Developing Ice Cream for Mucositis Management and Improving the Nutritional Support for Pediatric Cancer Patients

Authors

DOI:

https://doi.org/10.32635/2176-9745.RBC.2023v69n1.3325

Keywords:

mucositis/prevention & control, cryotherapy, nutritional status, ice cream, neoplasms

Abstract

 

Introduction: Mucositis is one of the main complications of cancer treatment, associated with several nutritional limitations and the ability to cause secondary infections. Cryotherapy is a low-cost treatment consistent with clinical practice guidelines for treating patients with mucositis. Objective: To develop and evaluate the acceptance of ice cream for the prevention and treatment of mucositis and nutritional support of pediatric cancer patients. Method: Based on knowledge about the side effects of chemotherapy (especially in oral and gastrointestinal mucositis) and the nutritional needs of pediatric cancer patients, a literature search for ingredients that could meet the study’s objectives was undertaken. Food Technology Laboratory of the São Paulo State University (Unesp), Botucatu campus, and in partnership with Sorvetes Naturais ice cream shop in the municipality of Botucatu-SP, produced the ice cream. An acceptance test was applied in ten patients undergoing cancer treatment and 30 individuals in the control group using the 5-point mixed facial hedonic scale. Results: The final formula consisted of semi-skimmed lactose-free milk, extra virgin coconut oil, oat flour, honey, chamomile, Fortini® food supplement, demerara sugar, and stabilizer/emulsifier. 90% of patients undergoing cancer treatment rated the final product as “liked” or “loved it,” compared to 63% of the control group. Conclusion: Development of an ice cream that met the objectives of the study was possible through the choice of its composition. Honey and chamomile can favor the prevention of mucositis, and other ingredients offer the caloric density and protein supply.

Downloads

Download data is not yet available.

References

Ferlay J, Ervik M, Lam F, et al. Global Cancer Observatory: cancer today [Internet]. Lyon, France: International Agency for Research on Cancer; 2020 [cited 2020 Dec 23]. Available from: https://gco.iarc.fr/today

Van Cutsem E, Arends J. The causes and consequences of cancer-associated malnutrition. Eur J Oncol Nurs 2005;9(Suppl 2):S51-S63. doi: https://doi.org/10.1016/j.ejon.2005.09.007 DOI: https://doi.org/10.1016/j.ejon.2005.09.007

Garófolo A. Diretrizes para terapia nutricional em crianças com câncer em situação crítica. Rev Nutr. 2005;18(4):513-27. doi: https://doi.org/10.1590/S1415-52732005000400007 DOI: https://doi.org/10.1590/S1415-52732005000400007

Murphy AJ, White M, Viani K, et al. Evaluation of the nutrition screening tool for childhood cancer (SCAN). Clin Nutr. 2016;35(1):219-24. doi: https://doi.org/10.1016/j.clnu.2015.02.009 DOI: https://doi.org/10.1016/j.clnu.2015.02.009

Brinksma A, Huizinga G, Sulkers E, et al. Malnutrition in childhood cancer patients: a review on its prevalence and possible causes. Crit Rev Oncol Hematol. 2012;83(2):249-75. doi: https://doi.org/10.1016/j.critrevonc.2011.12.003 DOI: https://doi.org/10.1016/j.critrevonc.2011.12.003

Grosvenor M, Bulcavage L, Chlebowski RT. Symptoms potentially influencing weight loss in a cancer population. Correlations with primary site, nutritional status, and chemotherapy administration. Cancer. 1989;63(2):330-4. doi: https://doi.org/10.1002/1097-0142(19890115)63:2%3C330::aid-cncr2820630221%3E3.0.co;2-u DOI: https://doi.org/10.1002/1097-0142(19890115)63:2<330::AID-CNCR2820630221>3.0.CO;2-U

Horie LM, Barrére APN, Castro MG, et al. Diretriz BRASPEN de terapia nutricional no paciente com câncer e BRASPEN recomenda: indicadores de qualidade em terapia nutricional. Braspen J [Internet]. 2019 [acesso 2020 dez 23];34(Suppl 1):2-32. Disponível em: https://www.braspen.org/_files/ugd/a8daef_19da407c192146e085edf67dc0f85106.pdf

Instituto Nacional de Câncer José Alencar Gomes da Silva. Consenso nacional de nutrição oncológica [Internet]. 2. ed. rev., amp. atual. Rio de Janeiro: INCA; 2015 [acesso 2018 dez 26]. Disponível em: https://www.inca.gov.br/sites/ufu.sti.inca.local/files//media/document/consenso_nacional_de_nutricao_oncologica_-_2a_edicao_2015_completo_0.pdf

Kwon Y. Mechanism-based management for mucositis: option for treating side effects without compromising the efficacy of cancer therapy. Onco Targets Ther. 2016;9:2007-16. doi: https://doi.org/10.2147/OTT.S96899 DOI: https://doi.org/10.2147/OTT.S96899

