Oxygen-ozone therapy for management of oral mucositis after hematopoietic stem cell transplantation: a quasi-experimental study

Authors

DOI:

https://doi.org/10.5902/2179769287024

Keywords:

Stomatitis, Complementary Therapies, Hematopoietic Stem Cell Transplantation, Nursing, Oncology Nursing

Abstract

Objective: to investigate the effect of Oxygen-Ozone Therapy (OOT) in the management of oral mucositis (OM) after Hematopoietic Stem Cell Transplantation (HSCT). Method: quasi-experimental study. Inclusion criteria: age over 7 years and OM Grade I. Seventeen patients participated and were allocated to the Control Group (n=8) or Intervention Group (n=9). The protocol consisted of mouthwashes with Water for Ozonated Injection, ozonation concentration of 56 µg/L and medicinal oxygen flow of 1/4L, for 15 minutes, twice a day. The OM grade, pain scores, positive blood cultures and length of hospital stay were assessed. Analysis using the Mann-Whitney U test. Results: in the Intervention Group, a predominance of Grade II OM was observed; the evolution of the OM grade and pain score was statistically lower with p<0.05, between days D+6 to D+11; it was also observed an average of 7.3 days less of length of stay. Conclusion: the effects of OOT on OM after HSCT are positive.

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Author Biographies

Káryta Jordana Santos de Paula, Federal University of Paraná

Master in Health Care Practice from UFPR (2021). Specialist in: Multiprofessional Preceptorship in the Health Area (2024), Clinical Hematology and Blood Bank (2016), Oncological Nursing (2011). Graduated in Nursing (bachelor's and licentiate's degree) from the Federal University of Paraná - UFPR (2008). Technical Member of the Laboratory of Innovation in Health Promotion and Surveillance (Lipvisa) at UFPR. Works as a Nurse at the Bone Marrow Transplant Service CHC-UFPR. Preceptor of the Integrated Multiprofessional Residency Program in Hospital Care, concentration area Oncology and Hematology at CHC-UFPR. Has experience in the area of ​​Nursing, with an emphasis on hematology and oncology, working mainly in the following topics: nursing, health preceptorship, oncology, hematology and hematopoietic stem cell transplantation.

Marcia Helena de Souza Freire, Federal University of Paraná

Graduated in Nursing from the University of São Paulo - USP (1982). Specialist in Public Policies in Childhood and Adolescence - State University of Maringá (1998) and Evidence-Informed Public Policies (2017) - Sírio-Libanês; Fellow in Implementation of Evidence-Based Clinical Practices - Joanna Briggs Institute (JBI) (2019). Specialist in Pro-oxidative Therapies, Medicinal Ozone and Applied Human Physiology (2022) - ABOZ. Master's degree (2000) - Maternal and Child Health and PhD (2007) - Epidemiology, both at the School of Public Health at USP. She was a Professor of the Nursing Course at UEM, from 1995 to 2010. Since the end of 2010, she has been a professor at UFPR; currently, Associate Professor of the Nursing Department - Maternal and Child Area, working in Undergraduate and Academic and Professional Postgraduate Programs. Researcher in the Lines of Policies and Practices in Education, Health, Nursing; Technology and Innovation for Care in Health and Nursing; and, Integrative and Complementary Practices in Health (PICS). Vice-Coordinator of the Professional PPG in Nursing / management from 2015 - 2016; Coordinator / management 2017-2019. Leader of the Research Group at the Health Promotion and Surveillance Laboratory (LIPVISA) / UFPR. Research Themes: Epidemiology - Fetal, Infant and Maternal Mortality; Neonatology - Kangaroo Method, IHAC, Minimum Handling, Continuity of Care; Pediatrics - Rooming-in and Care Practices; Health Assessment: Maternal and Child RAS Evaluation Model; and, Health Promotion & PICS: Oxygen-Ozone Therapy. Contemplated by Notice 27/2016 CAPES/COFEN Agreement (1st offer) as Coordinator of the Research Technologies to Qualify and Consolidate the Systematization of Nursing Care in Different Scenarios of Professional Practice in the State of Paraná. Member of the Center for Teaching, Research and Extension in Health (NEPES). Participant in National Research contemplated with funding from CNPq (Notice 46/2022) - Child Health, in 1st place (R$ 1,183,200.00), as proposed on the theme: Development of Technologies to promote Healthy Parenting and combat violence in early childhood. EAD Tutor by FIOCRUZ for the Course on Surveillance of Maternal, Child and Fetal Deaths (2018). Representative of Nursing from UFPR on the State Committee for the Prevention of Maternal, Infant and Fetal Mortality, of the Health Department of the State of Paraná, since 2013. Member of the Nursing and Public Health Course Evaluators' Bank of INEP - National Institute of Studies and Educational Research Anísio Teixeira, as well as of SETI - Secretariat of Science and Technology of the State of Paraná. Member of the Nascer no Brasil II Project, of the Sergio Arouca School of Public Health, ENSP/Fiocruz/RJ, as Coordinator of data collection in the state of Paraná. Associate Member: ABRASCO; ABEN/PR; Phi-Xi Chapter of Sigma Theta Tau International (Coimbra/Portugal); Brazilian Network of Collaborators of the Global Burden of Disease Project - GBD Brazil Network; Brazilian Association of Ozone Therapy (ABOZ); Founding member of ABENAH- Brazilian Association of Acupuncturist and Holistic Nurses, of the South Region.

