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Nursing care approaches to oral mucositis in pediatric oncology clinics: a cross-sectional study from Türkiye

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Abstract

Purpose

It is important to determine the approaches for oral mucositis (OM) care in pediatric oncology clinics to reflect the profile of practices. The aim of this study was to report on current nursing care approaches for OM in Türkiye.

Methods

The descriptive, cross-sectional study was conducted with nurse managers in pediatric oncology centers in Türkiye between April and December 2022. The data were obtained online by reaching pediatric oncology nurse managers. The data was collected with the “Oral Mucositis Care Application Form” developed by the researchers based on current literature.

Results

The study reached approximately 60% (n = 41) of pediatric oncology clinics across Türkiye. Oral assessment of children was mainly conducted by nurses (95.1%), and 53.7% of clinics used the WHO Oral Mucositis Assessment Scale. To prevent OM, oral care routines were performed twice a day (36.6%) using sodium bicarbonate (61%) and 0.9% sodium chloride (26.8%) agents. For oral mucositis management, pharmacological agents included glutamine (oral) (51.2%), chlorhexidine (43.9%), and benzydamine hydrochloride (36.6%), while non-pharmacological agents included black mulberry syrup (41.5%), honey (19.8%), and chewing gum (9.8%). Chlorhexidine and benzydamine hydrochloride were used for all mucositis grades, while glutamine was frequently used for grades 2 and above.

Conclusions

The study revealed that the practices related to preventing and managing oral mucositis in pediatric oncology clinics in Türkiye are heterogeneous. These findings will contribute to the existing literature on the multidisciplinary, systematic, and evidence-based approaches used in oral mucositis care in Türkiye.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

References

  1. Mazhari F, Shirazi AS, Shabzendehdar M (2019) Management of oral mucositis in pediatric patients receiving cancer therapy: a systematic review and meta-analysis. Pediatr Blood Cancer 66(3):27403. https://doi.org/10.1002/pbc.27403

    Article  Google Scholar 

  2. Damascena LCL, de Lucena NNN, Ribeiro ILA, Pereira TL, Lima-Filho LMA, Valença AMG (2020) Severe oral mucositis in pediatric cancer patients: survival analysis and predictive factors. Int J Environ Res Public Health 17(4):1235. https://doi.org/10.3390/ijerph17041235

    Article  PubMed  PubMed Central  Google Scholar 

  3. Gandhi K, Datta G, Ahuja S, Saxena T, Datta AG (2017) Prevalence of oral complications occurring in a population of pediatric cancer patients receiving chemotherapy. Int Int J Clin Pediatr Dent 10(2):166–171. https://doi.org/10.5005/iD-iournals-10005-1428

    Article  PubMed  Google Scholar 

  4. de Farias GA, Silveira FM, Curra M, Schuch LF, Wagner VP, Martins MAT et al (2022) Risk factors associated with the development of oral mucositis in pediatric oncology patients: Systematic review and meta-analysis. Oral Dis 28(4):1068–1084. https://doi.org/10.1111/odi.13863

    Article  Google Scholar 

  5. Curra M, Gabriel AF, Ferreira MBC, Martins MAT, Brunetto AT, Gregianin LJ, Martins MD (2021) Incidence and risk factors for oral mucositis in pediatric patients receiving chemotherapy. Support Care Cancer 29(11):6243–6251. https://doi.org/10.1007/s00520-021-06199-5

    Article  PubMed  Google Scholar 

  6. Cheng KK, Lee V, Li CH, Goggins W, Thompson DR, Yuen HL, Epstein JB (2011) Incidence and risk factors of oral mucositis in paediatric and adolescent patients undergoing chemotherapy. Oral Oncol 47(3):153–162. https://doi.org/10.1016/j.oraloncology.2010.11.019

    Article  PubMed  Google Scholar 

  7. Qutob AF, Gue S, Revesz T, Logan RM, Keefe D (2013) Prevention of oral mucositis in children receiving cancer therapy: a systematic review and evidence-based analysis. Oral Oncol 49:102–107. https://doi.org/10.1016/j.oraloncology.2012.08.008

    Article  PubMed  Google Scholar 

  8. Sevinir B (2009) Mukozit (mucositis). In: Özkan A (ed) Pediatrik Onkoloji (Pediatric Oncology), 1st edn. Nobel Tıp Kitabevleri, İstanbul, pp 1283–1300

    Google Scholar 

  9. Miller MM, Donald DV, Hagemann TM (2012) Prevention and treatment of oral mucositis in children with cancer. J Pediatr Pharmacol Ther 17(4):340–350. https://doi.org/10.5863/1551-6776-17.4.340

