A COMPARATIVE STUDY TO ASSESS THE EFFECTIVENESS OF POVIDONE IODINE MOUTHWASH VERSUS CHLORHEXIDINE WASH ON RADIATION THERAPY OR CHEMOTHERAPY INDUCED ORAL MUCOSITIS AMONG CANCER PATIENTS IN GANDHI MEDICAL COLLEGE BHOPAL, MADHYA PRADESH

Abstract

          Mucositis is also called as stomatitis is a common, debilitating complication of cancer chemotherapy and radiotherapy occurring in about 40% of patients. Mucositis may limit patient’s ability to tolerate chemotherapy and radiotherapy.

          In the year 2008 research conducted in England on mouth care for the patients receiving oral irradiations and found that oral irradiation causes acute Mucositis and pain, dry mouth, loss of taste, impaired nutrition, depression and isolation. These problems can be significantly improved by skilled; research- based nursing care reported that 70 % of 100 patients were found severe cases of oral Mucositis

          In the year 2008 A retrospective cohort study was conducted on risk, outcomes and costs of radiation induced Oral Mucositis among patients with head and neck malignancies which consisted of 204 consecutive head- neck cancer patients who received radiation therapy with or without chemotherapy during 2008. Result showed that Oral Mucositis occurred in 91% of patients, in 66% it was severe (grade 3-4). Patients with Oral Mucositis were significantly more likely to have severe pain and weight loss.

          In the year 2009 A study was conducted in the department of dental medicine, Winthrop university hospital New York, and it stated that the oral mucosa in common site for collateral damages of cancer therapies, including radiation, cytotoxic medication and newer targeted therapies. Ulcerative Oral Mucositis is typically painful and affect oral functions including speech, oral intake of food and medication, thus impacting the quality of life. Denuded epithelium may also provide access of oral microbial flora to the deeper the tissues and circulation.

          In the year 2011 A study was conducted in san Francisco general hospital, the USA to determine the pattern, severity and time course of radiation therapy induced Oral Mucositis pain, self care behaviors used to manage Mucositis pain and the effectiveness of these behaviors in relieving such pain. Forty nine patients with Mucositis we assessed using MacDibbs mouth assessment tool to determine the severity of radiation therapy induced Mucositis pain over their course of radiation therapy and at one month follow up visit. All patients developed pain due to radiation therapy induced Mucositis. A self care diary was used weekly by patients to record SCBs and their effectiveness. The most effective SCBs for RT induced Mucositis pain were mouth rinsing and using oral analgesics.

          Each year American cancer society estimates the number of new cancer cases and deaths that will occur in the united stated in the current year and complies the most recent data on cancer incidence, mortality and survival. Incidence data were collected by the national cancer institute (surveillance epidemiology and end results [SEER] program), the centers for disease control and prevention (national program for cancer registries), and the north American association of central cancer registries. Mortality data were collected by the national centre for health statistics. A total of 1,658,370 new cancer cases and 589,430 cancer deaths are projected to occur in the United States in 2015. During the most recent 5 years for which there are data (2007-2011), delay adjusted cancer incidence rates (13 oldest SEER registries) declined by 1.8% per year in men and by 1.4% per year in women.

          There are some standardized oral care protocol including brushing with a soft toothbrush, flossing and the use of non-medicated rinses. Patients and care givers should be educated regarding the importance of effective oral hygiene. Alcohol containing Chlorhexidine mouth rinse is considered as one of the most effective mouth washes. Multiple studies have examined the role of Chlorhexidine mouthwash in Oral Mucositis. 

          With my clinical experience in oncology ward, I came across patients undergoing chemotherapy or radiation and some both as treatment regimen. Though this helped in killing or destroying the cancer cells, it also caused a significant damage to oral mucosa layer with symptoms like pain, difficulty in swallowing, ulcer of oral cavity, bleeding and this further lead to infections, poor appetite and thus there is a great weight loss seen in these patients. Rinsing the mouth daily with Chlorhexidine solution is a preventive measure frequently recommended by nurses and doctors.

          To extent to which these mouthwashes actually help to prevent Mucositis is unclear. Clinical practice guidelines for the prevention and treatment of cancer therapy induced Oral Mucositis have been produced, but only two studies we used as evidence to support the use of Chlorhexidine although there are more studies available in the international literature.