September 22, 2009 (Berlin, Germany) — With all the other adverse effects of chemotherapy that cancer patients have to contend with, including nausea, vomiting and often hair loss, the development of sore lips may be pretty minor in the grand scheme of things, but it causes further discomfort for patients. It is also under-reported, so a new study set out to assess the magnitude to the problem and to find out what patients were doing about it.

The findings, reported here at the 15th Congress of the European CanCer Organization and the 34th European Society for Medical Oncology Multidisciplinary Congress, show that 69% of patients reported having chapped, sore lips after chemotherapy.

In addition, anecdotal reports from patients suggest that using a lip balm containing natural products is helpful, but using one containing petrochemicals is not, reported research manager Madeline Williams, from the Primrose Oncology Unit in Bedford, United Kingdom. She works closely with Robert Thomas, MD, consultant oncologist at the unit and at Cranfield University, who was so fired up by the findings that "he started making his own concoction from natural products, brewing various ingredients together in the microwave," she told Medscape Oncology in an interview.

The result was a product that is now being made in collaboration with a local firm, Adventis, and a randomized clinical trial that will compare this natural products with one containing petrochemicals in cancer patients on chemotherapy.

Self-Medication With Lip Salves

Chemotherapy can damage the rapidly dividing basal cells in the vermilion border of the lips, causing dryness, cracking, soreness, bleeding, infections that are fungal in origin, and cold sores from herpes simplex, Ms. Williams explained.

"We began the study because there was no patient information or advice on this side effect," she continued. A questionnaire was devised in collaboration with clinical research colleagues at Cranfield University, and distributed to 105 consecutive patients receiving any chemotherapy regimen between July and October 2008.

The results showed that 29% of patients reported having chapped lips before embarking on chemotherapy, compared with 69% while on chemotherapy.

There was no increase in the frequency of cold sores in 19% of patients, but the number of sores and the severity of the attacks increased while patients were on chemotherapy.

Two thirds of patients (66%) reported self-medicating with lip salves, but the majority of these patients (82%) said that they perceived no benefit. Closer questioning revealed that 83% of patients used a petroleum-based product, and only 9% of these perceived a benefit. A minority of patients (17%) used a natural oil product, and 63% of these patients perceived a benefit.

These findings triggered the experimentation that eventually led to the development, with Adventis, of "nature medical," a lip cream containing bee's wax, shea butter, and organic oil, with essential oils for fragrance; it contains no artificial ingredients.

This natural lip salve is now being tested in a randomized trial against a product containing petrochemicals in 200 patients on chemotherapy, who are being monitored for the incidence of chapped lips and cold sores.

But even before the results of this clinical trial become available, there is enough anecdotal data from the patient reports in this study "for us to start telling patients to be careful about what lip salves they are using," said Sultan Kav, PhD, associate professor of nursing at Başkent University in Ankara, Turkey. In addition to being the president-elect of the European Oncology Nursing Society, Dr. Kav chaired the session at which the study was presented.

"We are already telling patients, as part of the oral care protocol, that they should moisturize their lips, but the importance of this study is that now we can advise them to use lip products based on natural oils and to avoid products based on petrochemicals," she told Medscape Oncology. "We need the data from clinical trials, but we can already start giving this advice to patients," she added.

15th Congress of the European CanCer Organization (ECCO 15) and the 34th European Society for Medical Oncology (34th ESMO) Multidisciplinary Congress: Abstract 4162. Presented September 21, 2009.

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