Evidence-Based Interventions for Cancer Treatment-Related Mucositis: Putting Evidence Into Practice

Abstract

Mucositis is an inflammatory process that can involve the mucosal epithelial cells from the mouth to the rectum. Historically, mucositis and stomatitis were used interchangeably, but momentum has increased toward more specific terminology since the 2000s. Stomatitis refers to inflammatory diseases of the mouth, including the mucosa, dentition, periapices, and periodontium, whereas mucositis refers more globally to an inflammatory process involving the mucous membranes of the oral cavity and the gastrointestinal tract. In addition, differentiation is needed regarding mucositis involving the oral cavity and the remainder of the gastrointestinal tract that require use of a scope-type device for close examination. As a result, oral cavity mucositis has been the focus of the majority of the studies reported to date. The mucous membranes beyond the oral cavity are more challenging to view, so the mouth has been presented as revealing potential changes in the gastrointestinal tract. However, because of the variation in morphology, function of different locations, and risks associated with procedures to validate that speculation, evidence is limited. The purpose of this article is to review evidence-based interventions for mucositis, particularly in the oral cavity, and provide clinicians with guidelines for nursing interventions.

Role of Gabapentin in Managing Mucositis Pain in Patients Undergoing Radiation Therapy to the Head and Neck

“…Regular oral assessment before, during, and for several weeks following RT is generally recommended. Symptom management including pain control remains a pivotal part of care as no gold standard evidence exists to reliably prevent the development of OM in this population, supportive management is key (Eilers, et al, 2014). …”

“…(Takes, et al, 2010). However, concurrent treatment with chemotherapy and RT increases the incidence and severity of oral mucositis (OM) to as much as 100% (Eilers, et al, 2014). Oral mucositis in head and neck cancer patients undergoing RT with or without chemotherapy has been reported as the most distressing symptom in their treatment course (Eilers and Million, 2011).…”

“…Oral mucositis in head and neck cancer patients undergoing RT with or without chemotherapy has been reported as the most distressing symptom in their treatment course (Eilers and Million, 2011). High grade OM (grade 3 -4) is associated with significant patient morbidity including pain, inability to chew, swallow, maintain caloric intake, unplanned hospitalizations and an overall worsening quality of life (Trotti, et al, 2003; Eilers, et al, 2014). …”

“…With the breach in the oral mucosal membrane, secondary infections may occur resulting in potentially life threatening systemic infections and hospitalizations (Eilers, et al, 2014). Patients who develop severe OM from combined RT and chemotherapy for head and neck cancer are reported to incur 52% higher costs during their treatment when compared to patients who do not develop high grade OM (Mason, H, et al, 2013).…”

“…The reduction in locoregional control disease control is attributable to the biologic basis of radiation and the propensity of malignant tumors to accelerate the repopulation process and lead to development of resistant clones causing further compromising disease control during radiation treatment interruptions (Russo, 2008; Eilers, et al, 2014; Mallick, et. al., 2015).…”