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Clinicians’ experience with topical benzydamine and morphine for the management of oral mucositis: adverse effects and barriers

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Abstract

Introduction

Among the evidence-based agents outlined in the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) mucositis guidelines, benzydamine and morphine are advised for the management of oral mucositis (OM) in certain cancer patients. This study is aimed to collect information from a group of highly experienced healthcare professionals in the field of oral mucositis about their clinical experience with these agents.

Methods

A survey questionnaire about the clinical experience with topical benzydamine and morphine to manage oral mucositis and their related adverse effects (AEs) was electronically distributed to the members of the Mucositis Study Group of MASCC/ISOO.

Results

Eighty-eight entries were recorded (response rate 25%), and 54 entries submitted complete questionnaires about the drug-related AE (completion rate 65%) and were used for the data analysis. Of the respondents, 44% and 27.7% prescribed benzydamine and morphine to manage their patients’ oral mucositis, respectively. Lack of availability in the respondent’s country was the common reason for not prescribing benzydamine and morphine (18.9% and 5.4%, respectively); however, a large portion of the respondents indicated that ‘another reason’ stopped them from prescribing these agents (51.3% and 73%, respectively). AEs to benzydamine or morphine were observed by 25.9% and 12.9% of respondents, respectively, with mild numbness and tingling as the most common drug-related AE for both agents.

Conclusion

The use of topical benzydamine and morphine for the management of OM varies between countries. While relatively common, the AEs related to these agents are mild. Mitigating the barriers for prescribing them may increase their use.

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Author information

Authors and Affiliations

  1. Division of Oral & Maxillofacial Surgery, Department of Surgery, New York Presbyterian Hospital - Weill Cornell Medical Center, New York, NY, USA

    Ariel Blanchard

  2. Oral Medicine Unit, Sheba Medical Center, Tel Hashomer, Israel

    Noam Yarom

  3. School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel

    Noam Yarom

  4. Department of Oral & Maxillofacial Surgery, Division of Orofacial Pain, Thomas Jefferson Hospital, Philadelphia, PA, USA

    Lauren Levi

  5. Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Karis Kin Fong Cheng

  6. Department of Medical and Surgical Specialties, Radiological Sciences and Public Health – Medical Oncology, ASST-Spedali Civili, University of Brescia, Brescia, Italy

    Paolo Bossi

  7. Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Yehuda Zadik

  8. Department of Oral Medicine, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Yehuda Zadik

  9. Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA

    Sharon Elad

Authors
  1. Ariel Blanchard
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  2. Noam Yarom
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  3. Lauren Levi
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  4. Karis Kin Fong Cheng
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  5. Paolo Bossi
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  6. Yehuda Zadik
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  7. Sharon Elad
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Consortia

Atask force of the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO)

Contributions

Ariel Blanchard and Lauren Levi created the concept of the poll. Ariel Blanchard, Lauren Levi, and Sharon Elad composed the content of the poll, with feedback from all the coauthors. Sharon Elad coordinated the distribution of the survey. Noam Yarom managed the logistics of the electronic survey platform. Yehuda Zadik managed the IRB application. Sharon Elad and Ariel Blanchard wrote the main manuscript. All the coauthors reviewed the manuscript. Additionally, the authors thank the MASCC executive team for distributing the survey. Likewise, the authors thank then members of the Mucositis Study Group of MASCC/ISOO for participating in this survey.

Corresponding author

Correspondence to Ariel Blanchard.

Ethics declarations

Ethics approval

This study was approved by the Institute Review Board of the Faculty of Medicine, at the Hebrew University, Jerusalem, Israel (#25052021).

Consent to participate

Participants were informed that consent was implied by accessing the survey, which was voluntary and anonymous and allowed participants to withdraw from the survey at any time.

Consent for publication

All the participants were informed that their de-identified data may be published for scientific purposes.

Competing interests

The authors declare no competing interests.

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Blanchard, A., Yarom, N., Levi, L. et al. Clinicians’ experience with topical benzydamine and morphine for the management of oral mucositis: adverse effects and barriers. Support Care Cancer 30, 10255–10262 (2022). https://doi.org/10.1007/s00520-022-07443-2

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