propolis in the prevention of oral mucositis in patients receiving high-dose chemotherapy and/or hematopoietic stem cell transplantation. A total of 64 patients, 32 in the propolis group and 32 in the control group, were enrolled in this prospective randomized controlled experimental study. Whereas the standard oral care treatment protocol was administered to the control group, aqueous propolis extract was applied to the propolis intervention group in addition to the standard oral care treatment protocol. Data collection forms included a Descriptive Information Form, the Karnofsky Performance Scale, the Cumulative Illness Rating Scale-Geriatric, Patient Follow-up Form, the World Health Organization Oral Toxicity Scale, and the National Cancer Institute Common Terminology Criteria for Adverse Events. The incidence and duration of oral mucositis were statistically significantly lower in the propolis intervention group than the control group, and the onset of oral mucositis and grade 2 to 3 oral mucositis occurred later ( P < .05). Propolis mouthwash combined with standard oral care treatment delayed the onset of oral mucositis and decreased its incidence and the number of days it lasted. Mouthwash with propolis can be used as a nursing intervention to decrease oral mucositis and its symptoms in hematological cancer patients receiving high-dose chemotherapy.

Supplementation with Oral Vitamin C Prior to and during Myeloablative Chemotherapy and Autologous Haematopoietic Stem Cell Transplantation: A Pilot Study.

Chemotherapy-related side effects are common in patients undergoing myeloablative chemotherapy and haematopoietic stem cell transplantation. Some, such as oral mucositis, are believed to be due to enhanced oxidative stress and inflammation. Vitamin C, a potent antioxidant with anti-inflammatory properties, becomes severely depleted following myeloablative chemotherapy. The aim of our study was to assess the feasibility and efficacy of oral vitamin C supplementation to restore and maintain adequate vitamin C concentrations in patients undergoing myeloablative chemotherapy and stem cell transplantation. We carried out a pilot randomized controlled trial in 20 patients with myeloma and lymphoma. Placebo or vitamin C tablets (1 g twice daily) were initiated one week prior to transplantation and continued for 4 weeks post-transplantation. Blood samples were collected weekly for analysis of plasma vitamin C concentrations using high-performance liquid chromatography. The patients’ symptoms and quality of life parameters were monitored using the World Health Organization oral toxicity scale and the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ). Pre-supplementation with oral vitamin C doubled vitamin C concentrations relative to placebo by day 0 (median 61 vs. 31 µmol/L), with 60% of those in the vitamin C group achieving concentrations ≥ 50 µmol/L, compared with only 10% in the placebo group. Following chemotherapy and transplantation, significance between the vitamin C and placebo groups was lost by day 7, with only 30% of the patients in the vitamin C group having plasma concentrations ≥ 50 µmol/L. This was partly due to intolerance of the oral intervention due to nausea/vomiting and diarrhoea (40% of the participants in each group). Oral mucositis was also observed in 40% of the participants at day 7 or 14. Overall, our study showed that whilst short-term oral vitamin C pre-supplementation was able to restore adequate vitamin C status by day 0, ongoing supplementation could not maintain adequate vitamin C concentrations following chemotherapy and transplantation. Thus, intravenous vitamin C should be trialled as this bypasses the gastrointestinal system, negating intolerance issues and improving bioavailability of the vitamin.

A comparative study to assess the effectiveness of curcumin, mucosamin, and chlorhexidine in chemotherapy-induced oral mucositis

BackgroundOral mucositis is one of the most frequent and challenging side effects of chemotherapy. At present, none of the guidelines recommend the use of various mouthwashes available for the treatment of oral mucositis. MethodsThis study was designed to evaluate the efficacy of curcumin, mucosamin, and chlorhexidine in the treatment of chemotherapy-induced oral mucositis. In this randomized and double-blind study, 71 patients over 18 years, who received chemotherapy and suffered from chemotherapy-induced oral mucositis, were randomized into curcumin, mucosamin, and chlorhexidine groups. The World Health Organization (WHO) Oral Toxicity Scale, the Oral Mucositis Assessment Scale (OMAS), and the Numerical Rating Scale (NRS) were used to evaluate oral mucositis. The main endpoint included the onset of complete recovery after starting the treatment. FindingsBased on the WHO, OMAS for erythema, and NRS criteria, complete recovery was achieved from the third day in the curcumin group, which was significantly earlier compared to the other two groups (P < 0.05). The OMAS score for ulceration represented an improvement from day 5 in the curcumin group, which was significantly faster compared to the other two groups (P = 0.04). ConclusionsOur results indicated that all three approaches were effective in improving oral mucositis; however, curcumin could result in faster recovery in comparison with mucosamin and chlorhexidine. The use of curcumin in the treatment of oral mucositis appears to be a viable intervention for reducing potential compromise to treatment and improving the quality of life.

