Oral mucositis (inflammation of the lining of the mouth) is a very common adverse effect when chemotherapy and radiation therapy are used to treat cancer.
Because the pain from mucositis can be so bad it can cause the inability to eat or drink, inability to talk, gagging and drooling. Many times mucositis can affect cancer treatment because patients may have to be given a lower dose of a drug or stop treatment completely.
Symptoms:
- Pain and burning sensation that can lead to the inability to tolerate food or liquids. [1-3]
- Xerostomia or dry mouth. [1-3]
- Dysphagia and odynophagia, impossibility or pain when swallowing. [1-3]
- Speaking impediment. [1-3]
- Nutritional problems that can lead to a state of malnutrition. [1-3]
- Generalized infection with the formation of oral ulcerations. [1-3]
Appearance of mucositis:
- Location: Non-keratinized tissues (mouth, vocal cords, esophagus).[4]
- Start: 1 to 2 weeks after starting chemo and/or radiotherapy. [4]
- Duration: 2 to 4 weeks after the last dose. [4]
Incidence of mucositis:
- 100% radiotherapy treatments in patients with head and neck tumors. [2]
- 40% patients undergoing high-dose chemotherapy treatments [2]
- 100% patients undergoing concomitant treatment with chemotherapy and radiotherapy. [2]
- 80% patients undergoing bone marrow transplantation. [2]
Impact:
- It can contribute to reducing the effectiveness of cancer treatment [1-3]
- Interruption of treatment, reduction of the dose of chemotherapy or radiotherapy [1-3]
- Increases the risk of complications and health spending [1-3]
- Severe mucositis may require hospitalization for support treatment with opioids, enteral or parenteral nutrition, broad-spectrum antibiotic treatment, and antifungals [1-3]
- It worsens the patient’s quality of life and interferes with their recovery (Pain, anorexia, asthenia and malnutrition) [1-3]
Notes:
- McGuire DB. Mucosal Tissue Injury in Cancer Therapy. More than Mucositis and Mouthwash. Cancer Pract [Internet]. julio de 2002; 10(4):179-91. PMID: 12100102 DOI: 10.1046/j.1523-5394.2002.104009.x Disponible en: http://doi.wiley.com/10.1046/j.1523 – 5394.2002.104009.x.
- Kwon et al. Mechanism-based management for mucositis: option for treating side effects without compromising the efficacy of cancer therapy. Onco Targets Ther. 2016 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827894/
- Gholizadeh N, Sheykhbahaei N, Sadrzadeh-Afshar MS. New Treatment Approaches of Oral Mucositis: A Review of Literature. Adv Hum Biol 2016;6:66-72. https://www.researchgate.net/publication/308038404_New_Treatment_Approaches_of_Oral_Mucositis_A_Review_of_Literature
- Lalla RV, Sonis ST, Peterson DE. Management of oral mucositis in patients who have cancer. Dent Clin North Am. 2008;52(1):61‐viii. doi:10.1016/j.cden.2007.10.002 https://pubmed.ncbi.nlm.nih.gov/18154865/