Kemoterapi ve Radyoterapi Uygulanan Baş-Boyun Kanserli Hastalarda Mukozit Yönetimine Yönelik Kullanılan Oral Ajanların Retrospektif Olarak İncelenmesi

Year 2017, Volume: 4 Issue: 1, 15 - 27, 18.05.2017

Kübra Çıtlak Sevgisun Kapucu

Abstract

Amaç: Bu araştırma kemoterapi ve radyoterapi uygulanan baş-boyun kanserli hastalarda mukozit yönetimine yönelik kullanılan oral ajanların incelenmesi amacıyla retrospektif tanımlayıcı olarak yapılmıştır. Gereç ve Yöntem: Çalışma Dr. Abdurrahman Yurtaslan Onkoloji Eğitim ve Araştırma Hastanesi Radyasyon Onkolojisi Kliniğinde yürütülmüştür. Araştırmanın örneklemini tanı konduktan sonra tedavi amaçlı planlanmış kemoterapi ve radyoterapi kürü almak için Mayıs 2012-Mayıs 2015 tarihleri arasında klinikte yatışı olan 46 hastanın hastane kayıtları oluşturmuştur. Veriler araştırmacı tarafından geliştirilen dosya inceleme formu kullanılarak toplanmış olup, hasta dosyalarında var olan DSÖ Oral Toksisite Skalasına göre değerlendirilmiş oral mukozit dereceleri bu forma eklenmiştir. Grup farklılıklarının belirlenmesinde Mann Whitney U ve Kruskal Wallis Testi, iki sayısal değişken arasındaki ilişkiye bakmak için Spearman korelasyon testi kullanılmıştır. Bulgular: Araştırmaya alınan baş-boyun kanserli hastaların %39.1’inin 61 yaş ve üzeri, %84.8’inin erkek, %45.7’sinin ise larenks kanseri olduğu belirlenmiştir. Tedavi sürecinde hastaların %13’ünde mukozit görülmez iken, %30.4’ünde Grade 2, %26’sında Grade 3 ve %17.3’ünde Grade 4 seviyesinde oral mukozit görülmüştür. Hastaların %4.4’ünde grade 2 oral mukozitte sukralfat-lidokain karışımı, %6.6’sında grade 3 oral mukozitte nistatin+klorheksidin+L-Glutamin kombinasyonu, %10.9’unda grade 4 oral mukozitte sadece oral L-Glutamin kullanıldığı saptanmıştır.
Sonuç: Araştırmadan elde edilen sonuçlar doğrultusunda; baş-boyun radyoterapisi alanlarda oral mukozit yönetiminde kullanılan ağız bakım ajanlarının etkinliğine ilişkin randomize kontrollü çalışmaların yapılması ve rehberlere göre etkinliği kanıtlanmış ağız bakım ajanlarınının etkin kullanımı önerilmiştir.

Keywords

Ağız bakım ajanları, baş-boyun kanserleri, hemşirelik, oral mukozit, radyoterapi

Retrospective Investigation of Oral Agents Used for Management of Mucositis in Patients With Head and Neck Cancer Receiving Radiotherapy and Chemotherapy

Abstract

Aim: This study was conducted as a retrospective descriptive study with the aim of investigating the oral agents used for management of mucositis in patients with head and neck cancer receiving radiotherapy and chemotherapy. Material and Methods: The study was conducted in Dr. Abdurrahman Yurtaslan Oncology Education and Research Hospital Radiation Oncology Clinic. The sample of the study composed hospital records of 46 patients who were staying at the clinic to get radiotherapy and chemotherapy cures plannned for treatment after diagnosis between May 2012 and May 2015. Data was collected by using a file review form developed by the researcher, degrees of oral mucositis which had already been evaluated according to the WHO oral toxicity scale and was present in patient files were added into the review form. Non-parametric statistics including Mann-Whitney U Test and Kruskal Wallis Test for group comparisons and Spearman’s correlation analysis for relations among quantitative variables were used. Results: Of the patients with head and neck cancer, 39.1% were 61 years old and older, 84.8% were men, 45.7% had laryngeal cancer. During the treatment period while mucositis was not observed in 13% of the patients, Grade 2 oral mucositis was observed in 30.4% of the patients, Grade 3 in 26% of the patients and Grade 4 in 17.3% of the patients. In 4.4% of patients having grade 2 oral mucositis mixture of sucralfat-lidocain was used, in 6.6% of patients having grade 3 oral mucositis nystatin+chlorhexidin+L-Glutamin was used and in 10.9% of patients with grade 4 oral mucositis oral L-Glutamin was used. Conclusion: In the direction of results obtained in this study, it was recommended that randomized controlled studies on the effectiveness of the oral care agents used in the management of oral mucositis in the patients receiving head and neck radiotherapy should be conducted and effective use of the oral care agents, effectiveness of which are proven according to the guides, should be provided.

