Impact of severe oral mucositis in pediatric cancer patients on resource utilization and cancer treatment plans

Alsheyyab, Farah; Al-Momani, Deema; Kasht, Rawan; Kamal, Amr; Abusalem, Dana; Al-Qasem, Wiam

doi:10.1007/s11096-021-01253-y

Cited by 7 publications

(3 citation statements)

References 12 publications

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“…Chemotherapy‐induced peripheral neuropathy and acute neuropathic pain occur in 50%–90% of children treated with platinum compounds (eg, cisplatin) and 35%–45% with vinca alkaloids (eg, vincristine 70‐73 ), but the contribution of neuropathic mechanisms to prolonged mucositis pain is unclear. The ability to recognize and manage potential dose‐limiting toxicities is vital, as modification of treatment protocols may impair the recent advances in survival from pediatric cancer with newer multi‐agent protocols and therapies, and reduce the potential prolonged benefit following stem cell transplants for nonmalignant conditions 9,10,58,74 . Following survival from childhood cancer, 12%–20% of adults reported chronic pain, 16.7% used prescription analgesics, and 21% attributed pain to cancer and treatment 75 .…”

Section: Discussionmentioning

confidence: 99%

“…However, our 7‐year audit highlights the significant pain and disease burden experienced by children with cancer, and the requirement for multiple treatment episodes. While severe mucositis has significant implications for resource utilization and healthcare costs, a recent analysis 74 did not include costs associated with analgesia (eg, drugs and equipment) or the staffing, expertise, and frequency of review undertaken by many services to maximize analgesia 35 …”

Section: Discussionmentioning

confidence: 99%

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Intravenous opioids for chemotherapy‐induced severe mucositis pain in children: Systematic review and single‐center case series of management with patient‐ or nurse‐controlled analgesia (PCA/NCA)

Walker

Selers

Jay

et al. 2021

Pediatric Anesthesia

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Background: Chemotherapy-induced oral mucositis can result in severe pain.Intravenous (IV) opioids are recommended, but management protocols vary. We systematically reviewed studies reporting IV opioid use for pain related to chemotherapyinduced severe oral mucositis in children and conducted a large single-center case series.Methods: Ovid MEDLINE, PubMed, and Cochrane databases were searched for studies reporting IV opioid duration and/or dose requirements for severe mucositis.Secondly, our pain service database was interrogated to describe episodes of opioid administration by patient-or nurse-controlled analgesia (PCA/NCA) for children with mucositis and cancer treatment-related pain.Results: Seventeen studies (six randomized trials, two prospective observational, three retrospective cohort, six retrospective case series) included IV opioid in 618 patients (age 0.3-22.3 years), but reported parameters varied. Mucositis severity and chemotherapy indication influenced IV opioid requirements, with duration ranging from 3 to 68 days and variable dose trajectories (hourly morphine or equivalent 0-97 mcg/kg/h). Our 7-year series included PCA/NCA for 364 episodes of severe mucositis (302 patients; age 0.12-17.2 years). Duration ranged from 1 to 107 days and dose requirements in the first 3 days from 1 to 110 mcg/kg/h morphine. Longer PCA/ NCA duration was associated with: higher initial morphine requirements (ρ = 0.46 [95% CI 0.35, 0.57]); subsequent increased pain and need for ketamine co-analgesia (118/364 episodes with opioid/ketamine 13.9 [9.8-22.2] days vs opioid alone 6.0 [3.9-10.8] days; median [IQR]); but not with age or sex.Conclusions: Management of severe mucositis pain can require prolonged IV opioid therapy. Individual and treatment-related variability in analgesic requirements highlight the need for regular review, titration, and management by specialist services.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intravenous opioids for chemotherapy‐induced severe mucositis pain in children: Systematic review and single‐center case series of management with patient‐ or nurse‐controlled analgesia (PCA/NCA)

Walker

Selers

Jay

et al. 2021

Pediatric Anesthesia

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“…Oral mucositis causes significant oral pain and dysphagia, which negatively impacts the patient’s quality of life by affecting the patient’s nutritional status and causing difficulty in speaking. In addition, oral mucositis can lead to infection, worsening of the patient’s general condition, and reduction in the dose of chemotherapeutic agents that can affect the length of hospital stay and patient survival [ 2 , 3 , 4 ]. The use of 5-fluorouracil (5-FU) has led to a reduction in the dose or discontinuation of chemotherapeutic agents in more than 15% of patients due to grade 3 to 4 oral mucositis [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Anti-Inflammatory Effects of β-Cryptoxanthin on 5-Fluorouracil-Induced Cytokine Expression in Human Oral Mucosal Keratinocytes

et al. 2023

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Oral mucositis is a typical adverse effect of chemotherapy, causing oral pain that significantly reduces the patient’s quality of life. β-cryptoxanthin (β-cry) is a carotenoid abundant in citrus fruits with antioxidant and anti-inflammatory effects. However, the β-cry effect on oral mucositis remains unclear. We investigated the effects of 5-fluorouracil (5-FU) and β-cry on human normal oral mucosal keratinocytes (hOMK). hOMK was seeded on a culture plate and cultured with 5-FU and β-cry. The cell number, mRNA expression of inflammatory cytokines and matrix metalloproteinases (MMPs), and production of inflammatory cytokines in hOMK were evaluated. Additionally, the cell count and inflammatory cytokine production were analyzed when hOMK was co-stimulated with Porphyromonas gingivalis lipopolysaccharide (P. gingivalis LPS) in addition to 5-FU. The numbers of hOMK significantly reduced with 5-FU stimulation, whereas it increased with β-cry treatment. mRNA expression of interleukin (IL)-6, IL-8, metalloproteinase (MMP)-2, and MMP-9 and protein production of IL-6 and IL-8 in hOMK were augmented on 5-FU stimulation. Simultaneously, β-cry treatment significantly suppressed IL-8 and MMP-9 mRNA expression, and IL-8 production was induced on 5-FU stimulation. Co-stimulation with P. gingivalis LPS and 5-FU enhanced IL-6 and IL-8 production in hOMK. β-cry could enhance cell proliferation and suppress 5-FU-induced expression of inflammatory cytokines and MMP in hOMK. Thus, β-cry can alleviate the symptoms of chemotherapy-induced oral mucositis, and its combination with oral care is effective in managing oral mucositis.

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Anti-inflammatory mouthwashes for the prevention of oral mucositis in cancer therapy: an integrative review and meta-analysis

Thornton¹,

Budhathoki

et al. 2022

Support Care Cancer

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Impact of severe oral mucositis in pediatric cancer patients on resource utilization and cancer treatment plans

Cited by 7 publications

References 12 publications

Intravenous opioids for chemotherapy‐induced severe mucositis pain in children: Systematic review and single‐center case series of management with patient‐ or nurse‐controlled analgesia (PCA/NCA)

Intravenous opioids for chemotherapy‐induced severe mucositis pain in children: Systematic review and single‐center case series of management with patient‐ or nurse‐controlled analgesia (PCA/NCA)

Anti-Inflammatory Effects of β-Cryptoxanthin on 5-Fluorouracil-Induced Cytokine Expression in Human Oral Mucosal Keratinocytes

Anti-inflammatory mouthwashes for the prevention of oral mucositis in cancer therapy: an integrative review and meta-analysis

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