Chaveli-López B, Bagán-Sebastián JV. Treatment of oral mucositis due to chemotherapy. J Clin Exp Dent. 2016;8(2):e201-9. doi: https://doi.org/10.4317/jced.52917 DOI: https://doi.org/10.4317/jced.52917

Fliedner M, Baguet B, Blankart J, et al. Palifermin for patients with haematological malignancies: Shifting nursing practice from symptom relief to prevention of oral mucositis. Eur J Oncol Nurs. 2007;11(Suppl 1):S19-S26. doi: https://doi.org/10.1016/S1462-3889(07)70004-2 DOI: https://doi.org/10.1016/S1462-3889(07)70004-2

Hohloch K, Zeynalova S, Chapuy B, et al. Modified BEAM with triple autologous stem cell transplantation for patients with relapsed aggressive non-Hodgkin lymphoma. Ann Hematol. 2016;95(7):1121-8. doi: https://doi.org/10.1007/s00277-016-2671-5 DOI: https://doi.org/10.1007/s00277-016-2671-5

Spolarich AE. Risk management strategies for reducing oral adverse drug events. J Evid Based Dent Pract. 2014;14(Suppl):87-94.e1. doi: https://doi.org/10.1016/j.jebdp.2014.04.009 DOI: https://doi.org/10.1016/j.jebdp.2014.04.009

Peterson DE, Bensadoun RJ, Roila F, et al. Management of oral and gastrointestinal mucositis: ESMO clinical practice guidelines. Ann Oncol. 2011;22(Suppl 6):vi78-vi84. doi: https://doi.org/10.1093/annonc/mdr391 DOI: https://doi.org/10.1093/annonc/mdr391

Eilers J, Million R. Clinical update: prevention and management of oral mucositis in patients with cancer. Semin Oncol Nurs. 2011;27(4):e1-e16. doi: https://doi.org/10.1016/j.soncn.2011.08.001 DOI: https://doi.org/10.1016/j.soncn.2011.08.001

Bezinelli LM, de Paula Eduardo F, da Graça Lopes RM, et al. Cost-effectiveness of the introduction of specialized oral care with laser therapy in hematopoietic stem cell transplantation. Hematol Oncol. 2014;32(1):31-9. doi: https://doi.org/10.1002/hon.2050 DOI: https://doi.org/10.1002/hon.2050

Bezinelli LM, Eduardo FP, Neves VD, et al. Quality of life related to oral mucositis of patients undergoing haematopoietic stem cell transplantation and receiving specialised oral care with low-level laser therapy: a prospective observational study. Eur J Cancer Care (Engl). 2016;25(4):668-74. doi: https://doi.org/10.1111/ecc.12344 DOI: https://doi.org/10.1111/ecc.12344

Sonis ST. Health and economic consequences of mucositis. London: Springer Healthcare; 2012. Chapter 4, Oral mucositis; p. 25-9. doi: https://doi.org/10.1007/978-1-907673-46-7_4 DOI: https://doi.org/10.1007/978-1-907673-46-7_4

Al-Dasooqi N, Gibson RJ, Bowen JM, et al. Matrix metalloproteinases are possible mediators for the development of alimentary tract mucositis in the dark agouti rat. Exp Biol Med (Maywood). 2010;235(10):1244-56. doi: https://doi.org/10.1258/ebm.2010.010082 DOI: https://doi.org/10.1258/ebm.2010.010082

Cinausero M, Aprile G, Ermacora P, et al. New frontiers in the pathobiology and treatment of cancer regimen-related mucosal injury. Front Pharmacol. 2017;8:354. doi: https://doi.org/10.3389/fphar.2017.00354 DOI: https://doi.org/10.3389/fphar.2017.00354

Green R, Horn H, Erickson JM. Eating experiences of children and adolescents with chemotherapy-related nausea and mucositis. J Pediatr Oncol Nurs. 2010;27(40):209-16. doi: https://doi.org/10.1177/1043454209360779 DOI: https://doi.org/10.1177/1043454209360779

Bechard LJ, Guinan EC, Feldman HA, et al. Prognostic factors in the resumption of oral dietary intake after allogeneic hematopoietic stem cell transplantation (HSCT) in Children. JPEN J Parenter Enteral Nutr. 2007;31(4):295-301. doi: https://doi.org/10.1177/0148607107031004295 DOI: https://doi.org/10.1177/0148607107031004295

Kuiken NSS, Rings EHHM, Tissing WJE. Risk analysis, diagnosis and management of gastrointestinal mucositis in pediatric cancer patients. Crit Rev Oncol Hematol. 2015;94(1):87-97. doi: https://doi.org/10.1016/j.critrevonc.2014.12.009 DOI: https://doi.org/10.1016/j.critrevonc.2014.12.009

