The Pain of Oral Mucositis

The Pain of Oral Mucositis

Annette Quinn, Susan D Bruce
US Oncological Disease 2007 - Issue I
Published: October 2008
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Table 3: Updated Clinical Practice Guidelines for the Prevention and Treatment of Oral Mucositis

Source: Keefe et al., 2007.19

Risk Factors
OM is influenced by a variety of patient- and treatment-related risk factors. Patient-related factors include age, female gender, prior occurrences of herpes and OM, diabetes, tobacco and alcohol use, periodontal disease, poor nutrition, medications, and immune suppression. Younger patients and the elderly are most at risk for the development of OM. Tobacco and alcohol exacerbate periodontal disease and irritate the oral mucosa. Xerostomia prior to treatment may impair the permeability of the oral mucosa and reduces the pH of the saliva, resulting in tooth decay and gingivitis. Malnutrition can lead to increased dental decay, contribute to dehydration, and delay the healing of the oral mucosa. Medications that contribute to xerostomia may actually promote periodontal disease and predispose the oral cavity to bacterial and fungal overgrowth. Weekly treatment regimens significantly increase the risk of OM. Treatment-related risk factors are directly related to the impact of radiotherapy and chemotherapy regimens on the oral mucosa. The repetitive effects of daily radiation treatments are responsible for the inflammation and ulceration of the oral mucosa. The dose and fractionation schedule of radiation determines the degree of OM, particularly in patients receiving radiation to the head and neck and patients receiving total body irradiation in preparation for bone marrow transplantation. Standard doses of common chemotherapy agents produce OM; these include the antimetabolites (e.g. 5- FU, methotrexate, etoposide), bleomycin, busulfan, cyclophosphamide, doxorubicin, vinblastine, vincristine, vinorelbine, and the taxanes. Higher doses of these agents may more than double the incidence of OM. Also, if previous cancer treatment resulted in the development of OM, the likelihood of OM during subsequent cycles is greatly increased. Few cancers today are treated with single-modality therapies. Most are approached with a combination of chemotherapy and radiotherapy, often given concurrently. This combination significantly increases the risk and severity of OM.20

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