An evidence-based guideline on using cryotherapy for chemotherapy-induced oral mucositis in adult cancer patients

Abstract

Oral mucositis is a common adverse side-effect caused by cancer treatments and can lead to mucosa toxicity. Patients with oral mucositis may experience extreme pain and may not be able to eat, drink and talk and, as a result, their quality of life is impaired. Thirty to eighty five percent of patients undergoing chemotherapy would develop oral mucositis. Preventing or reducing incidence of oral mucositis and its severity can help reduce patients’ sufferings. One of the methods to achieve this objective is the oral cryotherapy, which is a prophylactic intervention. However, there is no evidence-based guideline to instruct nurses on providing oral cryotherapy to cancer patients.

The aims of this study are 1) to establish an evidence-based guideline on applying cryotherapy to reduce the incidence and severity of chemotherapy-induced oral mucositis, 2) to develop a standard nursing care and assess its transferability and feasibility, and 3) to develop a communication plan and evaluation plan for this guideline in an oncology ii-

department for the targeted local hospitals in Hong Kong.

A systematic search of four electronic journal databases identified seven articles corresponding to 6 randomized controlled trials (RCTs) on using oral cryotherapy for adult cancer patients. Five RCTs with high to weak quality reported supporting evidence for the beneficial effect of oral cryotherapy on chemotherapy-induced oral mucositis, whereas 1 RCT with moderate quality failed to identify supportive evidence for the use of oral cryotherapy. However, potential confounding factors were identified to be presented in that insignificant RCT. Hence, there was sufficient evidence to show that oral cryotherapy can significantly reduce chemotherapy-induced oral mucositis in adult cancer patients.

An evidence based guideline for using cryotherapy on chemotherapy-induced oral mucositis in adult cancer patients was established. The transferability and feasibility of the proposed oral cryotherapy guideline were assessed. As identified, the clinical situation and patient characteristics in the local settings are similar to those who reported in the reviewed studies. Staff readiness, skills and resources are also readily available in the target clinical settings. Findings from the reviewed studies of oral cryotherapy can be transferred to the local target settings and are feasible to be implemented. It is also estimated that the innovated guidelines for cryotherapy can save HK$3,210,745 per year for the target setting.

Stakeholders for the innovated guideline in the local setting were identified. And a communication plan was developed. A pilot study lasting for 10 weeks will be conducted to test the feasibility of the staff training session and the implementation of the oral cryotherapy guideline. Modification of innovated guidelines will be made after evaluating the data collected from the pilot study. Eventually, the final version of the evidence-based guideline will be established. A six months evaluation plan will be used to evaluate the implementation of the new guideline. The policy for adopting the oral cryotherapy will be determined with the outcome measures, including the incidence of chemotherapy-induced oral mucositis, mean of the oral mucositis score, staff satisfaction level, and the cost and benefit ratio of the innovated guideline.