Keywords

: Oral care agents, head-neck cancers, nursing, oral mucositis, radiotherapy

References

• 1. Öztürk E. Radyoterapi Alan Baş Ve Boyun Kanserli Hastalarda Yaşam Kalitesi Ve Yaşam Kalitesini Etkileyen Faktörler. Sağlık Bilimleri Enstitüsü, İç Hastalıkları Hemşireliği, Yüksek Lisans Tezi, İstanbul: İstanbul Üniversitesi, 2011.
• 2. Hu K, Han P, Harrison LB. Current Management of Oral cavity/oropharynx/Hipoharynx Cancer. In: Haffty, B.G., Wılson, L.D. (eds), Radiation Oncology. Jones and Publishers 2009; 251-278.
• 3. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JWW, Comber H et.al. Cancer incidence and mortality patterns in europe: estimates for 40 countries in 2012. European Journal of Cancer 2013; 49(6): 1374–1440.
• 4. Cancer facts and statistics (internet). Erişim adresi: http://www.cancer.org/research/cancerfactsstatistics/ index. (Erişim tarihi: 12.04.2015).
• 5. WHO 2020 cancer statistics Prediction (internet). Erişim adresi: http://globocan.iarc.fr/Pages/burden_ sel.aspx. (Erişim tarihi: 04.03.2016).
• 6. GLOBOCAN 2012:Estimated incidence,mortality and prevalence worldwide in 2012. Erişim adresi: http://globocan.iarc.fr/Pages/fact_sheets_population.aspx. (Erişim tarihi:12.04.2015).
• 7. World Health Statistics 2012 (internet). Erişim adresi: http://apps.who.int/iris/ bitstream/10665/44844/1/9789241564441_eng.pdf?ua=1&ua=1. (Erişim tarihi: 12.04.2015).
• 8. Sağlık Bakanlığı. 2009 Türkiye kanser istatistikleri (internet). Erişim tarihi: http://kanser.gov.tr/Dosya/ ca_istatistik/2009kanseraporu-1.pdf. (Erişim tarihi: 11.04.2015).
• 9. Sis Çelik A. Radyoterapi sonucu gelişen yan etkiler ve hemşirelik yaklaşımı. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 2014; 3(3): 933-947.
• 10. Rosenthal DI, Trotti A. Strategies for managing radiation-induced mucositis in head and neck cancer. Seminars in Radiation Oncology 2009; 19: 29–34.
• 11. Atasever Akkaş E, Yücel B, Kılıçkap S, Akgül Babacan N, Altuntaş EE. Baş boyun kanserli hastalarda tedavi sonuçları ve prognostik faktörler. Cumhuriyet Tıp Dergisi, 2013; 35: 66-75.
• 12. Haefner MF, Lang K, Krug D, Koerber SA, Uhlmann L, Kieser M ve et. al. Prognostic factors, patterns of recurrence and toxicity for patients with esophageal cancer undergoing definitive radiotherapy or chemo-radiotherapy. Journal of Radiation Research 2015; 1-8. Doi: 10.1093/jrr/rrv022.
• 13. Karthikeyan G, Jumnani D, Prabhu R, Manoor UK, Supe SS. Prevalence of fatigue among cancer patients receiving various anticancer therapies and its impact on quality of Life: A cross-sectional study. Indian Journal of Palliative Care 2012; 18: 165–75.
• 14. Bostanoğlu K. Radyoterapi Alan Baş Boyun Kanserli Hastaların Yaşadıkları Semptomların Belirlenmesi. Sağlık Bilimleri Enstitüsü, Hemşirelik Programı, Yüksek Lisans Tezi, Ankara: Gazi Üniversitesi, 2014.
• 15. Trottia A, Bellmb LA, Epsteinc JB, Framee D, Fuchsb HJ, Gwedea CK et. al. Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiotherapy and Oncology 2003; 66: 253–262.
• 16. Tekinsoy Kartın P. Radyoterapi Uygulanan Baş Boyun Kanserli Bireylerde Oral Mukozit Önleme Protokolünün Yaşam Kalitesine Etkisi. Sağlık Bilimleri Enstitüsü, Hemşirelik Anabilim Dalı, Doktora Tezi, Kayseri: Erciyes Üniversitesi, 2010.
