Effectiveness of Chlorhexidine vs KMnO₄ Oral care on Oral mucositis among Head and neck cancer patients admitted in Oncology ward at Pravara Rural Hospital, Loni Bk

Mr. Ravindra B. Kate¹, Ms. Heera Jayasheela²

¹Clinical Instructor, Maratha Vidya Prasarak Samaja’s Institute of Nursing Education, Nashik, Taluka Nashik, District Nashik, Maharashtra, India

²Professor, College of Nursing, Pravara Institute of Medical Sciences (DU), Loni (Bk) Taluka Rahata,

District Ahmednagar, Maharashtra, India

*Corresponding Author E-mail: ravikatepatil@gmail.com

ABSTRACT:

Head and neck cancer in India has distinct demographic profile, risk factors, food habits, personal and family history. Many of the cancer patients receiving cancer treatment do have variety of health problems like Oral mucositis. Nurses play an important role in reducing the oral mucositis problems and improve the health status. Objective: To determine the effectiveness of Chlorhexidine Vs KMnO4 oral care on oral mucositis. Method: True experimental study, where pre-test post-test design with control group approach was undertaken in Pravara Rural Hospital. The data were collected from 60 head and neck patients who were selected by sequential sampling technique and randomized in to experimental and control group (by using odd and even number method). The nurse investigator conducted a structured interview for 15 to 20 minutes to collect data and WHO oral mucositis scale was used to assess the oral mucositis grades. After the pre-test the nursing interventions (Chlorhexidine oral care in experimental group and KmnO4 oral care in control group) were implemented to the head and neck cancer patients from the day of admission to 4^th week. The post-test was carried out on the day of follow up visit after 4^th week of intervention. The data was analyzed with descriptive and inferential statistics wherever required. Results: It was found that before intervention the head and neck cancer patients (experimental group) had mean score (2.66±0.74) indicates ‘grade II’ oral mucositis whereas in control group patients had mean score (1.96±0.92) indicates ‘grade I’ oral mucositis. It was noted that after the nursing intervention (Chlorhexidine) the level of oral mucositis was significantly reduced the mean score was (1.73±0.82). It shows that the use of chlorhexidine for oral care helps in minimizing the oral mucositis i.e. from grade II to grade I. In control group the mean score was (1.26±0.66) it shows that the use of KmnO4 for oral care did not significant effect in reducing the level of oral mucositis. Conclusion: The study outcome revealed that the nurse intervention (Chlorhexidine) was found to be effective in reducing oral mucositis among head and neck cancer patients than the KmnO4 in control group. It should be emphasized that nurse intervention should be practiced and used routinely for the head and neck cancer patients to have better outcome.

KEYWORDS: Chlorhexidine, KMnO_4,Oral care, Oral mucositis, Head and neck cancer.

INTRODUCTION:

Cancer is a major public health problem in India¹. Cancer is 2^nd leading cause death². Treatment modalities for cancer such as Chemotherapy and Radiation therapy are very costly and have various side effects³. The mouth is a frequent site of complications arising from drug or radiation cancer therapy, with mucositis, xerostomia, osteoradionecrosis, and local infections being the most common.

Oral mucositis is defined as an injury of the oral mucosa in cancer patients, either induced by irradiation of patients who have head and neck cancer, or due to chemotherapy⁴.

STATEMENT OF THE PROBLEM:

Effectiveness of Chlorhexidine vs KMnO₄ oral care on oral mucositis among head and neck cancer patients admitted in Oncology ward at Pravara Rural Hospital Loni bk.

OBJECTIVES:

1. To assess the oral mucositis level before implementation of interventions.

2. To determine the effectiveness of Chlorhexidine Vs KMnO4 oral care on oral mucositis.

MATERIALS AND METHODS:

Research design and approach:

True experimental study where pre-test post-test design with control group

Setting of the study:

The study was conducted in oncology ward at Pravara Rural Hospital, Loni Bk, Taluka Rahata, District Ahemadnagar, Maharashtra, India

Population:

Head and neck cancer patients with oral mucositis.

Sampling technique:

Sequential sampling technique was used to select the sample and then they are randomized in experimental and control group using odd and even number method.

Sample size:

60 head and neck cancer patients with oral mucositis

Inclusion Criteria:

The study was limited to patients, who were

· Head and neck cancer patients having oral mucositis and receiving chemotherapy and radiation therapy.

· Present during the period of the sample collection.

· Age should be above 35 years.

Exclusion Criteria:

Patients who were

· Having other type of cancers

· Acutely ill and unable to respond

· Suffering with neurological and psychological disease

Tools/Instruments:

The instruments used for the present study are the demographic proforma, Clinical characteristics data sheet and WHO oral mucositis assessments scale.

