Management of oral mucositis in patients with cancer ncbi nih. This is especially important in patients treated for cancer. Jnsu1 covr cover1 nccn evidencebased cancer guidelines. Amifostine is a cytoprotectant agent that may help to reduce the incidence and severity of. Thus, oral mucositis is a major doselimiting toxicity of radiation therapy to the head and neck region. It is believed that colonization of ulcerated mucosa by bacteria, fungi, and virus results in secondary infections. Objective to examine the comparative efficacy and safety of interventions for preventing chemotherapyinduced oral mucositis om in adult cancer patients. Assessment of cancer therapyinduced oral mucositis using a. For years, doctors wondered what could be done to relieve oral mucositis in patients receiving cancer treatment. Oral mucositis, also called stomatitis, is a common, debilitating complication of cancer chemo therapy and radiotherapy, occurring in about 40% of patients.
Glutamine and elental, on the other hand, had no strong evidence in the prevention andor treatment of oral mucositis in patients with cancer. Cancer services directorate adult mouthcare guidelines. It results from the systemic effects of cytotoxic chemotherapy agents and from the local effects of radiation to the oral mucosa. However, clinicians should also use their own judgment in making treatment decisions for individual patients. Masccisoo clinical practice guidelines for the management of. Each of these factors needs to be critically considered while applying the principles set out in this guidance. Doxepin hydrochloride in treating oral mucositis pain in patients with head and neck cancer undergoing radiation therapy with or without chemotherapy. Oral care for head and neck cancer symptom management. Mucositis is a toxicity of cancer therapy that affects the lining surface of the mouth and the rest of the gastrointestinal tract.
Oral mucositis is a painful inflammation and ulceration of mucous membranes of the oral cavity. Chlorhexidine was not recommended to prevent oral mucositis in patients with head and neck cancer receiving radiotherapy or to treat chemotherapyinduced oral mucositis. Mucositis in cancer patients introduction oral mucositis, also called stomatitis, is a common, debilitating complication of cancer chemotherapy and radiotherapy, occurring in about 40% of patients. Oral mucositis is one of the most common side effects of cancer treatment chemotherapy. It is a common side effect of most chemotherapeutic drugs, and radiotherapy of the oral, and head. The mouth sores typically occur on the lining tissues of the mouth such as the inside the cheeks as well as sides of and under the tongue. Dental care for oral complications of cancer treatment oral mucositis. Whatshouldiexpectonceihave beendiagnosedwithoral mucositis. The incidence of oral mucositis varies according to treatment modality. Nutritional guidelines for symptom management mucositis definition.
Oral mucositis occurs in patients undergoing chemoradiation for cancer treatment. Get detailed information about mucositis, salivary gland dysfunction, and taste changes, as well as psychosocial issues in this clinician summary. Oral mucositis occurs independently of oral mucosal infections of viral and fungal etiology, but it may be exacerbated by such concomitant infections. This is a pdf file of an unedited manuscript that has been accepted. Through the leadership and expertise of clinical professionals at nccn member institutions, nccn develops. Comparative efficacy and safety of interventions for. Mascc isoo clinical practice guidelines for the management of. Prevention and management of mucositis in cancer care 1 2 mucositis. Cryotherapy was recommended for bolus 5fluorouracil 5fu and suggested for bolus edatrexate and in patients receiving highdose melphalan. This report describes the objectives, methods, and results of. Patients with oral mucositis and neutropenia a type of white blood cell deficiency have a relative risk of septicemia a systemic, toxic illness caused by the invasion of the bloodstream by virulent bacteria coming from a local infection more than 4 times that of patients with neutropenia only.
Prescribe topical anesthetics and systemic analgesics. Background modern radiotherapy rt planning techniques and the use of oral supportive care have reduced the occurrence of acute radiationinduced toxicities. Patientreported measurements of oral mucositis in head. The sores also leave patients open to potentially lifethreatening infections. Theseverityoforalmucositisvariesfrompatientto patient. Prevention and management of mucositis in patients with. Oral mucositis xerostomia oral infections oral graft versus host disease. The purpose of this project was to evaluate research in basic oral care interventions to update evidencebased practice guidelines for preventing and treating oral mucositis om in cancer patients undergoing radio or chemotherapy.
Association of hsv1 and reduced oral bacteriota diversity. Prevention of oral mucositis in cancer patients by patricia. Om is not only painful but also limits adequate nutritional intake and decreases the patient s willingness to continue treatment. Oral mucositis related symptoms grades of oral mucositis 4. Management of oral mucositis in patients with cancer. Mascc isoo clinical practice guidelines for the management.
