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Incidence of oral mucositis, its treatment and pain management in patients receiving cancer treatment at Radiation Oncology Departments in Spanish hospitals (MUCODOL Study)

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Abstract

Objective

To estimate the incidence of oral mucositis (OM) in patients receiving radiotherapy, describe the treatments used to manage pain in OM grades 3 and 4 and assess relief of pain and patient satisfaction.

Patients and methods

All patients older than 18 years consecutively attending a Radiation Oncology Department over 5 working days were included in a cross-sectional study. The data recorded were RTOG scale of OM (1, 2, 3 or 4), age and sex. In a second stage, a clinical cohort was followed for 2 months. Pain management was assessed in patients with grades 3 and 4.

Results

Two thousand and forty-seven patients (98.5%) from 55 participating centres were eligible for the first stage. The overall risk of OM was 16.4% (95% CI 14.8–18.1); prevalence was 26.4%. In the second stage, 282 (91.6%) of the patients recruited were eligible. At the baseline visit, 95.7% of the population had OM grade 3 and 4.3% grade 4. At two months, OM was resolved in 62.3%, grade 1 in 20%, grade 2 in 10.3% and grade 3 in only 7.4% (p<0.05). 98.9% of the patients had head and neck cancer. From baseline to the two-months session, reported pain fell from 96.1% of affected patients to 39.8%(p<0.01), while chronic pain increased (19.5% vs. 38.2%, p<0.05). Verbal scale OM pain intensity indicated intense pain at baseline in 42.2% and a mean visual analogue scale (VAS) score of 5.6 (2.3). Mean VAS scores fell significantly according to pain intensity due to the OM and cancer (p<0.01).

Conclusions

Pain due to OM, a common complication of chemotherapy and radiation, limits nutritional intake and oral function. Analgesia protocols need to be assessed to improve the quality of life of these patients.

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References

  1. Oral Complications of Chemotherapy and Head/Neck Radiation (PQD®). Health professional Version. National Cancer Institute. US National Institutes of Health (www.cancer.gov)

  2. Wadleigh R, Redman R, Graham ML et al (1992) Vitamin E in the treatment of chemotherapy-induced mucositis. Am J Med 92:481–484

    Article  CAS  PubMed  Google Scholar 

  3. (1998) Prevention and Treatment of Oral Mucositis in Cancer Patients. Evidence Based Practice Information Sheets for Health Professionals. Best Practice 2:1–6. (www.joannabriggs.edu.au)

  4. Complicaciones orales del cáncer y de su terapia. National Cancer Institute; http://www.meb.unibonn.de/Cancernet/spanish/302904.html

  5. Köstler W, Hejna M, Wenzel C, Zielinski C (2001) Oral mucositis complicating chemotherapy and/or radiotherapy: options for prevention and treatment. CA Cancer J Clin 51:290–315

    Article  PubMed  Google Scholar 

  6. Alonso P, Basté MA, Creus M et al (2001) Prevención y tratamiento de la mucositis en el paciente oncohematológico. Farmacia Hospitalaria 25:139–149

    Google Scholar 

  7. Naidu MU, Ramana GV, Rani PU et al (2004) Chemotherapy-induced and/or radiation therapy-induced oral mucositis: complicating the treatment of cancer. Neoplasia 6:423–431

    Article  PubMed  Google Scholar 

  8. World Health Organization (1979) Handbook for reporting results of cancer treatment. World Health Organization, Geneva, Switzerland, pp 15–22

    Google Scholar 

  9. WCCNR (1998) Assessing stomatitis: refinement of the Western Consortium for Cancer Nursing Research (WCCNR) stomatitis staging system. Can Oncol Nurs J 8:160–165

    Google Scholar 

  10. Trotti A, Byhardt R, Stetz J et al (2000) Common toxicity criteria: version 2.0. An improved reference for grading the acute effects of cancer treatment: impact on radiotherapy. Int J Radiat Oncol Biol Phys 47:13–47

    CAS  PubMed  Google Scholar 

  11. NIH (1999) National Cancer Institute Common Toxicity Criteria. Version 2.0, June 1. Available at: http://ctep.info.nih.gov

  12. NIH (2003) National Cancer Institute Common Terminology Criteria for Adverse Events v3.0 (CTCAE). Cancer Therapy Evaluation Program. Released December 2003. Available at: http://ctep.info.nih.gov

