Developing Ice Cream for Mucositis Management and Improving the Nutritional Support for Pediatric Cancer Patients / Desenvolvimento de um Sorvete para Prevenção e Tratamento da Mucosite e Suporte Nutricional a Pacientes Pediátricos com Câncer / Desarrollo de Helados para el Manejo de la Mucositis y del Soporte Nutricional a Pacientes Pediátricos con Cáncer

Introduction: Mucositis is one of the main complications of cancer treatment, associated with several nutritional limitations and the ability to cause secondary infections. Cryotherapy is a low-cost treatment consistent with clinical practice guidelines for treating patients with mucositis. Objective: To develop and evaluate the acceptance of ice cream for the prevention and treatment of mucositis and nutritional support of pediatric cancer patients. Method: Based on knowledge about the side effects of chemotherapy (especially in oral and gastrointestinal mucositis) and the nutritional needs of pediatric cancer patients, a literature search for ingredients that could meet the study's objectives was undertaken. Food Technology Laboratory of the São Paulo State University (Unesp), Botucatu campus, and in partnership with Sorvetes Naturais ice cream shop in the municipality of Botucatu-SP, produced the ice cream. An acceptance test was applied in ten patients undergoing cancer treatment and 30 individuals in the control group using the 5-point mixed facial hedonic scale. Results: The final formula consisted of semi-skimmed lactose-free milk, extra virgin coconut oil, oat flour, honey, chamomile, Fortini food supplement, demerara sugar, and stabilizer/emulsifier. 90% of patients undergoing cancer treatment rated the final product as "liked" or "loved it," compared to 63% of the control group. Conclusion: Development of an ice cream that met the objectives of the study was possible through the choice of its composition. Honey and chamomile can favor the prevention of mucositis, and other ingredients offer the caloric density and protein supply.

Introdução: A mucosite é uma das principais complicações do tratamento oncológico, está associada a várias limitações nutricionais e é capaz de causar infecções secundárias. A crioterapia é uma forma de tratamento de baixo custo, consistente com as diretrizes de prática clínica para o cuidado de pacientes com mucosite. Objetivo: Desenvolver e avaliar a aceitação de um sorvete para prevenção e tratamento da mucosite e para suporte nutricional de pacientes pediátricos com câncer. Método: Baseado no conhecimento sobre os efeitos colaterais da quimioterapia (especialmente na mucosite oral e gastrointestinal) e nas necessidades nutricionais do paciente oncológico pediátrico, buscou-se, na literatura, por ingredientes que pudessem alcançar os objetivos do estudo. O sorvete foi produzido no Laboratório de Tecnologia de Alimentos da Universidade Estadual Paulista (Unesp), campus de Botucatu, e em parceria com a sorveteria Sorvetes Naturais no município de Botucatu-SP. Foi realizado teste de aceitação com dez pacientes em tratamento oncológico e com 30 indivíduos do grupo controle usando a escala hedônica facial mista de 5 pontos. Resultados: A fórmula final consistiu em leite sem lactose semidesnatado, óleo de coco extravirgem, farinha de aveia, mel, camomila, suplemento alimentar Fortini, açúcar demerara e estabilizante/emulsificante. Dos pacientes em tratamento oncológico, 90% classificaram o produto final em "gostei" ou "adorei", comparado com 63% do grupo controle. Conclusão: O desenvolvimento de um sorvete que alcançasse os objetivos do estudo foi possível por meio da escolha da sua composição. O mel e a camomila podem favorecer a prevenção da mucosite, e outros ingredientes oferecem densidade calórica e oferta proteica.