Oral mucositis is currently considered to be the most severe complication of anticancer therapy, affecting 40. European oral care in cancer group oral care guidance and support. Contributing factors cancer related cancers of the head and neck e. The guideline for the prevention of oral and oropharyngeal mucositis in children receiving treatment for cancer or undergoing haematopoietic stem cell transplantation was endorsed by the cog supportive care guideline committee in february 2016. Mucositis management for patients treated with chemotherapy this information sheet is aimed at providing patients undergoing chemotherapy with evidencebased information about the management of oral mouth mucositis. Oral mucositis om is one of the most severe nonhematological problems related to cancer treatments and can impact quality of life. Poc was not adequate for prophylactic oral mucositis in these patients, and dexamethasone mouthwash prophylaxis is standard treatment before everolimus. Methods we searched pubmed, embase and the cochrane central systematically for the randomised control trials rcts of interventions for preventing om. Mar 17, 2016 one study compared palifermin versus placebo in patients receiving cisplatin and radiotherapy for head and neck cancer.
Clinically, it manifests as painful erythema and ulcerations. Cryotherapy was recommended for bolus 5fluorouracil 5fu and suggested for bolus edatrexate and in patients. Oral pilocarpine op is highly effective in the prevention of oral mucositis when given prophylactically to adult patients receiving a variety of cancer chemotherapy regimens. The panel recommends that sucralfate mouthwash not be used to prevent oral mucositis in patients receiving chemotherapy for cancer i, or in patients receiving radiation therapy i or concomitant chemoradiation ii for head and neck cancer. Patients treated with radiation therapy for head and neck cancer typically receive an. Prevention and management of oral mucositis in patients with. It can cause paindiscomfort and interfere with eating, swallowing and speech. Objective to report the rate of mucositis with the preventive use of surface lowlevel laser therapy in. Nutritional guidelines for symptom management mucositis. Prevention and treatment of oral mucositis in cancer patients. Patients should be assessed for the use of daily fluoride tray consult with a dentist cryotherapy may decrease the incidence and severity of oral mucositis patients should be instructed to hold ice chips in mouth five minutes prior, during, and for 30 minutes after the bolus infusion of fluorouracil 5fu not used for. The dentist plays an important role in the multidisciplinary health care team for the overall management of this condition. Although considered important in maintaining oral cleanliness,reducingriskoforalinfection,andpromotingoral comfort, the evidence for a role in preventing or treating oral mucositis om has been both scarce and inconsistent for basic oral care 52, 54, 58.
The multinational association of supportive care in cancer and international society of oral oncology masccisoo mucositis guidelines are developed to facilitate the evidencebased management of mucositis. It is a common side effect of most chemotherapeutic drugs, and radiotherapy of the oral. Younger patients tend to develop oral mucositis more often than older patients being treated for the same malignancy with the same regimen. Adverse event management of oral mucositis in patients with breast. An acute inflammation andor ulceration of the oral or oropharyngeal mucosal membranes. Prevention and treatment of oral mucositis in patients receiving. It occurs in almost all patients who receive radiation therapy in which. Oral mucositis is a debilitating and morbid condition among cancer patients that affects their quality of life and their overall ability to respond to treatment. Patients with severe mucositis may need intravenous nutrition, antibiotics to fight infections, pain medicines, and longer hospital stays. Severe om develops in more than 90% of patients undergoing combined chemotherapy and radiation. Oral complications of chemotherapy and headneck radiation are common and should be considered and addressed before, during, and after treatment. The purpose of this evidencebased practice project was to determine if om is preventable with the use of an oral care.
Oral mucositis remains a major concern in patients with head and neck cancer as it can compromise treatment compliance and outcome. Oral care evaluation to prevent oral mucositis in estrogen. Oral mucositis is a significant problem in patients undergoing chemotherapeutic management for solid tumors. Ons pep resources focus on oral mucositis, which is estimated to occur in about 40% of patients secondary to chemotherapy and almost 100% of those receiving radiation for head and neck cancer. Oral mucositis om is among the most common and dreaded toxicities of cancer therapy. Consequences of oral mucositis impact on chemotherapy dose and cancer outcomes quality of life issues hospitalisation and related issues. Efficacy of chlorhexidine for the prevention and treatment of. Clinical question in patients receiving treatment for cancer, does oral cryotherapy prevent oral mucositis bottom line oral cryotherapy is effective for the prevention of oral mucositis in adults receiving fluorouracilbased chemotherapy for solid cancers, and for the prevention of severe oral mucositis in adults receiving highdose melphalanbased chemotherapy before hematopoietic stem cell. Mucositis is a significant source of pain for many patients, and is thus of clinical relevance as it poses as a dose and treatmentlimiting side effect when it begins to interfere considerably with a patients quality of life qol 1. Oral glutamine in preventing treatmentrelated mucositis. Org cancercare connect managing oral mucositis 3 its vital to work closely with your health care team to manage mouth sores.