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hendrawati S, Nurhidayah I, SuzanaMediani H, Mardhiyah A, NurAsriyani Maryam N (2019) Mucositis effect on quality of life of hospitalized children with cancer who received chemotherapy. Jurnal Keperawatan Padjadjaran 7(1):29–37. https://doi.org/10.24198/jkp

    Article  Google Scholar 

  11. Cheng KKF, Lee V, Li CH, Yuen HL, Epstein JB (2012) Oral mucositis in pediatric and adolescent patients undergoing chemotherapy: the impact of symptoms on quality of life. Support Care Cancer 20(10):2335–2342. https://doi.org/10.1007/s00520-011-1343-1

    Article  PubMed  Google Scholar 

  12. Sung L, Robinson P, Treister N, Baggott T, Gibson P, Tissing W et al (2017) Guideline for the prevention of oral and oropharyngeal mucositis in children receiving treatment for cancer or undergoing haematopoietic stem cell transplantation. MJ Support Palliat Care 7(1):7–16. https://doi.org/10.1136/bmjspcare-2014-000804

    Article  Google Scholar 

  13. Amadori F, Bardellini E, Conti G, Pedrini N, Schumacher RF, Majorana A (2016) Low-level laser therapy for the treatment of chemotherapy-induced oral mucositis in childhood: a randomized double-blind controlled study. Lasers Med Sci 31(6):1231–1236. https://doi.org/10.1007/s10103-016-1975-y

    Article  PubMed  Google Scholar 

  14. Hashemi A, Bahrololoumi Z, Khaksar Y, Saffarzadeh N, Neamatzade H, Foroughi E (2015) Mouth-rinses for the prevention of chemotherapy induced oral mucositis in children: a systematic review. Iran J Ped Hematol Oncol 5(2):106

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Treister N, Nieder M, Baggott C, Olson E, Chen L, Dang H et al (2017) Caphosol for prevention of oral mucositis in pediatric myeloablative haematopoietic cell transplantation. Br J cancer 116(1):21–27. https://doi.org/10.1038/bjc.2016.380

    Article  CAS  PubMed  Google Scholar 

  16. Vitale MC, Modaffari C, Decembrino N, Zhou FX, Zecca M, Defabianis P (2017) Preliminary study in a new protocol for the treatment of oral mucositis in pediatric patients undergoing hematopoietic stem cell transplantation (HSCT) and chemotherapy (CT). Lasers Med Sci 32(6):1423–1428. https://doi.org/10.1007/s10103-017-2266-y

    Article  PubMed  Google Scholar 

  17. Hong CH, Gueiros LA, Fulton JS, Cheng KKF, Kandwal A, Galiti D et al (2019) Systematic review of basic oral care for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer 27(10):3949–3967. https://doi.org/10.1007/s00520-019-04848-4

    Article  PubMed  Google Scholar 

  18. Khalaf SM, Mohamed RAE, Elnagar SA (2020) Nursing care adherence regarding management of oral mucositis in children undergoing oncology therapy. Int J Novel Res Healthc Nurs 7(1):263–279

    Google Scholar 

  19. Miranda-Silva W, Gomes-Silva W, Zadik Y, Yarom N, Al-Azri AR, Hong CH et al (2021) MASCC/ISOO clinical practice guidelines for the management of mucositis: sub-analysis of current interventions for the management of oral mucositis in pediatric cancer patients. Support Care Cancer 29(7):3539–3562. https://doi.org/10.1007/s00520-020-05803-4

    Article  PubMed  Google Scholar 

  20. Steinmann D, BabadağSavaş B, Felber S, Joy S, Mertens I, Cramer H et al (2021) Nursing procedures for the prevention and treatment of mucositis induced by cancer therapies: clinical practice guideline based on an interdisciplinary consensus process and a systematic literature search. Integr Cancer Ther 20:1–12. https://doi.org/10.1177/1534735420940412

    Article  Google Scholar 

  21. Lalla RV, Bowen J, Barasch A, Elting L, Epstein J, Keefe DM et al (2014) MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer 120:1453–1461. https://doi.org/10.1002/cncr.28592

    Article  PubMed  Google Scholar 

  22. Peterson DE, Boers-Doets CB, Bensadoun RJ, Herrstedt J, ESMO Guidelines Committee (2015) Management of oral and gastrointestinal mucosal injury: Esmo Clinical practice guidelines for diagnosis treatment and follow-up. Ann Oncol 26(Suppl)5:139–51

    Article  Google Scholar 

  23. Heydari A, Manzari ZS, Ghayebie E (2023) Nursing intervention to manage oral mucositis in children chemotherapy: a systematic review. Iran J Ped Hematol Oncol 13(1):64–73. https://doi.org/10.18502/ijpho.v13i1.11634