  13. Wilkes JD (1998) Prevention and treatment of oral mucositis following cancer chemotherapy. Semin Oncol 25:538–551

    CAS  PubMed  Google Scholar 

  14. Elting LS, Cooksley C, Chambers M et al (2003) The burdens of cancer therapy. Clinical and economic outcomes of chemotherapy-induced mucositis. Cancer 98:1531–1539

    Article  PubMed  Google Scholar 

  15. Cox JD, Stetz J, Pajak TF (1995) Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 30:1341–1346

    Google Scholar 

  16. Vera-Llonch M, Oster G, Hagiwara M et al (2006) Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma. Cancer 106:329–336

    Article  PubMed  Google Scholar 

  17. Trotti A, Bellm LA, Epstein JB et al (2003) Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiother Oncol 66:253–262

    Article  PubMed  Google Scholar 

  18. Russo G, Haddad R, Posner M, Machtay M (2008) Radiation treatment breaks and ulcerative mucositis in head and neck cancer. Oncologist 13:886–898

    Article  PubMed  Google Scholar 

  19. Keefe DM (2006) Mucositis management in patients with cancer. Support Cancer Ther 3:154–157

    Article  PubMed  Google Scholar 

  20. Epstein JB, Schubert MM (2004) Managing pain in mucositis. Semin Oncol Nurs 20:30–37

    Article  PubMed  Google Scholar 

  21. Epstein JB, Schubert MM (1999) Oral mucositis in myelosuppressive cancer therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 88:273–276

    Article  CAS  PubMed  Google Scholar 

  22. Rubenstein EB, Peterson DE, Schubert M et al (2004) Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis. Cancer 100:2026–2046

    Article  PubMed  Google Scholar 

  23. Wojtaszek C (2000) Management of chemotherapy-induced stomatitis. Clin J Oncol Nurs 4:263–270

    CAS  PubMed  Google Scholar 

  24. Avritscher EB, Cooksley CD, Elting LS (2004) Scope and epidemiology of cancer therapy-induced oral and gastrointestinal mucositis. Semin Oncol Nurs 20:3–10

    Article  PubMed  Google Scholar 

  25. Yeager KA, McGuire DB, Sheidler YR (2000) Assessment of cancer pain. In: Yarbro CH, Frogge MH, Goodman M et al (eds) Cancer nursing principles and practice, 5th Edn. Jones & Bartlett, Boston, pp 633–656

    Google Scholar 

  26. Rose-Ped AM, Bellm LA, Epstein JB et al (2002) Complications of radiation therapy for head and neck cancers: the patient’s perspective. Cancer Nurs 25:468–469

    Article  Google Scholar 

  27. Ripamonti C, Dickerson ED (2001) Strategies for the treatment of cancer pain in the new millennium. Drugs 61:955–977

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Radiation Oncology Department, Hospital Universitario de La Paz, Paseo de la Castellana. 261, ES-28046, Madrid, Spain

    Ana Mañas

  2. Radiation Oncology Department, Hospital Reina Sofía, Córdoba, Spain

    Amalia Palacios

  3. Radiation Oncology Department, Hospital Carlos Haya, Málaga, Spain

    Jorge Contreras

  4. Medical Department, Grünenthal Pharma S.A, Madrid, Spain

    Isabel Sánchez-Magro & Pilar Blanco

  5. Research Unit, Hospital Clínico San Carlos, Madrid, Spain

    Cristina Fernández-Pérez

Authors
  1. Ana Mañas
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  2. Amalia Palacios
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  3. Jorge Contreras
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  4. Isabel Sánchez-Magro
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  5. Pilar Blanco
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  6. Cristina Fernández-Pérez
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Corresponding author

Correspondence to Ana Mañas.

Additional information

The first and second authors have contributed equally to the design of the study and writing the article.

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Mañas, A., Palacios, A., Contreras, J. et al. Incidence of oral mucositis, its treatment and pain management in patients receiving cancer treatment at Radiation Oncology Departments in Spanish hospitals (MUCODOL Study). Clin Transl Oncol 11, 669–676 (2009). https://doi.org/10.1007/s12094-009-0422-y

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  • DOI: https://doi.org/10.1007/s12094-009-0422-y

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