Cryotherapy as A Prophylaxis of Mucositis in Children with Cancer Undergoing Chemotherapy at Dr. M. Djamil General Hospital

Background: Mucositis is one of the side effects of chemotherapy, which can be a severe problem for children with cancer. Cryotherapy can cause vasoconstriction and decrease blood flow to the oral mucosa, resulting in lower concentrations of chemotherapy agents to prevent mucositis. This study aims at determining the effectiveness of oral cryotherapy as prophylaxis mucositis in children with cancer undergoing chemotherapy.Methods: This quasi-experiment study with a pretest-posttest control-group design involved 45 respondents (22 in the intervention group and 23 in the control group) selected using consecutive sampling. The data collection instrument was the WHO mucositis scale. Results: Of the 45 children undergoing chemotherapy, 24 (53.3%) were of school age, 25 (55.6%) were male, 33 (73.3%) had good nutritional status, and 17 (37.8%) had mild neutropenia before undergoing chemotherapy. All respondents (100%) did not experience mucositis, but after chemotherapy, 9 children (40.9%) in the intervention group had mucositis, and 19 children (82.6%) experienced mucositis in the control group. The data were analyzed using the Wilcoxon test to see the difference between the intervention group and the control group and the Chi-Square test with Yates’s correction to see the effect of cryotherapy on the prevention of mucositis. The results showed that there was a difference in the incidence of mucositis between before and after intervention in the intervention group (p = 0.003) and the control group (p = 0.000), and cryotherapy was effective in preventing mucositis (p = 0.01).Conclusions: Cryotherapy is effective against the prevention of mucositis. Nurses and families need to be able to apply oral cryotherapy and other evidence-based treatment as a method to prevent mucositis

Effectiveness of Oral Cryotherapy for Oral Mucositis on Cancer Patient Undergoing Cancer Therapy: A Systematic Review

BACKGROUND: Oral mucositis is one of the complications in patients undergoing cancer therapy. Oral cryotherapy (OC) is an intervention to reduce the severity of oral mucositis. AIM: To identify, analyze, and evaluate articles regarding the effectiveness of cryotherapy for oral mucositis in cancer patients undergoing cancer therapy. METHODS: We performed searching on seven databases (PubMed, CENTRAL, Wiley, CANCERLIT, Science Direct, EBSCO, and SpringerLink). The investigation focused on English-language articles, intervention, or observational study reporting on the effectiveness of OC against oral mucositis in patients undergoing chemotherapy, and published between October 2015 and October 2020. RESULTS: Eleven articles met the eligibility criteria for inclusion consisting of 5 RCTs, 3 Quasi-Experiment studies, 2 Cohort studies, and one pre-experimental study. The majority of the studies show that OC is an effective intervention to reduce the degree and severity of oral mucositis in patients undergoing cancer therapy (Hematopoietic Stem Cell Transplantation and chemotherapy). CONCLUSION: OC is practical, low-cost, and relatively safe and can be an alternative therapy in reducing oral mucositis as a side effect of cancer therapy.

Efficacy of Oral Cryotherapy in the Prevention of Oral Mucositis Associated with Cancer Chemotherapy: Systematic Review with Meta-Analysis and Trial Sequential Analysis

Background: This review aimed to evaluate the efficacy of oral cryotherapy in the prevention of chemotherapy-induced oral mucositis using meta-analysis and trial sequential analysis, as well as to assess the quality of the results by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Methods: A comprehensive search of three databases including Medline, Embase and Central was performed to identify randomized controlled trials that used oral cryotherapy for the prevention of chemotherapy-induced oral mucositis. The primary outcome was the incidence of oral mucositis for trials employing oral cryotherapy as the intervention for the prevention of oral mucositis. The meta-analysis was performed using the random-effects model and random errors of the meta-analyses were detected by trial sequential analysis. Results: A total of 14 RCTs with 1577 participants were included in the present meta-analysis. Patients treated with oral cryotherapy were associated with a significantly lower risk of developing oral mucositis of any grade (risk ratio (RR), 0.67 (95% CI: 0.56–0.81, p < 0.05)). Findings from the subgroup analyses showed that oral cryotherapy significantly reduced the risk of oral mucositis in patients undergoing bone marrow transplantation (RR 0.69, CI: 0.54–0.89, p < 0.05) as well as chemotherapy (RR 0.66, CI: 0.58–0.75, p < 0.05). Findings from the trial sequential analysis suggested that the evidence on oral cryotherapy as a preventive intervention for oral mucositis in patients with solid malignancies receiving conventional chemotherapy was conclusive. Conclusion: Oral cryotherapy is effective in preventing oral mucositis in patients undergoing chemotherapy for the management of solid malignancies. The use of oral cryotherapy in preventing oral mucositis in bone marrow transplantation settings showed promising efficacy, but the evidence is not conclusive and requires more high-quality randomized controlled trials.

Eficacy of Cryotherapy in the Prevention of Oral Mucosistis in Adult Patients with Chemotherapy

Oral mucositis (OM) is a common side effect of cancer therapies. It causes ulcerative, painful lesions in the oral cavity that can provoke malnutrition, increased risk of infection, longer hospital stays, and seriously affect the quality of life. Cooling the mucosa with oral cryotherapy (OC) during and/or after chemotherapy is the most accessible and tolerable intervention available. The aim of this study is to define the efficacy of OC for preventing OM induced by chemotherapy/radiotherapy in adult patients with cancer. Secondary endpoints include associated problems as pain. A systematic search was performed using the Pubmed, WOS (Web of Science), Cochrane Library, CINAHL, and BVS databases for articles published up to 2010. After inclusion and exclusion criteria were applied, a total of eight articles were analyzed in this review. In seven of the eight articles, the incidence of OM of all grades was significantly lower in the OC group compared with the no-OC group. Use of opioids and level of pain were also significantly reduced. OC is an effective intervention to reduce the incidence of OM induced by chemotherapy as well as the associated severity and pain. Based on these results, OC with only water or with chamomile, associated or not with other mouthwash therapies, is an effective intervention to reduce the incidence of OM induced by chemotherapy as well as the associated severity and pain.

