the use of chewing gum and associated benefits in the oral mucositis treatment in patients who underwent chemotherapy

The study’s goal was to write a critical assessment of an article about the use of chewing gum and its associated benefits in the treatment of oral mucositis in chemotherapy patients. The study was fully focused on locating and studying the paper based on specific questions about the quality, purpose, design, variables, framework, results, analysis, limitations, and interpretations. According to the analysis, the study was significant and beneficial in offering a greater comprehension and knowledge of the topic. Although, there were a few drawbacks, but the study was nonetheless beneficial in its premise and provided significant insight into the subject. The study has been worth evaluating and analyzing.

Keywords: chemotherapy, oral mucositis, chewing gum

Quantitative Article Critique

This paper is a review of the article titled The Effect of Chewing Gum on Oral Mucositis in Children Receiving Chemotherapy by Didem Ayverdi. The article searches for answers related to the health care significance of the chewing gums, whether they are efficient for the children undergoing chemotherapy treatments for the oral mucositis. The title of the topic sufficiently refers to all the primary variables and the individual participated.The abstract was very clear about why and how the study was implemented, providing significant results with positive conclusions.

Problem Statement

The problem statement identified in the article is “The purpose of this study was to assess the effect of chewing gums on preventing oral mucositis and decreasing its severity” (Didem et al. 2014). The problem has been clearly justified; it is not a fatal condition, however, directly affects the quality of patient’s life to clinical symptoms and signs.

Purpose of the Study

The purpose of the statement was specific that chewing gum has been used as a nonpharmacological intervention in testing oral cancer preventions and complications since the 1990s. The research elements identified the key elements to study through finer evaluation criteria.

Hypothesis

There was no hypothesis, however the evident results regarding the intraoral complications that mainly occurs in the chemotherapy recipients because of decreased pH and saliva levels. Therefore, chewing gums are used to increase the saliva production and pH levels showing 3-10 folds significant results which are important in preventing the oral mucositis complication during chemotherapy treatments.

Review of the Literature

The author reviewed many sources focusing the need and providing an evidence-based study. Although the cited sources used were not very recent, some sources cited are older than 5-10 years. For instance the article ”Development, testing, and application of the oral assessment

Guide” was from the year 1988. However, the literature review portion has covered the introduction appropriately, proving the background knowledge regarding the issue, mortality rate, severity, complications and relevant studies and treatments.

Variables or Concept

The author involved proper variables and concepts using the Cochrane database examination of 29 different kinds of interventions in the 71 randomized controlled studies, in order to prevent and reduce the oral mucositis severity in cancer patients. Despite the different outcomes from different studies, there are no effective treatment strategies available to prevent oral mucositis.

Theoretical Framework

The author used an experimental framework to elaborate study purpose using 60 children between the age group of 6-18 who had undergone chemotherapies, dividing the control and study group of 30 each with the provision of similar baseline characteristics.

Protection for Human Participants

The principal investigator of the study had taken permission from the institution to conduct a study and then informed consent was taken from the parents of each child addressing their questions and concerns. There was no mention of IRB approval documentation in the article. Also, there was no mention of the confidentiality of the participated subjects.

Research Design

The study design was quasi-experimental with a control group. The study was carried out in the university hospital’s pediatric oncology clinic in Istanbul, between August 2011 and February 2012 with 60 participants, 30 control, and cases each. The study assessments were made on the WHO criteria of oral mucositis assessment scale and Eilers’ oral assessment guide (Didem et al. 2014).

Population, Setting, Sample

The study was conducted on children from a pediatric oncology department, Istanbul. The participants were the children who have undergone chemotherapy. There was no specific mention of inclusion-exclusion criteria, however, the sampling process was clinical and physical examination based on filing information forms with demographical characteristics of children and family members. Although the sample size not too high, the results were significant.

Instrumentation

There was no specific mention of instrumentation in the study. The evaluation was based on WHO oral mucositis assessment scale and Eilers’ oral assessment guide (OAG), followed by the statistical analysis, permission from the national ministry of health and ethical approvals.

Data Collection and Measurements

The data was collected from the clinic from Istanbul, based on WHO and OAG measurements, analyzed using statistical U-test approach.

Procedure and Data Analysis

The researcher used a step-by- step procedure following two assessment tools for assessing mucositis occurrence and severity. The first method was WHO assessment scale due to its scientifically accepted objective scoring system. Due to lack of system details another method of assessment using Eilers’ oral assessment guide was used ( Eilers et al. 1988), consisting of ”eight categories—voice, swallow, lips and corner of mouth, tongue, saliva, mucous membranes, gingiva, and tooth.” The scale was prepared ‘according to Likert system’ ranging from normal to definitely compromise as 1 to 3. The total score of scale ranged 8-24, without any breaking point; the severity of mucositis increases with the higher score of scale (Eilers et al. 1998). The score results were then analyzed using the statistical SAS program ‘(version 9.3, 99PVKY, Istanbul, Turkey).’ The sample characteristics were described using ‘mean and standard deviation, frequencies, and percentages,’ where differences between the groups were examined using ‘the Mann-Whitney U test.’ The statistical threshold significance was referred as p < .05.

Findings/Results

The researchers referred back to the study statement multiple times. The initial results were not significant, however, appeared significant at the end presenting the comprehensible results with the adequate information with statistically significant data.

Interpretation of the Data

The correct tests were used for data analysis with concordant interpretation. The author explained the results in a clearly concise manner providing table 1, table 2 and figure 1 with organized and comprehensive information for understanding the data. The study was significant, although had certain limitations as the feasibility of limited patient groups of pediatric only pediatric oncology.

Implications/ Recommendations

Despite the limitation, the research was, however, was likely helpful in the decision-making process and understanding the relationship of chewing gum and oral mucositis prevention. The study is worthy of publication in an academic journal and inspiring a further research of same mucositis level comparison in grade 3 and 4 children for better assessment of the results. The study did provide a better knowledge and understanding with enough information of assessing the severity of oral mucositis on the basis of pH levels and use of chewing gum in prevention of the chemotherapy treatment complexities in children.

References

Didem, A., Ayfer, E., & Ferda, O.A. (2014). The Effect of Chewing Gum on Oral Mucositis in Children Receiving Chemotherapy. Health science journal, 8(3), 373-82.

Eilers, J., Berger, A., & Petersen, M. (1988). Development, testing, and application of the oral assessment guide. Oncology Nursing Forum, 15(3), 325-330.