References

Elad S, Yarom N, Zadik Y, Kuten-Shorrer M, Sonis ST. The broadening scope of oral mucositis and oral ulcerative mucosal toxicities of anticancer therapies. CA Cancer J Clin. 2022;72 (1):57-77. doi: 10.3322/caac.21704.

Triarico S, Agresti P, Rinninella E, Mele MC, Romano A, Attinà G. Oral microbiota during childhood and its role in chemotheraapy-induced oral mucositis in children with cancer. Pathogens. 2022;11(4):448. doi: 10.3390/pathogens11040448.

Villa A, Sonis ST. An update on pharmacotherapies in active development for the management of cancer regimen-associated oral mucositis. Expert Opin Pharmacother. 2020;21(5):541-8. doi: 10.1080/14656566.2020.1718652.

Elad S, Cheng KKF, Lalla RV, Yarom N, Hong C, Logan RM, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2020; 126(19):4423-31. doi: 10.1002/cncr.33100.

Ferreira AS, Macedo C, Silva AM, Matos CD, Costa P, Rodrigues F. Natural Products for the Prevention and Treatment of Oral Mucositis - A review. Int J Mol Sci. 2022;23:4385. doi: 10.3390/ijms23084385.

Butera A, Pascadopoli M, Gallo S, Martínez CPA, Val JEMS, Parisi L, et al. Ozonized hydrogels vs. 1% chlorhexidine gel for the clinical and domiciliary management of peri-implant mucositis: a randomized clinical trial. J Clin Med. 2023;12(4):1464. doi: 10.3390/jcm12041464.

Palma PV, Cunha RO, Leite ICG. Effectiveness of ozone therapy in the treatment of periodontal diseases: a systematic review. RGO Rev Gaúch Odontol. 2023;71: e20230004. doi: 10.1590/1981-86372023000420210085.

Özalp Ö, Sindel A, Altay MA, Özbudak IH, Bilgin B, Kocabalkan B, et al. Comparative evaluation of the efficacy of ozone therapy and low level laser therapy on oral mucosal wound healing in rat experimental model. J Stomatol Oral Maxillofac Surg. 2022;123(6):e670-4. doi: 10.1016/j.jormas.2022.03.018.

Wakamori S, Taguchi K, Nakayama Y, Ohkoshi A, Sporn MB, Ogawa T, et al. Nrf2 protects against radiation-induced oral mucositis via antioxidation and keratin layer thickening. Free Radic Biol Med. 2022;188:206-20. doi: 10.1016/j.freeradbiomed.2022.06.239.

Asociación Española de Profesionales Médicos en Ozonoterapia (AEPROMO). Madrid Declaration on Ozone Therapy [Internet]. 3ª ed. Madrid: AEPROMO; 2020 [cited 2023 ago 23]. Available from: https://aepromo.org/en/madrid-declaration-on-ozone-therapy-isco3-3rd-edition-2020-103-pages/.

BRASIL. Ministério da Saúde. Portaria nº 702, de 21 de março de 2018. Política Nacional de Práticas Integrativas e Complementares – PNPIC. Brasília, DF: Ministério da Saúde, 2018. Disponível em: https://bvsms.saude.gov.br/bvs/saudelegis/gm/2018/prt0702_22_03_2018.html. Acesso em: 24 set. 2024.

Lin TH, Wang YM, Huang CY. Effects of a mobile oral care app on oral mucositis, pain, nutritional status, and quality of life in patients with head and neck cancer: a quasi-experimental study. Int J Nurs Pract. 2022;28(4):e13042. doi: 10.1111/ijn.13042.

Cangul S, Erpacal B, Adiguzel O, Sagmak S, Unal S, Tekin S. Does the use of ozone as a cavity disinfectant affect the bonding strength of antibacterial bonding agents? Ozone Sci Eng. 2020;42(4):1-6. doi: 10.1080/01919512.2020.1746633.

