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Prevention of oral mucositis with cryotherapy in children undergoing hematopoietic stem cell transplantations-a feasibility study and randomized controlled trial

Journal article
Authors T. Kamsvag
A. Svanberg
K. G. Legert
J. Arvidson
L. von Essen
Karin Mellgren
J. Toporski
J. Winiarski
G. Ljungman
Published in Supportive Care in Cancer
Pages 11
ISSN 0941-4355
Publication year 2020
Published at Institute of Clinical Sciences, Department of Pediatrics
Pages 11
Language en
Keywords Oral mucositis, Children, Hematopoietic stem cell transplantation, Oral, cryotherapy, Feasibility, evaluation scale chimes, content validity, cancer, understandability, perspectives, chemotherapy, prophylaxis, guidelines, management, therapy, Oncology, Health Care Sciences & Services, Rehabilitation
Subject categories Pediatrics, Cancer and Oncology


Purpose To evaluate the feasibility of oral cryotherapy (OC) in children and to investigate if OC reduces the incidence of severe oral mucositis (OM), oral pain, and opioid use in children undergoing hematopoietic stem cell transplantation (HSCT). Methods Fifty-three children, 4-17 years old, scheduled for HSCT in Sweden were included and randomized to OC or control using a computer-generated list. OC instructions were to cool the mouth with ice for as long as possible during chemotherapy infusions with an intended time of >= 30 min. Feasibility criteria in the OC group were as follows: (1) compliance >= 70%; (2) considerable discomfort during OC < 20%; (3) no serious adverse events; and (4) ice administered to all children. Grade of OM and oral pain was recorded daily using the WHO-Oral Toxicity Scale (WHO-OTS), Children's International Oral Mucositis Evaluation Scale, and Numerical Rating Scale. Use of opioids was collected from the medical records. Results Forty-nine children (mean age 10.5 years) were included in analysis (OC = 26, control = 23). The feasibility criteria were not met. Compliance was poor, especially for the younger children, and only 15 children (58%) used OC as instructed. Severe OM (WHO-OTS >= 3) was recorded in 26 children (OC = 15, control = 11). OC did not reduce the incidence of severe OM, oral pain, or opioid use. Conclusion The feasibility criteria were not met, and the RCT could not show that OC reduces the incidence of severe OM, oral pain, or opioid use in pediatric patients treated with a variety of conditioning regimens for HSCT.

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