• 17. Roopashri G, Jayanthi K, Guruprasad R. Efficacy of benzydamine hydrochloride, chlorhexidine, and povidone iodine in the treatment of oral mucositis among patients undergoing radiotherapy in head and neck malignancies: A drug trail. Contemporary Clinical Dentistry 2011; 2(1): 8–12.
• 18. Henke M, Alfonsi M, Foa P, Giralt J, Bardet E, Cerezo L et al. Palifermin Decreases Severe Oral Mucositis of Patients Undergoing Postoperative Radiochemotherapy for Head and Neck Cancer: A Randomized, Placebo-Controlled Trial. Journal of Clinical Oncology 2011; 29(20): 2815-2820.
• 19. Kaytan E, Leblebicioğlu B, Coşar R, Taş Ş, Koyuncu H, Öngen B ve et. al. Efficacy of granulocyte macrophage colony-stimulating factor on oral mucositis. Türk Onkoloji Dergisi 2010; 25(1): 20-27.
• 20. Çıtlak K, Kapucu S. Kemoterapi Alan Hastalarda Görülen Oral Mukozitin Önlemesi ve Tedavisinde Güncel Yaklaşımlar: Kanıta Dayalı Uygulamalar. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi 2015; 2(1): 70–77.
• 21. Ünal Çubukçu N, Çınar S. Kemoterapi Alan Kanserli Hastalarda Oral Mukozitler Önlenebilir mi? Marmara Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 2012; 2(4): 155-163.
• 22. Epstein JB, Thariat J, Bensadoun RJ, Barasch A, Murphy BA, Kolnick L et. al. Oral Complications of Cancer and Cancer Therapy. CA: A Cancer Journal of Clinics 2012; 62: 400–422.
• 23. Çukurova İ, Özkul MD, Çerçi İ, Arslan İB, Demirhan E. Baş boyun kanserli hastalarda etiyolojik ve epidemiyolojik faktörler. Türk Otolarengoloji Arsivi 2007; 45(4): 217-223.
• 24. Demir Doğan, M. Baş-Boyun Radyoterapisi Alan Hastalarda Karadut Pekmezinin Oral Mukozitleri Önleme Etkisi. Sağlık Bilimleri Enstitüsü, İç Hastalıkları Hemşireliği, Doktora Tezi, İstanbul: İstanbul Üniversitesi, 2014.
• 25. Van Der Laan HP, Bijl HP, Steenbakkers RJHM, Van Der Schaaf A, Chouvalova O, Vemer-van den Hoek JGM. et. al. Acute symptoms during the course of head and neck radiotherapy or chemoradiation are strong predictors of late dysphagia. Radiotherapy and Oncology 2015; 115: 56–62.
• 26. Vera-Llonch M, Oster G, Hagiwara M, Sonis S. Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma. Cancer 2006; 106(2): 329-336.
• 27. Ferri FF. (Ed.). Stomatitis/Mucositis. In Ferri’s Clinical Advisor (digital version), 20016; 1163-1163. Erişim adresi: https://www.clinicalkey.com/#!/content/book/3-s2.0-B9780323280471007319. (Erişim tarihi: 18.02.2016).
• 28. MASCC=ISOO Evidence-based clinical practice guidelines for mucositis secondary to cancer therapy. Erişim adresi: http://www.mascc.org/assets/GuidelinesTools/mascc%20isoo%20mucositis%20 guidelines%20summary%201feb2014.pdf. (Erişim tarihi: 22.04.2015).
• 29. Can G. Onkoloji Hemşireliğinde Kanıta Dayalı Bakım, 2010 İstanbul Konsesusu. İstanbul: Nobel Tıp Kitabevleri; 2010. s. 57-64.
• 30. Sheıbanı KM, Mafı AR, Moghaddam S, Taslımı F, Amıran A, Amerı A. Efficacy of benzydamine oral rinse in prevention and management of radiation-induced oral mucositis: A double-blind placebocontrolled randomized clinical trial. Asia-Pacific Journal of Clinical Oncology 2015; 11: 22–27.
• 31. Meredıth R, Salter M, Kım R, Spencer S, Weppelmann B, Rodu B. et.al. Sucralfate For Radıatıon Mucosıtıs: Results Of A Double-Blınd Randomızed Trıal. International Journal of Radiation Oncology Biology Physics 1997; 37(2): 275-279.
• 32. Worthington HV, Clarkson JE, Bryan G, Furness S, Glenny AM, Littlewood A. et.al. İnterventions for preventing oral mucositis for patients with cancer receiving treatment. Cochrane Database of Systematic Reviews 2011; 13(4): CD000978.
