Expanding Access to Photobiomodulation Treatment for Paediatric Oncology Patients in Glasgow

IF 1.9 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE
Mairead Hennigan, Scott Wright, Owens Iguodala, Gillian Richardson, Paul McLaughlin, Jill Phillips
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引用次数: 0

Abstract

Oral mucositis (OM) is one of the most frequent side effects of cancer treatment. It is associated with intense oral pain, eating and swallowing difficulties, bacteraemia, opioid prescription, increased enteral or parenteral nutrition requirements, extended in-patient hospital stays, interruptions to cancer treatment, and a higher 100-day mortality [1, 2].

Photobiomodulation treatment (PBM) refers to the application of a range of non-ionising red and near-infrared light sources to positively influence cellular metabolism. PBM has an anti-inflammatory effect, wound healing properties, and promotes analgesia in patients with OM [3]. PBM is recommended for use in children by the Paediatric Oncology Group of Ontario (POGO) in clinical practice guidance in OM prevention [4].

The Royal Hospital for Children, Glasgow (RHC) is a Principal Treatment Centre for paediatric oncology, led by oncologists and haematologists, with Advanced Nurse Practitioners (ANPs) having a vital role in the patient's treatment journey. RHC was an early adopter of PBM in the United Kingdom [5], with treatment delivered by the paediatric dentistry team using a class 3B laser since 2012 primarily on an inpatient basis. It has been empirically embraced by paediatric oncology patients, parents, and staff who report it to be easy and beneficial, with frequent requests for treatment and positive feedback from families [6].

The LaserPen from Reimers & Janssen GmbH is operated in continuous wave (CW) mode at a wavelength of 810 nm with an output power of 500 mW. At the time of writing, PBM is delivered at RHC as a treatment for established mucositis rather than for prevention. The local protocol for delivery of PBM is dictated by mucositis severity according to the World Health Organisation (WHO) oral mucositis scale. The protocol specifies the total laser energy (J) to be delivered to each mucositis-affected area of the mouth and throat. Full details of this protocol have been published previously [6]. Class 3B lasers are potentially harmful to the eyes, and safety precautions must be taken. Locally, the agreed standards include laser safety training for PBM providers, eye protection for all people present for PBM delivery, and designated laser-safe rooms with window coverings and signage on external doors.

Existing guidance does not specify which staff groups should deliver PBM and this has been highlighted as a barrier to its use [5]. At the outset of this evaluation, PBM was delivered solely by the paediatric dentistry team, limited to 9-5 pm Monday to Friday (excluding public holidays). Patient/parent feedback through local service questionnaire, indicated desire for wider access to PBM—‘Usually [my son's] mucositis would occur at [the] weekend and I just wish it [PBM] was available at the weekends as he's in pain all weekend then has instant relief after receiving laser. Laser is invaluable but with weekend availability then he would not have to go through days of pain’.

To evaluate the demand for and use of PBM in RHC for the treatment of OM in paediatric oncology patients.

Data were subsequently collected prospectively over a 6-month period from December 2023 to June 2024 to re-evaluate the service following the implementation of changes, with additional data collected pertaining to job role.

The service will be re-evaluated in 6 months' time to assess change over time, service demands, and any need for further staff training.

Service development is ongoing to support delivery of PBM on a preventative basis to patients, in line with existing guidance [4].

The first evaluation showed that the most common days for PBM treatment were at the start of the week. This was thought to be related to the lack of access to this service over the weekend and supported patient/parent concerns regarding the impact of limited weekend access. This finding resulted in multidisciplinary collaboration to train oncology ANPs to provide PBM. During the second evaluation, 26 patients received PBM treatment on weekends and 13 patients on public holidays, respectively—something that was not possible previously due to the weekday schedule for dentists at RHC. Additionally, the three PBM-trained ANPs delivered a notable proportion (16%; n = 51) of all paediatric PBM treatments delivered in RHC in this period, including on weekdays.

Between the cycles, a change in modal delivery day was observed. While both rounds show similar demand for PBM on Tuesdays through to Fridays, a reduction in utilisation of PBM on Mondays occurred in evaluation 2, with a new demand for delivery on Sundays. The lack of utilisation on Saturdays may indicate that a single day PBM treatment gap is acceptable to patients (compared to a 2 day weekend break in service), or may reflect other unobserved, competing service demands on Saturdays that affect PBM delivery.

PBM treatment remains in high demand at RHC. Indeed, there was a 115% increase in the number of episodes of PBM between evaluations (145–312), with the median number of episodes of PBM per patient increasing from 3.5 to 5. This may be related to the expansion of the service outside of standard hours, including through the weekend and over holiday periods. Additionally, the wider staff training has allowed for increased flexibility within the PBM service, supporting the paediatric dentistry team where there is a shortage of dental staff (e.g., staff illness or study days) which would have previously limited delivery.

The service evaluation supported a response to patient and family concerns, improving treatment access and consistency for paediatric oncology patients with OM. It addressed unwarranted variation in availability of care, providing continuity and enhancing patients' quality of life. The service development highlights the importance of collaborative, adaptive healthcare in addressing patient needs, delivering a more resilient and flexible service by utilising ward-based staff.

The authors declare no conflicts of interest.

