The effect of cryotherapy on chemotherapy induced oral mucositis in Egyptian cancer patients: A randomized controlled trial

Abstract

Background and objective: Oral Mucositis (OM) is a common adverse side-effect caused by cancer treatments (chemotherapy and/or radiotherapy). And can lead to mucosa toxicity. Patients with OM may experience extreme pain and may not be able to eat, drink and talk and, as a result, their quality of life is impaired. Treatment and prevention of OM in adult patients treated with chemotherapy are challenging issues for health care professionals. The aim of this study was to evaluate the effect of cryotherapy on incidence and severity of chemotherapy-induced OM and OM related pain in patients treated with combined chemotherapy (Fluorouracil and Leucovorin).Methods: This study is a randomized controlled trial with a random assignment to cryotherapy and control groups. The study was conducted on 40 cancer patients who underwent chemotherapy. The 20 patients in cryotherapy group were received instructions for sucking ice cubes in their mouth for five minutes before, during and shortly after chemotherapy. The 20 patients in control group received routine care. OM and pain severity were evaluated at 7th, 14th and 21st days of the study after chemotherapy using WHO Mucositis grading and-Numeric Pain Rating Scale.Results: In the majority of patients in cryotherapy group, oral Mucositis was not detected (Grade 0) at 7th, 14th and 21st days similarly incidence of grade 1 and 2 of OM in cryotherapy group significantly lowered when compared with control group where p < .001. During the study period, patients in the control group exhibit a significantly higher level of oral discomfort (p = .001).Conclusions: Oral cryotherapy due to its easy administration, tolerability and lack of adverse effects which makes it a very important method for decreasing the severity and incidence of OM and OM associated pain. The oncology nurses have a pivotal role in the application and success of cryotherapy.

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

“…Eleven studies included in this review used different instruments to assess oral mucositis in cancer patients undergoing cancer therapy. The instruments were the WHO mucositis scale [23], [28], [30], [31], [33], the Oral Assessment Guide (OAG) [27], [29], the Oral Mucositis Assessment Scale (OMAS) [23], the National Cancer Institute Common Toxicity Criteria (NCI-CTC) [24], and Oral Mucositis Daily Questionnaire (OMDQ) [24], [26]. The OMDQ is a self-assessed questionnaire, whereas other tools are used by health practitioners.…”

“…The majority of studies applied OC procedures before cancer therapy interventions were carried out. Six studies started giving ice cube 5 min before cancer therapy was started [28], [29], [30], [31], [32], [33]. Another study started 10 min [25] and 30 min before cancer therapy was given [23].…”

“…Regarding the size of the ice cube, only four studies that describe the ice cube criteria were used for the OC [24], [25], [30], [31]. In detail, Lu et al stated that the size of the ice cube was 3.2 cm × 3.3 cm × 1 cm [24].…”

“…Okamoto et al further explained the total water content for making ice cube, which was around 200-300 mL for making ice chunks [25]. Meanwhile, Soliman et al did not explain size details, but the criteria for the ice cube must be suitable and moveable in the mouth [31]. Although the size criteria of the ice cube were different, these studies agreed that the ice cube used were rounded corners to prevent mouth irritation.…”

“…The majority of the reviewed studies described that OC intervention was effective in reducing the degree and severity of oral mucositis in patients undergoing cancer therapy, either HSCT or chemotherapy. Based on the mucositis grading assessment instruments, these studies found mucositis grade reduction in the OC group [25], [26], [27], [28], [29], [30], [31], [32]. Meanwhile, three studies reported that the incidence of oral mucositis on different grades was significantly lower in the group of patients receiving OC than the non-OC group [25], [26], [31].…”