Mutluay Yayla, E., Izgu, N., Ozdemir, L., Aslan Erdem, S., & Kartal, M. (2016). Sage tea-thyme-peppermint hydrosol oral rinse reduces chemotherapy-induced oral mucositis: A randomized controlled pilot study. Complementary Therapies in Medicine, 27, 58–64. 

DOI Link

Study Purpose

To see the preventive effect of a sage tea–thyme–peppermint hydrosol oral rinse used in combination with oral care

Intervention Characteristics/Basic Study Process

This study aimed at discovering the preventive effect of sage tea–thyme–peppermint hydrosol oral rinse four times a day in addition to oral care (saline rinse and teeth brushing) in patients receiving chemotherapy regimens using 5-fluorouracil (5-FU). The study collected data through a patient questionnaire, the World Health Organization (WHO) Oral Toxicity Scale, oral cavity photos, and compliance checklists. The study completed assessments at 5 and 14 days after the completion of chemotherapy.

Sample Characteristics

  • N = 60, 30 in control group and 30 in intervention   
  • MEAN AGE = intervention group: 52.6 years (SD = 8.2 years), control group: 48.7 years (SD = 10 years)
  • MALES: 40%, FEMALES: 60%
  • CURRENT TREATMENT: Chemotherapy
  • KEY DISEASE CHARACTERISTICS: Colon cancer (majority), solid tumor 
  • OTHER KEY SAMPLE CHARACTERISTICS: Denture use varied in the control and intervention groups.

Setting

  • SITE: Multi-site   
  • SETTING TYPE: Outpatient    
  • LOCATION: Ankara, Turkey

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Study Design

Patients receiving bolus or infusion of 5-FU chemotherapy were randomly assigned to the intervention or control group.

Measurement Instruments/Methods

Measurement tools used included a patient questionnaire, the WHO Oral Toxicity Scale, oral cavity photos, and compliance checklists (self-reported by the patients).

Results

Using kappa analysis, the kappa coefficient on day 5 was 0.98 and on day 14 was 0.85 in the intervention group. Oral mucositis in the invention group occurred in 30% of patients compared to 60% of patients in the intervention group. Grade 1 mucositis was statistically lower in the intervention group (10%) versus the control group (53.3%) on day 5 (p < 0.001). Grade 2 mucositis occurred more in the intervention group (20%) versus the control group (6.7%); on day 5, there was no statistical significance. On day 14, 93% of patients in the intervention group did not have mucositis and 96% in the control group did not have mucositis. No grade 3 or 4 mucositis occurred during this study.

Conclusions

Oral mucositis occurred in only 30% of the intervention group compared to 60% of the control group. The sage tea–thyme–peppermint hydrosol rinses are cost-effective, well tolerated, safe, and noninvasive. This intervention may be effective, but more randomized, controlled clinical trials of different types of treatment, as well as larger sample sizes, are needed.

Limitations

  • Small sample (< 100)
  • Risk of bias (no blinding)
  • Lack of follow-up
  • Some patient-reported data

Nursing Implications

This intervention is a low-cost, effective, and well tolerated intervention. One downside is that this hydrosol needs refrigerated, and the solution needs to be analyzed in the pharmacy for consistency. Nurses need to educate patients and reinforce the importance of oral hygiene and adherence to the schedule of oral rinsing with this solution four times a day. This intervention may be effective but needs more research and data to show its effectiveness.