Data collection procedure:

The present study was approved by the institutional ethics committee (IEC) and institutional research committee (IRC) of the PIMS (DU) Reg no: CON/59/2016 dated 15.04.2016. Informed consent was obtained from all the head and neck cancer patients. Pre-test was conducted on day of admission before implementation of oral care by using WHO oral mucositis assessment scale. After the pre-test the chlorhexidine oral care mouthwash was given to experimental group samples and educated them to how to use chlorhexidine mouthwash, its benefits and side effects and told them use chlorhexidine mouth care solution thrice in a day for 4 weeks, and KMnO4 mouthwash was given to control group samples thrice a day for 4 weeks. Post-test was carrying out on the day of completion (after 4^th week). It was carrying out the WHO oral mucositis assessment scale.

Data analysis:

The systematic organization and synthesis of research data is done by data analysis. Researchers will analysis the data by using descriptive and inferential statistics based on the objectives and hypotheses of the study. Compute the data sheet was prepared by the investigator

RESULTS:

Table 1: Frequency and percentage distribution of demographic variables

Demographic Variables	Number of respondent		Percentage (%)
	Experimental Group	Control Group	Experimental Group	Control Group
Age
35 – 40	2	3	7	10
41 – 45	5	7	17	23
46-50	7	6	23	20
51-55	6	5	20	17
>55	10	9	33	30
Gender
Male	18	21	40	30
Female	12	9	60	70
Educational qualification
No formal education	4	5	13	17
Primary education	13	8	43	27
Secondary education	10	15	33	50
Higher secondary education	3	2	10	6
Occupation
Homemaker	12	7	40	23
Daily wages	7	14	23	47
Private Employee	4	4	13	13
Govt. employee	5	3	17	10
Business	2	2	7	7
Type of Family
Nuclear	10	8	33	27
Joint	15	18	50	60
Extended	5	4	17	13
Religion
Hindu	23	22	77	73
Muslim	4	5	13	17
Christian	3	3	10	10
Family history of cancer
Yes	0	0	0	0
No	30	30	100	100

Table 2: Frequency and percentage distribution of Clinical characteristics

Demographic Variables	Number of respondent		Percentage(%)
	Experimental Group	Control Group	Experimental Group	Control Group
Stages of cancer
Stage I	1	0	3	0
Stage II	7	12	23	40
Stage III	18	18	60	60
Stage IV	4	0	13	0
Type of Head and Neck cancer
Cancer of Buccal Mucosa	12	5	40	17
Cancer of tongue	13	5	43	17
Cancer of oesophagus	3	9	10	30
Any other	2	11	7	37
Duration of Cancer
< 6 months	5	5	17	17
> 6 months	25	25	83	83
Treatment of Cancer
Radiation Therapy	5	5	17	17
Chemotherapy	3	1	10	3
Combined therapy	22		73	80
Duration of treatment
31 – 45	27	25	90	83
> 45	3	5	10	17
Personal Habit
Smoking	3	6	10	20
Alcoholism	3	7	13	23
Tobacco chewing	12	7	40	23
Use of Pan/ Supari/ Snuff	8	10	10	0
Combined habit	4	0	27	34
Treatment compliance
Regular	30	30	100	100
Irregular	0	0	0	0

The above table shows that distribution of mean, SD, mean % of oral mucositis of head and neck cancer patients in experimental group shows that in posttest the mean score is (1.73±0.82) which is 43% of total score it is lower than the pretest score i.e. (2.66±0.74) and the effectiveness is (24%). Its shows that the use of chlorhexidine for oral care helps in minimizing the oral mucositis i.e. from grade II to grade I.

However in control group posttest mean score is (1.26±0.66) which is 41% of total score it is lower than the pretest score i.e. (1.96±0.92) and the effectiveness is (8%). Its shows that the use of KmnO₄ for oral care do not have significant effect in reducing the level of oral mucositis.

It interprets that the use of chlorhexidine for oral care significantly reduces the oral mucositis than the KmnO4.

Table No.5: Paired ‘t’ test value of experimental group and control group of oral mucositis

S No.	Oral mucositis	‘t’ value	Level of significance
1	Level of oral mucositis on 1^st week	3.31	Significant
2	Level of oral mucositis on 4^th week	2.19	Significant

(df= 29, table value: 2.05 at p<0.05 level)

The above table shows that Paired ‘t’ test is done to analyze the difference in posttest oral mucositis level among head and neck cancer patients between experimental and control group. There are a significant difference found in level of oral mucositis in 1^st and 4^th week between the experimental and control group. Calculated ‘t’ value 3.31 and 2.19 is greater than table value at 0.05 level of significance in all the comparison hence the research hypotheses is accepted. So, it can be concluded that there are significance difference in between experimental and control group of oral mucositis among head and neck cancer patients.

