Managing Oral Mucositis in Patients With Cancer

Patients with oral mucositis (OM) have inflamed epithelial lesions of the mouth that progress to form painful ulcerations with submucosal hemorrhaging and infection. Oral mucositis makes it painful to eat, drink, and speak, resulting in distress, weight loss, and declining health. These symptoms occur in up to 40% of patients within 5 to 10 days after beginning chemotherapy (CT), and in nearly all patients within 1 to 2 weeks of starting radiotherapy (RT) for head and neck cancer. Oral mucositis can be severe enough to interrupt treatment and reduce survival rates. In 2014, the Mucositis Guidelines Leadership Group of the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology released OM treatment guidelines aiming to provide nutritional support, while reducing pain, inflammation, hemorrhaging, and oral microbial contamination. This installment of Evidence Corner explores 2 recent systematic reviews of randomized controlled trial (RCT) evidence informing clinical decisions in ways that may change thoughts about effective topical OM treatment.

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The post hoc analysis comparing the severity grades of chemoradiotherapy-induced oral mucositis scored between the central and local assessors in a multicenter, randomized controlled trial of rebamipide for head and neck cancer

International Journal of Clinical Oncology ◽

10.1007/s10147-018-1355-7 ◽

2018 ◽

Vol 24 (3) ◽

pp. 241-247

Author(s):

Takao Ueno ◽

Sadamoto Zenda ◽

Tetsuhito Konishi ◽

Takashi Yurikusa ◽

Yoshiyuki Shibasaki ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Oral Mucositis ◽

Controlled Trial ◽

Post Hoc Analysis ◽

Randomized Controlled ◽

Multicenter Randomized Controlled Trial ◽

Post Hoc

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OT-Equator® Attachments Comparison for Retaining an Early Loaded Implant Overdenture on Two or Three Implants: 1 Year RCT Preliminary Data

Applied Sciences ◽

10.3390/app11188601 ◽

2021 ◽

Vol 11 (18) ◽

pp. 8601

Author(s):

Marco Tallarico ◽

Gabriele Cervino ◽

Marco Montanari ◽

Roberto Scrascia ◽

Emiliano Ferrari ◽

...

Keyword(s):

Controlled Trial ◽

Survival Rates ◽

Marginal Bone Loss ◽

Patient Centered ◽

Randomized Controlled ◽

Multicenter Randomized Controlled Trial ◽

Long Term Follow Up ◽

Implant Overdenture

The purpose of this multicenter randomized controlled trial was to compare the clinical, radiographic, and patient-centered outcomes of early loaded mandibular overdentures deliberately placed on two or three implants. The outcomes were: implant and prosthesis success and survival rates; biological and technical complications; marginal bone loss; patient satisfaction; and periodontal parameters. The results showed no differences between the groups in any of the outcomes analyzed. With the limitations of the present study, and looking at long-term follow-up, the gold standard of prosthetic rehabilitations with attachments, in agreement with the scientific community, should prefer two non-splinted implants.

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Preventing smoking relapse in patients with cancer: A randomized controlled trial

Cancer ◽

10.1002/cncr.33162 ◽

2020 ◽

Vol 126 (23) ◽

pp. 5165-5172

Author(s):

Vani N. Simmons ◽

Steven K. Sutton ◽

Lauren R. Meltzer ◽

Ursula Martinez ◽

Amanda M. Palmer ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Smoking Relapse ◽

Patients With Cancer ◽

Randomized Controlled

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Efficacy of folinic acid rescue following MTX GVHD prophylaxis: results of a double-blind, randomized, controlled study

Blood Advances ◽

10.1182/bloodadvances.2020002039 ◽

2020 ◽

Vol 4 (16) ◽

pp. 3822-3828

Author(s):

Moshe Yeshurun ◽

Uri Rozovski ◽

Oren Pasvolsky ◽

Ofir Wolach ◽

Ron Ram ◽

...

Keyword(s):

Folinic Acid ◽

Oral Mucositis ◽

Hematopoietic Cell Transplantation ◽

Controlled Trial ◽

Chronic Gvhd ◽

Controlled Study ◽

Double Blind ◽

Randomized Controlled ◽

Gvhd Prophylaxis ◽

Organ Specific

Abstract The use of methotrexate (MTX) for graft-versus-host disease (GVHD) prophylaxis is associated with increased rates of organ-specific toxicities. Despite limited data, the European Society for Blood and Marrow Transplantation-European LeukemiaNet working group recommend the use of folinic acid (FA) rescue to reduce MTX toxicity after allogeneic hematopoietic cell transplantation (allo-HCT). In a multicenter, double-blind, randomized, controlled trial, we explored whether FA rescue reduces MTX-induced toxicity. We enrolled patients undergoing allo-HCT with myeloablative conditioning with peripheral blood stem cell grafts, with GVHD prophylaxis consisting of cyclosporine and MTX. Patients were randomized to receive FA or placebo starting 24 hours after each MTX dose and continuing over 24 hours in 3 to 4 divided doses. The primary end point was the rate of grades 3 and 4 oral mucositis. After enrollment of 52 patients (FA, n = 28; placebo, n = 24), preplanned interim analysis revealed similar rates of grade 3 and 4 (46.6% vs 45.8%; P = .97) and grades 1 to 4 (83.3% vs 77.8%; P = .65) oral mucositis. With a median follow-up of 17 (range, 4.5-50) months, there was no difference in the rates of acute and chronic GVHD, disease relapse, nonrelapse mortality, and overall survival. These interim results did not support continuation of the study. We conclude that FA rescue after MTX GVHD prophylaxis does not decrease regimen-related toxicity or affect transplantation outcomes. This study was registered at clinicaltrials.gov as #NCT02506231.