Introducción: La mucositis es una de las principales complicaciones del tratamiento del cáncer, asociada a varias limitaciones nutricionales y la capacidad de causar infecciones secundarias. La crioterapia es una forma de tratamiento de bajo costo consistente con las guías de práctica clínica para el cuidado de pacientes con mucositis. Objetivo: Desarrollar y evaluar la aceptación de un helado para la prevención y tratamiento de la mucositis y para el apoyo nutricional de pacientes pediátricos con cáncer. Método: Con base en el conocimiento sobre los efectos secundarios de la quimioterapia (especialmente en la mucositis oral y gastrointestinal) y las necesidades nutricionales de los pacientes con cáncer pediátrico, buscamos en la literatura ingredientes que pudieran lograr los objetivos del estudio. El helado fue producido en el Laboratorio de Tecnología de Alimentos de la Universidad Estatal de São Paulo (Unesp), campus de Botucatu y en sociedad con la heladería Sorvetes Naturais del municipio de Botucatu-SP. Se realizó una prueba de aceptación con diez pacientes en tratamiento oncológico y 30 individuos del grupo control utilizando la escala hedónica facial mixta de 5 puntos. Resultados: La fórmula final estuvo compuesta por leche semidesnatada sin lactosa, aceite de coco virgen extra, harina de avena, miel, manzanilla, complemento alimenticio Fortini, azúcar demerara y estabilizante/emulsionante. El 90% de los pacientes en tratamiento contra el cáncer calificaron el producto final como "me gustó" o "me encantó", en comparación con el 63% del grupo de control. Conclusión: El desarrollo de un helado que cumpliera con los objetivos del estudio fue posible a través de la elección de su composición. La miel y la manzanilla pueden favorecer la prevención de la mucositis y otros ingredientes ofrecen densidad calórica y aporte proteico.

Efeitos da sinvastatina na mucosite gastrointestinal induzida por 5-fluorouracil em ratos / Effects of simvastatin on 5-fluorouracil-induced gastrointestinal mucositis in rats

RESUMO Objetivo: examinar os efeitos da sinvastatina na mucosite gástrica e intestinal após o tratamento com 5-fluorouracil (5-FU), determinados pela expressão de citocinas e histologia em ratos. Métodos: ratos pesando 270±15g foram divididos em dois grupos. O grupo 5-FU+salina foi tratado com 5-FU (50mg/kg) mais solução salina a 0,9% por gavagem uma vez ao dia por cinco dias. O grupo 5-FU+sinvastatina foi tratado com 5-FU (50mg/kg), mais sinvastatina (10mg/kg), da mesma forma. Foi feita a eutanásia dos animais no sexto dia. O estômago e o intestino foram fotografados e removidos para exame. Dosagens séricas de TNF-a, IL-1ß, IL-6 e histopatologia (coloração HE) do estômago e intestino foram realizadas. Resultados: o peso corporal diminuiu em ratos no grupo 5-FU+salina. A sinvastatina não inibiu a perda de peso induzida pelo 5-FU. Danos significativos da mucosa no estômago e no jejuno foram observados em ratos que receberam apenas 5-FU. As dosagens séricas de citocinas foram significativamente menores no grupo 5-FU+sinvastatina do que no grupo 5-FU (p<0,05). A sinvastatina causou efeitos protetores significativos contra as lesões da mucosa gástrica e jejunal induzidas por 5-FU. Conclusão: a sinvastatina atenua a mucosite gástrica e intestinal relacionada à terapêutica com 5-FU. Nossos dados encorajam futuros estudos pré-clínicos e clínicos sobre a utilidade das estatinas na prevenção da mucosite gastrointestinal.

