Effects of professional oral health care on reducing the risk of chemotherapy-induced oral mucositis

Hirokazu Saito, Yutaka Watanabe, Kazumichi Sato, Hiroaki Ikawa, Yoshifumi Yoshida, Akira Katakura, Shin Takayama, Michio Sato, Hirokazu Saito, Yutaka Watanabe, Kazumichi Sato, Hiroaki Ikawa, Yoshifumi Yoshida, Akira Katakura, Shin Takayama, Michio Sato

Abstract

Purpose: Recent years have seen remarkable progress in cancer therapy, although treatment-induced adverse reactions and complications are not uncommon. Approximately 40 % of patients undergoing chemotherapy for cancer experience adverse reactions in the oral cavity, with nearly half of them developing severe oral mucositis that necessitates postponing therapy and/or changing the drug dosage. The objective of this study was to assess the usefulness of prophylactic professional oral health care (POHC) for preventing mucositis in patients undergoing chemotherapy.

Methods: Twenty-six female patients scheduled for chemotherapy for breast cancer were included in this study and randomized to the self-care or POHC groups. Assessment parameters included oral cavity photographs, plaque control records, Saxon test scores, Oral Assessment Guide scores, and grading using the Common Terminology Criteria for Adverse Events. Beginning before surgery and continuing through the completion of chemotherapy, the POHC patient group received weekly professional oral health care, including scaling, professional cleaning of the tooth surfaces, brushing instructions, and nutritional and lifestyle guidance.

Results: More patients in the self-care group developed oral mucositis than in the POHC group. The Oral Assessment Guide score, which was used as an index of oral mucositis, was also significantly lower in the POHC group. Based on the Oral Assessment Guide and plaque control records, there was almost no deterioration of the oral environment in the POHC group, whereas deterioration was observed in the self-care group.

Conclusions: These findings demonstrate the efficacy of regular POHC in reducing the risk of oral mucositis in breast cancer patients undergoing chemotherapy.