Drinking Ice-Cold Water Reduces the Severity of Anticancer Drug-Induced Taste Dysfunction in Mice

Taste disorders are common adverse effects of cancer chemotherapy that can reduce quality of life and impair nutritional status. However, the molecular mechanisms underlying chemotherapy-induced taste disorders remain largely unknown. Furthermore, there are no effective preventive measures for chemotherapy-induced taste disorders. We investigated the effects of a combination of three anticancer drugs (TPF: docetaxel, cisplatin and 5-fluorouracil) on the structure and function of mouse taste tissues and examined whether the drinking of ice-cold water after TPF administration would attenuate these effects. TPF administration significantly increased the number of cells expressing apoptotic and proliferative markers. Furthermore, TPF administration significantly reduced the number of cells expressing taste cell markers and the magnitudes of the responses of taste nerves to tastants. The above results suggest that anticancer drug-induced taste dysfunction may be due to a reduction in the number of taste cells expressing taste-related molecules. The suppressive effects of TPF on taste cell marker expression and taste perception were reduced by the drinking of ice-cold water. We speculate that oral cryotherapy with an ice cube might be useful for prophylaxis against anticancer drug-induced taste disorders in humans.

Primary evaluation of an air-cooling device to reduce oral mucositis: a pilot study in healthy volunteers

Oral mucositis is a common side effect of chemo and radiotherapy causing painful ulcers in the oral mucosa. One of the preventive treatments recommended in international guidelines is oral cryotherapy (OC). Randomized clinical trials on OC have used ice and ice-chips to cool the mouth, but this cooling method can be difficult for the patients to tolerate. Studies have shown that OC with ice for a period of 60 min reduces the oral temperature by 12.9 °C. The aim of this pilot study was to evaluate the temperature reduction and tolerability of OC using an intra-oral air-cooling (IOAC) device in healthy volunteers. Twelve healthy volunteers, mean age 35.4 years, were included in the study. They were treated with OC using the IOAC device for 60 min. Measurements of temperature were obtained at baseline, 5 and 60 min using a FLIR® C2 camera. After the OC session, tolerability and adverse events were documented using a questionnaire. All participants were able to use the device for 60 min. The overall temperature reduction after 5 min of OC was 10.7°C (p < 0.01) and after 60 min 14.5°C (p < 0.01). The most common adverse events were bad fit of the mouthpiece (n = 6), hypersalivation (n = 6), and difficulties swallowing (n = 5). The oral device reduced the temperature of the oral mucosa as much as treatment with ice with tolerable adverse events. The mouthpiece will be remodeled to improve tolerability before further studies are conducted.

REVISIÓN DE LA EFECTIVIDAD DE MEDIDAS NO FARMACOLÓGICAS DIRIGIDAS A LA PREVENCIÓN DE LA MUCOSITIS ORAL EN PACIENTES ONCOLÓGICOS

La Mucositis oral (MO) es una de las complicaciones más frecuentes y graves entre los pacientes sometidos a tratamientos de radioterapia y/o quimioterapia. Su impacto como evento adverso (EA) afecta directamente a las necesidades básicas, derivando incluso en la interrupción o retraso del tratamiento oncológico. Este trabajo de revisión crítica de la literatura pretende analizar la efectividad de diferentes medidas no farmacológicas como alternativa en la prevención de la MO. La metodología llevada a cabo sigue un proceso planificado y estructurado con la pertinente búsqueda exhaustiva en diversas bases de datos y revistas científicas, tales como: Medline (OVID), Cinhal, Cochrane y Cuiden. Existen numerosas medidas recogidas en la literatura para abordar la prevención de la MO tales como la crioterapia oral, miel, melaza de morera negra, silimarina, propóleo, polen de palmera datilera, enjuagues de clorhexidina y povidona yodada. La evidencia obtenida resulta inconcluyente, siendo necesario realizar más investigaciones. Palabras Clave: Mucositis oral, Prevención primaria, Radioterapia, Quimioterapia, Crioterapia, Miel, Silimarina, Polen de palmera datilera, Propóleo, enjuagues bucales, Canela. ABSTRACT: Oral Mucositis (OM) is one of the most frequent and serious complications of patients undergoing radiotherapy and / or chemotherapy treatments. Its impact as an adverse event (AE) directly affects basic needs, even leading to the interruption or delay of cancer treatment. A bibliographic search has been done in order to analyze the effectiveness of different non-pharmacological measures as an alternative in preventing OM. The methodology carried out follows a planned and structured process with an exhaustive search in several databases and scientific journals, for example: Medline (OVID), Cinhal, Cochrane and Cuiden. There are numerous measures collected in the literature to prevent OM such as: oral cryotherapy, honey, black mulberry molasses, silymarin, propolis, date palm pollen, chlorhexidine and povidone-iodine rinses. The evidence obtained is inconclusive, and further research is needed. Key words: Oral mucositis/stomatitis, Primary prevention, Radiotherapy, Drug therapy, Cryotherapy, Honey, Silymarin, Pollen, Propolis, mouthwashes, Cinnamomum osmophloeum.