Ask an answerable question (PICO)：
Among patients receiving 5-fluorouracil-based chemotherapy, approximately 90% patients experience varying degrees of oral mucositis, which reduce nutrient intake, cause difficulty in communication, and decrease the quality of life. To prevent oral mucositis from receiving 5-fluorouracil treatment, oral cryotherapy is commonly recommended to patients. However, whether oral cryotherapy can prevent oral mucositis lacks empirical evidence. A clinical problem emerges as whether oral cryotherapy prevents oral mucositis induced by 5-fluorouracil-based chemotherapy.
The Method and Analysis of Literature Review：
Five scientific databases (CEPS, Cochrane Library, Embase, Pubmed, and Scopus) were searched from inception until December 2021 with Chinese and English language restrictions, using keywords and related MeSH terms. A total of 174 studies was retrieved. After examination of the inclusion and exclusion criteria, four randomized controlled trials (RCTs) studies have been included in the systematic review.
Critical Appraisal：
The CASP Checklist was used to examine the 4 RCTs studies, each of which attained 8 of 11 points, revealing that 4 studies were valid. The Oxford Centre for Evidence-based Medicine (CEBM) 2011 was used to evaluate the levels of evidence, and the results indicated that all the 4 RCTs studies reached Level 2. In the four RCTs studies, the participants (> aged 18) underwent 5-fluorouracil-based chemotherapy for breast, colorectal or gastric cancers. The participants suck on ice or hold ice in their mouths 5 minutes prior to 5-fluorouracil-based chemotherapy and continued for at least 30 minutes. The evaluation tool included WHO Oral Mucositis Grading Scale and the Visual Analogue Scale. The 4 RCTs studies concluded that oral cryotherapy induced oral vasoconstriction which reduced the incidence of oral mucositis. Meanwhile, pain was also alleviated.
Clinical Application of Evidence：
A preliminary study was conducted in the oncology wards of a regional teaching hospital in southern Taiwan. The study period was from December 13, 2021 to February 16, 2022. A total of 20 participants received 5-fluorouracil-based chemotherapy, and was randomly allocated into experimental and control groups. The participants in the experimental group received oral cryotherapy for at least 30 minutes while receiving 5-fluorouracil-based chemotherapy, whereas those in the control group received conventional oral care. Data were collected on Day 7, 14, and 21 after the chemotherapy. Chi-squared test was used for data analysis.
Evaluation of Effectiveness：
The results revealed that the experimental group has significantly lower rate of oral mucositis than the control group on Day 7, 14, and 21 after the chemotherapy. The mean of mucositis was 0.17 (SD=0.28) in the experimental group and 1.13 (SD=0.78) in the control group. It is the same as mucositis that the mean of mucosal pain scale was 0.23 (SD=0.39) in the experimental group and 1.60 (SD = 1.14) in the control group. The oral mucositis and mucosal pain in the experimental group were significantly lower than those in the control group (p<0.05).
Conclusions and Recommendations：
This article explores the effectiveness of oral cryotherapy on preventing oral mucositis after receiving 5-fluorouracil-based chemotherapy. The four RCTs studies concluded the effectiveness of oral cryotherapy on preventing oral mucositis, and then a preliminary test was conducted in our clinical settings. The results showed that the rate of oral mucositis was significantly lower in the experimental group than in the control group, indicating that oral cryotherapy is a reliable intervention for preventing oral mucositis. Because of methodological limitation, we recommend a RCT study with appropriate sample size for further examination.
