Managing Oral Mucositis in Cancer Patients: The Role of Cryotherapy

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Oral mucositis is a painful condition characterized by inflammation and ulceration of the mucous membranes lining the oral cavity, often caused by chemotherapy, hematopoietic stem cell transplantation, and radiotherapy. It is estimated that 40% of patients receiving cytotoxic chemotherapy for solid tumor treatment and up to 80% of patients receiving high doses of chemotherapy to undergo stem cell transplantation will experience oral mucositis. The incidence of oral mucositis in patients receiving head and neck radiotherapy is as high as 90%, with some studies reporting 100% of cases. The symptoms of oral mucositis affect quality of life and range from pain, oral bleeding, taste changes, risk of infection, and compromised oral function that is associated with ulcerative lesions.

The World Health Organization (WHO) mucositis grading scale is used to evaluate the severity of mucositis, grading oral mucositis from 0 to 4, with 0 as no oral mucositis. Supportive therapies are the primary management of oral mucositis, such as the application of mouthwash, oral hygiene, and adequate liquid consumption. Current pharmacologic guidelines include the use of nonsteroidal anti-inflammatory drugs, polyvinylpyrrolidone, and hyaluronic acid, and analgesics such as morphine mouthwash for severe pain. One of the key interventions for the prevention and reduction of the severity of oral mucositis is oral cryotherapy in conjunction with basic oral care, which includes the use of ice-cold water, ice chips, or popsicles during chemotherapy, causing regional hypothermia and reducing the metabolic function of the epithelial and basal cells.

The Mucositis Study Group of the Multinational Association of Supportive Care in Cancer (MASCC/ISOO) developed guidelines for oral mucositis that support implementing cryotherapy to aid in prevention. The use of cryotherapy is also supported because of its safety, accessibility, and cost-effectiveness. Other potential management options for oral mucositis include the use of sodium bicarbonate, photobiomodulation, and honey. Sodium bicarbonate mouthwash has been used because of its ability to create an alkaline environment in the oral cavity, decreasing the opportunity for bacteria to multiply. Photobiomodulation involves low-level laser therapy using either red or near-infrared light lasers over the lesions or tissue to reduce inflammation and provide pain relief. The use of conventional honey as prevention and treatment of oral mucositis has much potential, as it has been studied as a treatment for burns to help with epithelial healing.

Studies have shown that oral cryotherapy can significantly reduce the incidence of oral mucositis in patients receiving chemotherapy. A meta-analysis conducted by Park et al included 919 cancer patients from 15 studies to evaluate the effectiveness of oral cryotherapy in the prevention of oral mucositis. The occurrence of oral mucositis was statistically lower in patients receiving chemotherapy for solid tumors compared to those with hematologic malignancies. Specifically, the incidence of WHO grade 2 to 4 oral mucositis was found to be significantly lower with the use of cryotherapy before and during the administration of the chemotherapy. The findings suggest the application of oral cryotherapy during chemotherapy, specifically 5-FU and cisplatin, for solid tumors, was successful in preventing oral mucositis. Cryotherapy has become a standard of care in some clinical settings, and because of its affordability and safety, providers should implement it as a standard of care within their outpatient clinical setting. This simple intervention can help give patients an improved quality of life and ease some of the burden they experience while undergoing cancer treatment, reducing the risk of mucositis and improving patient outcomes.

In conclusion, oral mucositis is a common and debilitating side effect of cancer treatment, but there are effective management options available. Oral cryotherapy is a simple, safe, and cost-effective intervention that can help prevent and reduce the severity of oral mucositis. Healthcare providers should consider implementing oral cryotherapy as a standard of care for patients receiving chemotherapy, and patients should be educated on the importance of oral care and the benefits of cryotherapy in preventing oral mucositis. By working together, we can improve the quality of life for cancer patients and reduce the burden of oral mucositis. Some of the key points to consider include: * The use of oral cryotherapy in conjunction with basic oral care * The implementation of supportive therapies such as mouthwash and oral hygiene * The use of pharmacologic guidelines such as nonsteroidal anti-inflammatory drugs and analgesics * The potential benefits of sodium bicarbonate, photobiomodulation, and honey in managing oral mucositis * The importance of patient education and awareness of oral mucositis prevention and management.