Table No. 6: Association of oral mucositis level outcome of head and neck cancer patients in experimental group with their selected socio demographic variables

S No.	Variable	χ2	Level of significance
1	Age	0.016	Not significant
2	Gender	3.79	Not significant
3	Stages of cancer	3.03	Not significant
4	Type of head and neck cancer	8.74	Significant
5	Duration of cancer	0.53	Not significant
6	Treatment of cancer	0.64	Not significant

(df – 1, table = 3.84, p> 0.05, not significant)

Chi- square values were calculated to find out the association between the experimental group oral mucositis with socio demographic variable of head and neck cancer patients. The findings revealed that there was a significant association found between oral mucositis level and demographic variable like type of head and neck cancer. However the other variables like age, gender and clinical characteristics like stages of cancer, duration of cancer and treatment of cancer. Hence the research hypotheses is accepted So, it can be concluded that there there are a significant association between oral mucositis with their selected socio demographic variables.

DISCUSSION:

The present study findings is consistent with another study, which was conducted by G. Roopashri, K. Jayanthi, and R. Guruprasad. Sampling technique was purposive sampling, research design was three study group pre test, post-test with control group. The population of study was head and neck cancer patients with oral mucositis. The study findings showed that before the nursing intervention (Benzydamine hydrochloride, Chlorhexidine, Povidone-iodine) on oral mucositis among head and neck cancer patients shows that patients in the povidone-iodine group had significantly lower mucositis scores when compared to the chlorhexidine group and Benzydamine hydrochloride⁵.

CONCLUSION:

This study attempted to assess the effectiveness of Chlorhexidine vs. KMnO4 oral care on oral mucositis among head and neck cancer patients. The following conclusions are made drown from the findings of the study.

· The head and neck cancers patients admitted in the oncology ward have significant level of oral mucositis.

· Clorhexidine oral care solution to be effective than KMnO₄ solution in reducing level of oral mucositis of head and neck cancer patients.

· The level of oral mucositis of head and neck cancer patients shows a constant pattern of significance in terms with selected demographic variables.

RECOMMENDATIONS:

On the basis of the findings of study, the following recommendations are offered.

· These findings can be used as a evidence for standardizing the nursing care practice of head and neck cancer patient undergoing radiation and chemotherapy treatment.

· Replicate this study by utilizing an increased sample size.

· A comparative study can be conducted among head and neck cancer patients with other oral care solutions.

· A same study can be done with other types of cancers.

REFERENCES:

1. Public health problems in India, cancer management, Available from URL://http://www.medicine.net.com>home>cancer>ezlist>medterm

2. Worldwide statistics of cancer disease, Available from URl://http://www.cancerresearch.uk.org>health>professional>cancerstatistics

3. Treatment modalities of cancer, Brunnars and Sidhharths, textbook of medical surgical mursing, Vol.2, 6^th edition, page No.1223-34. Available from URL://http://www.medicinenet.com>home>cancercenter>cancer.az.list

4. Carrel SB, Blakerkee DB, Oswal SG, Barneam, textbook of radiation and chemotherapy induced stomatitis, otolaryngeal, head and neck surgery (serial online) 1990, april (cited 2012, Nov 20); (10)2, Available from URL://http://www.ncbi.nim.nih.gov/pubmed/2113238

5. G. Roopani, K. Jayanti and R Guruprasad, Efficacy of Benzydamine hydrochloride, Chlorhexidine, Povidone-iodine, WolterKluveron- Medknow publication, contem din dent.2011 Jan-March; 2(1): 8-12, DOI.10.4103/0976-237X. http://WWW.ncbi.nim.nih.9007<artical

Received on 17.07.2018 Modified on 24.07.2018

Int. J. Nur. Edu. and Research. 2019; 7(1): 55-59.

DOI: 10.5958/2454-2660.2019.00011.5

	Oral mucositis level
Groups	Pretest
	Mean	SD	Mean%
Experimental group	2.66	0.74	66%
Control group	1.96	0.92	49%

Groups	Oral mucositis level
	Pretest (Iweek)			Posttest (IV week)			Difference in mean %
	Mean	SD	Mean %	Mean	SD	Mean %	Difference in mean %
Experimental group	2.66	0.74	67%	1.73	0.82	43%	24%
Control group	1.96	0.92	49%	1.26	0.86	41%	8%