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This is an old revision of this page, as edited by Academia salad (talk | contribs) at 10:12, 7 June 2018 (→Treatment & Prevention of OM). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

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"Magic Mouthwash"

In 2014, while I was hospitalized for cancer, my mucositis was treated with a pink liquid - swish and swallow every 4 hours - called Magic Mouthwash. It's an older supportive treatment for which doctors can have varying recipes. It had to be specially compounded to each doctor's order. The version I took included a liquid antacid, Benadryl, xylocaine, and I think an antibiotic. It had an awful taste, so I avoided it when I got home.

There may be newer ways to deal with this painful and unsettling side-effect, but MM seems to still enjoy some popularity amongst oncologists. Thank you, Wordreader (talk) 21:21, 19 February 2017 (UTC)[reply]

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Treatment & Prevention of OM

I have a COI on this topic, as per my user page.

MASCC performed a systematic review of the evidence and published a guideline for the prevention of Oral Mucositis using Low-level laser therapy (LLLT)[1] (note; the preferred term within the industry is "photobiomodulation"). This is a conclusion that was shared in a meta analysis published in Current Opinion in Oncology[2]. In May 2018, [NICE] published a guideline for the use of LLLT/PBM for both the prevention and treatment of OM.[3]

My recommendation would be to add to the section on prevention

In 2013 MASCC published a systematic review of laser and other light therapy for the management of oral mucositis which resulted in a recommendation for the use of LLLT for the prevention of severe OM.[4] They wrote in its discussion that low-level laser therapy "seems to be effective in controlling the appearance and severity of OM". In 2018 NICE published a guideline in favor of the use of LLLT for the prevention and treatment of OM.[5]

I would also add this to the section on treatment:

NICE, the body which publishes guidelines for the NHS, published a guideline in favor of the use of LLLT for the prevention and treatment of OM[6]. It noted that the specialist advisors and the committee considered the key efficacy outcomes to be "improved quality of life, reduction in oral mucositis, reduction in pain and the need for analgesia, reduction in dysphagia and the need for feeding tubes, improved nutrition, and reduction in chemotherapy treatment breaks." — Preceding unsigned comment added by Academia salad (talk • contribs) 12:58, 25 May 2018 (UTC)[reply]


As stated in an above edit, I have a COI for LLLT, which you can see you on my user page and the LLLT talk page. My recommendation:
Add: In 2013 MASCC published a guideline supporting the use of LLLT for the prevention of oral mucositis[7], followed by a guideline published by the BMJ supporting the treatment for children undergoing haematopoietic stem cell transplantation.[8] In 2018 NICE published a guideline for both the prevention and treatment of mucositis using LLLT.[9]
It seems appropriate with the guidelines issued to add LLLT to the mucositis page. Academia salad (talk) 12:00, 30 May 2018 (UTC)[reply]
Thank you for your request. Please take a moment to familiarize yourself with the guidelines at WP:MEDRS if you haven't so far. Those guidelines will govern this decision. Please indicate whether you have read these guidelines and still wish to proceed with your request, by changing the answer parameter in the edit request template to read from ans=yes to ans=no, and by leaving a short note in this discussion thread that you have completely read the guidelines and wish to proceed. Thank you! .spintendo  15:17, 30 May 2018 (UTC)[reply]
Thanks for your response. I have read WP:MEDRS and wish to proceed. I would like to add that, after reading the mucositis page, I decided that my post on 25 May could be written more neutrally. The outcomes highlighted by NICE should apply to any effective mucositis treatment. So please only review/implement the recommended addition posted 30 May. Academia salad (talk) 16:43, 30 May 2018 (UTC)[reply]

Reply 04-JUN-2018

BMJ: LLLT in children

The guidelines put forth by the Mucositis Prevention Guideline Development Group suggest low level light therapy (LLLT) which is anti-inflammatory, influencing wound healing while acting as an analgesic.[1] This recommendation came with a caveat — LLLT was given a weak recommendation by the Group due to the treatment requiring "specialized equipment and expertise", and because it was unknown whether it would be "feasible to deliver this therapy modality in routine clinical practice, particularly in a pediatric population."[1] The Group's conclusion was that the ideal treatment parameters and cost-effectiveness of LLLT were unknown, adding that "methodological concerns and potential publication bias may mean that the treatment effects observed in these trials are exaggerated."[1] These concerns are not apparent in the wording of the COI edit request. If the recommendations reached by the Group are to be included in the Wikipedia article, then I believe that the full WP:WEIGHT of their conclusion — including the language describing the suggestion as a "weak recommendation" — ought to be included here as well.

