Original Article

Supportive Care in Cancer

, Volume 18, Issue 11, pp 1477-1485

First online:

Severe oral mucositis associated with cancer therapy: impact on oral functional status and quality of life

  • Karis Kin-Fong ChengAffiliated withFaculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong Email author 
  • , S. F. LeungAffiliated withDepartment of Clinical Oncology, Prince of Wales Hospital
  • , Raymond H. S. LiangAffiliated withDivision of Hematology, Medical Oncology and Bone Marrow transplantation, Faculty of Medicine, The University of Hong Kong
  • , Josepha W. M. TaiAffiliated withBone Marrow Transplantation Unit, Queen Mary Hospital
  • , Rebecca M. W. YeungAffiliated withDepartment of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital
  • , David R. ThompsonAffiliated withUniversity of Leicester

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Goals of work

This study determined the incidence of severe oral mucositis (OM), patients’ self-reported moderate and severe oral symptoms, and change of quality of life (QoL), as well as examined whether OM severity and pain scores predicted the impairment of oral function and QoL.

Patients and methods

A multicenter approach was used and 137 patients treated with stomatotoxic chemotherapy (45%), high-dose myeloablative chemotherapy with or without concomitant total body irradiation (12%), head and neck irradiation with or without concomitant chemotherapy (44%) completed the OM-specific QoL measure (OMQoL) once or twice weekly over a 4- or 10-week period, along with concurrent measures of OM using WHO Mucositis Grading System and oral symptoms using 10 cm visual analog scale.

Main results

The incidence of severe OM was 50% (n = 68). About 77–80% of patients with severe OM reported moderate or severe mouth or throat pain, and 66–78% reported moderate or severe oral functional problems. The oral symptoms peak and area-under-the-curve (AUC) scores of patients with severe OM (peak 5.6 to 6.8; AUC 3.8 to 5.2) were significantly higher than those without OM and those with mild OM (p < 0.01). The OMQoL subscales peak and AUC scores of patients with severe OM (peak 47.9 to 62.1; AUC −40.1 to −25.8) were significantly lower than those without OM and those with mild OM (p < 0.01). Of those with severe OM, 88–94% had a drop in the OMQoL subscale scores to at least 10 points from the baseline. Pain resulting from OM, in particular throat pain, is most predictive of oral functional impairment (standardized β = 0.53–0.83).


Severe OM can cause profound pain and oral functional incapability and clinical significant impairment of QoL.


Severe oral mucositis Symptoms Pain Quality of life