Hospital Pharmacist Interventions for the Management of Oral Mucositis in Patients with Head and Neck Cancer Receiving Chemoradiotherapy: a Multicenter, Prospective Cohort Study

Overview

Journal Support Care Cancer

Specialties Critical Care
Oncology

Date 2023 May 3

PMID 37133630

Authors

Kensuke Yoshida

Shinichi Watanabe

Naoto Hoshino

Kyongsun Pak

Noriaki Hidaka

Noboru Konno

Masaki Nakai

Chinami Ando

Tsuyoshi Yabuki

Naoto Suzuki

Kouji Katsura

Kei Tomihara

Akira Toyama

Affiliations

Soon will be listed here.

Abstract

Purpose: Oral mucositis is a severe adverse event in patients with head and neck cancer (HNC) receiving chemotherapy and radiotherapy that may cause the termination of cancer treatment. In this study, we aimed to reveal the benefits of pharmacist interventions in oral health care for patients with HNC receiving concurrent chemoradiotherapy (CCRT).

Methods: We conducted a multicenter, prospective cohort study on 173 patients from September 2019 to August 2022. We evaluated the association between the occurrence of oral mucositis during CCRT and various factors in the absence or presence of direct medication instructions from hospital pharmacists.

Results: Sixty-eight patients received medication instructions from pharmacists (the pharmacist intervention group), whereas 105 patients did not receive instructions (the control group). Logistic regression analysis showed that grade 2 (Gr 2) oral mucositis was significantly lower in patients receiving pharmacist interventions than in patients in the control group (adjusted odds ratio [aOR], 0.42; 95% confidence interval [CI], 0.18-0.96; P = 0.04). The time to onset of Gr 2 oral mucositis was significantly longer in the pharmacist intervention group than in the control group (hazard ratio, 0.53; 95% CI, 0.29-0.97; P = 0.04).

Conclusion: Direct intervention, especially when provided by hospital pharmacists, can have a real effect in supporting patients with HNC experiencing severe side effects of treatments. Moreover, the integration of pharmacists into the oral healthcare team is becoming even more essential to reduce the severity of side effects.

References

Saito H, Watanabe Y, Sato K, Ikawa H, Yoshida Y, Katakura A . Effects of professional oral health care on reducing the risk of chemotherapy-induced oral mucositis. Support Care Cancer. 2014; 22(11):2935-40. PMC: 4183888. DOI: 10.1007/s00520-014-2282-4. View

Kubota K, Kobayashi W, Sakaki H, Nakagawa H, Kon T, Mimura M . Professional oral health care reduces oral mucositis pain in patients treated by superselective intra-arterial chemotherapy concurrent with radiotherapy for oral cancer. Support Care Cancer. 2015; 23(11):3323-9. DOI: 10.1007/s00520-015-2774-x. View

Legert K, Remberger M, Ringden O, Heimdahl A, Dahllof G . Reduced intensity conditioning and oral care measures prevent oral mucositis and reduces days of hospitalization in allogeneic stem cell transplantation recipients. Support Care Cancer. 2014; 22(8):2133-40. DOI: 10.1007/s00520-014-2190-7. View

Soga Y, Sugiura Y, Takahashi K, Nishimoto H, Maeda Y, Tanimoto M . Progress of oral care and reduction of oral mucositis--a pilot study in a hematopoietic stem cell transplantation ward. Support Care Cancer. 2010; 19(2):303-7. DOI: 10.1007/s00520-010-1002-y. View

Peterson D, Boers-Doets C, Bensadoun R, Herrstedt J . Management of oral and gastrointestinal mucosal injury: ESMO Clinical Practice Guidelines for diagnosis, treatment, and follow-up. Ann Oncol. 2015; 26 Suppl 5:v139-51. DOI: 10.1093/annonc/mdv202. View

Elad S, Cheng K, Lalla R, Yarom N, Hong C, Logan R . MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2020; 126(19):4423-4431. PMC: 7540329. DOI: 10.1002/cncr.33100. View