Hrishi TS, Kundapur PP, Bhat GS, Vishwanath S, Kamath S. Efficacy of subgingival ozone irrigation for management of chronic periodontitis – a clinical, microbiological and biochemical study. J Cont Med Dent [Internet]. 2020 [cited 2024 Aug 28];8(1). Available from: http://www.jcmad.com/admin/pdf/819a12.pdf .

Suh Y, Patel S, Re K, Gandhi J, Joshi G, Smith NL, et al. Clinical utility of ozone therapy in dental and oral medicine. Med Gas Res. 2019;9(3):163-7. doi: 10.4103/2045-9912.266997.

Paula KJS, Urruchi WMI, Freire MHS. Determination of ozone concentration in different types of aqueous solutions for use in clinical practice. Glob Acad Nurs J. 2021;2(1):e64. doi: 10.5935/2675-5602.20200064.

World Health Organization (WHO). Handbook for reporting results for cancer treatment. Geneva (CH): WHO; 1979. (WHO offset publication; 48).

Baamer RM, Iqbal A, Lobo DN, Knaggs RD, Levy NA, Toh LS. Utility of unidimensional and functional pain assessment tools in adult postoperative patients: a systematic review. Br J Anaesth. 2022;128(5):874-88. doi: 10.1016/j.bja.2021.11.032.

Fritz CO, Morris PE, Richler JJ. Effect size estimates: current use, calculations, and interpretation. J Exp Psychol Gen. 2012;141(1):2-18. doi: 10.1037/a0024338.

Cuschieri S. The CONSORT statement. Saudi J Anaesth. 2019;13(1):S27-30. doi: 10.4103/sja.SJA_559_18.

IBM. IBM Brasil [Internet]. 2023 [acesso em 2023 jul 20]. Disponível em: https://www.ibm.com/br-pt.

Pchepiorka R, Moreira MS, Lascane NAS, Catalani LH, Allegrini Júnior S, Lima NB, et al. Effect of ozone therapy on wound healing in the buccal mucosa of rats. Arch Oral Biol. 2020;119:104889. doi: 10.1016/j.archoralbio.2020.104889.

Hayashi K, Onda T, Honda H, Ozawa N, Ohata H, Takano N, et al. Effects of ozone nano-bubble water on mucositis induced by cancer chemotherapy. Biochem Biophys Rep. 2019;20:100697. doi: 10.1016/j.bbrep.2019.100697.

Veneri F, Bardellini E, Amadori F, Conti G, Majorana A. Efficacy of ozonized water for the treatment of erosive oral lichen planus: a randomized controle study. Med Oral Patol Oral Cir Bucal. 2020 Jul;25(5):e675-82. doi: 10.4317/medoral.23693.

Ghorbani F, Yazdanian M, Tahmasebi E, Izadi M, Mofid B, Varpaei HA. Effect of ozonated water on oral mucositis and pain induced by head and neck radiotherapy: a cross-sectional study. Arch Neurosci. 2021;8(4):e118914. doi: 10.5812/ans.118914.

Zecha JAEM, Raber-Durlacher JE, Laheij AMGA, Westermann AM, Lange J, Smeele L. The potencial contribution of dental foci and oral mucositis to febrile neutropenia in patients treated with myelosuppressive chemotherapy for solid tumors and lymphoma. Front Oral Health. 2022;3:940044. doi: 10.3389/froh.2022.940044.

Shehatta OM, Osman AL, Elsayed WS, Reddy S, Dsouza J, Abdelmagyd H, et al. Antimicrobial efficacy of chlorhexidine and hyaluronic acid mouthwashes on streotococcus viridans: an in-vitro study. J Int Dent Med Res [Internet]. 2022 [cited 2024 Aug 24];15(2):485-9. Available from: https://www.proquest.com/scholarly-journals/antimicrobial-efficacy-chlorhexidine-hyaluronic/docview/2685100593/se-2.

Radocha J, Paterová P, Zavrelová A, Visek B, Gabalec F, Zemlicková H, et al. Viridans group streptococci bloodstream infections in neutropenic adult patientes with hematologuc malignancy: single center experience. Folia Microbiol (Praha). 2018;63(2):141-6. doi: 10.1007/s12223-017-0542-7.

Shetty SS, Maruthi M, Dhara V, Arruda JAA, Abreu LG, Mesquita RA, et al. Oral mucositis: current knowledge and future directions. Disease-a-Month. 2022;68(5):101300. doi: 10.1016/j.disamonth.2021.101300.

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Published

2024-11-08

How to Cite

Paula, K. J. S. de, & Freire, M. H. de S. (2024). Oxygen-ozone therapy for management of oral mucositis after hematopoietic stem cell transplantation: a quasi-experimental study. Revista De Enfermagem Da UFSM, 14, e32. https://doi.org/10.5902/2179769287024

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Vol. 14 (2024): Artigos do volume 14

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