Highlights
- •Oral mucositis is one of the most prevalent side effects in cancer patients receiving radiotherapy and or chemotherapy.
- •This is the first clinical trial that test Plantago major solution versus bicarbonate and chlorhexidine 0.12% solution.
- •The bicarbonate solution improved the healing time and decreased pain compared to plantago major solution and chlorhexidine 0.12%.
Abstract
Purpose
Oral mucositis is one of the most common adverse effects of chemotherapy and radiotherapy.
The aim of this study was to compare the efficacy of Plantago major extract versus chlorhexidine 0.12% versus sodium bicarbonate 5% in the symptomatic
treatment of chemotherapy-induced oral mucositis in solid tumour cancer patients.
Method
Multicentre randomised controlled trial estimated sample of 45 solid tumour patients
with grade II-III mucositis. The participants were randomised to one of three treatments,
consisting of sodium bicarbonate 5% aqueous solution together with: an additional
dose of sodium bicarbonate 5% aqueous solution, Plantago major extract, or chlorhexidine 0.12%. The primary outcomes were severity of mucositis,
pain intensity, oral intake capacity and quality of life. The independent variable
was treatment group, and confounders included sociodemographic data, neutrophil count,
chemotherapy drug and dose received.
Results
Of the 50 patients enrolled, 68% (n = 34) achieved grade 0 mucositis (none), with
those using the double sodium bicarbonate rinse healing in five days on average (95%
CI 3.9, 6.5) versus seven days (95% CI 5.3, 9,0) for the chlorhexidine group and seven
days (95% CI 5.3, 8.5) for the Plantago major group. The pain experienced by the participants lessened over the 14 days of treatment,
but differences in pain intensity between the three groups did not show statistical
significance (p = 0.762).
Conclusions
Healing time was shorter with the double sodium bicarbonate solution compared to the
other two rinses, but the differences were not significant. Our results suggest it
may be time to reconsider the use of Plantago major extract in the management of oral mucositis.
Keywords
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References
- Natural products for management of oral mucositis induced by radiotherapy and chemotherapy.Integr. Cancer Ther. 2016; 15: 60-68
- Prevention and treatment of mucositis in the onco-hematologic patient.Farm. Hosp. Span. 2001; 25: 139-149
- Quality of life in hematologic oncology patients undergoing chemotherapy.Rev. Esc. Enferm. Usp. 2013; 47: 355-361
- Streptococcal bacteraemia in patients submitted to hematopoietic stem cell transplantation: the role of tooth brushing and use of chlorhexidine.Med. Oral Patol. Oral Cir. Bucal. 2010; 15: e303-e309
- Use of chamomilla recutita in the prevention and treatment of oral mucositis in patients undergoing hematopoietic stem cell transplantation: a randomized, controlled, phase II clinical trial.Cancer Nurs. 2015; 38: 322-329
- Estudio de incidencia de mucositis en la unidad de hospital de día de quimioterapia del Instituto Catalán de Oncología de HUGTIP.Rev. SEEO Span. 2006; 10: 16-18
- Patients' experiences and perceptions of chemotherapy-induced oral mucositis in a day unit.Cancer Nurs. 2008; 31: 363-369
- The impact of oral herpes simplex virus infection and candidiasis on chemotherapy-induced oral mucositis among patients with hematological malignancies.Eur. J. Clin. Microbiol. Infect. Dis. 2011; 30: 753-759
- New measure of health-related quality of life for patients with oropharyngeal mucositis.Cancer. 2007; 109: 2590-2599
- Interventions for treating oral mucositis for patients with cancer receiving treatment.Cochrane Database Syst. Rev. 2010; 10CD001973
- Randomized clinical trial of the effectiveness of 3 commonly used mouthwashes to treat chemotherapy-induced mucositis.Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2000; 90: 39-47
- Radiation-induced mucositis: a randomized clinical trial of micronized sucralfate versus salt & soda mouthwashes.Cancer Invest. 2003; 21: 21-33
- Evidence-based interventions for cancer treatment-related mucositis: putting evidence into practice.Clin. J. Oncol. Nurs. 2014; 18: 80-96
- The burdens of cancer therapy. Clinical and economic outcomes of chemotherapy-induced mucositis.Cancer. 2003; 98: 1531-1539
- Degree of mucositis and duration of neutropenia are the major risk factors for early post-transplant febrile neutropenia and severe bacterial infections after reduced-intensity conditioning.Eur. J. Haematol. 2012; 88: 46-51
- Cancer treatment-induced mucositis pain: strategies for assessment and management.Ther. Clin. Risk Manag. 2006; 2: 251-258
- Hydroalcoholic plant extracts with anti-inflammatory activity.Roum. Arch. Microbiol. Immunol. 2003; 62: 117-129
