Chemotherapy mucositis, omega-3 supplements promote wound healing

Supplementation with EPA and DHA can help prevent and treat injuries caused by mucositis, the inflammation of the mucosa of the oral cavity that is a serious and frequent complication in cancer patients undergoing chemotherapy. In fact, according to a recent study, treatment with omega-3 supplements can reduce the pain and duration of mucositis in hospitalized patients. The research was conducted by researchers at kerman University (Iran), and published in the journal Wounds.

Mucositis, a consequence of chemotherapy 

Chemotherapy has several side effects, including ulcers and inflammation of the buccal mucosa, a condition also called mucositis. Mucositis affects a very high number of cancer patients receiving high-dose chemotherapy, as well as 80 percent of patients with head and neck malignancies. Severe pain, increased risk of local and systemic infection, dysfunction and bleeding from the oral cavity, mouth and pharynx are all associated with mucositis. 

The research was conducted by researchers at kerman University (Iran), and published in the journal Wounds.

This condition often prolongs the period of treatment in the hospital because of the patient's pain and limitations to nutrition. In addition, oral ulcers can cause bacteria in the mouth to enter the bloodstream, causing septicemia, especially in immunocompromised individuals. 

Mucositis also reduces the patient's ability to tolerate chemotherapy and, especially if severe, has a great impact on quality of life and daily routine by interfering with oral functions such as swallowing, eating, drinking, and speaking. 

Of course, in most cases, the main goal in treating patients with cancer is to inhibit the cancer itself, and little attention is paid to the problems caused by chemotherapy drugs, including mucositis; and there is currently no specific drug for the treatment or prevention of this inflammation, only drug therapies that alleviate its symptoms. Scientific literature shows that omega-3 fatty acids can be used in wound treatment. 

They, in fact, reduce inflammation and accelerate the healing of skin burns and appear to improve the progress of gastric and duodenal ulcers, and thus can be safely used in the healing of skin wounds. Molecular and cellular processes during the inflammatory stage are controlled by specific proteins, called pro-inflammatory cytokines. 

The synthesis and activation of these mediators are significantly influenced by omega-3 concentration. According to some studies, dietary supplements containing EPA and DHA can act on molecular and cellular activities, such as activation of inflammatory cytokine genes during inflammation, healing and later stages, and also have an inhibitory effect on key mediators of inflammation such as prostaglandin E2. 

Omega-3 supplements improve mucositis symptoms faster 

In light of this evidence, and considering that there are no studies on the effect of omega-3s on mucositis, the Iranian researchers hypothesized a positive effect of omega-3s and studied the action of EPA and DHA supplementation in a group of patients undergoing chemotherapy. The results showed that the subjects who had followed omega-3 supplementation had less intense pain during the three weeks of treatment, and after the first two weeks, mucositis severity was significantly lower in the group that had consumed the supplements, compared with the control group that had taken a placebo. 

The average duration of mucositis in the group that had received omega-3 was about 5 days; in the placebo group the minimum amount of time required for mucositis recovery was 10 days; and in 12 cases recovery had taken more than 16 days. The quality of life of patients in both groups showed no significant differences in the first week of treatment, but in subsequent weeks, subjects in the omega-3 group experienced a better quality of life. 

The ability to eat, sleep, drink and talk was assessed by specific questionnaires. The results showed significant differences between the effects of mucositis on drinking, sleeping, and teeth cleaning between the 2 groups. Patients who had taken omega-3, compared with placebo, also showed better eating ability. Almost all patients had reported that EPA and DHA had reduced the size of their wounds, without toxic or allergic responses or other side effects. 

Some details about the methods of the study 

To conduct the research, scientists recruited 60 patients, of whom 37 women and 23 men with malignancies undergoing chemotherapy treatment carried on treatments. The patients, aged 22 to 64 years old, were selected by the treating physician based on their diagnosis of leukemia or breast cancer, underwent tumor surgery before chemotherapy, and were developing grade 1 oral mucositis, according to a specific WHO classification. The subjects involved were grouped equally into a placebo group (11 males, 19 females) and a group to be treated with omega-3 fatty acids (12 males, 18 females). Mucositis severity was assessed on the basis of a weekly World Health Organization questionnaire, which revealed differences in mucositis severity between the groups in the first, second and third week of treatment. Patients in both groups received 2 capsules daily with meals; a 1 g omega-3 bead contained 2000 mg of fish oil with 360 mg of EPA and 240 mg of DHA; the placebo group capsule contained the same amount of corn oil. 

Omega-3: will they be used to prevent and treat mucositis? 

According to the results of this study, omega-3 supplements have a significant effect on wound healing induced by oral mucositis, in patients following chemotherapy. These results suggest the introduction of new groups of substances or drugs, based on omega-3 to prevent and treat mucositis. 

As the authors themselves specified the study shows some limitations, the first being that it involved too small a number of patients; therefore, further research with at least 80 subjects will be needed. In addition, only patients with leukemia and breast cancer were included; therefore, the authors recommend repeating a future study for other types of cancer. 

Source: Maryam Alsadat Hashemipour, et al. " Effects of Omega-3 Fatty Acids Against Chemotherapy-induced Mucositis: A Double-blind Randomized Clinical Trial." Wounds, Vol. 29, Issue 12 (December 2017)