Kartin, P., Tekinsoy, Tasci, S., Soyuer, S., & Elmali, F. (2014). 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, 18, E118–E125. 

To determine the effect of an oral mucositis prevention protocol on nutritional status and quality of life in patients receiving radiation therapy for head and neck cancers

The intervention group received an oral care protocol that included tooth brushing, features of the tooth brush, and a sodium bicarbonate mouth rinse. It also included an oral evaluation, precautions for oral mucositis, and a nutrition protocol. The nutrition protocol consisted of recommendations for wounds, irritation, intensive secretion, xerostomia, smell or taste changes, nausea, vomiting, and nutritional principles after radiation therapy (RT). The protocols were used for preventing oral mucositis and malnutrition, and interventions were used according to the grading of mucositis. Assessments were done weekly for seven weeks.

• N = 50  
• AGE = less than 39 to greater than 60
• MALES: 86%, FEMALES: 14%
• KEY DISEASE CHARACTERISTICS: Nasopharyngeal, laryngeal, salivary gland, gingiva, hypo pharyngeal, and tongue
• OTHER KEY SAMPLE CHARACTERISTICS: Education status from illiterate to high school or higher

• SITE: Single site    
• SETTING TYPE: Outpatient    
• LOCATION: Turkey

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Elder care and palliative care 

Randomized, controlled, experimental study

• Face to face interviews were done using an oral assessment guide, oral toxicity scale from the World Health Organization (WHO), a Visual Analog Scale (VAS), the Subjective Global Assessment (SGA) index, and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ).
• A data analysis was conducted using SPSS v15.0 and SigmaStat v3.5.

Oral mucositis severity was lower in the group receiving the oral care protocol compared to the control group. As the post-treatment period progressed, the prevalence of malnutrition in the intervention group was lower than the control group, and the intervention group experienced significantly less pain related to oral mucositis. A similar deterioration in quality of life was noted in each group.

Oral mucositis severity was lower in the two groups receiving the oral care protocol compared to the control group. This study demonstrated that oral mucositis rate may be reduced with an oral care protocol.

• Small sample (< 100)
• Risk of bias (no blinding)
• Unintended interventions or applicable interventions not described that would influence results
• Findings not generalizable
• Other limitations/explanation: This study reported a number of patients who experienced occasional breakdowns in RT treatment devices with delays that could have affected results. It was not clear what care patients in the control group received when they developed mucositis.

Nurses working in RT units should explain oral care protocols to patients before treatment and assess patients' mouths every week using evidence-based assessment criteria. Healthcare professionals should evaluate the nutritional status of individuals receiving RT before, during, and after treatment, and patients should be offered education and training. Nurses should use evidence-based protocols for patient care. This study added to the body of evidence pointing to the importance and effectiveness of standardized oral care for the reduction of mucositis severity.