Leppla L, de Geest S, Fierz K, Deschler-Baier B, Koller A . An oral care self-management support protocol (OrCaSS) to reduce oral mucositis in hospitalized patients with acute myeloid leukemia and allogeneic hematopoietic stem cell transplantation: a randomized controlled pilot study. Support Care Cancer. 2015; 24(2):773-782. DOI: 10.1007/s00520-015-2843-1. View

Yoshida K, Kodama Y, Tanaka Y, Pak K, Soga M, Toyama A . Pharmacist involved education program in a multidisciplinary team for oral mucositis: Its impact in head-and-neck cancer patients. PLoS One. 2021; 16(11):e0260026. PMC: 8608342. DOI: 10.1371/journal.pone.0260026. View

Yokota T, Tachibana H, Konishi T, Yurikusa T, Hamauchi S, Sakai K . Multicenter phase II study of an oral care program for patients with head and neck cancer receiving chemoradiotherapy. Support Care Cancer. 2016; 24(7):3029-36. DOI: 10.1007/s00520-016-3122-5. View

10.

Okada H, Onda M, Shoji M, Sakane N, Nakagawa Y, Sozu T . Effects of lifestyle advice provided by pharmacists on blood pressure: The COMmunity Pharmacists ASSist for Blood Pressure (COMPASS-BP) randomized trial. Biosci Trends. 2017; 11(6):632-639. DOI: 10.5582/bst.2017.01256. View

11.

Okada H, Johnston K, Nakayama T, Marra C, Tsuyuki R . Economic Evaluation of Pharmacists Tackling the Burden of Hypertension in Japan. Hypertension. 2019; 74(6):e54-e55. DOI: 10.1161/HYPERTENSIONAHA.119.13527. View

12.

Nutting C, Morden J, Harrington K, Urbano T, Bhide S, Clark C . Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol. 2011; 12(2):127-36. PMC: 3033533. DOI: 10.1016/S1470-2045(10)70290-4. View

13.

Saito Y, Takekuma Y, Takeshita T, Oshino T, Sugawara M . Impact of systemic dexamethasone administration on oral mucositis induced by anthracycline-containing regimens in breast cancer treatment. Sci Rep. 2022; 12(1):12587. PMC: 9307799. DOI: 10.1038/s41598-022-16935-4. View

14.

Mirabile A, Airoldi M, Ripamonti C, Bolner A, Murphy B, Russi E . Pain management in head and neck cancer patients undergoing chemo-radiotherapy: Clinical practical recommendations. Crit Rev Oncol Hematol. 2015; 99:100-6. DOI: 10.1016/j.critrevonc.2015.11.010. View

15.

Silver N, Dourado J, Hitchcock K, Fullerton A, Fredenburg K, Dziegielewski P . Chronic opioid use in patients undergoing treatment for oropharyngeal cancer. Laryngoscope. 2019; 129(9):2087-2093. DOI: 10.1002/lary.27791. View

16.

Konopka-Filippow M, Zabrocka E, Wojtowicz A, Skalij P, Wojtukiewicz M, Sierko E . Pain management during radiotherapy and radiochemotherapy in oropharyngeal cancer patients: single-institution experience. Int Dent J. 2015; 65(5):242-8. PMC: 9376506. DOI: 10.1111/idj.12181. View

17.

Fasano M, DOnofrio I, Belfiore M, Angrisani A, Caliendo V, Della Corte C . Head and Neck Squamous Cell Carcinoma in Elderly Patients: Role of Radiotherapy and Chemotherapy. Cancers (Basel). 2022; 14(3). PMC: 8833743. DOI: 10.3390/cancers14030472. View

18.

Perez-Jover V, Mira J, Carratala-Munuera C, Gil-Guillen V, Basora J, Lopez-Pineda A . Inappropriate Use of Medication by Elderly, Polymedicated, or Multipathological Patients with Chronic Diseases. Int J Environ Res Public Health. 2018; 15(2). PMC: 5858379. DOI: 10.3390/ijerph15020310. View

19.

van Beek F, Wijnhoven L, Holtmaat K, Custers J, Prins J, Verdonck-de Leeuw I . Psychological problems among cancer patients in relation to healthcare and societal costs: A systematic review. Psychooncology. 2021; 30(11):1801-1835. PMC: 9291760. DOI: 10.1002/pon.5753. View