ABSTRACT Objective: simvastatin has pleiotropic anti-inflammatory and immunomodulatory effects potentially usefull to prevent chemotherapy-induced gastrointestinal mucositis. Studies on this are scarce. This study aimed to examine the effects of simvastatin on gastric and intestinal mucositis after 5-fluorouracil (5-FU) treatment in rats. Methods: rats weighing 270±18g were divided into two groups. The 5-FU+saline group (5-FU/SAL) rats were treated with 5-FU (50mg/kg) plus 0.9% saline orally (gavage) once daily for five days. The 5-FU+simvastatin (5-FU/SIMV) group was treated with 5-FU (50mg/kg), plus simvastatin (10mg/kg), in the same way. The rats were euthanased on the sixth day, then their stomach and intestine were photographed and removed for exams. Dosages of serum TNF-a, IL-1ß, IL-6 and histopathology were done for stomach and intestine. Results: body-weight was significantly lower in rats treated with 5-FU+saline than the weight loss of the 5-FU/SIMV group rats. TNF-a expression was lower in 5-FU/SIMV group (172.6±18pg/ml) than in 5-FU/SAL (347.5±63pg/ml). Serum IL-1b was lower in 5-FU/SAL group (134.5±23pg/ml) than in 5-FU/SIMV (48.3±9pg/ml). Serum IL-6 was 61.8±15pg/ml in 5-FU/SIMV and 129.4±17pg/ml in 5-FU/SAL groups. These differences were significant (p<0.05). Mucosal damage in stomach and jejunum were observed in rats receiving 5-FU alone. In the stomach and jejunum, simvastatin caused significant protective effects against 5-FU-induced mucosal injury. Conclusion: simvastatin attenuated gastric and intestinal mucositis related to 5-FU therapeutics in animal model. These data encourage forthcoming clinical studies addressing the usefulness of statins in the prevention and treatment of gastrointestinal mucositis.

Preventing and therapeutic effect of propolis in radiotherapy induced mucositis of head and neck cancers: a triple-blind, randomized, placebo-controlled trial

Background: Mucositis is one of the acute complications of radiotherapy which can ulcerate oral mucosa and cause severe pain and discomfort which can affect oral normal function. Propolis is a natural source of flavenoid which has antiulcer, antibacterial, antifungal, healing and anti-inflammatory effects. Using such an affordable compound without any bad smell or taste that has reasonable price can help the radiotherapy undergoing patients

Objectives: Our goal is assessing the preventing and therapeutic effect of propolis in radiotherapy induced mucositis in patients with head and neck cancer

Patients and Methods: In a randomized triple blind clinical trial, 20 patient were selected randomly to swish and swallow 15 ml of water based extract of propolis mouth wash 3 times a day in the case group [n = 10] and 15 ml placebo mouth wash in control group [n = 10]. We use NIC-CTC scale for determining mucositis grading

Results: We use T-test, Man-Whitney, Chi-square, and Friedman as analyzing tests. Case group had significantly [P < 0.05] lower grade of mucositis in all of the follow-ups, but xerostomia is not significantly different in two groups [P > 0.05]

Conclusions: This is a pilot study which shows water based extract of propolis efficiently prevents and heals radiotherapy induced mucositis

Efficacy of HPA Lanolin® in treatment of lip alterations related to chemotherapy

The side effects of chemotherapy on the lips may cause esthetic and functional impact and increase the risk of infection. HPA Lanolin® is an option for supportive therapy because it has anti-inflammatory, antimicrobial and moisturizing properties. Objective: To evaluate the efficacy of this product in the prevention of lip alterations in a population of patients undergoing chemotherapy. Material and Methods: Patients undergoing chemotherapy (n = 57) were examined and distributed into two groups: study (used HPA Lanolin®) and control (without supportive therapy on the lips). We evaluated the patients two weeks after chemotherapy, registering oral alterations, symptoms of pain, discomfort, limitation of mouth opening and dehydration, classified according to a visual analogue scale. Results: Patients who used HPA Lanolin® had lower dehydration and experienced improvement of lip dryness (p<0.001). The main symptoms were dehydration, discomfort, limitation of mouth opening, pain. The main clinical signs were dry lips, mucositis, cheilitis, hematoma, swelling and cracking. We found no difference concerning the variables of pain, discomfort, and limitation of mouth opening between the study and control group. Conclusions: We suggest that HPA Lanolin® is effective in reducing the symptoms of dehydration and the signs of lip dryness resulting from toxicity of chemotherapy, proving to be an interesting alternative supportive therapy for cancer patients.

