PURPOSE:The aim of this study is to compare cryotherapy made only with water and cryotherapy made with chamomile infusion for prevention and reduction of intensity of oral mucositis in patients with cancer receiving 5-fluorouracil and leucovorin.

METHOD:This is a randomized pilot study with two groups: cryotherapy made only with water (control group, n = 18) and cryotherapy made with chamomile infusion (chamomile group, n = 20). Both groups were instructed to swish the ice around in their oral cavity for at least 30 min during chemotherapy. Assessment of oral mucosa occurred on days 8, 15, and 22 after the first day of chemotherapy.

RESULTS:Fifty percent of the patients in the control and 30 % in the chamomile group developed oral mucositis. Mouth pain score was higher in patients in the control group on all evaluations (p = 0.02 for day 8, p = 0.09 for day 15, and p = 0.14 for day 22). Patients in the chamomile group never developed mucositis with grade 2 or higher. Presence of ulceration was statistically significant on day 8 (16 % in the control vs. 0 % in the chamomile group, p = 0.10), but not in days 15 and 22, although 11 % still had ulcerations in the control group and none in the chamomile group.

CONCLUSION:The occurrence of oral mucositis was lower in patients in the chamomile group than in the control group. When compared to the controls, the chamomile group presented less mouth pain and had no ulcerations. Cryotherapy was well tolerated by both groups, and no toxicity related to chamomile was identified.

Oral mucositis (OM) induces severe pain and limits fundamental life behaviors such as eating, drinking, and talking for patients receiving chemotherapy or radiotherapy. In addition, through opportunistic microorganisms, OM frequently leads to systemic infection which then leads to prolonged hospitalization. Severe lesions often adversely affect curative effects in cancer cases. Therefore, the control of OM is important for oral health quality of life and prognosis. Low-level laser therapy (LLLT) and ozone may be useful to accelerate wound healing. In this study, 24 Sprague-Dawley rats were divided into three groups as control, ozone, and laser groups. All groups received 5-fluorouracil intraperitoneally and trauma to the mouth pouch with a needle. After the formation of OM in the mouth, the control group had no treatment; the ozone group was administered ozone, and the laser group, LLLT. Then, all groups were sacrificed and basic fibroblast growth factor (bFGF), transforming growth factor (TGF-β), and platelet-derived growth factor (PDGF) were evaluated in all groups. LLLT was determined to be statistically significantly more effective than ozone on FGF and PDGF. However, in respect of TGF-β, no statistically significant difference was observed between the groups. In conclusion, withinthe limitations of this study, LLLT is more effective than ozone. However, further studies on this subject are required.

Oral mucositis (OM) induces severe pain and limits fundamental life behaviors such as eating, drinking, and talking for patients receiving chemotherapy or radiotherapy. In addition, through opportunistic microorganisms, OM frequently leads to systemic infection which then leads to prolonged hospitalization. Severe lesions often adversely affect curative effects in cancer cases. Therefore, the control of OM is important for oral health quality of life and prognosis. Low-level laser therapy (LLLT) and ozone may be useful to accelerate wound healing. In this study, 24 Sprague-Dawley rats were divided into three groups as control, ozone, and laser groups. All groups received 5-fluorouracil intraperitoneally and trauma to the mouth pouch with a needle. After the formation of OM in the mouth, the control group had no treatment; the ozone group was administered ozone, and the laser group, LLLT. Then, all groups were sacrificed and basic fibroblast growth factor (bFGF), transforming growth factor (TGF-β), and platelet-derived growth factor (PDGF) were evaluated in all groups. LLLT was determined to be statistically significantly more effective than ozone on FGF and PDGF. However, in respect of TGF-β, no statistically significant difference was observed between the groups. In conclusion, withinthe limitations of this study, LLLT is more effective than ozone. However, further studies on this subject are required.

PURPOSE:This paper aims to evaluate the effects of laser (660 nm) and light-emitting diode (LED) (670 nm) irradiation in the cheek pouch mucosa of hamsters with oral mucositis (OM) induced by chemotherapy (Che) with 5-fluorouracil (5-FU).

MATERIALS AND METHODS:In the preventive groups, the photobiomodulation was started 1 day before the drug administration and was performed every 48 h (Ia, IIa, Ib, and IIb). In the therapeutic groups (IIIa, IIIb, IVa, and IVb), the irradiations were started on the third day after the Che d(0) and was performed every 48 h. In both groups, animals were sacrificed 7 or 14 days after Che. In the positive control groups, the hamsters were subjected to Che but did not receive irradiation, and they were sacrificed in 7 days (Va) or 14 days (Vb). In the negative control groups, no procedures were done and the animals were sacrificed 7 days (Vc) or 14 days (Vd) after the experiment started.