Riley P, Glenny AM, Worthington HV, et al. Interventions for preventing oral mucositis in patients with cancer receiving treatment: oral cryotherapy. Cochrane Database Syst Rev. 2015;2015(12):CD011552. doi: https://doi.org/10.1002/14651858.CD011552.pub2 DOI: https://doi.org/10.1002/14651858.CD011552

Wang L, Gu Z, Zhai R, et al. Efficacy of oral cryotherapy on oral mucositis prevention in patients with hematological malignancies undergoing hematopoietic stem cell transplantation: a meta-analysis of randomized controlled trials. PLoS One. 2015;10(5):e0128763. doi: https://doi.org/10.1371/journal.pone.0128763 DOI: https://doi.org/10.1371/journal.pone.0128763

Karagözoğlu S, Filiz Ulusoy M. Chemotherapy: the effect of oral cryotherapy on the development of mucositis. J Clin Nurs. 2005;14(6):754-65. doi: https://doi.org/10.1111/j.1365-2702.2005.01128.x DOI: https://doi.org/10.1111/j.1365-2702.2005.01128.x

Peterson DE, Lalla RV. Oral mucositis: the new paradigms. Curr Opin Oncol. 2010;22(4):318-22. doi: https://doi.org/10.1097/CCO.0b013e32833a9fab DOI: https://doi.org/10.1097/CCO.0b013e32833a9fab

Peterson DE, Ohrn K, Bowen J, et al. Systematic review of oral cryotherapy for management of oral mucositis caused by cancer therapy. Support Care Cancer. 2013;21(1):327-32. doi: https://doi.org/10.1007/s00520-012-1562-0 DOI: https://doi.org/10.1007/s00520-012-1562-0

Lalla RV, Bowen J, Barasch A, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2014;120(10):1453-61. doi: https://doi.org/10.1002/cncr.28592 DOI: https://doi.org/10.1002/cncr.28592

Elad S, Cheng KKF, Lalla RV, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2020;126(19):4423-31. doi: https://doi.org/10.1002/cncr.33100 DOI: https://doi.org/10.1002/cncr.33100

Hyams JS, Batrus CL, Grand RJ, et al. Cancer chemotherapy-induced lactose malabsorption in children. Cancer. 1982;49(4):646-50. doi: https://doi.org/10.1002/1097-0142(19820215)49:4<646::AID-CNCR2820490407>3.0.CO;2-M DOI: https://doi.org/10.1002/1097-0142(19820215)49:4<646::AID-CNCR2820490407>3.0.CO;2-M

Gomes VTS, Gomes RNS, Gomes MS, et al. Effects of matricaria recutita (L.) in the treatment of oral mucositis. Sci World J. 2018;2018:4392184. doi: https://doi.org/10.1155/2018/4392184 DOI: https://doi.org/10.1155/2018/4392184

Reis PED, Ciol MA, Melo NS, et al. Chamomile infusion cryotherapy to prevent oral mucositis induced by chemotherapy: a pilot study. Support Care Cancer. 2016;24(10):4393-8. doi: https://doi.org/10.1007/s00520-016-3279-y DOI: https://doi.org/10.1007/s00520-016-3279-y

Liu TM, Luo YW, Tam KW, et al. Prophylactic and therapeutic effects of honey on radiochemotherapy-induced mucositis: a meta-analysis of randomized controlled trials. Support Care Cancer. 2019;27(7):2361-70. doi: https://doi.org/10.1007/s00520-019-04722-3 DOI: https://doi.org/10.1007/s00520-019-04722-3

Münstedt K, Momm F, Hübner J. Honey in the management of side effects of radiotherapy- or radio/chemotherapy-induced oral mucositis. A systematic review. Complement Ther Clin Pract. 2019;34:145-52. doi: https://doi.org/10.1016/j.ctcp.2018.11.016 DOI: https://doi.org/10.1016/j.ctcp.2018.11.016

Sang S, Chu YF. Whole grain oats, more than just a fiber: role of unique phytochemicals. Mol Nutr Food Res. 2017;61(7):1600715. doi: https://doi.org/10.1002/mnfr.201600715 DOI: https://doi.org/10.1002/mnfr.201600715

Boateng L, Ansong R, Owusu WB, et al. Coconut oil and palm oil’s role in nutrition, health and national development: a review. Ghana Med J. 2016;50(3):189-96. doi: https://doi.org/10.4314/gmj.v50i3.11 DOI: https://doi.org/10.4314/gmj.v50i3.11

Sturion GL. Programa de alimentação escolar: avaliação do desempenho em dez municípios brasileiros [tese]. Campinas (SP): Universidade Estadual de Campinas; 2001.