Criterios de evaluación odontológica pre-radioterapia y necesidad de tratamiento de las enfermedades orales post-radioterapia en cabeza y cuello / Pre-radiotherapy dental evaluation criteria and treatment needs of oral side effects after head and neck radiotherapy

El objetivo de esta revisión es presentar criterios de evaluación odontológica pre-radioterapia y cuáles son las principales necesidades de tratamiento de estos pacientes después del tratamiento de radiación. Fueron revisados artículos en inglés, español y portugués entre 1995 y 2009 indexados en Pubmed y Scielo. Las palabras claves fueron: cáncer oral y radioterapia, complicaciones de la radioterapia en cabeza y cuello, evaluación oral pre-radioterapia. Los efectos colaterales de la radioterapia en la región de cabeza y cuello pueden ser temporales o tardíos. Aquellos que son tardíos, como la caries de radiación y la osteorradionecrosis pueden estar directamente relacionados con el hecho de no haber realizado una evaluación odontológica previa y pueden afectar severamente la calidad de vida del paciente.La participación del cirujano-dentista en el equipo multidisciplinario y la evaluación odontológica de los pacientes que serán sometidos a radioterapia en la región de cabeza y cuello son de vital importancia en mejorar la calidad de vida post-operatoria de estos pacientes.

The objective of this review is to present pre-radiotherapy evaluation criteria and the main needs for treatment of these patients after the radiation therapy. Were revised articles in English, Spanish and Portuguese language between 1995 and 2009 indexed in Pubmed and Scielo. The keywords were oral cancer and radiotherapy, complications in head and neck radiotherapy, oral pre-radiotherapy evaluation.The adverse complications of radiotherapy in head and neck area could be temporary or late. The late effects, such as radiation caries and osteorradionecrosis could be directly associated with the fact that previous dental evaluation was not performed and can severely affect the post-operatory quality of life. The participation of the dentist in the multidisciplinary team and dental evaluation of the patients that will receive radiotherapy in the head and neck area are of vital importance to improve the post-operatory quality of life of these patients.

Effect of oral zinc sulphate in prevention of radiation induced oropharyngeal mucositis during and after radiotherapy in patients with head and neck cancers

Mucositis is a disturbing side effect of radiotherapy treatment for head and neck cancer. To date, no effective modality for its prophylaxis and treatment has been found. We performed this study to evaluate the efficacy of oral zinc sulphate in delaying the onset of oral and pharyngeal mucositis and decreasing their severity. A total of 58 patients who were treated for head and neck squamous cell carcinoma with radiotherapy or chemoradiotherapy were randomly assigned to receive oral zinc sulphate [220 mg] or an oral placebo 3 times a day during their radiotherapy course. Total radiation dose was 6000 cGy to 7000 cGy by conventional radiotherapy. Seventy nine percent of the patients also received concurrent chemotherapy. Oral and pharyngeal mucositis were scored according to an RTOG protocol. Time to onset of mucositis did not vary between the two groups. However, oral mucositis scores were less severe in the zinc group in weeks 4 to 6. The difference was statistically significant and the P values for weeks 4, 5 and 6 were 0.02, 0.007, and 0.012, respectively. Treatment interruptions in both groups were the same [four cases each] and all were due to dysphagia [pharyngeal mucositis]. Our results suggest that zinc is effective in reducing the severity of oral mucositis but not pharyngeal mucositis. Treatment interruptions were more frequently caused by pharyngeal mucositis which presented as dysphagia, rather than oral pain that was a manifestation of oral mucositis

[ study of effective risk factors in head and neck radiotherapy and chemotherapy induced mucositis]