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Subcortical Vascular Dementia: Survey of Treatment Patterns and Research Considerations

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100034351 ◽

1998 ◽

Vol 25 (4) ◽

pp. 320-324 ◽

Cited By ~ 11

Author(s):

Frank J. Molnar ◽

Malcolm Man-Son-Hing ◽

Phil John ◽

Chris Brymer ◽

Kenneth Rockwood ◽

...

Keyword(s):

Vascular Dementia ◽

Practice Patterns ◽

Treatment Guidelines ◽

Controlled Trial ◽

Treatment Options ◽

Geriatric Medicine ◽

Initial Therapy ◽

Randomized Controlled ◽

Subcortical Vascular Dementia ◽

Methodological Difficulties

ABSTRACT:Background:Since few studies have examined the effectiveness of therapies for subcortical vascular dementia, treatment guidelines are not available. Current patterns in the treatment of such dementias have not been studied.Objective:To determine the practice patterns of Canadian specialists for the treatment of subcortical vascular dementia, and to survey their opinions regarding issues which are important in the design of a randomized controlled trial (RCT) in this field.Design:National survey of all specialists certified in Neurology or Geriatric Medicine.Results:Of responding physicians (78%) prescribed antithrombotic therapy for patients with vascular dementia. Most begin treatment with aspirin 325 mg daily (64%). The next three most common initial treatments were; no pharmacotherapy (12%), aspirin 650 mg daily (11%), and aspirin 1300 mg daily (11%). If the dementia continued to progress despite initial therapy, the treatment options were more varied. Most specialists (69%) believed that an RCT to assess the efficacy of aspirin in vascular dementia is warranted. The majority (69%) also felt that serial neuroimaging would be required for participants in such a trial, with magnetic resonance imaging being cited most frequently (41%). The majority of specialists considered three years as the minimum durationb for such a trial.Conclusions:Specialist physician practice patterns vary significantly for the treatment of patients with subcortical vascular dementia. Most physicians believe that an RCT testing the efficacy of aspirin in this condition is required. However, before such a trial can be conducted, many methodological difficulties need to be addressed.

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Effectiveness of a comprehensive oral management protocol for the prevention of severe oral mucositis in patients receiving radiotherapy with or without chemotherapy for oral cancer: a multicentre, phase II, randomized controlled trial

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.ijom.2018.10.010 ◽

2019 ◽

Vol 48 (7) ◽

pp. 857-864 ◽

Cited By ~ 1

Author(s):

Y. Kawashita ◽

Y. Koyama ◽

H. Kurita ◽

M. Otsuru ◽

Y. Ota ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Oral Cancer ◽

Phase Ii ◽

Oral Mucositis ◽

Controlled Trial ◽

Multicentre Phase ◽

Randomized Controlled ◽

Management Protocol ◽

Severe Oral Mucositis

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The effect of cryotherapy on chemotherapy induced oral mucositis in Egyptian cancer patients: A randomized controlled trial

Journal of Nursing Education and Practice ◽

10.5430/jnep.v9n11p63 ◽

2019 ◽

Vol 9 (11) ◽

pp. 63

Author(s):

Hanan Mohamed Mohamed Soliman

Keyword(s):

Randomized Controlled Trial ◽

Cancer Patients ◽

Oral Mucositis ◽

Health Care Professionals ◽

Controlled Trial ◽

Routine Care ◽

Control Group ◽

Adverse Side Effect ◽

Randomized Controlled ◽

Oral Cryotherapy

Background and objective: Oral Mucositis (OM) is a common adverse side-effect caused by cancer treatments (chemotherapy and/or radiotherapy). And can lead to mucosa toxicity. Patients with OM may experience extreme pain and may not be able to eat, drink and talk and, as a result, their quality of life is impaired. Treatment and prevention of OM in adult patients treated with chemotherapy are challenging issues for health care professionals. The aim of this study was to evaluate the effect of cryotherapy on incidence and severity of chemotherapy-induced OM and OM related pain in patients treated with combined chemotherapy (Fluorouracil and Leucovorin).Methods: This study is a randomized controlled trial with a random assignment to cryotherapy and control groups. The study was conducted on 40 cancer patients who underwent chemotherapy. The 20 patients in cryotherapy group were received instructions for sucking ice cubes in their mouth for five minutes before, during and shortly after chemotherapy. The 20 patients in control group received routine care. OM and pain severity were evaluated at 7th, 14th and 21st days of the study after chemotherapy using WHO Mucositis grading and-Numeric Pain Rating Scale.Results: In the majority of patients in cryotherapy group, oral Mucositis was not detected (Grade 0) at 7th, 14th and 21st days similarly incidence of grade 1 and 2 of OM in cryotherapy group significantly lowered when compared with control group where p < .001. During the study period, patients in the control group exhibit a significantly higher level of oral discomfort (p = .001).Conclusions: Oral cryotherapy due to its easy administration, tolerability and lack of adverse effects which makes it a very important method for decreasing the severity and incidence of OM and OM associated pain. The oncology nurses have a pivotal role in the application and success of cryotherapy.

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