Chemotherapy Mucositis: Omega-3 Supplements Promote Wound Healing

Supplementation with EPA and DHA may help prevent and treat wounds caused by mucositis, the inflammation of the oral mucosa that represents a serious and frequent complication in cancer patients undergoing chemotherapy. According to a recent study, treatment with omega-3 supplements can reduce pain and the duration of mucositis in hospitalized patients. The research was conducted by researchers from the University of Kerman (Iran) and published in the journal Wounds.

Mucositis, a consequence of chemotherapy

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

This condition often prolongs hospitalization due to pain and limits to the patient’s nutrition. Moreover, oral ulcers can cause bacteria in the mouth to enter the bloodstream, causing sepsis, especially in immunocompromised patients.

Additionally, mucositis reduces the patient’s ability to tolerate chemotherapy and, especially if severe, has a large impact on quality of life and daily routine, interfering with oral functions such as swallowing, eating, drinking, and speaking.

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

They reduce inflammation and accelerate healing of skin burns and seem to improve the course of gastric and duodenal ulcers, so they can be safely used in skin wound healing. 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 inflammatory mediators such as prostaglandin E2.

Omega-3 supplements improve mucositis symptoms faster

In light of these evidences, and considering there are no previous studies on the effect of omega-3 on mucositis, the Iranian researchers hypothesized a positive effect and studied the action of supplementation with EPA and DHA in a group of chemotherapy patients. Results showed that subjects who followed omega-3 supplementation experienced less intense pain during the three weeks of treatment and, after the first two weeks, mucositis severity was significantly lower in the group consuming the supplements compared to the control group that took placebo.

The average duration of mucositis in the omega-3 group was about 5 days; in the placebo group the minimum recovery time was 10 days, and in 12 cases recovery took more than 16 days. Quality of life of patients in both groups showed no significant difference in the first week of treatment, but in subsequent weeks those in the omega-3 group experienced better quality of life.

Eating, sleeping, drinking, and speaking ability were assessed with specific questionnaires. Results showed significant differences between the effects of mucositis on drinking, sleeping, and tooth cleaning between the two groups. Patients who took omega-3, compared to placebo, also showed better eating ability. Almost all patients reported that EPA and DHA reduced their wound size, with no toxic or allergic reactions or other side effects.

Study methods details

To conduct the research, scientists recruited 60 patients, including 37 women and 23 men with malignant tumors undergoing chemotherapy. Patients, aged between 22 and 64 years, were selected by their physician based on a diagnosis of leukemia or breast cancer, underwent tumor surgery before chemotherapy, and were developing grade 1 oral mucositis according to a WHO classification. Subjects were evenly divided into a placebo group (11 males, 19 females) and an omega-3 treatment group (12 males, 18 females). Mucositis severity was assessed based on a weekly questionnaire from the World Health Organization, which revealed differences in mucositis severity between groups in the first, second, and third week of treatment. Patients in both groups received 2 capsules daily with meals; one 1 g omega-3 capsule contained 2000 mg fish oil with 360 mg EPA and 240 mg DHA; the placebo 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 healing wounds caused by oral mucositis in chemotherapy patients. These results suggest the introduction of new groups of omega-3-based substances or drugs to prevent and treat mucositis.

As the authors specified, the study has some limitations, the first being the small number of patients involved; thus, further research with at least 80 subjects is needed. Also, only patients with leukemia and breast cancer were included; therefore, the authors recommend repeating a future study on 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)