Weissheimer, C., Curra, M., Gregianin, L.J., Daudt, L.E., Wagner, V.P., Martins, M.A.T., & Martins, M.D. (2017). New photobiomodulation protocol prevents oral mucositis in hematopoietic stem cell transplantation recipients--A retrospective study. Lasers in Medical Science, 32, 2013–2021.

DOI Link

Study Purpose

The aim of this study was to evaluate the effect of photobiomodulation (PBM) in reducing the incidence and severity of OM in patients undergoing HSCT, comparing two protocols that differ only in session frequency, either daily or three times a week.

Intervention Characteristics/Basic Study Process

PBM applied three times per week versus seven times per week in patients undergoing HSCT

  • Patients received three PBM sessions weekly (on Monday, Wednesday, and Friday). PBM was applied using a continuous-wave diode laser (0.24 J total radiant energy per point, 33 points)
  • Patients received daily PBM sessions. PBM was applied using the same continuous-wave diode laser at the same settings used for group I (0.24J total radiant energy per point, 33 points)
  • There is a slight difference in the power outage of each intervention as well as exposure time.

Sample Characteristics

  • N = 99
  • AGE: 13 to 71 years
  • MALES: 51.5%
  • FEMALES: 48.5%
  • CURRENT TREATMENT: Chemotherapy
  • KEY DISEASE CHARACTERISTICS: OM
  • OTHER KEY SAMPLE CHARACTERISTICS: Allogeneic HSCT, autologous HSCT

Setting

  • SITE: Single site    
  • SETTING TYPE: Inpatient  (not specifically  identified)
  • LOCATION: Porto Alegre Clinical Hospital

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active anti-tumor treatment
  • APPLICATIONS:  Pediatrics, elder care, palliative care

Study Design

A retrospective study was to evaluate the preventive effect of PBM applied three times per week versus seven times per week in patients undergoing HSCT.

Measurement Instruments/Methods

Differences between groups were evaluated using the chi-square test or Fischer’s exact test for qualitative data and the Mann-Whitney test for quantitative data. Receiver operating characteristic (ROC) curves were constructed to analyze the sensitivity and specificity of quantitative risk factors in predicting the presence or absence of OM. The area under the curve is a measure of test accuracy. The SPSS for Windows software package, version 18.0, was used to perform these statistical analyses. Two-way analysis of variance (ANOVA) was used to compare OM average between groups, and the t test was used to compare the average OM at each point.

Results

PBM was effective in preventing OM in patients undergoing HSCT even when it was applied three times a week. Both PBM protocols were equally efficient in preventing OM (p = 0.34, ANOVA). 

Independent of the PBM protocol used, patients who received allogeneic transplant (p < 0.01, Fischer’s exact test), total body irradiation (TBI, 12 Gy) (p = 0.01, chi-square test), busulfan plus cyclophosphamide (p < 0.01, chi-square test), or methotrexate-containing regimens (p < 0.01, Fischer’s exact test) demonstrated higher OM incidence and severity. Myelosuppression (p < 0.01, Mann-Whitney test) and impaired renal function (p = 0.02, Mann-Whitney test) were also considered risk factors for OM.

Conclusions

The study indicates that PBM is effective in preventing OM in patients undergoing HSCT even when administered three times a week.

Limitations

  • Small sample (< 100)
  • Intervention expensive, impractical, or training needs (The cost of bringing in a professional or asking the patient to go to a dental office was a hindrance.)
  • Other limitations/explanation: Retrospective nature of the study. Allo versus auto transplant regimens are different treatment paths especially the chemotherapy regimens that could influence toxicities.

Nursing Implications

OM is frequently seen side effect of patients receiving HSCT, these lesions impact patient quality of life, controlling this condition is extremely important, and developing effective interventions is a high priority in protocol support among patients with cancer.