Open Access Open Access  Restricted Access Subscription or Fee Access

Systematic Review on Interventions for Mucositis in Cancer Therapy – An Update

Kripa Angeline

Abstract


Background: Mucositis is highly significant, and frequently dose-limiting, toxicity of cancer therapy. Oral mucositis is an inflammation of the mucosa of the mouth which ranges from the redness to the severe ulceration. Symptoms of mucositis may vary from pain and discomfort to an inability to tolerate food or fluids. Mucositis may also limit the patient’s ability to tolerate either to chemotherapy or radiotherapy. Oral mucositis presents with erythema, ulceration of the oral mucosa. In addition, the pharyngeal, laryngeal, and esophageal mucosa is also at risk for mucositis, particularly in patients undergoing Head & Neck Radiation Therapy. It is typically very painful, requiring opioid analgesics which impair nutritional intake and quality of life. The goal of this systematic review was to update the interventions for oral mucositis. Methods: A literature search was conducted to identify eligible published articles, based on predefined inclusion exclusion criteria. Each article was independently reviewed. The body of evidence for each intervention, in each treatment setting, was assigned a level of evidence, based on previously published criteria. Results: The literature search identified 45 papers, and a detailed evaluation was done based on titles and abstracts. Of these, 37 papers qualified for final inclusion in the systematic reviews. The use of various interventions in specific treatment settings of mucositis was identified. This article describes these updated interventions. Conclusions: The updated Nursing interventions for mucositis will help nurses follow evidence-based practice of mucositis secondary to cancer therapy.

Full Text:

PDF

References


J.A. Jones, E.B. Avritscher, C.D. Cooksley, M. Michelet, B.N. Bekele, L.S. Elting. Epidemiology of treatment-associated mucosal injury after treatment with newer regimens for lymphoma, breast, lung, or colorectal cancer, Support Care Cancer. 2006; 14: 505–15p.

M. Vera-Llonch, G. Oster, C.M. Ford, J. Lu, S. Sonis. Oral mucositis and outcomes of allogeneic hematopoietic stem-cell transplantation in patients with hematologic malignancies, Support Care Cancer. 2007; 15: 491–6p.

M. Vera-Llonch, G. Oster, M. Hagiwara, S. Sonis. Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma, Cancer. 2006; 106: 329–36p.

D.B. McGuire, V. Altomonte, D.E. Peterson, J.R. Wingard, R.J. Jones, L.B. Grochow. Patterns of mucositis and pain in patients receiving preparative chemotherapy and bone marrow transplantation, Oncol Nurs Forum. 1993; 20: 1493–502p.

G.G. Duncan, J.B. Epstein, D. Tu, et al. Quality of life, mucositis, andxerostomia from radiotherapy for head and neck cancers: a report from the NCIC CTG HN2 randomized trial of an antimicrobial lozenge to prevent mucositis, Head Neck. 2005; 27: 421–8p.

L.S. Elting, C. Cooksley, M. Chambers, S.B. Cantor, E. Manzullo, E.B. Rubenstein. The burdens of cancer therapy. Clinical and economic outcomes of chemotherapy-induced mucositis, Cancer. 2003; 98: 1531–9p.

A. Trotti, L.A. Bellm, J.B. Epstein, et al. Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature.

S. Sonis. Oral mucositis: a challenging complication of radiotherapy, chemotherapy, and radiochemotherapy, Radiother Oncol. 2003; 66: 253–62p.

C. Scully, J. Epstein. Part 2: diagnosis and management of mucositis, Head Neck. 2004; 26: 77–84p. [PubMed].

F. Tiberg, et al. Treatment of oral mucositis pain by a bioadhesive barrier forming lipid solution, Supp Cancer Care. 2009; 17: 918p.

A. Hernández-Fernández, R.E. Oñate-Sánchez, M.C. Cabrerizo-Merino, F. de Arriba-de la-Fuente, I. Heras-Fernando, V. Vicente-García. Influence of oral health on mucositis in patients undergoing hematopoietic progenitor cell transplantation(HPCT), Med Oral Patol Oral Cir Bucal. 2012; 17: e94–101p. [PMC free article] [PubMed].

E.B. Rubenstein, D.E. Peterson, M. Schubert, D. Keefe, D. McGuire, J. Epstein. Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis, Cancer. 2004; 100: 2026–46p. [PubMed].

