Oral Mucositis and the Clinical and Economic Outcomes of Hematopoietic Stem-Cell Transplantation

Abstract

Oral mucositis is associated with significantly worse clinical and economic outcomes in blood and marrow transplantation.

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

“…1 This second analysis of data from this pan-European audit provides new insights into the clinical sequelae of severe OM and associated medical resource use. Consistent with other observations, 8,13 we found that severe OM was closely related to development of fever, with the incidence of fever being 21% higher and the duration of fever 1.2 days longer, in those with severe OM. Previous studies in the SCT setting have shown that the risk of fever and/or febrile neutropenia (FN) increases with increasing grade of OM.…”

“…Previous studies in the SCT setting have shown that the risk of fever and/or febrile neutropenia (FN) increases with increasing grade of OM. 8,9 Moreover, the recombinant growth factor palifermin, which protects the oral mucosa from damage induced by myelotoxic-conditioning treatment, was able to reduce the risk of FN in patients undergoing SCT. 14 The association of fever with oral mucositis has been attributed to local and systemic infections, as disruption of the mucosal barrier may provide an entry point for pathogens.…”

“…Our findings are consistent with earlier data from the United States. An earlier prospective, multicentre study in blood or marrow transplant recipients (n ¼ 92) 8 and a retrospective chart review in SCT recipients (n ¼ 281) 9 found that resource use and clinical outcomes, including duration of hospitalization, were significantly correlated with the severity of OM. A retrospective case-control study in 24 patients who developed a-haemolytic streptococcal bacteraemia following autologous BMT 13 found that OM prolonged hospital stay both independently and as a cofactor associated with bacteraemia.…”

“…6 Several US-based analyses from various cancer settings have demonstrated that severe OM increases healthcare resource utilization by necessitating opioid analgesia, antiinfective treatment, total parenteral nutrition (TPN) and subsequently prolonging hospitalization. 3,5,8,9 However, medical resource use in relation to OM has not been systematically assessed in the European SCT setting, although a recently published overview provided insights in the management of OM in European transplantation centres. 10 The Prospective Oral Mucositis Audit (POMA), conducted by our group in 25 centres across 13 European countries, was the first multi-country audit study with OM occurrence as the primary objective.…”

“…Severe OM interferes with daily activities such as speaking, eating and swallowing and has a negative impact on quality of life. 3,4 It can lead to dehydration, malnutrition and serious infections [5][6][7][8] and has been linked to inferior overall survival (P ¼ 0.002) after SCT. 6 Several US-based analyses from various cancer settings have demonstrated that severe OM increases healthcare resource utilization by necessitating opioid analgesia, antiinfective treatment, total parenteral nutrition (TPN) and subsequently prolonging hospitalization.…”