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Published in: BMC Oral Health 1/2021

Open Access 01-12-2021 | Cytostatic Therapy | Research

Effectiveness of zinc chloride mouthwashes on oral mucositis and weight of patients with cancer undergoing chemotherapy

Authors: Khodayar Oshvandi, Seyed Yaser Vafaei, Seyed Ramesh Kamallan, Salman Khazaei, Hossein Ranjbar, Fateme Mohammadi

Published in: BMC Oral Health | Issue 1/2021

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Abstract

Background

Oral mucositis is one of the most emerging and debilitating complications of chemotherapy during the treatment period, which strongly affects the nutritional status and physical and mental condition of these patients. Zinc increased protein synthesis and improved cell membrane stability so passible effective in prevent and treat oral mucositis and promote oral health. Therefore, this study aimed to evaluate the effect of zinc chloride mouthwash on the prevention, incidence, and severity of oral mucositis in cancer patients undergoing chemotherapy.

Methods

The present study was a randomized control trial study. 96 patients with a cancer diagnosis selected from one oncology clinic in the west of Iran. Then they assigned randomly to the zinc chloride group and placebo group. The patients in each group should rinse their mouths every 8 h two times and each time 2 min with 7.5 ml from mouthwash. The severity of mucositis and weight loss examined blindly at the baseline and 3-week follow-up.

Results

The incidence and severity of oral mucositis between groups were significant higher at the end of the second (p < 0.002) and third (p < 0.001) week. The mucositis severity decreased well during the third weeks in the zinc chloride group. The difference in the weight loss was significant higher between the zinc chloride and the placebo group (p < 0.01).