Validation of healthcare professional proxy-reported children's International Mucositis Evaluation Scale.

The objective was to describe the reliability and validity of the healthcare professional proxy-report version of the Children's International Mucositis Evaluation Scale (ChIMES). We included pediatric patients who were between 4 and 21years of age and scheduled to undergo hematopoietic cell transplantation. Mucositis was evaluated by trained healthcare professionals who scored ChIMES, the World Health Organization oral toxicity scale, mouth, and throat pain visual analogue scale, National Cancer Institute-Common Terminology Criteria and the Oral Mucositis Daily Questionnaire. Measures were completed daily and evaluated on days 7-17 post-stem cell infusion for this analysis. Psychometric properties examined were internal consistency, test-retest reliability (days 13 and 14), and convergent construct validity. There were 192 participants included. Cronbach's alpha was 0.90 for ChIMES Total Score and 0.93 for ChIMES Percentage Score. Test-retest reliability were as follows: intraclass correlation coefficient (ICC) 0.82 (95% confidence interval (CI) 0.77-0.85) for ChIMES Total Score and ICC 0.82 (95% CI 0.77-0.86) for ChIMES Percentage Score. In terms of construct validation, all correlations between measures met or exceeded those hypothesized (all p<0.05). The healthcare professional proxy-report version of ChIMES is reliable and valid for children and adolescents undergoing hematopoietic cell transplantation.

Incidence of mucositis in patients undergoing autologous hematopoietic stem cell transplantation at a single center

Goal: The aim of this study was to describe the incidence of oral mucositis (OM) in patients undergoing autologous hematopoietic stem cell transplantation (auto-HSCT), relating it to the main clinical factors. Methodology: Descriptive analysis based on a randomized clinical study was conducted with patients undergoing HSCT at the University Hospital of Federal University of Juiz de Fora between January 2018 and June 2019. The World Health Organi­zation oral toxicity scale was used to assess the degree of oral mucositis and adverse events were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) 4.0 version. Results: Thirty-eight patients were evaluated. The incidence of OM and severe oral mucositis (SOM) was 57.9% and 21.0%, respectively. The mean duration of OM was 7.2 ± 2.6 days and the lomustine, etoposide, cytarabine and cyclophosphamide protocol (LEAC) pre­sented the longest mean time 8.1 ± 3.1 days (p-value 0.02). The number of viable CD34+ cells and the onset day of neutropenia were predictors of SOM. Conclusion: The incidence of OM in patients undergoing HSCT was lower than reported in the literature, being more severe in patients who received less CD34+ cells and in patients with early onset of neutropenia.

Epidemiology, patient adherence, and costs of oral mucositis in routine care in stem cell transplantation.

Limited data about oral mucositis (OM) in stem cell transplant patients with underlying hematological disease is available in Germany. The purpose of this feasibility study was to determine the incidence, treatment patterns, patients' adherence, and costs of OM. Prospective, noninterventional single-center observational study. allogenic/autologous stem cell transplant patients ≥ 18 years, high-dose chemotherapy. OM assessment: WHO Oral Toxicity Scale. Adherence was measured in patient interviews. Preventive and therapeutic measures were extracted from patients' charts. Forty-five patients (25 allogenic, 20 autologous) were enrolled. Twenty-six (58%) patients developed OM (54% grade I/II, 46% grade III/IV). Age ≥ 65 (31% vs 69%, p = 0.021) was associated with a lower OM incidence. A positive history of smoking (1.77 vs 2.69, p = 0.036) was associated with a lower OM grade, patients with unrelated donors (2.63 vs 1.29, p = 0.014) were associated with higher OM grades and females (80% vs 47%, RR = 1.71, p = 0.035) with a higher incidence. OM patients were less adherent to recommended daily mouth rinses (35% vs 68%, p = 0.027). More analgesic treatment (80% vs 32%, p = 0.001) and intravenous opioids (24% vs 0%, p = 0.023) were prescribed in OM patients. Total drug treatment and nutrition costs were 824€ (p = 0.037) higher in autologous transplanted patients. Initial risk and consecutive OM assessment, determination of patients' adherence, resource consumption, and costs are prerequisites to evaluate OM care. In the best case, several centers will follow the same methodological approach and the collected data will serve as a basis for benchmarking analyses to optimize OM care where required.