Abstract Image

扩大获得光生物调节治疗的儿科肿瘤患者在格拉斯哥
口腔黏膜炎(OM)是癌症治疗最常见的副作用之一。它与强烈的口腔疼痛、进食和吞咽困难、菌血症、阿片类药物处方、肠内或肠外营养需求增加、住院时间延长、癌症治疗中断以及100天死亡率升高有关[1,2]。光生物调节治疗(PBM)是指应用一系列非电离红色和近红外光源对细胞代谢产生积极影响。PBM具有抗炎作用,伤口愈合特性,并促进OM bbb患者镇痛。安大略省儿科肿瘤小组(POGO)在OM预防bbb的临床实践指南中推荐PBM用于儿童。格拉斯哥皇家儿童医院(RHC)是儿科肿瘤学的主要治疗中心,由肿瘤学家和血液学家领导,高级执业护士(ANPs)在患者的治疗过程中起着至关重要的作用。RHC是英国b[5]的早期PBM采用者,自2012年以来,儿科牙科团队主要在住院患者中使用3B级激光进行治疗。儿科肿瘤患者、家长和工作人员都经验丰富地接受了这种疗法,他们认为这种疗法既简单又有益,经常要求治疗,而且家庭的反馈也很积极。雷默斯杨森有限公司的激光笔工作在连续波(CW)模式下,波长为810纳米,输出功率为500兆瓦。在撰写本文时,PBM在RHC是作为治疗已建立的粘膜炎而不是预防的。根据世界卫生组织(WHO)口腔黏膜炎量表,当地的PBM方案是由黏膜炎严重程度决定的。该方案规定了要传递到口腔和喉咙每个粘膜炎影响区域的总激光能量(J)。该协议的全部细节已在b[6]上发表。3B类激光对眼睛有潜在危害,必须采取安全防范措施。在当地,商定的标准包括对PBM供应商进行激光安全培训,对所有在场的PBM交付人员进行眼睛保护,并指定有窗帘和外部门上标识的激光安全室。现有的指导没有明确规定哪些工作人员小组应该提供PBM,这被强调为使用PBM的一个障碍。在这项评估开始时,PBM仅由儿科牙科小组提供,仅限于周一至周五(不包括公共假期)下午9点至5点。患者/家长通过当地服务问卷的反馈表明,希望更广泛地使用PBM——“(我儿子的)粘膜炎通常在周末发生,我只是希望(PBM)在周末可用,因为他整个周末都在疼痛中,接受激光治疗后立即得到缓解。”雷泽是无价的,但如果周末可以上场,他就不用忍受几天的痛苦了。”目的:评价小儿肿瘤OM患者在RHC中对PBM的需求和使用情况。随后,在2023年12月至2024年6月的6个月期间,前瞻性地收集数据,以便在实施变更后重新评估服务,并收集与工作角色相关的额外数据。服务将在6个月后重新评估,以评估随时间的变化、服务需求和是否需要进一步培训员工。服务开发正在进行中,以支持在预防的基础上向患者提供PBM,符合现有的指导方针。第一次评估显示,PBM治疗最常见的日子是在一周的开始。这被认为与周末无法获得这项服务有关,并支持了患者/家长对周末有限访问影响的担忧。这一发现导致了多学科合作,以培训肿瘤anp提供PBM。在第二次评估中,26名患者在周末接受PBM治疗,13名患者在公共假期接受PBM治疗,这在之前是不可能的,因为RHC牙医的工作日安排。此外,在此期间(包括工作日),三个PBM培训的anp提供了RHC所有儿科PBM治疗的显着比例(16%;n = 51)。在两个周期之间,观察到模式交付日的变化。虽然两轮都显示周二到周五对PBM的需求相似,但周一PBM的利用率减少发生在评估2中,周日有新的交付需求。周六缺乏利用可能表明,一天的PBM治疗缺口对患者来说是可以接受的(与周末两天的服务中断相比),或者可能反映了周六其他未被观察到的、影响PBM交付的竞争性服务需求。在RHC, PBM治疗仍然有很高的需求。 事实上,在两次评估之间,PBM发作次数增加了115%(145-312),每位患者PBM发作的中位数从3.5次增加到5次。这可能与标准时间以外的服务扩展有关,包括在周末和假日期间。此外,更广泛的工作人员培训增加了PBM服务的灵活性,在牙科工作人员短缺(例如,工作人员生病或学习日)的情况下,为儿科牙科小组提供支持,这在以前是有限的。服务评估支持对患者和家属的关切作出回应,改善了小儿肿瘤OM患者的治疗可及性和一致性。它解决了护理可得性方面的不合理变化,提供了连续性并提高了患者的生活质量。服务发展强调了协作、适应性医疗保健在解决患者需求方面的重要性,并通过利用病房工作人员提供更有弹性和更灵活的服务。作者声明无利益冲突。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.50
自引率
2.60%
发文量
82
审稿时长
6-12 weeks
期刊介绍: The International Journal of Paediatric Dentistry was formed in 1991 by the merger of the Journals of the International Association of Paediatric Dentistry and the British Society of Paediatric Dentistry and is published bi-monthly. It has true international scope and aims to promote the highest standard of education, practice and research in paediatric dentistry world-wide. International Journal of Paediatric Dentistry publishes papers on all aspects of paediatric dentistry including: growth and development, behaviour management, diagnosis, prevention, restorative treatment and issue relating to medically compromised children or those with disabilities. This peer-reviewed journal features scientific articles, reviews, case reports, clinical techniques, short communications and abstracts of current paediatric dental research. Analytical studies with a scientific novelty value are preferred to descriptive studies. Case reports illustrating unusual conditions and clinically relevant observations are acceptable but must be of sufficiently high quality to be considered for publication; particularly the illustrative material must be of the highest quality.
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