- A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact.Support Care Cancer. 2010; 18: 1061-1079
- Effect of an oral mucositis protocol on quality of life of patients with head and neck cancer treated with radiation therapy.Clin. J. Oncol. Nurs.18. 2014; : E118-E125
- Evaluation of the effect of cryotherapy in preventing oral mucositis associated with chemotherapy -A randomized controlled trial.Eur. J. Oncol. Nurs. 2012; 16: 339-344
- Updated clinical practice guidelines for the prevention and treatment of mucositis.Cancer. 2007; 109: 820-831
- Association of oral mucositis with quality of life and symptom clusters in patients with solid tumors receiving chemotherapy.Support Care Cancer. 2012; 20: 395-403
- MASCC/ISOO Clinical practice guidelines for the management of mucositis secondary to cancer therapy.Cancer. 2014; 120: 1453-1461
- Mucositis in irradiated cancer patients: effects of an antiseptic mouthrinse.Med. Oral Patol. Oral Cir. Bucal. 2010; 15: e732-e738
- Health-related quality of life in advanced non-small cell lung cancer: correlates and comparisons to normative data.Eur. J. Cancer Care. 2012; 21: 642-649
- Nutritional interventions in head and neck cancer patients undergoing chemoradiotherapy: a narrative review.Nutrients. 2015; 7: 265-276
- A guide tomanaging the pain if treatment-related oral mucositis.Int. J. Palliat. Nurs. 2005; 11 (338): 340-345
- Systematic review of basic oral care for the management of oral mucositis in cancer patients.Support Care Cancer. 2013; 21: 3165-3177
- A comparison between zinc sulfate and chlorhexidine gluconate mouthwashes in the prevention of chemotherapy-induced oral mucositis.Daru. 2011; 9: 71-73
- Clinical and economic consequences of mucositis induced by chemotherapy and/or radiation therapy.J. Support Oncol. 2007; 5 (9 Suppl 4): 13-21
- Impact of chronic oral mucosal disease on daily life: preliminary observations from a qualitative study.Oral Dis. 2011; 17: 265-269
- Enteral feeding methods for nutritional management in patients with head and neck cancers being treated with radiotherapy and/or chemotherapy.Cochrane Database Syst. Rev. 2013; 1CD007904
- Preventive effects of amino-acid-rich elemental diet Elemental® on chemotherapy-induced oral mucositis in patients with colorectal cancer: a prospective pilot study.Support Care Cancer. 2016; 24: 783-789
- Systematic review of oral cryotherapy for management of oral mucositis caused by cancer therapy.Support Care Cancer. 2013; 21: 327-332
- Systematic review of cytokines and growth factors for the management of oral mucositis in cancer patients.Support Care Cancer. 2013; 21: 343-355
- A review of the efficacy of traditional Iranian medicine for inflammatory bowel disease.World J. Gastroenterol. 2010; 16: 4504-4514
- Buccodental health and oral mucositis. Clinical study in patients with hematological diseases.Med. Oral Patol. Oral Cir. Bucal. 2006; 11: E497-E502
- Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients.Support Care Cancer. 2013; 21: 3191-3207
- Diagnosis and management of oral mucositis.J. Support Oncol. 2007; 5: 13-21
- Mucositis as a biological process: a new hypothesis for the development of chemotherapy-induced stomatotoxicity.Oral Oncol. 1998; 34: 39-43
- Pathobiology of mucositis.Semin. Oncol. Nurs. 2004; 20: 11-15
- The pathobiology of mucositis.Nat. Rev. Cancer. 2004; 4: 277-284
- Oral mucositis.Anticancer Drugs. 2011; 22: 607-612
- Oral mucositis and the clinical and economic outcomes of hematopoietic stem-cell transplantation.J. Clin. Oncol. 2001; 19: 2201-2205
- Effect of sodium bicarbonate on Candida albicans adherence to thermally activated acrylic resin.Braz Oral Res. 2009; 23: 381-385
- The effect of cryotherapy on oral mucosa: a study in healthy volunteers.Med. Oncol. 2012; 29: 3587-3591
- Oral mucositis and outcomes of allogeneic hematopoietic stem-cell transplantation in patients with hematologic malignancies.Support Care Cancer. 2007; 15: 491-496
- In-vitro anti-inflammatory activity of Pinus sylvestris and Plantago lanceolata extracts: effect on inducible NOS, COX-1, COX-2 and their products in J774A.1 murine macrophages.J. Pharm. Pharmacol. 2005; 57: 383-391
- Evaluación del efecto genotóxico en extractos fluidos de Plantado Lanceolada L. (Llantén menor) y matricaria recutita L. (Manzanilla).Rev. Cuba. Plant Med. Span. 2000; 5: 59-63
- Lidocaine toxicity during frequent viscous lidocaine use for painful tongue ulcer.J. Pain Symptom Manage. 2002; 24: 543-545
- Effects of Plantago major L. leaf extracts on oral epithelial cells in a scratch assay.J. Ethnopharmacol. 2012; 141: 825-830
Article info
Publication history
Published online: December 13, 2017
Accepted:
November 23,
2017
Received in revised form:
November 20,
2017
Received:
August 16,
2017
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
