ONS Connect - January 2008 - (Page 23)

Figure 1. Interventions for Oral Mucositis Recommended for Practice • Oral care protocols Likely to Be Effective • Cryotherapy for bolus chemotherapy with short half-life (e.g., bolus 5-fluorouracil, melphalan) • Palifermin for autologous hematopoietic stem cell transplantation for hematologic malignancies Effectiveness Not Established • Allopurinol • Aloe vera • Amifostine • Anti-inflammatory rinses • Antimicrobial agents • Benzydamine hydrochloride • Flurbiprofen tooth patch • Granulocyte–colony-stimulating factor (subcutaneous) • Granulocyte macrophage–colonystimulating factor (subcutaneous) • Immunoglobin • L-alanyl-l-glutamine • Low-level laser therapy • Multiagent (“magic”) rinses • Pilocarpine • Povidone-iodine • Tetracaine • Zinc supplements Effectiveness Unlikely • Iseganan Not Recommended for Practice • Chlorhexidine • Granulocyte macrophage–colonystimulating factor mouthwash • Sucralfate Note. Based on information from Harris et al., in press. Figure 2. Core Elements of an Oral Care Protocol Clinicians • Collaborate with a multidisciplinary team in all phases of treatment. • Conduct a systematic assessment daily or at least at each patient visit. In the outpatient setting, teach patients to perform oral assessments daily. Teach patients when to report findings to clinicians. • Provide written instruction and education to patients regarding oral care. Verify understanding with return explanations and demonstrations. Patients • Brush all tooth surfaces for at least 90 seconds and at least twice daily using a soft toothbrush. Allow toothbrush to air dry before storing. Replace toothbrush on a regular basis. • Floss at least once daily or as advised by clinicians. • Rinse mouth four times a day with a bland rinse. • Avoid tobacco, alcohol, and irritating foods (e.g., acidic, hot, rough, spicy). • Use water-based moisturizers to protect lips. • Maintain adequate hydration. Note. From “Putting Evidence Into Practice®: Evidence-Based Interventions for Management of Mucositis in People Receiving Treatment for Cancer,” by D.J. Harris, J. Eilers, A. Harriman, B.J. Cashavelly, and C. Maxwell, in press, Clinical Journal of Oncology Nursing. Copyright 2007 by the Oncology Nursing Society. Reprinted with permission. illustrates the minimum elements of a good oral care protocol. Two other interventions were deemed to be likely to be effective, but only for particular patient populations. The literature demonstrated that cryotherapy can reduce oral mucositis in patients receiving rapid infusions of 5-fluorouracil or melphalan. Cryotherapy causes vasoconstriction in the oral cavity, protecting the area during the agents’ short half-life. It has not been proven effective with other agents to date. Palifermin (Kepivance®, Amgen)—recombinant human keratinocyte growth factor—stimulates the growth of epithelial cells and reduces the severity and duration of oral mucositis in patients with hematologic malignancies who receive high-dose chemotherapy and total body irradiation with autologous stem cell transplantation. Many other methods and agents have been tested or are in clinical trials for the management of oral mucositis. The PEP team’s review did not demonstrate that any has yet proven its utility. However, the team did find that expert opinion (i.e., low-risk interventions that are consistent with sound clinical practice, are suggested by an expert in a peer-reviewed publication, and have limited evidence) agreed that oral care protocols, including bland rinses (0.9% saline, sodium bicarbonate, or a combination), can be effective in reducing the effects of mucositis. The ONS PEP card on mucositis is available in volume 2 of the ONS PEP cards, which also contains cards on caregiver burden and strain, constipation, depression, dyspnea, and peripheral neuropathy. To order the pocket cards, visit http://esource.ons.org/Publications or e-mail customer.service@ons.org. ✱ Harris, D.J., Eilers, J., Harriman, A., Cashavelly, B.J., & Maxwell, C. (in press). Putting Evidence Into Practice®: Evidence-based interventions for management of mucositis in people receiving treatment for cancer. Clinical Journal of Oncology Nursing. JANUARY 2008 ONS CONNECT 23 http://esource.ons.org/Publications

Table of Contents Feed for the Digital Edition of ONS Connect - January 2008

ONS Connect - January 2008 Contents Editor's Note Just In Up Front You Tell Us Up Close & Professional Web Connect Capitol Connection Notice Nursing Now Caregiver Care Five Minute In-Service New Treatments, New Hope Calendar of Events ONS Election Working For You Staying On Top

ONS Connect - January 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.