Background: Oral mucositis is a common complication of chemotherapy that significantly reduces patients' quality of life. While chlorhexidine mouthwash has been shown to improve oral mucositis, it can also cause side effects such as dysgeusia. In this context, simpler, plant-based alternatives like cinnamol may offer similar benefits without the associated side effects. This study aimed to compare the effectiveness of cinnamol mouthwash with that of chlorhexidine mouthwash in treating oral mucositis in cancer patients undergoing treatment with doxorubicin.
Methods: This randomized clinical trial included ۸۱ patients with cancer (breast, ovarian, bladder, lung, and colorectal) from two hospitals in Neyshabur and Sabzevar cities, located in northeastern Iran, in ۲۰۲۳. Participants were allocated to the control (n=۲۷), chlorhexidine (n=۲۷), and cinnamol (n=۲۷) groups using a block randomization method. The control group received ۰.۹% physiological saline; the chlorhexidine group used chlorhexidine mouthwash, and the cinnamol group used cinnamol mouthwash. Participants were instructed to mix ۲۵ drops of their assigned solution with ۵۰ mL of lukewarm water, gargle for ۳۰ seconds, and then expel the mixture. The intervention was administered twice every ۱۲ hours for ۱۴ days. Data were collected using a demographic questionnaire and the Standard
Mucositis Assessment Tool on the first, seventh, and fourteenth days of the intervention. Data analysis was performed using R software version ۴.۲.۲, employing univariate tests and the cumulative link mixed-effects model (CLMM). Results were presented as odds ratios with ۹۵% confidence intervals.
Results: Both cinnamol and chlorhexidine mouthwashes significantly reduced oral mucositis severity compared to the control group. The odds of more severe mucositis in patients using chlorhexidine were ۰.۰۰۲۱ times the odds in the control group (OR = ۰.۰۰۲۱, p<۰.۰۰۱), meaning a lower risk in the chlorhexidine group by a factor of about ۱/۰.۰۰۲۱ ≈ ۴۷۶). Also, cinnamol administration significantly diminished the odds of severe mucositis (OR = ۰.۰۰۰۵, p<۰.۰۰۱) compared to the control. Over time, the protective effects of chlorhexidine (OR = ۰.۰۲۴, p<۰.۰۰۱) and cinnamol (OR = ۰.۲۶۹, p=۰.۰۶۰) became more pronounced, indicating a progressive healing trajectory.
Conclusion: Cinnamol and chlorhexidine mouthwashes demonstrated significant efficacy in reducing oral mucositis severity, while chlorhexidine effects were more enhanced over time. These insights suggest that both interventions are valuable in managing oral mucositis, offering valuable guidance for nursing practice and patient care.
