Aim: Mucositis is a potentially serious side effect of chemotherapy used for severe malignancies. Concerns about potential barriers to the use of oral cryotherapy has lead to difficulties when providing patients with information. The aim was to identify those chemotherapies which benefit from the prior administration of oral cryotherapy in order to reduce the incidence of mucositis. In addition best practice guidelines will be used to implement a uniform approach to cryotherapy management targeting patient compliance.
Methods: A literature review of the following databases were comprehensively searched via Monash University Databases: EMBASE (OVID), CINAHL, Austhealth, Clinical Evidence, Cochrane Database, EBM Reviews, Current Contents, PubMed. A search from 1980 through 2012 was performed, linking the subject search headings ‘oral cryotherapy‘, ‘ice chips‘, and ‘oral mucositis‘ with each of the following headings: ‘chemotherapy‘, ‘haematology‘, ‘antineoplastic agents’, ‘guidelines’, and ‘oncology’. The search was restricted to studies of chemotherapy induced oral mucositis in which clinical practice guidelines was a major focus.
Results: The search identified a number of studies that examined oral cryotherapy on the development of chemotherapy induced oral mucositis. Studies suggest fluorouracil and melphalan are implicated in oral related complications more so than anthracycline based treatments. Practice guidelines recommend the use of cryotherapy for the following chemotherapies; fluorouracil, cycloposphamide, melphalan, methotrexate (IV), etoposide, cisplatin, mitomycin, and vinblastine. In addition patient compliance has been reported to improve with the concurrent use of sensitive toothpaste and salt and sodium bicarbonate mouthwashes. Reported limitations of oral cryotherapy include sensitive teeth, continuous infusions, cold, headaches and unwillingness to continue the cryotherapy through the entire infusion. Contraindications to the use of oral cryotherapy is existing mucositis and oxaliplatin based regimens.
Conclusion: A unit based protocol for the administration of oral cryotherapy for the purpose of reducing the incidence of mucositis was implemented as a result of this review. Furthermore, a uniform approach to cryotherapy management, targeting patient compliance, had improved confidence amongst staff.