Effect of Oral Care Protocol on Oral Cavity Status and Self-care Performance in Solid Cancer Patients Receiving Chemotherapy

구강관리 프로토콜 적용이 항암화학요법을 받는 고형암 환자의 구강상태 및 자가간호수행에 미치는 효과

  • Received : 2018.06.25
  • Accepted : 2018.07.20
  • Published : 2018.08.28


The purpose of this study was to identify the effectiveness of oral care protocol including individual oral care education, cryotherapy and benzydamine gargling on oral cavity status and self-care performance in solid cancer patients receiving chemotherapy. Thirty-one patients were enrolled by convenience sampling in this study and allocated to control (n=18) and experimental group (n=13). In the intervention group, individual oral care education, oral cryotherapy and benzydamine gargling were applied, while the control group received pre-existed oral care. Oral cavity status and self-oral care behavior were measured in five periods. The data were analyzed using the Mann-Whitney test, Friedman test, and Chi-square test. There was no significant difference in oral cavity status between the groups. But the two groups showed the poorest oral cavity status on $14^{th}$ day. Self-care behavior was significantly higher in the intervention group than the control group. This effect had maintained for 4months after completion of study. The results showed that individual oral care education by oncology nurse is effective to encourage patients to do self-care behavior and a further study is needed to explore the effect of cryotherapy and benzydamine gargling on oral cavity status of patient with solid tumor.