• 33. Dodd MJ, Dibble SL, Miaskowski C, MacPhail L, Greenspan D, Paul SM. et. al. Randomized clinical trial of the effectiveness of 3 commonly used mouthwashes to treat chemotherapy-induced. Oral Surgery, Oral Medicine, Oral pathology, Oral Radiology, and Endodontics 2000; 90(1): 39-47.
• 34. McGuire DB, Fulton J, Park J, Brown CG, Correa MEP, Eilers J. et. al. Systematic review of basic oral care for the management of oral mucositis in cancer patients. Supportive Care in Cancer 2013; 21: 3165-3177.
• 35. Can G. Onkoloji Hemşireliğinde Kanıttan Uygulamaya, Konsensus 2014. İstanbul: Nobel Tıp Kitabevleri; 2010.
• 36. Madan PD, Sequeira PS, Shenoy K, Shetty J. The effect of three mouthwashes on radiation-induced oral mucositis in patients with head and neck malignancies: a randomized control trial. Journal of Cancer Research and Therapeutics 2008; 4: 3–8.
• 37. Papadeas E, Naxakis S, Riga M, Kalofonos C. Prevention of 5-fluorouracil-related stomatitis by oral cryotherapy: A randomized controlled study. European Journal of Oncology Nursing 2007; 11: 60–65.
• 38. Sonis ST. The pathobiology of mucositis. Nature Reviews Cancer 2004; 4: 277-284.
• 39. Raber-Durlacher JE, Elad S, Barasch A. Oral mucositis. Oral Oncology 2010; 46(6): 452–456.
• 40. Coracin FL, Santos PS, Gallottini MH, Saboya R, Musqueira PT, Barban A. ve et. al. Oral health as a predictive factor for oral mucositis. Clinics 2013; 68(6): 792–796.
• 41. Napenas JJ, Brennan MT, Bahrani-Mougeot FK, Fox PC, Lockhart PB. Relationship between mucositis and changes in oral microflora during cancer chemotherapy. Oral Surgery, Oral Medicine, Oral pathology, Oral Radiology, and Endodontics 2007; 103(1): 48–59.
• 42. Laheij AM, De Soet JJ. Can the oral microflora affect oral ulcerative mucositis? Current Opinion in Supportive and Palliative Care 2014; 8(2): 180–187.
• 43. Velez I, Tamera LA, Mintz S. Management of oral mucositis induced by chemotherapy and radiotherapy. Quintessence International 2004;35: 129-136.
• 44. Saadeh CE. Chemotherapy- and radiotherapy-induced oral mucositis: review of preventive strategies and treatment. Pharmacotherapy 2005; 25: 540-554.
• 45. Vera-Llonch M, Oster G, Hagiwara M, Sonis S. Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma. Cancer 2006; 106(2): 329-336.
• 46. Sideras K, Hallemeier CL, Loprinzi CL. Oral Complications. In Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE. (Ed.) Abeloff’s Clinical Oncology (digital version) (5th ed.) 2014; 635-647. Erişim adresi: https://www.clinicalkey.com/#!/content/book/3-s2.0-B9781455728657000436?scrollTo= %23refInSitubib5. (Erişim tarihi: 18.02.2016)
• 47. Al-Ansari S, Zecha JAEM, Barasch A, De Lange J, Rozema FR, Raber-Durlacher JE. Oral Mucositis Induced By Anticancer Therapies. Current Oral Health Reports 2015; 2: 202–211.
• 48. Cheng KK, Leung SF, Liang RH, Tai JW, Yeung RM, Thompson DR. Severe oral mucositis associated withcancer therapy: impact on oral functional status and quality of life. Support Care Cancer 2010; 18: 1477–1485.
• 49. Murphy B, Beaumont J, Isitt J, Garden A, Gwede C. Mucositis-Related Morbidity and Resource Utilization in Head and Neck Cancer Patients Receiving Radiation Therapy With or Without Chemotherapy. Journal of Pain and Symptom Management 2009; 38(4), 522-532