M.A. Stokman, F.K. Spijkervet, H.M. Boezen, J.P. Schouten, J.L. Roodenburg, E.G. de Vries. Preventive intervention possibilities in radiotherapy- and chemotherapy-induced oral mucositis: results of meta-analyses, J Dent Res. 2006; 85: 690–700p. [PubMed].

A. Rodriguez-Caballero, D. Torres-Lagares, M. Robles-García, J. Pachon-Ibañez, D. Gonzalez-Padilla, J.L. Gutierrez-Perez. Cancer treatment-induced oral mucositis: a critical review, Int J Oral Maxillofac Surg. 2012; 41: 225–38. [PubMed].

J.M. Bjordal, R.J. Bensadoun, J. Tunér, L. Frigo, K. Gjerde, R.A. Lopes-Martins. A systematic review with meta-analysis of the effect of low-level laser therapy(LLLT) in cancer therapy-induced oral mucositis, Support Care Cancer. 2011; 19: 1069–77p. [PubMed].

S.T. Sonis, L.S. Elting, D. Keefe, D.E. Peterson, M. Schubert, M. Hauer-Jensen. Perspectives on cancer therapy-induced mucosal injury: pathogenesis, measurement, epidemiology, and consequences for patients, Cancer. 2004; 100: 1995–2025p. [PubMed].

D.J. Harris, J. Eilers, A. Harriman, B.J. Cashavelly, C. Maxwell. Putting evidence into practice: evidence-based interventions for the management of oral mucositis, Clin J Oncol Nurs. 2008; 12: 141–52p. [PubMed].

F. López-Casta-o, R.E. Oñate-Sánchez, R. Roldán-Chicano, M.C. Cabrerizo-Merino. Measurement of secondary mucositis to oncohematologic treatment by means of different scale, Rev Med Oral Patol Oral Cir Bucal. 2005; 10: 412–21p. [PubMed].

Guide to the Development, Implementation and Evaluation of Clinical Practice Guidelines. Canberra: National Health and Medical Research Council; 1998. [cited 1998 Nov]. [Internet] Available from: http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp30.pdf.

D.B. McGuire, M.E. Correa, J. Johnson, P. Wienandts. The role of basic oral care and good clinical practice principles in the management of oral mucositis, Support Care Cancer. 2006; 14: 541–7p. [PubMed].

A.J. Nashwan. Use of chlorhexidine mouthwash in children receiving chemotherapy: a review of literature, J Pediatr Oncol Nurs. 2011; 28: 295–9p. [PubMed].

O. Nicolatou-Galitis, T. Sarri, J. Bowen, M. Di Palma, V.E. Kouloulias, P. Niscola. Systematic review of amifostine for the management of oral mucositis in cancer patients, Support Care Cancer. 2013; 21: 357–64p. [PubMed].

M. Sabater Recolons Mdel, J. López López, M.E. Rodríguez de Rivera Campillo, E. Chimenos Küstner, J.M. Conde Vidal. Buccodental health and oral mucositis. Clinical study in patients with hematological diseases, Med Oral Patol Oral Cir Bucal. 2006; 11: E497–502p. [PubMed].

M. Nottage, S.A. McLachlan, M.A. Brittain, A. Oza, D. Hedley, R. Feld. Sucralfate mouthwash for prevention and treatment of 5-fluorouracil-induced mucositis: a randomized, placebo-controlled trial, Supp Care Cancer. 2003; 11: 41–7p. [PubMed].

E. Gori, M. Arpinati, F. Bonifazi, A. Errico, A. Mega, F. Alberani. Cryotherapy in the prevention of oral mucositis in patients receiving low-dose methotrexate following myeloablative allogeneic stem cell transplantation: a prospective randomized study of the Gruppo Italiano Trapianto di Midollo Osseo nurses group. Bone Marrow Transplant. 2007; 39: 347–52p. [PubMed].

E. Papadeas, S. Naxakis, M. Riga, C. Kalofonos. Prevention of 5-fluorouracil-related stomatitis by oral cryotherapy: a randomized controlled study. Eur J Oncol Nurs. 2007; 11: 60–5p. [PubMed].

C. Sornsuvit, S Komindr, S. Chuncharunee, P. Wanikiat, N. Archararit, P. Santanirand. Pilot Study: effects of parenteral glutamine dipeptide supplementation on neutrophil functions and prevention of chemotherapy induced side-effects in acute myeloid leukaemia patients, J Int Med Res. 2008; 36: 1383–91p. [PubMed].