Conclusion

Zinc chloride mouthwash was effective in preventing and reducing the severity of oral mucositis and improving weight in patients undergoing chemotherapy.
Trial registration We can therefore recommend more studies examine the effects zinc chloride as preventive care at the beginning of chemotherapy to improve oral health and subsequently preventing weight loss in these patients.
Literature
1.
go back to reference Zhang H, Zhao Q, Cao P, Ren G. Resilience and quality of life: exploring the mediator role of social support in patients with breast cancer. Med Sci Monit. 2017;23:5969.CrossRef Zhang H, Zhao Q, Cao P, Ren G. Resilience and quality of life: exploring the mediator role of social support in patients with breast cancer. Med Sci Monit. 2017;23:5969.CrossRef
2.
go back to reference Nipp RD. The relationship between coping strategies, quality of life, and mood in patients with incurable cancer. Cancer. 2017;122(13):2110–6.CrossRef Nipp RD. The relationship between coping strategies, quality of life, and mood in patients with incurable cancer. Cancer. 2017;122(13):2110–6.CrossRef
3.
go back to reference Kunitake H. Quality of life and symptoms in long-term survivors of colorectal cancer: results from NSABP protocol LTS-01. J Cancer Surviv. 2017;11(1):111–8.CrossRef Kunitake H. Quality of life and symptoms in long-term survivors of colorectal cancer: results from NSABP protocol LTS-01. J Cancer Surviv. 2017;11(1):111–8.CrossRef
4.
go back to reference Yavari P, Hislop TG, Bajdik C, Sadjadi A, Nouraie M, Babai M, Malekzadeh R. Comparison of cancer incidence in Iran and Iranian immigrants to British Columbia, Canada. Asian Pac J Cancer Prev. 2006;7(1):86.PubMed Yavari P, Hislop TG, Bajdik C, Sadjadi A, Nouraie M, Babai M, Malekzadeh R. Comparison of cancer incidence in Iran and Iranian immigrants to British Columbia, Canada. Asian Pac J Cancer Prev. 2006;7(1):86.PubMed
5.
go back to reference Rambod M. The effect of zinc sulfate on prevention, incidence, and severity of mucositis in leukemia patients undergoing chemotherapy. Eur J Oncol Nurs. 2018;33:14–21.CrossRef Rambod M. The effect of zinc sulfate on prevention, incidence, and severity of mucositis in leukemia patients undergoing chemotherapy. Eur J Oncol Nurs. 2018;33:14–21.CrossRef
6.
go back to reference Rosenberg SM, Tamimi RM, Gelber S, Ruddy KJ, Kereakoglow S, Borges VF, Come SE, Schapira L, Winer EP, Partridge AH. Body image in recently diagnosed young women with early breast cancer. Psychooncology. 2013;22(8):1849–55.CrossRef Rosenberg SM, Tamimi RM, Gelber S, Ruddy KJ, Kereakoglow S, Borges VF, Come SE, Schapira L, Winer EP, Partridge AH. Body image in recently diagnosed young women with early breast cancer. Psychooncology. 2013;22(8):1849–55.CrossRef
7.
go back to reference Adi Pamungkas R. Family support integrated with diabetes self-management among uncontrolled type II diabetes mellitus patients. Behav Sci. 2017;7:62.CrossRef Adi Pamungkas R. Family support integrated with diabetes self-management among uncontrolled type II diabetes mellitus patients. Behav Sci. 2017;7:62.CrossRef
8.
go back to reference Bagherian S, Sharif F, Zarshenas L, Torabizadeh C, Abbaszadeh A, Izadpanahi P. Cancer patients’ perspectives on dignity in care. Nurs Ethics. 2019;0969733019845126. Bagherian S, Sharif F, Zarshenas L, Torabizadeh C, Abbaszadeh A, Izadpanahi P. Cancer patients’ perspectives on dignity in care. Nurs Ethics. 2019;0969733019845126.
9.
go back to reference Al Ibraheemi AA. Incidence and risk factors of oral mucositis in patients with breast cancer who receiving chemotherapy in Al-Bashir Hospital. Int J Hematol Oncol Stem Cell Res. 2016;10(4):217.PubMedPubMedCentral Al Ibraheemi AA. Incidence and risk factors of oral mucositis in patients with breast cancer who receiving chemotherapy in Al-Bashir Hospital. Int J Hematol Oncol Stem Cell Res. 2016;10(4):217.PubMedPubMedCentral
10.
go back to reference Mehdipour M. A comparison between zinc sulfate and chlorhexidine gluconate mouthwashes in the prevention of chemotherapy-induced oral mucositis. Daru. 2011;19(1):71–3.PubMedPubMedCentral Mehdipour M. A comparison between zinc sulfate and chlorhexidine gluconate mouthwashes in the prevention of chemotherapy-induced oral mucositis. Daru. 2011;19(1):71–3.PubMedPubMedCentral
