Advancing Proactive Care in Oral Mucositis Management for Head & Neck Cancer Patients

Authors

Fahida Rehman, Lead Head & Neck/Thyroid Cancer Clinical Nurse Specialist, Torbay & South Devon NHS Foundation Trust

Rohit Sagoo, PhD Researcher, University of Bedfordshire  

Oral mucositis (OM) is a common and debilitating adverse effect of radiotherapy, chemotherapy, or a combination of both in head and neck cancer treatment, characterised by painful inflammation and ulceration of the mucosal membranes in the mouth and throat, leading to pain and discomfort, impacting the ability to speak, swallowing difficulty, and compromised nutrition (Singh & Singh, 2020). The impact of this has been shown to increase opioid use, weight loss, feeding tube placement, and hospitalisation; Symptoms which can increase the risk of treatment interruptions, potentially compromising clinical outcomes (Blakaj et al., 2019). The challenges are not only in alleviating the patient’s suffering but also in optimising treatment outcomes. Studies have shown that severe OM occurs in 29-66% of patients receiving radiation (PS et al, 2009). Early detection, correct assessment and treatment plans with active intervention are paramount, in order to avoid or minimise oral problems, prevent delays or interruptions to anti-cancer treatment plans and to maximise patient comfort (UKOMiC).

Given the multilayered impact of OM, proactive care and preventative measures emerge as imperative components of cancer treatment protocols. In pursuing proactive care, choosing interventions becomes pivotal; among the arsenal of options, GelX® emerges as an effective ally in treating OM. This specially formulated gel combines efficacy with patient comfort, providing a protective barrier over the oral mucosa, which also has the added benefit of easy-to-use instructions and application. Its soothing properties help alleviate pain and discomfort, improving oral hygiene and nutritional intake (Zannier et al., 2019); this is also significant with paediatric patients (Dragomir, 2015). Additionally, Dragomir’s findings showed pain reduction in 80% of patients after treatment with GelX®, swallowing difficulties were reduced in 74% of patients, and improvement in OM severity, preventing delays in treatment.

Steinmann et al. (2021) state that due to the complexities of OM, there is strong evidence to suggest a lack of treatment preventions for OM. In contrast, GelX® is a supportive measure to reduce OM risk and severity (Fondevilla et al., 2022). By incorporating GelX® into the treatment plan, healthcare professionals can enhance the overall proactive care strategy, contributing to a more favourable treatment trajectory for their patients (Zannier et al., 2019). We have found that ease of application and positive impact on pain management have translated into improved patient compliance with prescribed interventions. Moreover, by incorporating GelX® in our proactive care approach, we have observed a notable reduction in the severity of OM cases, allowing patients to navigate their cancer treatment with greater resilience and minimal disruptions. In Niculita et al.’s (2020) study cohort, no patients discontinued chemotherapy or radiotherapy because of OM. GelX® Oral Spray was well tolerated, with no adverse device effects attributed to product usage. Furthermore, Minniti et al. (2023) findings suggest that GelX® may serve as a valuable adjunct in preventing and managing OM, in conjunction with proper oral hygiene and dietary measures. Further investigations are warranted to validate its efficacy in mitigating this significant complication and enhancing clinical approaches to OM management.

Innovative solutions like GelX® not only address OM symptoms but enhance the overall treatment experience for patients experiencing head and neck cancer. Prioritising proactive care, preventative strategies, nutritional support, effective pain management, patient education, and interdisciplinary collaboration, can significantly enhance the well-being of individuals undergoing cancer treatment. This comprehensive approach minimises the impact of OM, paving the way for a smoother treatment journey, ultimately contributing to improved outcomes and enhanced quality of life for our patients. This article has a comprehensive examination of GelX®, an available treatment option for nursing OM. The current evidence-based practice regarding GelX® demonstrates how oral hygiene care standards can be developed to treat and prevent OM.

References

Singh V, Singh AK. Oral mucositis. Natl J Maxillofac Surg. 2020 Jul-Dec;11(2):159-168. doi: 10.4103/njms.NJMS_10_20. Epub 2020 Dec 16. PMID: 33897175; PMCID: PMC8051654. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051654/

Blakaj A, Bonomi M, gamezME, Blakaj DM. (2019). Oral mucositis in head and neck cancer:evidence-based mangement and review of clinical trial data.. Oral Oncology. 95(05.013), pp.29-34. https://doi.org/10.1016/j.oraloncology.2019.05.013

Ps SK, Balan A, Sankar A, Bose T. Radiation induced oral mucositis. Indian J Palliat Care. 2009 Jul;15(2):95-102. doi: 10.4103/0973-1075.58452. PMID: 20668585; PMCID: PMC2902123. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902123

UKOMiC.  https://www.stlukes-hospice.org.uk/wp-content/uploads/2017/06/UK_OM_Guidelines_v3.pdf

Dragomir, M. (2015). 1593 gelx oral spray in prevention and treatment of chemotherapy-induced oral mucositis in children with cancer. European Journal of Cancer, 51, S235. https://doi.org/10.1016/s0959-8049(16)30682-7

Fondevilla, A., Serradilla, A., Moreno-Olmedo, E., Matskov, K., Belmonte, M., Sáez, A., Acevedo, M.,   & López, E. (2022). Radiochemotheraphy-induced oral mucositis: ectoin solution as a new treatment. Journal of Clinical and Experimental Dentistry, e433-e438. https://doi.org/10.4317/jced.59110

Minniti et al (2023). The 49th annual meeting of the European society for blood and marrow transplantation: nurses group – poster sessions (np001-np041). Bone Marrow Transplantation, 58(S1), 638-659. https://doi.org/10.1038/s41409-023-02058-5

Niculita O, Jercan C, Colita A,. (2020). The efficacy of Polyvynilpyrrolidone-Zn Gluconate and Taurine in the Prevention of Oral Mucositis in Haematological Pati. Revista De Chimie. 71(8), pp.195-205. 10.37358/RC.20.8.8280

Steinmann, D., Savaş, B. B., Felber, S., Joy, S., Mertens, I., Cramer, H., Voiß, P. (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. Integrative Cancer Therapies, 20, 153473542094041. https://doi.org/10.1177/1534735420940412

Zannier F, Di Bella S, Della Torre S. (2019). Effects of three products in the prevention and treatment of chemotherapy and radiation therapy -induced oral mucositis. Annals of Oncology. 30(5), p.20. https://www.annalsofoncology.org/article/S0923-7534(19)58306-5/fulltext