Zinc is a promising strategy in the management of oral mucositis since it delayed the occurrence and reduced its severity. Gussgard am, hope aj, jokstad a, et al assessment of cancer therapyinduced oral mucositis using a patientreported oral. Oral cryotherapy for preventing oral mucositis in patients. In recent studies, severe oral mucositis occurred in 2966% of all patients receiving radiation therapy for head and neck cancer 5, 6. Supportive care in cancer international society of oral, o. Almost all such patients will develop some degree of oral mucositis. Prevention and management of mucositis in cancer care nccn. It is linked to poorer outcomes due to the associated weight loss, pain, dehydration, and risk of developing lifethreatening infections. Pdf palifermin for management of treatmentinduced oral.
Efficacy of chlorhexidine for the prevention and treatment. Oral mucositis is a significant problem in patients undergoing. Patients undergoing cytotoxic treatment, particularly hematopoietic stem cell transplantation, highdose chemotherapy or radiation to the head and neck region. Although considered important in maintaining oral cleanliness,reducingriskoforalinfection,andpromotingoral comfort, the evidence for a role in preventing or treating oral mucositis om has been both scarce and inconsistent for basic oral. Use small, extra soft nylon bristled manual tooth brush. Oral mucositis refers to mouth sores caused by some cancer treatments such as high dose chemotherapy, or head and neck radiation for treatment of mouth cancer. Pdf purpose the purpose of this project was to evaluate research in basic oral. It is very important to work closely with your health care team to manage mouth sores, also known as oral mucositis. The panel recommends patientcontrolled analgesia with morphine as the treatment of choice for om pain in patients undergoing hct. Mucositis is an inflammatory process that affects the mucous membranes of the oral cavity and gastrointestinal tract. If you are applying for financial assistance, all correspondence must be done electronically through email or fax.
Current trends in management of oral mucositis in cancer treatment. Palifermin for oral mucositis after intensive therapy for. Prevention and management of oral mucositis in patients. Oral mucositis refers to mouth sores caused by cancer treatments such as high dose chemotherapy, or head and neck radiation for treatment of mouth cancer. Request pdf management of oral mucositis in patients with cancer oral mucositis om is a distressing toxic effect of chemotherapy and radiotherapy. Oral cryotherapy to prevent oral mucositis in patients receiving high dose melphalan. In one study, it was reported that 303 of 599 patients 51 % receiving chemotherapy for solid tumors or lymphoma developed oral andor gi mucositis 3. Network metaanalysis nma was performed to estimate risk ratios rr and 95%.
It should notice that pilocarpine is a parasympathomimetic medicine should be prescribed cautiously, because of side effects such as stomach ache, nausea, tachycardia. Clinical practice guidelines for the prevention and treatment. Pdf oral mucositis is a clinically important and sometimes doselimiting complication of cancer therapy. Many studies have evaluated the use of oral glutamine to prevent mucositis in these settings, but current guidelines make no recommendations with regard to its use. Clinical practice guidelines for the prevention and. Cancer services directorate adult mouthcare guidelines june 2010 pinkie chambers background oral mucositis, is a common, debilitating complication of cancer chemotherapy and head and neck radiotherapy. Have the patient avoid roughtextured foods and report oral problems early. Younger patients tend to develop oral mucositis more often than older patients, possibly because of a more rapid turnover of basal cells in the oral mucosa of younger patients. Effects of oral supplementation in the management of oral. Consult the oncologist about prescribing antimicrobial agents for known infections.
Pdf management of oral mucositis in patients with cancer. Jan 11, 2017 oral mucositis occurs in patients undergoing chemoradiation for cancer treatment. This report describes the objectives, methods, and results of the masccisoo. Patient reported measurements of oral mucositis in head and neck cancer patients treated with radiotherapy with or without chemotherapy demonstration of increased frequency, severity. No guideline was possible for any other intervention, due to insufficient evidence. Key points to understand from the oral mucositis guidelines 4. Oral mucositis is a common complication of cancer chemotherapy. It results from systemic effects of cytotoxic chemotherapy and from the local effects of the oral mucosa. Oral mucosal complications mucositis the toxicity of chemotherapy, rt or combination affecting the oral mucosa, causing in. Economic impact of mucositis chemotherapy patients who have significant oral mucositis require supportive care measures such as use of total parenteral nutrition, fluid replacement and prophylaxis against infections. Prevention of oral mucositis in cancer patients by.
The resulting guidelines are intended for oral health care specialists, oncology and oral medicine patients, oncologists, clinical investigators, and policy makers. Volume 6 supplement 1 journal of the national comprehensive cancer network the national comprehensive cancer network nccn, a notforprofit alliance of 21 of the worlds leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Find out about medications which may be used to decrease the chance of developing oral mucositis mouth sores or to shorten the duration of oral mucositis in some cancer patients receiving chemotherapy and radiation therapy. The incidence of oral mucositis was especially high in 1 patients with primary tumors in the oral cavity. The incidence of oral mucositis in cancer patients varies widely. Oral mucositis is a condition that is characterized by ulcerative lesions in the mucosa of patients undergoing radiotherapy or chemotherapy. Oral mucositis was once thought to be an inevitable consequence of treatment.
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