11.
go back to reference Umeta M, West CE, Haidar J, Deurenberg P, Hautvast JG. Zinc supplementation and stunted infants in Ethiopia: a randomised controlled trial. The Lancet. 2000;355(9220):2021–6.CrossRef Umeta M, West CE, Haidar J, Deurenberg P, Hautvast JG. Zinc supplementation and stunted infants in Ethiopia: a randomised controlled trial. The Lancet. 2000;355(9220):2021–6.CrossRef
12.
go back to reference Ertekin MV, Koç M, Karslioǧlu I, Sezen O. Zinc sulfate in the prevention of radiation-induced oropharyngeal mucositis: a prospective, placebo-controlled, randomized study. Int J Radiat Oncol Biol Phys. 2004;58(1):167–74.CrossRef Ertekin MV, Koç M, Karslioǧlu I, Sezen O. Zinc sulfate in the prevention of radiation-induced oropharyngeal mucositis: a prospective, placebo-controlled, randomized study. Int J Radiat Oncol Biol Phys. 2004;58(1):167–74.CrossRef
13.
go back to reference Cirillo N, Vicidomini A, McCullough M, Gambardella A, Hassona Y, Prime SS, Colella G. A hyaluronic acid-based compound inhibits fibroblast senescence induced by oxidative stress in vitro and prevents oral mucositis in vivo. J Cell Physiol. 2015;230(7):1421–9.CrossRef Cirillo N, Vicidomini A, McCullough M, Gambardella A, Hassona Y, Prime SS, Colella G. A hyaluronic acid-based compound inhibits fibroblast senescence induced by oxidative stress in vitro and prevents oral mucositis in vivo. J Cell Physiol. 2015;230(7):1421–9.CrossRef
14.
go back to reference Elad S, Cheng KKF, Lalla RV, Yarom N, Hong C, Logan RM, Bowen J, Gibson R, Saunders DP, Zadik Y. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2020;126(19):4423–31.CrossRef Elad S, Cheng KKF, Lalla RV, Yarom N, Hong C, Logan RM, Bowen J, Gibson R, Saunders DP, Zadik Y. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2020;126(19):4423–31.CrossRef
15.
go back to reference Cabrera-Jaimea S. Efficacy of Plantago major, chlorhexidine 0.12% and sodium bicarbonate 5% solution in the treatment of oral mucositis in cancer patients with solid tumour: a feasibility randomised triple-blind phase III clinical trial. Eur J Oncol Nurs. 2018;32:40–7.CrossRef Cabrera-Jaimea S. Efficacy of Plantago major, chlorhexidine 0.12% and sodium bicarbonate 5% solution in the treatment of oral mucositis in cancer patients with solid tumour: a feasibility randomised triple-blind phase III clinical trial. Eur J Oncol Nurs. 2018;32:40–7.CrossRef
16.
go back to reference Yarom N, Ariyawardana A, Hovan A, Barasch A, Jarvis V, Jensen SB, Zadik Y, Elad S, Bowen J, Lalla RV. Systematic review of natural agents for the management of oral mucositis in cancer patients. Support Care Cancer. 2013;21(11):3209–21.CrossRef Yarom N, Ariyawardana A, Hovan A, Barasch A, Jarvis V, Jensen SB, Zadik Y, Elad S, Bowen J, Lalla RV. Systematic review of natural agents for the management of oral mucositis in cancer patients. Support Care Cancer. 2013;21(11):3209–21.CrossRef
17.
go back to reference So-Eun C. Sodium bicarbonate solution versus chlorhexidine mouthwash in oral care of acute leukemia patients undergoing induction chemotherapy: a randomized controlled trial. Asian Nurs Res. 2012;6:60–6.CrossRef So-Eun C. Sodium bicarbonate solution versus chlorhexidine mouthwash in oral care of acute leukemia patients undergoing induction chemotherapy: a randomized controlled trial. Asian Nurs Res. 2012;6:60–6.CrossRef
18.
go back to reference Ghadiri K, Farokhi A, Akramipour R, Rezaei M, Razaghei R. Effect of honey use in preventing the occurrence and reduction of mucositis severity chemotherapy in children with cancer. J Kermanshah Univ Med Sci. 2014;18(2):74–9. Ghadiri K, Farokhi A, Akramipour R, Rezaei M, Razaghei R. Effect of honey use in preventing the occurrence and reduction of mucositis severity chemotherapy in children with cancer. J Kermanshah Univ Med Sci. 2014;18(2):74–9.
19.