RESULTS:The results indicated loss of body mass, xerostomia, and alopecia in the animals subjected to Che and the healing of OM to different degrees after the photobiomodulation treatment. Histologically, the positive control and experimental groups showed inflammation, predominately with lymphocytes and plasma cells, which tended to diminish with time. Epithelial atrophy, hyperemia, fibroblast proliferation, and vascular congestion were also observed at those intervals.

CONCLUSIONS:The best results were obtained from the preventive laser and LED photobiomodulation groups; both treatments were effective in diminishing the OM lesions.

CLINICAL RELEVANCE:A noninvasive and effective method with sparse side effects of OM would be desirable for use in cancer centers around the world.

PURPOSE:This paper aims to evaluate the effects of laser (660 nm) and light-emitting diode (LED) (670 nm) irradiation in the cheek pouch mucosa of hamsters with oral mucositis (OM) induced by chemotherapy (Che) with 5-fluorouracil (5-FU).

MATERIALS AND METHODS:In the preventive groups, the photobiomodulation was started 1 day before the drug administration and was performed every 48 h (Ia, IIa, Ib, and IIb). In the therapeutic groups (IIIa, IIIb, IVa, and IVb), the irradiations were started on the third day after the Che d(0) and was performed every 48 h. In both groups, animals were sacrificed 7 or 14 days after Che. In the positive control groups, the hamsters were subjected to Che but did not receive irradiation, and they were sacrificed in 7 days (Va) or 14 days (Vb). In the negative control groups, no procedures were done and the animals were sacrificed 7 days (Vc) or 14 days (Vd) after the experiment started.

RESULTS:The results indicated loss of body mass, xerostomia, and alopecia in the animals subjected to Che and the healing of OM to different degrees after the photobiomodulation treatment. Histologically, the positive control and experimental groups showed inflammation, predominately with lymphocytes and plasma cells, which tended to diminish with time. Epithelial atrophy, hyperemia, fibroblast proliferation, and vascular congestion were also observed at those intervals.

CONCLUSIONS:The best results were obtained from the preventive laser and LED photobiomodulation groups; both treatments were effective in diminishing the OM lesions.

CLINICAL RELEVANCE:A noninvasive and effective method with sparse side effects of OM would be desirable for use in cancer centers around the world.

AIMS:To review scientific evidence related to oral cryotherapy to prevent oral mucositis after cancer therapy.

BACKGROUND:Oral mucositis is a common complication of cancer therapy. In the most severe form of oral mucositis, patients cannot eat or drink at all and must receive nutrition and fluid replacement through parenteral support. Topical cooling of the oral mucosa may be an option for the prevention of oral mucositis.

DESIGN:Systematic review and meta-analysis.

DATA SOURCES:The literature search was performed using the Ovid MEDLINE, Embase, Cochrane Library, and CINAHL Complete electronic databases for articles published up to 2017. The reference lists of all retrieved articles were manually reviewed to identify additional relevant studies.

RESULTS:Of 353 publications, 15 randomized controlled trials, involving 919 cancer patients, conducted between 1994 and 2017 were included in the present meta-analysis. Oral cryotherapy, applied during treatment of solid cancers, led to a statistically lower level (P < .05) of oral mucositis overall, and of the more severe grades (3-4 and 2-4).

CONCLUSIONS:Results of this study provide a scientific basis for oral cryotherapy as a viable nursing intervention that can significantly reduce the occurrence of severe oral mucositis.

BACKGROUND:Chemotherapy, including preoperative chemotherapy, plays an important role in the treatment of esophageal cancer. However, although docetaxel, cisplatin, and fluorouracil (DCF) therapy has a powerful antitumor effect, the associated adverse events make it difficult to maintain the patient's general condition. Oral mucositis is an important adverse effect of chemotherapy, and its severity, frequency, and impact on patient quality of life should not be underestimated. This study evaluated the role of oral cryotherapy for prophylaxis of oral mucositis caused by DCF therapy.

METHODS:We retrospectively examined the incidence and severity of adverse events, including mucositis, in 72 patients with esophageal cancer treated with DCF. Fifty-eight patients received cryotherapy during docetaxel administration and 14 received no cryotherapy.

RESULTS:The incidence of mucositis of all grades and grade 3 was significantly lower in the cryotherapy group compared with the no-cryotherapy group (24.1% vs. 71.4%, P < 0.001 and 0% vs. 28.6%, P = 0.001, respectively). The incidence of anorexia of all grades and grade 3 was also significantly lower in the cryotherapy group (22.4% vs. 57.1%, P = 0.037 and 0% vs. 28.6%, P = 0.010, respectively).

CONCLUSION:Adjunctive oral cryotherapy is effective for the prophylaxis and relief of oral mucositis and anorexia caused by chemotherapy.

