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김대희 ( Kim Dae-Hee ) - 서울대학교 어린이병원 소아혈액종양병동
박수정 ( ) - 서울대학교 어린이병원 소아혈액종양병동
장명숙 ( ) - 서울대학교 어린이병원 소아혈액종양병동
손순금 ( ) - 서울대학교 어린이병원 소아혈액종양병동
박소현 ( Park So-Hyun ) - 서울대학교 어린이병원 소아혈액종양병동
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Abstract
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Introduction: Even if todays medicine is extremely developed, higher death rate caused by cancer is emphasized. Especially, for child patient, as their growth and segmentation of cancer cells is very fast, the countermeasure is required greatly. Fortunately, through positive therapy, the curing results are raised in general, but also the ill effects are happening more frequently and more harmfully. Out of cancer patient therapies, chemotherapy is the one of the most basic therapies, along with surgical therapy. And oral ulcer becomes a hindrance to the cancer therapy and provides patients with not a little inconvenience. It is one of the complications caused frequently in chemotherapy alone or in chemotherapy combined with cranial radiotheraphy. It makes patients have a severe pain and inconvenience, and in some cases, results in their weight loss due to malnutrition or secondary infection. Notably, now, many child cancer patients suffer from oral ulcer when they undergo high dose chemotherapy.
Objectives: The purpose of this study is to confirm whether oral care has an influence upon the frequency and extent of oral ulcer occurrences. Also it is checked if it has an influence on the basis of the oral assessment of 8 areas, such as voice, swallowing, lips, saliva, tongue, mucose membrane, gingiva, and teeth, before hemotherapy, on the 3rd, the 5th, the 7th, 10th, and 14th after chemotherapy respectively, for the following two groups: the Experiment Group where GM-CSF oral gargling was carried out, in addition to the use of existent betadine and nystatin, and the Comparison Group where only betadine and nystatin was used, and GM-CSF oral gargling was not carried out. To mention the aim of this study more concretely, it lies in analyzing the frequency of oral ulcer occurrences, for the patients(children) who are under chemotherapy, and at the same time, (in) comparing and analyzing the occurrence frequency, the severity degree, and the recovery period of oral ulcer, for the possible oral ulcer patients[children] of the Experiment Group(where GM-CSF oral gargling was carried ou), with those of the Comparison Group.
Object and Method: This study took, as object, the total 62 patients (Experiment Group: 27; Comparison Group: 35), whose parents agreed to participate in this study, of the patients who had been hospitalized in the Hemato-oncology Ward at Seoul National University childern hospital, from May 4, 1998 to July 5, 1999. From the day when cancer therapy was started until 10 days after chemotherapy was oral gargling carried out 4 times a day, with 4ml(10㎍/ml) of GM-CSF oral gargling solution. Oral assessment was executed, by the previously-educated nurses seeing and recording the patients oral conditions, with the tonguepress and the penlight, before chemotherapy and on the 3rd, the 5th, the 7th, 10th, and 14th after chemotherapy respectively. The density of GM-CSF of the oral gargling solutions which were provided for the oral caring (method) of Experiment Group, was adopted[choseni as 4 ml (10㎍/ ml). And, from the day when chemotherapy was begun, each patient[childi of Experiment Group was told to gargle his/her oral cavity for more than 1 minute, after every meal and before sleeping, after being supplied with 4m1(10㎍/ml) of cool GM-CSF oral gargling solution kept in the refrigerator. The duty nurse was ordered to check the oral cavity every duty-time. For the guide to assess oral problems, Oral Assessment Guide(OAG) was used, which was developed by Eilers, Berger & Petersen(1988) and verified by Chung Yeon Ie(1996).
Results: 1. (It was found that) there was no distinct statistical difference between the oral ulcer occurrence frequency of Comparison Group and that of Experiment Group where oral caring was carried out, with GM-CSF oral gargling solution. 2. In case of the frequency of the areas where oral ulcer happened, the frequency of Experiment Group was less, compared to that of Comparison Group(P[x]<0.05). 3. In case of the severity of oral ulcer, the severity of that of Experiment Group where oral caring[nursingj was carried out, with GM-CSF oral gargling solution was remarkably lower, compared to that of Comparison(P[x]<0.05). 4. Oral ulcer started from the 3rd after chemotherapy, and happened more slowly in Experiment Group than in Comparison Group. It was most severe on the 10th, and from the 14, began to decrease. 5. When comparing the oral ulcer conditions of each area of Experiment Group and Comparison Group, according to each time, there appeared an evident difference among lips, tongue, and gingiva areas, on the 3rd after chemotherapy (P[x]<0.05), and there happened a remarkable difference between lips and sa1iva, on the 5th(P[x]<0.01). On the 7th, there was difference among swallowing, lip, and tongue(P[x](0.05), and on 10th, there was a notable difference among voice, swollowing difficulty, and tongue(P[x]<0.05). And on 14th, there was a similar difference between voice and tongue(P[x]<0.05). Especially, in case of lips and gingiva of 8 oral areas, there was a difference according to time lapse between Experiment Group and Comparison, and a statistically similar result was shown.(P[x]<0.05). 6. There was no clear difference between the general characteristics of Comparison Group and that of Experiment Group. Also, in case of hematologist factor & cause diseases, past oral ulcer experiences, oral gargling times, care givers, chemotherapy-executed times, and used chemotherapy medicines, there was no notable difference between 2 groups.
Conclusion and Discussion: For the above results, even though oral ulcer occurred, for all the patients who underwent the combined chemotherapy, the starting point of the oral ulcer caused due to anticancer medication could be delayed and the severity could be also lowered, through the execution of oral caring[nursing] with GM-CSF oral gargling solution. Also, oral ulcer occurred on the 3rd to 5th after chemotherapy carried out; it was most severe from the 7th to the 10th; and its severity tended to decrease around the 14th day. In Experiment Group, the areas where oral ulcer occurred appeared less, compared with those of Comparison Group. And it was found out that the regions where oral ulcer happened most severely were oral mucose membrane, tongue, and lips. It was discovered that severe oral ulcers occurred more frequently to the object patients [children] who specially underwent a high dose of combined chemotherapy, of chemodrug therapies which were akeady known ta give rise to oral ulcer, through many literatures. Accordingly, the oral care for the patients who under a high dose of chemotherapy must be carried out for not less than 14 days from the starting point of chemotherapy. And GM-CSF oral gargling is thought to contribute greatly to the prevention and minimization of severe oral ulcer.
Proposals: 1. It is proposed that taking the patients an object, the types of pain and oral intake should be studied, together with the objective measurement of oral ulcer. 2. It is proposed that in hospital setting GM-CSF should be utilized.
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KeyWords
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원문 및 링크아웃 정보
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등재저널 정보
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