go back to reference Khanjani Pour-Fard-Pachekenari A, Rahmani A, Ghahramanian A, Jafarabadi MA, Onyeka TC, Davoodi A. The effect of an oral care protocol and honey mouthwash on mucositis in acute myeloid leukemia patients undergoing chemotherapy: a single-blind clinical trial. Clin Oral Invest. 2019;23(4):1811–21.CrossRef Khanjani Pour-Fard-Pachekenari A, Rahmani A, Ghahramanian A, Jafarabadi MA, Onyeka TC, Davoodi A. The effect of an oral care protocol and honey mouthwash on mucositis in acute myeloid leukemia patients undergoing chemotherapy: a single-blind clinical trial. Clin Oral Invest. 2019;23(4):1811–21.CrossRef
20.
go back to reference Mosalaei A, Nasrolahi H, Shafizad A, Ahmadloo N, Ansari M, Mosleh-Shirazi MA, Omidvari S, Mohammadianpanah M. Effect of oral zinc sulphate in prevention of radiation induced oropharyngeal mucositis during and after radiotherapy in patients with head and neck cancers. Middle East Journal of Cancer. 2010;1(2):69–76. Mosalaei A, Nasrolahi H, Shafizad A, Ahmadloo N, Ansari M, Mosleh-Shirazi MA, Omidvari S, Mohammadianpanah M. Effect of oral zinc sulphate in prevention of radiation induced oropharyngeal mucositis during and after radiotherapy in patients with head and neck cancers. Middle East Journal of Cancer. 2010;1(2):69–76.
21.
go back to reference Moslemi D, Nokhandani AM, Otaghsaraei MT, Moghadamnia Y, Kazemi S, Moghadamnia AA. Management of chemo/radiation-induced oral mucositis in patients with head and neck cancer: a review of the current literature. Radiother Oncol. 2016;120(1):13–20.CrossRef Moslemi D, Nokhandani AM, Otaghsaraei MT, Moghadamnia Y, Kazemi S, Moghadamnia AA. Management of chemo/radiation-induced oral mucositis in patients with head and neck cancer: a review of the current literature. Radiother Oncol. 2016;120(1):13–20.CrossRef
22.
go back to reference Lin L-C, Que J, Lin L-K, Lin F-C. Zinc supplementation to improve mucositis and dermatitis in patients after radiotherapy for head-and-neck cancers: a double-blind, randomized study. Int J Radiat Oncol Biol Phys. 2006;65(3):745–50.CrossRef Lin L-C, Que J, Lin L-K, Lin F-C. Zinc supplementation to improve mucositis and dermatitis in patients after radiotherapy for head-and-neck cancers: a double-blind, randomized study. Int J Radiat Oncol Biol Phys. 2006;65(3):745–50.CrossRef
23.
go back to reference Do Carmo FLR, Rabah H, Cordeiro BF, Da Silva SH, Pessoa RM, Fernandes SOA, Cardoso VN, Gagnaire V, Deplanche M, Savassi B. Probiotic Propionibacterium freudenreichii requires SlpB protein to mitigate mucositis induced by chemotherapy. Oncotarget. 2019;10(68):7198.CrossRef Do Carmo FLR, Rabah H, Cordeiro BF, Da Silva SH, Pessoa RM, Fernandes SOA, Cardoso VN, Gagnaire V, Deplanche M, Savassi B. Probiotic Propionibacterium freudenreichii requires SlpB protein to mitigate mucositis induced by chemotherapy. Oncotarget. 2019;10(68):7198.CrossRef
24.
go back to reference Toyomasu Y, Mochiki E, Yanai M, Suzuki M, Yanoma T, Kimura A, Kogure N, Ogata K, Kuwano H. A prospective pilot study of an elemental nutritional supplement for prevention of oral mucositis during S-1 adjuvant chemotherapy for gastric cancer. Surg Oncol. 2019;29:97–101.CrossRef Toyomasu Y, Mochiki E, Yanai M, Suzuki M, Yanoma T, Kimura A, Kogure N, Ogata K, Kuwano H. A prospective pilot study of an elemental nutritional supplement for prevention of oral mucositis during S-1 adjuvant chemotherapy for gastric cancer. Surg Oncol. 2019;29:97–101.CrossRef
25.
go back to reference Pathak S, Soni TP, Sharma LM, Patni N, Gupta AK. A randomized controlled trial to evaluate the role and efficacy of oral glutamine in the treatment of chemo-radiotherapy-induced oral mucositis and dysphagia in patients with oropharynx and larynx carcinoma. Cureus. 2019;11(6). Pathak S, Soni TP, Sharma LM, Patni N, Gupta AK. A randomized controlled trial to evaluate the role and efficacy of oral glutamine in the treatment of chemo-radiotherapy-induced oral mucositis and dysphagia in patients with oropharynx and larynx carcinoma. Cureus. 2019;11(6).
Metadata
Title
Effectiveness of zinc chloride mouthwashes on oral mucositis and weight of patients with cancer undergoing chemotherapy
Authors
Khodayar Oshvandi
Seyed Yaser Vafaei
Seyed Ramesh Kamallan
Salman Khazaei
Hossein Ranjbar
Fateme Mohammadi
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2021
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-021-01706-w

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