NICE: LLLT in adults

The NICE evidence included 11 reviews: 3 systematic reviews and meta-analysis and 7 randomized controlled trials (1 of which also reported outcomes from a prospective case series) and 1 non-randomised comparative study. The NICE review also repeats the recommendations reached by the other two reports.[2]: 42 

MASCC: Laser and other light therapy

This systematic review of 24 trials (this paper was not a meta-analysis on effect of outcomes) was specific to recommending LLLT only for "oral mucositis in patients undergoing hematopoietic stem cell transplant, with or without total body irradiation" and was done in 2012.[3]: 336 

Conclusion

All three of the papers suggest that LLLT is workable for a narrowly defined patient population, most of those results coming from adults, while the 1st reference offers a lukewarm recommend for children. I've asked for a 2nd opinion for this review to be sure.  spintendo  11:42, 6 June 2018 (UTC)[reply]

 Unable to implement. The recommendations given in two of these sources do not entirely align. The proposed sentence states:

In 2013 MASCC published a guideline supporting ("recommends"[a]) the use of LLLT for the prevention of oral mucositis, followed by a guideline published by the BMJ supporting ("weak recommendation"[b]) the treatment for children undergoing haematopoietic stem cell transplantation. In 2018 NICE published a guideline for both the prevention and treatment of mucositis using LLLT.

I believe that since the therapy is recommended for adults in one of the publications but given a weak recommendation in the other, that this might need to be reflected in the proposal. It is important to ask whether this difference in terms is really important or not, and to question whether the inclusion of this qualification might be inappropriately introducing doubt about the therapy into the Wikipedia article. These are questions which require further discussion.  spintendo  01:30, 7 June 2018 (UTC)[reply]

Notes

  1. ^ "The panel recommends that, for centers able to support the necessary technology and training, LLLT be used to prevent oral mucositis, in HSCT patients receiving high-dose chemotherapy with or without TBI."[3]: 336 
  2. ^ "It is a weak recommendation because of the lack of efficacy and toxicity data in children, a theoretical concern that young children may be at increased risk of adverse effects related to mucosal thickening and the lack of long-term follow-up data in pediatric cancer."[1]: 9 

References

  1. ^ a b c d Sung, Lillian; Robinson, Paula; Treister, Nathaniel; Baggott, Tina; Gibson, Paul; Tissing, Wim; Wiernikowski, John; Brinklow, Jennifer; Dupuis, L. Lee (1 March 2017). "Guideline for the prevention of oral and oropharyngeal mucositis in children receiving treatment for cancer or undergoing haematopoietic stem cell transplantation". BMJ Supportive & Palliative Care. 7 (1): 11. doi:10.1136/bmjspcare-2014-000804. ISSN 2045-435X.
  2. ^ National Institute for Health and Care Excellence (2018). "Interventional procedure overview of low-level laser therapy for preventing or treating oral mucositis caused by radiotherapy or chemotherapy". nice.org.uk. p. 7.
  3. ^ a b Migliorati, Cesar; Hewson, Ian; Lalla, Rajesh V.; Antunes, Heliton Spindola; Estilo, Cherry L.; Hodgson, Brian; Lopes, Nilza Nelly Fontana; Schubert, Mark M.; Bowen, Joanne; Elad, Sharon (22 September 2012). "Systematic review of laser and other light therapy for the management of oral mucositis in cancer patients". Supportive Care in Cancer. 21 (1): 333–341. doi:10.1007/s00520-012-1605-6. ISSN 0941-4355.
Thank you for the time taken to review my request. If I am reading this correctly, your concern is that the word "supporting" did not fully communicate the weights of the recommendations in the papers submitted? So it would be better if the proposal was something like "published a recommendation for the use…" and "published a guideline with a weak recommendation for the use…" (or something similar)? Do you also think it is appropriate to include the reasons for the weak recommendation? To amend my proposal, do I have to submit another edit request or are we able to amend this proposal? Appreciate your help. Academia salad (talk) 10:12, 7 June 2018 (UTC)[reply]
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