    Article  Google Scholar 

  24. Di Fede O, Canepa F, Maniscalco L, Tozzo P, Matranga D, Giuliana G (2023) Prevention and the treatment of oral mucositis: the efficacy of sodium bicarbonate vs other agents: a systematic review. BMC Oral Health 23(1):1–13. https://doi.org/10.1186/s12903-022-02586-4

    Article  Google Scholar 

  25. Bezerra PMM, Vieira TI, Dos Santos FG, Ribeiro ILA, de Sousa SA, Valença AMG (2022) The impact of oral health education on the incidence and severity of oral mucositis in pediatric cancer patients: a systematic review and meta-analysis. Support Care Cancer 30(11):8819–8829. https://doi.org/10.1007/s00520-022-07296-9

    Article  PubMed  Google Scholar 

  26. McGuire DB, Fulton JS, Park J, Brown CG, Correa MEP, Eilers J et al (2013) Systematic review of basic oral care for the management of oral mucositis in cancer patients. Support Care Cancer 21(11):3165–3177. https://doi.org/10.1007/s00520-013-1942-0

    Article  PubMed  Google Scholar 

  27. Yarom N, Hovan A, Bossi P, Ariyawardana A, Jensen SB, Gobbo M et al (2019) Systematic review of natural and miscellaneous agents for the management of oral mucositis in cancer patients and clinical practice guidelines part 1: vitamins, minerals, and nutritional supplements. Support Care Cancer 27:3997–4010. https://doi.org/10.1007/s00520-019-04887-x

    Article  PubMed  Google Scholar 

  28. Widjaja NA, Pratama A, Prihaningtyas RA, Irawan R, Ugrasena I (2020) Efficacy oral glutamine to prevent oral mucositis and reduce hospital costs during chemotherapy in children with acute lymphoblastic leukemia. Asian Pac J Cancer Prev 21(7):2117. https://doi.org/10.31557/APJCP.2020.21.7.2117

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Sener DK, Aydin M, Cangur S, Guven E (2019) The effect of oral care with chlorhexidine, vitamin E and honey on mucositis in pediatric intensive care patients: a randomized controlled trial. J Pediatr Nurs 45:e95–e101. https://doi.org/10.1016/j.pedn.2019.02.001

    Article  Google Scholar 

  30. Gholizadeh N, Mehdipoor M, Sajadi H, Moosavi MS (2016) Palifermin and chlorhexidine mouthwashes in prevention of chemotherapy-induced mucositis in children with acute lymphocytic leukemia: a randomized controlled trial. J Dent 17(4):343

    Google Scholar 

  31. OsmanogluYurdakul Z, Esenay FI (2019) Complementary and integrative health methods used for the treatment of oral mucositis in children with cancer in Turkey. J Spec Pediatr Nurs 24(3):e12260. https://doi.org/10.1111/jspn.12260

    Article  Google Scholar 

  32. Gündogdu F, Sayar S (2022) Oncology nursing practices in the management of chemotherapy-related oral mucositis in accordance with evidence-based guidelines: a descriptive and cross-sectional study. Support Care Cancer 30(11):9549–9557. https://doi.org/10.1007/s00520-022-07361-3

    Article  PubMed  Google Scholar 

  33. Karabey T, Karagözogli Ş, Aygün N, Sümer Z (2022) The effect of oral care with black mulberry extract on oral mucositis, dry mouth, and weight gain in patients with cancer. Clin J Oncol Nurs 26(6):636–642. https://doi.org/10.1188/22.CJON.636-642

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Nursing, Faculty of Health Sciences, Karamanoglu Mehmetbey University, Karaman, Turkey

    Tuba Arpaci

  2. Department of Child Health and Disease Nursing, School of Nursing, Koç University, Istanbul, Turkey

    Remziye Semerci

  3. Oncology Hospital, Pediatric Oncology Clinic, Hacettepe University, Ankara, Turkey

    Pınar Yılmaz

Authors
  1. Tuba Arpaci
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Contributions

Tuba Arpaci: conceptualization, investigation, methodology, data curation, original draft preparation, and writing—review and editing. Remziye Semerci: conceptualization, investigation, methodology, data curation, and writing—review and editing. Pınar Yılmaz: methodology and data curation. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Tuba Arpaci.

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Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. The study was approved by the Ethics Commission of the Koç University (Ref. No: 2022.144.IRB3.068).

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The authors declare no competing interests.

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Arpaci, T., Semerci, R. & Yılmaz, P. Nursing care approaches to oral mucositis in pediatric oncology clinics: a cross-sectional study from Türkiye. Support Care Cancer 31, 557 (2023). https://doi.org/10.1007/s00520-023-08030-9

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