References

    1. Sonis ST. Mucositis as a biological process: a new hypothesis for the development of chemotherapy-induced stomatotoxicity. Oral Oncol. 1998;34:39–43. doi: 10.1016/S1368-8375(97)00053-5.
    1. Majorana A, Schubert MM, Porta F, Ugazio AG, Sapelli PL. Oral complications of pediatric hematopoietic cell transplantation: diagnosis and management. Support Care Cancer. 2000;8:353–365. doi: 10.1007/s005200050003.
    1. Raber-Durlacher JE, Weijl NI, Abu Saris M, de Koning B, Zwinderman AH, Osanto S. Oral mucositis in patients treated with chemotherapy for solid tumors: a retrospective analysis of 150 cases. Support Care Cancer. 2000;8:366–371. doi: 10.1007/s005200050004.
    1. Barber C, Powell R, Ellis A, Hewett J. Comparing pain control and ability to eat and drink with standard therapy vs Gelclair: a preliminary, double centre, randomised controlled trial on patients with radiotherapy-induced oral mucositis. Support Care Cancer. 2007;15:427–440. doi: 10.1007/s00520-006-0171-1.
    1. Sonis ST, Elting LS, Keefe D, Petersen DE, Schubert M, Hauer-Jensen M, Bekele BN, Raber-Durlacher J, Donnelly JP, Rubenstein EB. Mucositis Study Section of the Multinational Association for Supportive Care in Cancer, International Society for Oral Oncology Perspectives on cancer therapy-induced mucosal injury: pathogenesis, measurement, epidemiology, and consequences for patients. Cancer. 2004;100:1995–2025. doi: 10.1002/cncr.20162.
    1. Keefe DM, Schubert MM, Elting LS, Sonis ST, Epstein JB, Raber-Durlacher JE, Migliorati CA, McGuire DB, Hutchins RD, Peterson DE. Mucositis Study Section of the Multinational Association for Supportive Care in Cancer and the International Society for Oral Oncology Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer. 2007;109:820–831. doi: 10.1002/cncr.22484.
    1. Kennedy HF, Morrison D, Kaufmann ME, Jackson MS, Bagg J, Gibson BE, Gemmell CG, Michie JR. Origins of Staphylococcus epidermidis and Streptococcus oralis causing bacteraemia in a bone marrow transplant patient. J Med Microbiol. 2000;49:367–370.
    1. Yoneyama T, Yoshida M, Matsui T, Sasaki H. Oral care and pneumonia. Oral Care Working Group. Lancet. 1999;354:515. doi: 10.1016/S0140-6736(05)75550-1.
    1. McGuire DB, Fulton JS, Park J, Brown CG, Correa ME, Eilers J, Elad S, Gibson F, Oberle-Edwards LK, Bowen J, Lalla RV. Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) Systematic review of basic oral care for the management of oral mucositis in cancer patients. Support Care Cancer. 2013;21:3165–3177. doi: 10.1007/s00520-013-1942-0.
    1. Greene FL, Page DL, Fleming ID, Fritz AG, Balch CM, Haller DG, Morrow M. AJCC cancer staging manual. 6. New York: Springer; 2002.
    1. Common terminology criteria for adverse events v3.0 (CTCAE) (2006) US National Cancer Institute. . Accessed 23 Jan 2013
    1. Eilers J, Berger AM, Peterson MC. Development, testing, and application of the oral assessment guide. Oncol Nurs Forum. 1988;15:325–330.
    1. Koshino M, Sakai C, Ogura T, Kawasaki A, Fukuzato F, Miyazaki Y. Efficacy of oral cavity care in preventing stomatitis (mucositis) in cancer chemotherapy. Gan To Kagaku Ryoho. 2009;36:447–451.
    1. O’Leary TJ, Drake DB, Naylor JE. The plaque control record. J Periodontol. 1972;43:38. doi: 10.1902/jop.1972.43.1.38.
    1. Seki S, Sonoda S, Suzuki M, Fujii W. The saliva secretion test in stroke patients: reliability of the Saxon test. Japan J Rehabil Med. 2003;40:858–862. doi: 10.2490/jjrm1963.40.858.
    1. Jellema AP, Slotman BJ, Doornaert P, Leemans CR, Langendijk JA. Impact of radiation-induced xerostomia on quality of life after primary radiotherapy among patients with head and neck cancer. Int J Radiat Oncol Biol Phys. 2007;69:751–760. doi: 10.1016/j.ijrobp.2007.04.021.
    1. Tamura Y, Sakurai A, Yamamura C. Comparison of oral mucosa humidity and salivary flow rate, and the effects of moisturizer on the salivary flow rate. Niigata Dent J. 2009;39:35–42.
    1. Hovan AJ, Williams PM, Stevenson-Moore P, Wahlin YB, Ohrn KE, Elting LS, Spijkervet FK, Brennan MT. Dysgeusia Section, Oral Care Study Group, Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO) A systematic review of dysgeusia induced by cancer therapies. Support Care Cancer. 2010;18:1081–1087. doi: 10.1007/s00520-010-0902-1.
    1. Kobayashi M, Okada Y, Toda K. Gustatory sensitivity in different regions of the tongue in Japanese young women. J Jpn Dent Soc Orient Med. 2007;25:1–2.
    1. Schubert MM, Williams BE, Lloid ME, Donaldson G, Chapko MK. Clinical assessment scale for the rating of oral mucosal changes associated with bone marrow transplantation. Development of an oral mucositis index. Cancer. 1992;69:2469–2477. doi: 10.1002/1097-0142(19920515)69:10<2469::AID-CNCR2820691015>;2-W.
    1. Sonis ST, Eilers JP, Epstein JB, LeVeque FG, Liggett WH, Jr, Mulagha MT, Peterson DE, Rose AH, Schubert MM, Spijkervet FK, Wittes JP. Validation of a new scoring system for the assessment of clinical trial research of oral mucositis induced by radiation or chemotherapy. Mucositis Study Group. Cancer. 1999;85:2103–2113. doi: 10.1002/(SICI)1097-0142(19990515)85:10<2103::AID-CNCR2>;2-0.
    1. McGuire DB, Peterson DE, Muller S, Owen DC, Slemmons MF, Schubert MM. The 20 item oral mucositis index: reliability and validity in bone marrow and stem cell transplant patients. Cancer Investig. 2002;20:893–903. doi: 10.1081/CNV-120005902.
    1. Borowski B, Benhamou E, Pico JL, Laplanche A, Margainaud JP, Hayat M. Prevention of oral mucositis in patients treated with high-dose chemotherapy and bone marrow transplantation: a randomised controlled trial comparing two protocols of dental care. Eur J Cancer B Oral Oncol. 1994;30B:93–97. doi: 10.1016/0964-1955(94)90059-0.
    1. Sugiura Y, Soga Y, Tanimoto I, Kokeguchi S, Nishide S, Kono K, Takahashi K, Fujii N, Ishimaru F, Tanimoto M, Yamabe K, Tsutani S, Nishimura F, Takashiba S. Antimicrobial effects of the saliva substitute, oral balance, against microorganisms from oral mucosa in the hematopoietic cell transplantation period. Support Care Cancer. 2008;16:421–424. doi: 10.1007/s00520-007-0391-z.
    1. Soga Y, Sugiura Y, Takahashi K, Nishimoto H, Maeda Y, Tanimoto M, Takashiba S. Progress of oral care and reduction of oral mucositis—a pilot study in a hematopoietic stem cell transplantation ward. Support Care Cancer. 2010;19:303–307. doi: 10.1007/s00520-010-1002-y.
    1. Japanese Society of Oral and Maxillofacial Surgeons (2011) Report of survey involving hospital oral and maxillofacial surgery.
    1. Katsura K, Goto S, Sasai K, Sato K, Tomita M, Matsuyama H, Hayashi T. The effect of dental management for maintaining dental health in patients with head and neck cancer after radiotherapy. Japan J Head Neck Cancer. 2009;35:266–272.
    1. Akintoye SO, Brennan MT, Graber CJ, McKinney BE, Rams TE, Barrett AJ, Atkinson JC. A retrospective investigation of advanced periodontal disease as a risk factor for septicemia in hematopoietic stem cell and bone marrow transplant recipients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94:581–588. doi: 10.1067/moe.2002.128960.
    1. Raber-Durlacher JE, Epstein JB, Raber J, van Dissel JT, van Winkelhoff AJ, Guiot HF, van der Velden U. Periodontal infection in cancer patients treated with high-dose chemotherapy. Support Care Cancer. 2002;10:466–473. doi: 10.1007/s00520-002-0346-3.
    1. Myers RA, Marx RE. Use of hyperbaric oxygen in postradiation head and neck surgery. NCI Monogr. 1990;9:151–157.

Source: PubMed

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