Ministério da Educação (BR). Manual para aplicação dos testes de aceitabilidade no Programa Nacional de Alimentação Escolar (PNAE) [Internet]. 2. ed. rev. atual. Brasília (DF): Ministério da Educação; 2017 [acesso 2020 dez 26]. Disponível em: http://www.fnde.gov.br/index.php/centrais-de-conteudos/publicacoes/category/110-alimentacao-e-nutricao?download=5096:manual-para-aplicacao-dos-testes-de-aceitabilidade-no-pnae

Kibon [Internet]. São Paulo (SP): Unilever; c2023. Fruttare Coco [acesso 2020 dez 26]. Disponível em: https://www.kibon.com.br/nossas-marcas/fruttare/fruttare-coco.html

Mishra L, Nayak G. Effect of flavored (Honey and Tulsi) ice chips on reduction of oral mucositis among children receiving chemo therapy. Int J Pharm Sci Rev Res. 2017;43(1):25-8.

Nikoletti S, Hyde S, Shaw T, et al. Comparison of plain ice and flavoured ice for preventing oral mucositis associated with the use of 5 fluorouracil. J Clin Nurs. 2005;14(6):750-3. doi: https://doi.org/10.1111/j.1365-2702.2005.01156.x DOI: https://doi.org/10.1111/j.1365-2702.2005.01156.x

Trinidade A, Martinelli K, Andreou Z, et al. Soft, fortified ice-cream for head and neck cancer patients: a useful first step in nutritional and swallowing difficulties associated with multi-modal management. Eur Arch Otorhinolaryngol. 2012;269(4):1257-60. doi: https://doi.org/10.1007/s00405-011-1769-6 DOI: https://doi.org/10.1007/s00405-011-1769-6

Casas F, León C, Jovell E, et al. Adapted ice cream as a nutritional supplement in cancer patients: impact on quality of life and nutritional status. Clin Transl Oncol. 2012;14(1):66-72. doi: https://doi.org/10.1007/s12094-012-0763-9 DOI: https://doi.org/10.1007/s12094-012-0763-9

Palmieri BN, Moulatlet EM, Buschinelli LKO, et al. Aceitação de preparações e sua associação com os sintomas decorrentes do tratamento de câncer em pacientes de uma clínica especializada. Cad Saúde Colet. 2013;21(1):2-9. doi: https://doi.org/10.1590/s1414-462x2013000100002 DOI: https://doi.org/10.1590/S1414-462X2013000100002

Vieira FGK, De Salles RK, Mannes P, et al. Development and acceptance of an ice cream as food alternative for cancer patients. J Culin Sci Technol. 2020;18(2):89-97. doi: https://doi.org/10.1080/15428052.2018.1509752 DOI: https://doi.org/10.1080/15428052.2018.1509752

Okkels SL, Bredie WLP, Klausen TW, et al. An investigation into between-meal food desires among hospitalised haematological cancer patients. Clin Nutr. 2016;35(2):440-5. doi: https://doi.org/10.1016/j.clnu.2015.03.010 DOI: https://doi.org/10.1016/j.clnu.2015.03.010

Magalhães ES, Oliveira AEM, Cunha NB. Atuação do nutricionista para melhora da qualidade de vida de pacientes oncológicos em cuidados paliativos. Arch Health Sci. 2018;25(3):4-9. doi: https://doi.org/10.17696/2318-3691.25.3.2018.1032 DOI: https://doi.org/10.17696/2318-3691.25.3.2018.1032

Bellows LL, Johnson SL, Davies PL, et al. The Colorado LEAP study: rationale and design of a study to assess the short term longitudinal effectiveness of a preschool nutrition and physical activity program. BMC Public Health. 2013;13:1146. doi: https://doi.org/10.1186/1471-2458-13-1146 DOI: https://doi.org/10.1186/1471-2458-13-1146

Robinson S, Fall C. Infant nutrition and later health: a review of current evidence. Nutrients. 2012;4(8):859-74. doi: https://doi.org/10.3390/nu4080859 DOI: https://doi.org/10.3390/nu4080859

Hetherington MM, Schwartz C, Madrelle J, et al. A step-by-step introduction to vegetables at the beginning of complementary feeding. The effects of early and repeated exposure. Appetite. 2015;84:280-90. doi: https://doi.org/10.1016/j.appet.2014.10.014 DOI: https://doi.org/10.1016/j.appet.2014.10.014

Downloads

Published

2023-02-10

How to Cite

1.
Lourenção JTV, Mendes H de S, Veiga-Santos P, Machado NC. Developing Ice Cream for Mucositis Management and Improving the Nutritional Support for Pediatric Cancer Patients. Rev. Bras. Cancerol. [Internet]. 2023 Feb. 10 [cited 2024 Nov. 22];69(1):e-153325. Available from: https://rbc.inca.gov.br/index.php/revista/article/view/3325

Issue

Section

ORIGINAL ARTICLE