Comparison of efficacy of cryotherapy and chlorhexidine to oral nutrition transition time in chemotherapy-induced oral mucositis

Abstract

The aim of this study was to compare the efficacy of cryotherapy and chlorhexidine to oral nutrition transition time in chemotherapy-induced oral mucositis. This randomised controlled trial with random assignments to the experimental and control groups was conducted with cancer patients. Study data were collected from 90 cancer patients. The first experimental group (n = 30) received chlorhexidine mouthwash, the second experimental group (n = 30) received oral cryotherapy and the control group (n = 30) received routine care. To collect data we used the 'Mucositis Rating Index'. Changes in patients' oral mucosa in each group were checked and oral feeding transition periods were recorded. There was an important statistical difference between the times of transition to oral nutrition for patients (P < 0.01). Oral nutrition transition time of patients in the first experimental group who had applied chlorhexidine was shorter than in other groups. Following the tests, we detected a significant shortening in oral nutrition transition time of patients in first group who used chlorhexidine gargle as compared to the second group and control group. There was no significant difference between cryotherapy application and control group. In parallel with these findings, we detected that the degree of oral mucositis decreased.

Nutritional interventions for oral mucositis: a systematic literature review

“…Of the 915 articles, 893 were potentially eligible for inclusion and 802 were then excluded based on title and abstract. After full texts were obtained and eligibility criteria applied to the remaining 91 articles, 23 articles 23,24,28‐49 were included in the review (total unique study participants n = 7605; Table 1). These included five systematic reviews with meta‐analyses 23,41,43‐45 ; six systematic reviews, 24,34,35,38,39,46 two randomised controlled trials (RCTs) 30,33 ; one non‐randomised controlled trial 48 ; four prospective cohort studies 32,37,42,47 ; two retrospective cohort studies 29,31 and three case series 28,36,40 …”

“…Articles investigating more than one intervention were eligible to fall into multiple intervention review areas. These included: oral cryotherapy (five studies; n = 1777) 29,30,39,41,44 ; elemental oral nutrition supplements (five studies; n = 186) 31,32,36,37,42 ; beta‐hydroxy‐beta‐methylbutyrate‐, arginine‐ and glutamine‐enriched (HMB/Arg/Gln) powdered supplement (two studies; n = 64) 47,48 ; immune‐modulating oral nutrition supplements (one study; n = 40) 28 ; fat‐soluble vitamins (two studies; n = 103) 23,46 ; glutamine supplementation (five studies; n = 2050) 24,33,38,40,46 ; zinc supplementation (three studies; n = 1009) 34,43,46 ; miscellaneous mineral supplements (two studies; n = 1188) 34,46 and honey (three studies; n = 1292) 35,45,46 …”

“…Three positive quality systematic reviews with meta‐analyses, 41,44 one positive quality systematic review, 39 one negative quality RCT 30 and one neutral quality retrospective cohort study 29 were identified (total n = 1777) investigating oral cryotherapy for oral mucositis management. Oral cryotherapy is cooling of the mouth using ice cubes, ice‐cold water, ice‐cream or ice‐lollies for 20‐30 minutes prior to and during treatment 44 .…”

“…Regarding other cancer subpopulations, Erden and Ipekcoban 30 concluded that an oral cryotherapy protocol (ice cubes held in mouth for 30 minutes/day) did not reduce the time to oral nutrition re‐introduction (n = 30; mean days 12.13; SD 1.8 days; P = <.01) in adult patients with advanced gastrointestinal cancer with chemotherapy‐related severe oral mucositis compared to controls using either chlorhexidine (n = 30; mean days 8.53; SD 1.04 days) or standard oral hygiene practices (n = 30; mean days 13.53; SD 1.69 days). Overall certainty of evidence was moderate ⊕ ⊕ ⊕⊝, downgraded due to inconsistency of interventions used, heterogeneity for study populations and effect size.…”

The Effects of Oral Cryotherapy on Oral Mucositis, Reactive Oxygen Series, Inflammatory Cytokines, and Oral Comfort in Gynecologic Cancer Patients Undergoing Chemotherapy: A Randomized Controlled Trial

“…. 항암화학요법 중 Cisplatin과 Gemcitabine의 항암 제를 사용하는 경우 3등급 이상의 구내염 발생빈도는 47%로 [4] 구 내염으로 인한 타액 변화 및 작열감 [5,6], 연하 곤란 [7]의 구강 불편 감은 영양 섭취 저하 [8], 통증 및 전신 패혈증 [9,10]을 야기시킬 수 있다. 이는 항암제 용량 감량이나 암 치료 기간이 연장되는 결과를 초래할 수 있으므로 [11], 항암화학요법을 받는 암환자들에게 구강 안위감을 저해하는 요인을 감소시켜 줄 수 있는 간호가 치료 시작 이전에 선행되어야 한다 [12].…”