Assessment and management of chemotherapy-induced mucositis in children

Abstract

Oral mucositis is one of the most common side effects of cancer treatment. The oral mucosa is comprised of membranes of a high mitotic index with rapid epithelial turnover and maturation rates. This causes the mucosa to be vulnerable to the adverse effects of chemotherapy. Chemotherapy alters the integrity of the mucosa, the microbial flora which normally inhabit the oral cavity, salivary quantity and composition, as well as the epithelial maturation. As a result, the child receiving chemotherapy may experience significant pain, dysphagia, alteration in nutritional status, and risk of infection. Severe mucositis can also delay therapy that may compromise the child's treatment and chance for cure. Not all chemotherapy-induced mucositis can be prevented. However, with proper management, the severity and duration of oral complications can be minimized.

Measurement of oral mucositis in children: a review of the literature

“…A basic tool that graded mucositis on a scale of 0 to 4 was reported in a study by Kennedy and Diamond [19] as an example of how to assess and subsequently manage chemotherapy-induced mucositis in children. However, the authors did not report any reliability or validity considerations with use of the scale, and there was no report of this scale being implemented.…”

“…Oral mucositis is a common consequence of cancer therapy [19,31]. It is important because it is painful and affects quality of life, may lead to hospitalisation for hydration or pain control, and provides a portal of entry for oral microflora [24].…”

Nutritional considerations in children undergoing bone marrow transplantation

“…Others do not support the above ®nding (Donaldson et al, 1981;Carter et al, 1983b;Besscho 1986;Tamminga et al, 1990). Most clinicians, however, agree that intensive chemotherapy is often associated with a deterioration of nutritional status of the patients (Bernstein & Sigmundi, 1980;Dorr & Fritz 1980;Rickard et al, 1980;Bernstein et al, 1982;Donaldson et al, 1981;Nunnaly, 1983;Keenan 1989;Kennedy & Diamond, 1997;Papadopoulou et al, 1996a).…”

“…Furthermore, anorexia and low oral intake are also associated with the use of chemotherapy: associations between the taste of foods and tumour growth per se (Bernstein & Sigmundi, 1980), altered taste sensations which are often associated with the use of cyclophosphamide (Nunnaly, 1983), and learned aversions for foods eaten before the administration of chemotherapy may all cause nausea and/or vomiting (Bernstein et al, 1982). Oral mucositis is one of the more common side-effects of chemotherapy (Kennedy & Diamond, 1997). Chemotherapy alters the integrity of the oral mucosa, the microbial ora, the composition of saliva, as well as the epithelial maturation.…”

Designing an oral mucositis assessment instrument for use in children: generating items using a nominal group technique

“…A number of studies have provided some better understanding of oral mucositis in children [1,3,5,8,10,15,17,20,21,33]. However, few of these studies are comparable due to variation in assessment scales used.…”