The Prospective Oral Mucositis Audit: relationship of severe oral mucositis with clinical and medical resource use outcomes in patients receiving high-dose melphalan or BEAM-conditioning chemotherapy and autologous SCT

Abstract

The Prospective Oral Mucositis Audit was an observational study in 197 patients with multiple myeloma (MM) or non-Hodgkin's lymphoma (NHL) undergoing, respectively, high-dose melphalan or BEAM chemotherapy and autologous SCT at 25 European centres. We evaluated the relationship between severe oral mucositis (SOM; WHO Oral Toxicity Scale grade 3-4) and local and systemic clinical sequelae and medical resource use. SOM occurred in 44% of patients. The duration of SOM (mean 5.3 days) correlated with time to neutrophil engraftment. The following parameters increased gradiently with maximum grade of oral mucositis: duration of pain score X4, opioid use, dysphagia score X4, total parenteral nutrition (TPN) use, incidence and/or duration of fever and infection, and duration of antibiotic use. SOM increased the duration of TPN use by 2.7 days (Po0.001), opioids by 4.6 days (Po0.001), and antibiotics by 2.4 days (P ¼ 0.045). SOM prolonged hospital stay by 2.3 days (P ¼ 0.013) in MM patients, but not in NHL patients (who tended to have a longer hospital stay).In conclusion, this analysis of prospectively collected observational data provides important insight into the scope and impact of SOM in the European transplant setting.

A prospective evaluation of patients' health-related quality of life during auto-SCT: a 3-year follow-up

“…We only found two studies that compared lymphoma and myeloma patients undergoing auto-SCT, and they focused on mucositis. 20,21 Patients recovered fairly quickly after transplantation; as early as the second month, nearly all values on the scales had returned to the baseline values. Role and social functions were affected more before and during the transplant than other functions.…”

“…We need to become better at preventing and treating mucositis through improved cooperation with the hospital dentistry department and by developing care plans. 21,29 The study population changed over time; 3 years after the transplantation 30 patients had died and a further 13 patients had dropped out of the study, leaving a study population of 53 patients. We found no significant differences between the patients who dropped out and those alive.…”

Systematic review of laser and other light therapy for the management of oral mucositis in cancer patients

“…One additional issue that might play a role in the appearance and duration of OM is the absolute neutropenia observed in cancer populations treated with myelosuppressive therapies [50]. This confounder has not been evaluated in the majority of the trials and should be included in future investigations of the applicability of LLLT in OM prevention, treatment, and associated pain.…”

Adverse Effects of Morphine and Fentanyl for Stomatitis in Patients Receiving Allogeneic Hematopoietic Cell Transplantation—A Single Center Retrospective Analysis

“…Insufficient pain management leads to inadequate oral care and difficulty with food intake. Moreover, it can cause dehydration, malnutrition, and serious infections [1], and has been linked to inferior overall survival after HCT [2]. With conventional conditioning regimens, and in particular by the use of methotrexate for graft-versus-host disease prophylaxis, most of the patients experience oral mucositis at some degree within 3 -5 days after HCT [3].…”