Assessment of oral health status of children with Leukemia: A cross-sectional study.

The present study was conducted with an aim to assess the oral hygiene status, gingival health status, and prevalence of dental caries, oral mucositis and xerostomia among children with leukemia and compare it with healthy children. A total sample size of 220 children with 110 children with Leukemia of subtype acute lymphoblastic leukemia (ALL) undergoing treatment and 110 healthy children in the age group of 3-14 years was selected. Evaluation of caries status using dmft/DMFT indices, oral hygiene status using OHI-S and plaque index by Sillness and Loe, gingival health status using modified gingival index, oral mucositis as per WHO oral toxicity scale, xerostomia as per common terminology criteria for adverse events for dry mouth, and salivary pH using pH paper strips was done. Results revealed a lower prevalence of dental caries, good oral hygiene and mild gingivitis in children with ALL when compared to healthy children. Oral mucositis was found to occur only in children with ALL and a reduced salivary flow rate and reduced salivary pH were seen in these children when compared to healthy children. It was concluded that children with ALL undergoing treatment and following an oral care protocol presented with a good Oral Health Status when compared with healthy children.

Oncoxin nutritional supplement in the management of chemotherapy- and/or radiotherapy-associated oral mucositis.

Oral mucositis (OM) is a common and potentially dangerous complication of anticancer treatment. Since there are only few therapeutic options for OM, there is a need to identify novel approaches to its management and prevention. The aim of the present study was to evaluate the efficacy of Oncoxin (ONCX), a nutritional supplement that contains microelements, vitamins, amino acids and certain biologically active substances of natural origin, in cancer patients who receive chemotherapy, radiotherapy or a combination of the two. A total of 15 male and female patients (aged 45–75 years) with malignant neoplasms, who had been prescribed radiotherapy, chemotherapy or a combination of the two, with an Eastern Cooperative Oncology Group performance status score ≤3, and grade 2–3 OM based on the World Health Organization (WHO) Oral Toxicity Scale, were enrolled in a 20-day study; 10 patients were in the ONCX group and 5 served as controls. The patients were allowed to use any anticancer treatment and any type of OM care. In addition to their current treatment, patients in the ONCX group used 25 ml of the ONCX nutritional supplement twice daily for 20 days. The mean WHO Oral Toxicity Scale grade decreased by 41% in the ONCX group after ~7 days from the beginning of the study compared with minimal change in the control group. At the end of the study, the difference was even more prominent, with a 73 and 20% decrease from baseline in the ONCX and control groups, respectively (P<0.001). During the entire trial period, patients in the ONCX group were able to eat normally during 65% of the time, in contrast to only 29% in the control group (P=0.04). There were no statistically significant changes in absolute body mass, or in the number of days with normal appetite. This was a pilot study aiming to show the benefits of the ONCX nutritional supplement in OM, and the results demonstrated that ONCX rapidly improved the symptoms of OM and helped to maintain normal eating habits in patients undergoing cancer treatment.

Evaluating the adverse effects of melphalan formulations.

For multiple myeloma patients who respond to primary therapy, autologous hematopoietic stem cell transplant (HSCT) is considered standard of care with high-dose melphalan for transplant candidates. There are now two different melphalan formulations available, including a propylene glycol containing (PG-MEL) product and a propylene glycol-free (PG-free MEL) product. Although considered bioequivalent, there remains limited literature directly evaluating the adverse events between the two agents. We seek to assess the tolerability and severity of side effects between the two formulations in a real-life practice setting. A retrospective, descriptive analysis was conducted of multiple myeloma patients who received autologous stem cell conditioning with either melphalan formulation when dosed at 100 mg/m2/dose for two consecutive doses. The primary outcome was the assessment of tolerability and severity of side effects. Tolerability was split into four major categories including hematologic toxicity, gastrointestinal toxicity, renal toxicity, and highest recorded mucositis grade. There were a total of 78 patients who received a melphalan preparation during the study. The median time to myeloablation and neutrophil engraftment was five and seven days post-HSCT, respectively, for all patients. Patients who received PG-free MEL were less likely to develop mucositis, with 22 (56%) reported highest grade 0, defined by World Health Organization oral toxicity scale, compared to those who received PG-MEL (33%), p = 0.04. There were minimal differences in tolerability or side effects observed between PG-free MEL and PG-MEL. These data may assist in better understanding the anticipated adverse effects of a high-dose melphalan conditioning therapy.

