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Oral cryotherapy reduces mucositis and opioid use after myeloablative therapy-a randomized controlled trial
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Hematologi)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Hematologi)
2007 (English)In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 15, no 10, 1155-1161 p.Article in journal (Refereed) Published
Abstract [en]

Introduction: Mucositis is a major complication in myeloablative therapy, which often necessitates advanced pharmacological pain treatment, including i.v. opioids. Attempts to prevent oral mucositis have included oral cryotherapy, which has been shown to reduce mucositis, but there is a lack of knowledge concerning the effect of oral cryotherapy on opioid use by reducing the mucositis for patients treated with myeloablative therapy before bone marrow transplantation (BMT). Aim: The aim of the present study was to evaluate if oral cryotherapy could delay or alleviate the development of mucositis and thereby reduce the number of days with i.v. opioids among patients who receive myeloablative therapy before BMT. Materials and methods: Eighty patients 18 years and older, scheduled for BMT, were included consecutively and randomised to oral cryotherapy or standard oral care. A stratified randomisation was used with regard to type of transplantation. Intensity of pain, severity of mucositis and use of opioids were recorded using pain visual analogue scale (VAS) scores, mucositis index scores and medical and nursing charts. Results: This study showed that patients receiving oral cryotherapy had less pronounced mucositis and significantly fewer days with i.v. opioids than the control group. In the autologous setting, cryotherapy patients also needed significantly lower total dose of opioids. Conclusion: Oral cryotherapy is an effective and well-tolerated therapy to alleviate mucositis and consequently reduce the number of days with i.v. opioids among patients treated with myeloablative therapy before BMT.

Place, publisher, year, edition, pages
2007. Vol. 15, no 10, 1155-1161 p.
Keyword [en]
Oral cryotherapy, Bone marrow transplantation, Mucositis, Oral pain, Opioid use
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-11834DOI: 10.1007/s00520-007-0245-8ISI: 000249632900004PubMedID: 17393189OAI: oai:DiVA.org:uu-11834DiVA: diva2:39603
Available from: 2007-10-26 Created: 2007-10-26 Last updated: 2017-12-11Bibliographically approved
In thesis
1. Mucositis Prevention for Patients Receiving High Dose Chemotherapy and Stem Cell Transplantation: Preventive Strategies - There is Always More to do
Open this publication in new window or tab >>Mucositis Prevention for Patients Receiving High Dose Chemotherapy and Stem Cell Transplantation: Preventive Strategies - There is Always More to do
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to investigate oral cryotherapy (OC) as prophy-laxis against oral mucositis (OM) in patients given high-dose chemotherapy for stem cell transplantation (SCT). A new mouth rinse device was tested for possible additive effect to OC.

For study I-III, 78 patients were randomised to OC or standard oral care (SOC). Papers I and II showed that OC patients had significantly less severe mucositis, pain, opioid use, lower C-reactive protein and less parenteral nutrition treatment (TPN).

There was no difference in relapse rate, and 5-year survival was unexpectedly significantly better in the OC group (Paper III). In paper IV, the local effect of OC on the mucosa of the mouth was investigated by the use of an infrared thermograph. Change in surface temperature in eight areas of the mouth cavity was measured after cooling of the mouth in healthy volunteers. A substantial lowering of the temperature (-12.9 °C, mean) was seen which could explain the efficacy of OC. To exclude that acute cooling in itself is traumatic, the proinflammatory cytokine IL-6 was measured in saliva and showed no increase after cooling. Paper V reported a study in 40 allogeneic SCT patients. 20 were given SOC including OC and 20 in addition received Caphosol®, a calcium phosphate mouth rinse, during chemotherapy and until day 21. Severity of mucositis, use of opioids and TPN, effects on nutrition and CRP levels were measured. No significant difference was found between the groups in any of these variables, but a non-significant trend for an advantage for the combination could be seen. IL-6 saliva levels were measured. There was a substantial increase (more than 10-fold), in mean IL-6 levels from baseline to beginning of mucositis and a weak correlation between increased IL-6 levels and severity of OM, suggesting that IL-6 in saliva may be a useful marker of the inflammatory mucosal process.

This thesis demonstrates that OC is effective as prophylaxis against chemotherapy-induced OM. As a consequence of this work, OC has been introduced as the standard of care in all SCT patients in our institution.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 57 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 798
Keyword
oral mucositis, stem cell transplantion, oral cryotherapy, cooling, cytokine IL-6
National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-179508 (URN)978-91-554-8438-5 (ISBN)
Public defence
2012-09-28, Robergsalen, ing 40, 4 tr, Akademiska. sjukhuset, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2012-09-07 Created: 2012-08-17 Last updated: 2013-01-22

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