E. Gori, M. Arpinati, F. Bonifazi, A. Errico, A. Mega, F. Alberani. Cryotherapy in the prevention of oral mucositis in patients receiving low-dose methotrexate following myeloablative allogeneic stem cell transplantation: a prospective randomized study of the Gruppo Italiano Trapianto di Midollo Osseo nurses group, Bone Marrow Transplant. 2007; 39: 347–52p. [PubMed].

K. Lilleby, P. Garcia, T. Gooley, P. McDonnnell, R. Taber, L. Holmberg. A prospective, randomized study of cryotherapy during administration of high-dose melphalan to decrease the severity and duration of oral mucositis in patients with multiple myeloma undergoing autologous peripheral blood stem cell transplantation, Bone Marrow Transplant. 2006; 37: 1031–5p. [PubMed].

A. Svanberg, G. Birgegard, K. Ohrn. Oral cryotherapy reduces mucositis and opioid use after myeloablative therapy – a randomized controlled trial, Supp Care Cancer. 2007; 15: 1155–61p. [PubMed].

D.M. Keefe. Intestinal mucositis: mechanisms and management, Curr Opin Oncol. 2007; 19: 323–7p.

S. Vadhan-Raj, J. Trent, S. Patel, X. Zhou, M.M. Johnson, D. Araujo. Single-dose palifermin prevents severe oral mucositis during multicycle chemotherapy in patients with cancer: a randomised trial, Ann Intern Med. 2010; 153: 358–67p. [PubMed].

C. Migliorati, I. Hewson, R.V. Lalla, H.S. Antunes, C.L. Estilo, B. Hodgson. Systematic review of laser and other light therapy for the management of oral mucositis in cancer patients, Supp Care Cancer. 2013; 21: 333p. [PubMed].

H.V. Worthington, J.E. Clarkson, G. Bryan, S. Furness, A.M. Glenny, A. Littlewood. Interventions for preventing oral mucositis for patients with cancer receiving treatment, Cochrane Database Syst Rev. 2011; 13: CD000978. [PubMed].

J.E. Raber-Durlacher, I. von Bültzingslöwen, R.M. Logan, J. Bowen, A.R. Al-Azri, H. Everaus. Systematic review of cytokines and growth factors for the management of oral mucositis in cancer patients, Supp Care Cancer. 2013; 21: 343–55p. [PubMed].

J. Buentzel, O. Micke, I.A. Adamietz, A. Monnier, M. Glatzel, A. de Vries. Intravenous amifostine during chemoradiotherapy for head-and-neck cancer: a randomized placebo-controlled phase III study, Int J Radiat Oncol Biol Phys. 2006; 64: 684–91p. [PubMed].

Y. Panahi, S. Ala, M. Saeedi, A. Okhovatian, N. Bazzaz, M.M. Naghizadeh. Allopurinol mouth rinse for prophylaxis of fluorouracil-induced mucositis, Eur J Cancer Care. 2010; 19: 308–12p. [PubMed].

D.E. Peterson, K. Ohrn, J. Bowen, M. Fliedner, J. Lees, C. Loprinzi. Systematic review of oral cryotherapy for management of oral mucositis caused by cancer therapy, Support Care Cancer. 2013; 21: 327–32p. [PubMed].

O. Nicolatou-Galitis, T. Sarri, J. Bowen, M. Di Palma, V.E. Kouloulias, P. Niscola. Systematic review of amifostine for the management of oral mucositis in cancer patients, Support Care Cancer. 2013; 21: 357–64. [PubMed].

N.J. Meropol, R.A. Somer, J. Gutheil, R.J. Pelley, M.R. Modiano, E.K. Rowinsky. Randomized phase I trial of recombinant human keratinocyte growth factor plus chemotherapy: potential role as mucosal protectant, J Clin Oncol. 2003; 21: 1452–8p. [PubMed].

L.S. Rosen, E. Abdi, I.D. Davis, J. Gutheil, F.M. Schnell, J. Zalcberg. Palifermin reduces the incidence of oral mucositis in patients with metastatic colorectal cancer treated with fluorouracil-based chemotherapy, J Clin Oncol. 2006; 24: 5194–200p. [PubMed].


Refbacks

  • There are currently no refbacks.