The effectiveness of a saline mouth rinse regimen and education programme on radiation-induced oral mucositis and quality of life in oral cavity cancer patients: A randomised controlled trial.

Radiation therapy (RT) and concurrent chemotherapy RT (CCRT) generate radiation-induced oral mucositis (OM) and lower quality of life (QOL). This study assessed the impact of a saline mouth rinse regimen and education programme on radiation-induced OM symptoms, and QOL in oral cavity cancer (OCC) patients receiving RT or CCRT. Ninety-one OCC patients were randomly divided into a group that received saline mouth rinses and an education programme and a control group that received standard care. OM symptoms and QOL were assessed with the WHO Oral Toxicity Scale, MSS-moo and UW-QOL. Data were collected at the first postoperative visit to the radiation department (T0) and at 4weeks and 8weeks after beginning RT or CCRT. Patients in both groups had significantly higher levels of physical and social-emotional QOL at 8weeks after beginning RT or CCRT compared to the first visit. Patients in the saline rinse group had significantly better physical and social-emotional QOL as compared to the standard care group at 8weeks. Radiation-induced OM symptoms and overall QOL were not different between the groups. We thus conclude the saline rinse and education programme promote better physical and social-emotional QOL in OCC patients receiving RT/CCRT.

Burden of oral mucositis in stem cell transplant patients-the patients' perspective.

Purpose of this study was to determine the impact of Oral Mucositis (OM) on health-related quality of life (HRQoL) and quality of life associated symptoms and functions in patients undergoing hematopoietic stem cell transplantation (HSCT). Prospective, non-interventional single-center observational study at a German tertiary teaching hospital. Inpatient allogenic and autologous stem cell transplant patients ≥18-year-old with high-dose chemotherapy. OM was assessed with the WHO Oral Toxicity Scale, pain according to the Numeric Rating Scale (NRS) and the performance status using the ECOG Score. QOL was captured with the EORTC QLQ-C30 and the QLQ-OH15 questionnaires. Forty-five stem cell transplant patients (20 autologous, 25 allogenic) were enrolled between August 2016 and February 2017. Twenty-six (58%, 95% CI: 42% - 72%) patients developed OM (10 grade I, 4 grade II, 8 grade III, 4 grade IV). OM affected patients suffered more from pain, sore mouth and sensitive mouth. A lower physical functioning (34.5 vs 7.5, p = 0.003) and a lower oral health-related quality of life (24.3 vs 7.7, p = 0.006) was found in patients with OM development. There was found a positive correlation between the grade of OM and the NRS-value (r = 0.93, 95% CI: 0.89-0.96, p < 0.001). OM is associated with health-related quality of life and quality of life associated functions and symptoms. More research should be performed to find ways to prevent OM and to stabilize patients' quality of life during HSCT.

Impact of Using Pure Natural Honey as a Topical Application for Patients Who Receiving Chemotherapy Regimen on Reducing Risk of Stomatitis

Background: Stomatitis accompanied with receiving chemotherapy occur approximately 40% among all patients. The onset of starting stomatitis among patients receiving chemotherapy around days four to five day from starting chemotherapy with a peak on the 7th -14th day after chemotherapy. Aim of the study: to evaluate impact of using pure natural honey as a topical application for patients who receiving chemotherapy regimens on reducing risk of stomatitis. Research design: Quasi-experimental research design was utilized in the current study. Subjects: A purposive sample including (60) male and female adult patients were included in the current study. Setting: This study was carried out at oncology center in Minia city in chemotherapy outpatient clinic, inpatient and outpatient chemotherapy department. Tools of data collection: Three tools were utilized to collect data: 1- Patient's biosociodemographic characteristic: structured interview tool; 2- Beck Oral Assessment Scale (BOAS); 3- oral toxicity Scale. Results: There was a highly statistical significant difference regard beck oral assessment manifestations between study and control groups during third observation for them post first session of chemotherapy. Also, there was a highly statistical significant difference among same groups during three observations post second and third session of chemotherapy. Results illustrate that the percentage of oral stomatitis degree occurs among study group in three sessions were (0.0%, 3.3%, 6.7%) in the three observations respectively. Conclusion: Honey was an effective in preventing and decreasing oral stomatitis and gingivitis in patients receiving chemotherapy. Recommendations: Regular training programs to keep nurses in oncology unit updated with the most recent strategy for oral hygiene that promote oral wellness.

