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Guideline for the prevention of oral and oropharyngeal mucositis in children receiving treatment for cancer or undergoing …

Sung L, Robinson P, Treister N, Baggott T, Gibson P, Tissing W, Wiernikowski J, Brinklow J, Dupuis LL.

BMJ Support Palliat Care. 2015 Mar 27. pii: bmjspcare-2014-000804. doi: 10.1136/bmjspcare-2014-000804. [Epub ahead of print] Review.

Editors’ comment: Dr Ricardo Caponero

Guidelines are always important in our daily practice. It helps us free ourselves from the continuous work of reviewing the changes in conceptual approaches that are the basis of our clinical activities. Furthermore, the majority of us is focused on adult patients, but those who deal with kids are frequently forgotten. This paper gives us some guidance for the treatment of children with cancer or who are undergoing haematopoietic stem cell transplantation.


Depression, fatigue, and sleep disturbances have been identified as a symptom cluster among breast cancer patients. However, few longitudinal studies have examined the temporal relations between these symptoms surrounding diagnosis and treatment.

The present study investigated the co-occurrence of and interrelations between nonsomatic depressive symptoms, fatigue, and sleep disturbances in breast cancer patients at three time points: before, after, and six to eight months following adjuvant chemotherapy treatment.

Separate samples of premenopausal (n = 67) and postmenopausal (n = 67) breast cancer patients completed self-report measures of depression, fatigue, and sleep disturbances at all three time points. Path analysis was used to explore within- and cross-symptom paths across time.

Depression, fatigue, and sleep disturbances were correlated within each time point. Continuity paths, whereby prior levels of symptom severity tended to predict subsequent severity of the same symptom at the subsequent time point, were significant in both samples, except for depression in the premenopausal sample. Instead, significant cross-symptom paths emerged whereby baseline fatigue predicted postchemotherapy depression, and postchemotherapy fatigue predicted depression at follow-up in the premenopausal patients. No significant cross-symptom paths emerged for the postmenopausal sample.

Findings supported the notion that depression, fatigue, and sleep disturbances manifest as a symptom cluster. Fatigue may precede nonsomatic symptoms of depression among premenopausal breast cancer patients and represents a potential intervention target.

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