Cancer is the second leading cause of death in the united states. The ultimate aim of treatment of cancerous patients is defintive cure and improvement of quality of life. Side effects of cancer therapy are acute and chronic, so study of different factors which influence mucositis as an acute side-effect of head and neck chemotherapy and radiotherapy would be beneficial. Mucositis in severe cases could lead to treatment stoppage. 90 patients under chemotherapy and 10 patients under head and neck radiotherapy were included in this descriptive analytic study at Omid hospital [cancer treatment center] from Oct. 2002 to Apr. 2003. A questionnaire including patient and treatment related risk factors was filled for each patient. Patient related risk factors consisted of sex, age, oral hygiene, history of systemic disease, and smoking habits while treatment related risk factors consisted of schedule, chemotherapeutic agent, total dose and field of radiotherapy. The patients in radiotherapy group were examined clinically every two weeks and patients in chemotherapy group were examined only if they complained of mucositis. No one in the chemotherapy group referred to the hospital with mucositis. 80% of the patients in the radiotherapy group suffered from mucositis [from grade I to IV]. There was no significant relationship between the radiotherapy and patient risk factors and either the time of mucositis onset or the highest grade of mucositis. This can be due to the insufficient number of samples. Considering the insufficient number of samples in radiotherapy group and lack of patient referring in chemotherapy group due to mucositis, other studies with sufficient samples and longer periods are recommended. Conducting studies including hematologic malignancies as well as other malignancies are also recommended

Estudo de fatores de risco, prevenção e controle da mucosite oral radioinduzida / Study of risk factors, prevention and control of the severe radiation-induced oral mucositis

Objetivo. Analisar fatores de risco e medidas de prevenção e controle da mucosite oral radioinduzida severa. Métodos. Este estudo incluiu duas partes: (1) análise retrospectiva (n=100) e (2) análise prospectiva (n=96). Foram elegíveis pacientes com carcinomas de cabeça e pescoço submetidos a radioterapia tendo a boca incluída nos portais de radiação. Radioterapia ou quimioterapia prévias, quimioterapia concomitante, e interrupções do tratamento não relacionadas à toxicidade foram critérios de exclusão. Para classificação do performance funcional utilizou-se o índice ECOG PS. A mucosite foi avaliada segundo o critério de toxicidade aguda da WHO. Suporte clínico e odontológico foi realizado antes e durante a radioterapia, porém, apenas na Parte 2, suporte nutricional e um protocolo padronizado para abordagem das complicações orais agudas foram adicionados. Resultados. A freqüência da mucosite foi de 96% na coorte retrospectiva e 100% na prospectiva. Mucosite severa (WHO 3-4) resultou em 25% de interrupção do tratamento na Parte 1, e somente 1% na Parte 2 (p<0,0001). Pobre performance funcional - ECOG PS 3 (OR= 5,0) e sexo feminino (OR=6,6) foram identificados como fatores de risco independentes para mucosite severa na Parte 1; e, história de tabagismo e etilismo associados (OR=5,5), irritação ocasional da mucosa (OR=4,9) e candidíase (OR=7,6) na Parte 2. Conclusões. Controle rigoroso da mucosite pode controlar casos severos e reduzir a interrupção da radioterapia. Fatores de risco devem ser considerados na elaboração de protocolos específicos para prevenção e controle da mucosite oral...

Objective. To analyze risk factors and approach to preventing and controlling severe radiation induced oral mucositis. Methods. This study comprises two parts: ( 1) a retrospective analysis and (2) a prospective cohort of patients with head and neck carcinomas, submitted to radiotherapy (oral cavity included in radiation field) included in this survey. Prior radio or chemotherapy, radiochemotherapy, treatment breaks not related to treatment-related toxicity were exclusion criteria. Functional status was scored by ECOG PS. Mucositis severity was evaluated by the WHO index. Clinicai and dental support was given before and during treatment, however, nutritional support was given only to patients in the prospective group, as a standardized protocol of measures for approaching acute oral radiotherapyrelated complications. Results. Some degree of mucositis occurred in most patients (96% of Part 1 and 1 00°/o of Part 2). Severe mucositis was developed by approximately 29°/o, however treatment interruption occurred in 25°/o of Part 1 versus 1% of Part 2 patients (p<0,0001 ). Poor functional status (OR= 5,0) and female gender (OR=6,6) were identified as independents risk factors to severe oral mucositis (Part 1 ), besides combined use of tobacco and alcohol (OR=5,5), occasional mucosa irritation (OR=4,9) and candidiasis (OR=7,6) in prospective cohort. Conclusions. An aggressive approach of oral mucositis may contrai severe cases and decrease unplanned gaps in radiotherapy. Risk factors must be considered when making protocols for preventing and controlling oral mucositis