Caphosol for prevention of oral mucositis in pediatric myeloablative haematopoietic cell transplantation

Background:The primary objective was to determine whether topically administered Caphosol, rinsed orally four times daily at the initiation of conditioning, reduces the duration of severe oral mucositis (OM) compared with placebo among children and adolescents undergoing haematopoietic cell transplantation (HCT).Methods:This was a Children’s Oncology Group multicentre randomised double-blinded placebo-controlled clinical trial. Patients between the ages of 4 and 21 years who were scheduled to undergo myeloablative HCT for any indication were randomised to Caphosol or placebo saline rinses four times daily from initiation of conditioning through day +20. Subjects were assessed daily for OM using the World Health Organisation (WHO) Oral Toxicity Scale, Mouth Pain Categorical Scale (0–10) and the Oral Mucositis Daily Questionnaire (OMDQ). The primary end point was duration of severe OM (WHO ⩾3).Results:The study enrolled 220 participants with a median age of 13.7 years (range 4.0–21.9); 163 (74%) received allogeneic HCT. The mean (±s.d.) duration of severe OM was not reduced among Caphosol (4.5±5.0 days) vs placebo (4.5±4.8; P=0.99) recipients. The incidence of severe OM in the Caphosol and placebo arms was 63% (57 out of 91) and 68% (62 out of 91), respectively (P=0.44). There were no significant differences in any of the secondary end points between the groups.Conclusions:Caphosol did not reduce severe OM when compared with placebo among children and adolescents undergoing myeloablative HCT. Studies to identify effective interventions for OM are needed in this population.

Oral mucositis in leukemic Saudi children following chemotherapy

Abstract Objective: The purpose of this study was to determine the incidence and severity of oral mucositis (OM) in Saudi children newly diagnosed with Acute lymphoblastic leukemia (ALL) following chemotherapy, and to evaluate the significance of independent risk factors (age, gender, parents’ educational level, family income, oral hygiene practices, dietary habits and different chemotherapy regimens) on the development of OM. Methods: Sixty Saudi children newly diagnosed with ALL of both genders, aged (6–14 years) were examined and their parents were interviewed and asked to fill a questionnaire before and within the third week of receiving chemotherapy. The World Health Organization’s (WHO) oral toxicity scale was used to record OM. Results: The prevalence of OM was 23.3% with a mean age of 8.36 (2.98). 92.9% High risk patients had OM and 7.1% with Low risk patients. The results showed a highly significant difference between oral hygiene practices before and within the third week of receiving chemotherapy in relation to OM. Also, there were strong associations between presence of OM, and frequency of oral hygiene practice in and dietary habits within the third week of receiving chemotherapy. Conclusion: There is a strong correlation between oral hygiene practices and the developmental severity of OM in ALL children before and during chemotherapy treatment. Oral mucositis severity associated with chemotherapy treatment has a significant effect on the dietary habits of ALL children and the use of different treatment regimens with ALL children is considered to be an important risk factor for the development of OM.

Icing oral mucositis: Oral cryotherapy in multiple myeloma patients undergoing autologous hematopoietic stem cell transplant

Background Up to 70% of patients receiving hematopoietic stem cell transplant develop oral mucositis as a side effect of high-dose melphalan conditioning chemotherapy. Oral cryotherapy has been documented to be potentially effective in reducing oral mucositis. The aim of this study was to examine the effectiveness of the cryotherapy protocol implemented within the hematopoietic stem cell transplant program. Methods A retrospective chart review was conducted of adult multiple myeloma patients who received high-dose melphalan conditioning therapy for autologous hematopoietic stem cell transplant. Primary endpoints were incidence and severity of oral mucositis. Secondary endpoints included duration of oral mucositis, duration of hospital stay, parenteral narcotics use and total parenteral nutrition use. Results One hundred and forty patients were included in the study, 70 patients in both no cryotherapy and cryotherapy groups. Both oral mucositis incidence and severity were found to be significantly lower in the cryotherapy group. Fifty (71.4%) experienced mucositis post cryotherapy compared to 67 (95.7%) in the no cryotherapy group (p < 0.001). The median oral mucositis severity, assessed using the WHO oral toxicity scale from grade 0-4, experienced in the no group was 2.5 vs. 2 in the cryotherapy group (p = 0.03). Oral mucositis duration and use of parenteral narcotics were also significantly reduced. Duration of hospital stay and use of parenteral nutrition were similar between the two groups. Conclusion The cryotherapy protocol resulted in a significantly lower incidence and severity of oral mucositis. These results provide evidence for the continued use of oral cryotherapy, an inexpensive and generally well-tolerated practice.