Vidal-Casariego, A., Calleja-Fernandez, A., Ballesteros-Pomar, M. D., & Cano-Rodriguez, I. (2013). Efficacy of glutamine in the prevention of oral mucositis and acute radiation-induced esophagitis: a retrospective study. Nutrition and Cancer, 65, 424-429.

DOI Link

Study Purpose

To evaluate the effect of oral glutamine on the prevalence and severity of acute radiation-induced oral and esophageal mucositis

Intervention Characteristics/Basic Study Process

Data were collected retrospectively for patients receiving radiation therapy. Findings were compared between those who did and did not receive glutamine. Outcomes between those who were given glutamine early (prior to radiation therapy) versus late (after radiation therapy was begun) in the course of radiation therapy were compared. Data on nutritional status and interruptions in treatment were evaluated.

Sample Characteristics

  • The sample was composed of 117 patients, including 79 cases with oral mucositis.
  • Mean patient age was 62.2 years (SD = 13.6 years) in the experimental group.
  • The sample was 81.2% male and 10.8% female.
  • Diagnoses were head and neck, lung, esophageal, and lymphoma.
  • The majority of patients (73.5%) were also receiving chemotherapy.

Setting

The study was conducted at a single site outpatient setting in Spain.

Phase of Care and Clinical Applications

Patients were undergoing the active antitumor treatment phase of care.

Study Design

This was a retrospective study.

Measurement Instruments/Methods

The World Health Oragnization (WHO) mucositis grading scale was used.

Results

  • In the final sample, 27.4% of patients received early glutamine, 49.5% received glutamine late, and 23.1% of patients did not receive glutamine.
  • Analysis showed that prevalence of mucositis was lower among patients who received early glutamine compared to those who either did not receive glutamine or were given glutamine late (p ≤ 0.02).
  • After correction for sex, age, chemotherapy, radiation dose, and previous surgery, only glutamine use was predictive of risk for development of oral mucositis (risk difference = -9.0%; 95% CI = -18%, -1%).
  • For patients receiving radiation to the head and neck region, severity of oral mucositis was higher among those who did not receive early glutamine (p = 0.039).

Conclusions

Provision of oral glutamine prior to the beginning radiation therapy may be of benefit in the prevention of oral mucositis. Firm conclusions cannot be made because of multiple study limitations.

Limitations

  • Differences in the baseline sample group and variations in chemotherapy regimens, which could have affected the development of mucositis, could have influenced results.
  • A risk of bias exists because of the lack of a control group, blinding, and random assignment.
  • Unintended interventions or applicable interventions that were not described could have influenced results.
  • Measurement and methods were not well described.
  • No information about the oral care used was provided.
  • The timing of mucositis evaluation and how evaluations were done was not reported. 

Nursing Implications

This study has numerous limitations and risks of bias, and it attempted to draw conclusions across a very heterogenous population of patients. Findings suggest that oral glutamine may be helpful in preventing oral mucositis in patients receiving radiation to the head and neck area, and it appears that glutamine treatment may be most beneficial if treatment is begun prior to the initiation of radiation therapy.