BACKGROUND:Evidence remains mixed on the benefits of oral cryotherapy in the prevention of oral mucositis and pain associated with fluorouracil-based chemotherapy.

OBJECTIVES:The intent of this article is to evaluate the effect of oral cryotherapy on the prevention of oral mucositis and pain among patients with colorectal cancer undergoing fluorouracil-based chemotherapy.

METHODS:Using an experimental study design, the authors randomly assigned 80 patients to either the intervention (n = 40) or usual care group (n = 40). Intervention group participants received oral cryotherapy in the form of ice chips held in their mouths during chemotherapy infusion. Both groups used sodium bicarbonate mouthwash postchemotherapy until the next cycle.

FINDINGS:In the usual care group, most participants reported grade 2 (moderate to life-threatening) or greater mucositis. Pain associated with mucositis was lower using oral cryotherapy, with the majority of participants in the intervention group reporting no pain.

BACKGROUND:The aim of this study was to review the available literature and define clinical practice guidelines for the use of laser and other light therapies for the prevention and treatment of oral mucositis.

METHODS:A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology. The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, and no guideline possible.

RESULTS:A new recommendation was made for low-level laser (wavelength at 650 nm, power of 40 mW, and each square centimeter treated with the required time to a tissue energy dose of 2 J/cm(2) (2 s/point)) for the prevention of oral mucositis in adult patients receiving hematopoietic stem cell transplantation conditioned with high-dose chemotherapy, with or without total body irradiation. A new suggestion was made for low-level laser (wavelength around 632.8 nm) for the prevention of oral mucositis in patients undergoing radiotherapy, without concomitant chemotherapy, for head and neck cancer. No guideline was possible in other populations and for other light sources due to insufficient evidence.

CONCLUSIONS:The increasing evidence in favor of low-level laser therapy allowed for the development of two new guidelines supporting this modality in the populations listed above. Evidence for other populations was also generally encouraging over a range of wavelengths and intensities. However, additional well-designed research is needed to evaluate the efficacy of laser and other light therapies in various cancer treatment settings.

PURPOSE:To update the 2013 Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) clinical practice guidelines on oral cryotherapy for the management of oral mucositis (OM) caused by cancer therapies.

METHODS:A systematic review was conducted by the Mucositis Study Group of MASCC/ISOO. The evidence for each intervention for specific cancer treatment modalities was assigned a level of evidence (LoE). The findings were added to the database used to develop the 2013 MASCC/ISOO clinical practice guidelines. Based on the LoE, the guidelines were set as: recommendation, suggestion, or no guideline possible.

RESULTS:A total of 114 papers were identified: 44 from PubMed and 70 from Web of Science. After abstract triage and merging with the 2013 database, 36 papers were reviewed. The LoE for prevention of OM with oral cryotherapy in patients undergoing autologous hematopoietic stem cell transplant using high-dose melphalan conditioning protocols was upgraded, and the guideline changed to recommendation. Additionally, the recommendation for prevention of OM with oral cryotherapy in patients receiving bolus 5-fluorouracil for the treatment of solid tumors was confirmed. No guidelines were possible for other clinical settings.

CONCLUSIONS:The evidence supports recommendations for the use of oral cryotherapy for the prevention of OM for either (i) patients undergoing autologous hematopoietic stem cell transplant with high-dose melphalan conditioning protocols or (ii) patients receiving bolus 5-fluorouracil chemotherapy.

PURPOSE:The purpose of this study was to examine the effects of oral cryotherapy on oral mucositis, reactive oxygen series, inflammatory cytokines, and oral comfort in patients undergoing chemotherapy for gynecologic cancers.

METHODS:Participants were randomly assigned to the experimental group (n=25, receiving oral cryotherapy during chemotherapy) and the control group (n=25, receiving the usual care consisting of 0.9% normal saline gargles three times before meals). Oral mucositis was assessed using the oral assessment guide, while oral comfort was assessed using the oral perception guide. Reactive oxygen series was measured as total oxidant stress, and the level of two inflammatory markers, interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), were examined. The data were analyzed using t-test, chi-square test, Fisher's exact test, Mann-Whitney U-test, and repeated measures analysis of variance.

RESULTS:There was a significant difference in the oral mucositis score, reactive oxygen series score, TNF-α level, and oral comfort score between the two groups, and there were significant changes over time and in the group-by-time interactions. There was a significant difference in the IL-6 score between the two groups, but there were no significant changes over time or in the group-by-time interactions.

CONCLUSION:The study results revealed that oral cryotherapy was more effective than the usual care regime of normal saline gargles for reducing oral mucositis, reactive oxygen series, and inflammatory cytokines and for improving oral comfort in gynecologic cancer patients undergoing chemotherapy.