Supported by : 전남대학교병원


  1. K. D. Miller, R. L. Siegel, C. C. Lin, A. B. Mariotto, J. L. Kramer, J. H. Rowland, K. D. Stein, R. Aleri, and A. Jemal, "Cancer Treatment and Survivorship Statistics, 2016," CA Cancer Journal of Clinician, Vol.66, pp.271-289, 2016.
  2. B. K. Edwards, A. M. Noone, A. B. Mariotto, E. P. Simard, F. P. Boscoe, S. J. Henley, A. Jemal, H. Cho, R. N. Anderson, B. A. Kohler, C. R. Eheman, and E. M. Ward, "Annual Report to the Nation on The Status of Cancer, 1975-2010, Featuring Prevalence of Comorbidity and Impact on Survival Among Persons with Lung, Colorectal, Breast, or Prostate Cancer," Cancer, Vol.120, pp.290-314, 2014.
  3. E. Mazzotti, G. C. Antonini Cappellini, S. Buconovo, R. Morese, A. Scoppola, C. Sebastiani, and P. Marchetti, "Treatment-Related Side Effects and Quality of Life in Cancer Patients," Supportive Care in Cancer, Vol.20, No.10, pp.2553-2557, 2012.
  4. P. Riley, A. M. Glenny, H. V. Worthington, A. Littlewood, J. E. Clarkson, and M. G. McCabe, "Interventions for Preventing Oral Mucositis in Patients with Cancer Receiving Treatment: Oral Cryotherapy," Cochrane Database Systematic Review, Vol.23, No.12, CD011552, 2015.
  5. Y. L. Chung and N. N. M. Pui, "Confounding Factors Associated with Oral Mucositis Assessment in Patients Receiving Chemoradiotherapy for Head and Neck Cancer," Supportive Care in Cancer, Vol.25, No.9, pp.2743-2751, 2017.
  6. D. J. Harris, J. Eilers, A. Harriman, B. J. Cashavelly, and C. Maxwell, "Putting Evidence into Practice: Evidence-Based Interventions for The Management of Oral Mucositis," Clinical Journal of Oncology Nursing, Vol.12, No.1, pp.141-152, 2008.
  7. P. T. Kartin, S. Tasci, S. Soyuer, and F. Elmali, "Effect of an Oral Mucositis Protocol on Quality of Life of Patients With Head and Neck Cancer Treated With Radiation Therapy," Clinical Journal of Oncology Nursing, Vol.18, No.6, pp.118-125, 2014.
  8. E. Riley, "Understanding Oral Mucositis: Causes and Treatments," J. Community Nursing, Vol.31, No.5, pp.69-72, 2017.
  9. R. V. Lalla, J. Bowen, A. Barasch, L. Elting, J. Epstein, D. M. Keefe, D. B. McGuire, C. Migliorati, O. Nicolatou-Galitis, D. E. Peterson, J. E. Raber-Durlacher, S. T. Sonis, S. Elad, and The Mucositis Guidelines Leadership Group of the Multinational Association of Supportive Care in Cander and International Society of Oral Oncology, "MASCC/ISOO Clinical Practice Guidelines for the Management of Mucositis Secondary to Cancer Therapy," Cancer, Vol.120, No.10 pp.1453-1461, 2014.
  10. A. Barkokebas, I. H. Silva, S. C. de Andrade, A. A. Carvalho, L. A. Gueiros, S. M. Paiva, and J. C. Leao, "Impact of Oral Mucositis on Oral-Health-Related Quality of Life of Patients Diagnosed with Cancer," J. Oral Pathology & Medicine, Vol.44, pp.746-751, 2015.
  11. J. Eilers, D. Harris, K. Henry, and L. A. Johnson, "Evidence-Based Interventions for Cancer Treatment-Related Mucositis: Putting Evidence Into Practice," Clinical Journal of Oncology Nursing, Vol.18, pp.80-96, 2014.
  12. D. E. Peterson, C. B. Boers-Doets, R. J. Bensadoun, and J. Herrstedt, "Management of Oral and Gastrointestinal Mucosal Injury: ESMO Clinical Practice Guidelines for Diagnosis, Treatment, and Follow-up," Annuals of Oncology, Vol.26, pp.139-151, 2015.
  13. T. Yokota, H. Tachibana, T. Konishi, T. Yurikusa, S. Hamauchi, K. Sakai, M. Nishikawa, M. Suzuki, Y. Naganawa, T. Hagihara, H. Tsumaki, T. Kubo, M. Taguri, S. Morita, T. Eguchi, K. Kubota, and S. Zenda, "Multicenter Phase II Study of An Oral Care Program for Patients with Head and Neck Cancer Receiving Chemoradiotherapy," Supportive Care in Cancer, Vol.24, No.7, pp.3029-3036, 2016.
  14. K. Kubota, W. Kobayashi, H. Sakaki, H. Nakagawa, T. Kon, M. Mimura, R. Ito, K. Furudate, and H. Kimura, "Professional Oral Health Care Reduces Oral Mucositis Pain in Patients Treated by Super Selective Intra-Arterial Chemotherapy Concurrent with Radiotherapy for Oral Cancer," Supportive Care in Cancer, Vol.23, No.11, pp.3323-3329, 2015.
  15. W. M. Y. Wee, E. Ang, and P. I. Ng, "Oral Hygiene of Patients with Cancer in an Acute Oncology Ward: A Best Practice Project," International Journal of Evidence-Based Healthcare, Vol.11, No.3, pp.194-201, 2013.
  16. M. O. Morais, M. R. Elias, C. R. Leles, J. C. Dourado Pinezi, and E. F. Mendonca, "The Effect of Preventive Oral Care on Treatment Outcomes of a Cohort of Oral Cancer Patients," Supportive Care in Cancer, Vol.24, No.4, pp.1663-1670, 2016.
  17. K. M. Sheibani, A. R. Mafi, S. Moghaddam, F.Taslimi, A. Amiran, and A. Ameri, "Efficacy of Benzydamine Oral Rinse in Prevention and Management of Radiation-Induced Oral Mucositis: A Double-Blind Placebo-Controlled Randomized Clinical Trial," Asia-Pacific Journal of Clinical Oncology, Vol.11, No.1, pp.22-27, 2015.
  18. I. Chitapanarux, T. Tungkasamit, J. Petsuksiri, D. Kannarunimit, K. Katanyoo, C. Chakkabat, J. Setakornnukul, S. Wongsrita, N. Jirawatwarakul, C. Lertbusayanukul, P. Sripan, and P. Traisathit, "Randomized Control Trial of Benzydamine HCl versus Sodium Bicarbonate for Prophylaxis of Concurrent Chemoradiation-induced Oral Mucositis," Supportive Care in Cancer, Vol.26, No.3, pp.879-886, 2018.
  19. S. Beck, "Impact of a Systematic Oral Care Protocol on Stomatitis after Chemotherapy," Cancer Nursing, Vol.2, No.3, pp.185-199, 1979.
  20. Y. Park, The Influence of Saline and Betadine Soulution for Gargle in The Leukemic Patients Receiving Chemotherapy, Chonnam National University, 1997.
  21. B. Chaveli-Lopez and J. V. Bagan-Sebastian, "Treatment of oral mucositis due to chemotherapy," J. Clinical and Experimental Dentistry, Vol.8, No.2, pp.201-209, 2016.
  22. N. Nishimura, K. Nakano, K. Ueda, M. Kodaira, S. Yamada, Y. Mishima, M. Yokoyama, Y. Terui, S. Takahashi, and K. Hatake, "Prospective Evaluation of Incidence and Severity of Oral Mucositis Induced by Conventional Chemotherapy in Solid Tumors and Malignant Lymphomas," Supportive Care in Cancer, Vol20, No.9, pp.2053-2059, 2012.
  23. P. J. Oh and H. J. Choi, "The Effect of Patient Education Interventions on Distress, Self-Care Knowledge and Self-Care Behavior of Oncology Patients: A Meta-Analysis," Asian Oncology Nursing, Vol.12, No.4, pp.257-266, 2012.