Oral mucositis: the new paradigms

Abstract

Purpose of review Mucositis has long been viewed as an unavoidable consequence of high-dose chemotherapy and/or radiation. Management has been directed to supportive care including oral pain control, nutritional support, infection treatment and control of diarrhea. While these interventions have been valuable for clinical management, they have not been collectively directed to molecularly targeted prevention and treatment. This review addresses recent advances regarding mucosal injury in cancer patients, with emphasis on symptom clusters, genetically-based tissue susceptibility and risk prediction, imaging technology, and computational biology. Recent findings Modeling of symptom clusters in cancer patients continues to mature. Although integration of mucositis into the paradigm is at an early stage, recent reports suggest that important molecular and clinical insights will emerge in this regard. Initial studies of genetic-based tissue risk are also providing a research basis that may lead to clinical risk prediction models. These advances are in part being engineered via new imaging and computational biology technologies, drawing upon literature in non-mucositis systems. Just as the past decade has been hallmarked by linkage of pathobiology with clinical expression of mucosal toxicity, the next decade promises to identify new molecular interactions and risk prediction models based on novel application of the analytic technologies. Summary Recent research has culminated in convergence of molecular pathobiology with models of symptom clusters, genetic-based risk, and imaging and computational biology. The field is poised to further delineate this paradigm, with the goal of development of molecularly targeted drugs and devices for mucositis management.

Prospective evaluation of HSV, Candida spp., and oral bacteria on the severity of oral mucositis in pediatric acute lymphoblastic leukemia

“…Key clinical manifestations of oral mucositis include painful erythema and ulceration [4]. Further secondary morbidity caused by mucositis may interfere with therapy, and this may lead to treatment suspension until the complications are resolved [5].…”

Prevention and Treatment of Mucositis at an Oncology Outpatient Clinic: A Collective Construction

“…This low-cost therapeutic choice is risk-free, highly effective and easy to apply in clinical practice, offers pain relief and can prevent the development of new lesions. [20][21] This intervention is consistent with the 2014 clinical practice guidelines for care to clients with oral and intestinal mucositis of the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO). 4 Studies prove a consensus on the recommendation to use cryotherapy to prevent oral mucositis in individuals who received 5-fluorouracil.…”

“…[6][7][17][18][19] In the protocol, due to consistent recommendations in the literature and which could be established at the place of study, a tooth brushing routine was determined, using a small and soft brush (child toothbrush), making very short horizontal movements, turning the bristles at least ten times in each region, on the upper as well as lower teeth and external and internal surfaces. [20][21][22] Delicate brushing of the tongue should be stimulated. The non-abrasive toothpaste should preferably contain fluor.…”

Management of oral mucositis

“…There are no FDA-approved molecularly targeted drugs to prevent gastrointestinal mucositis. Oral and gastrointestinal mucositis therefore continues to represent an important unmet clinical need (5). Few interventions are of proven efficacy in reducing the severity or duration of mucositis, and there are no universally accepted treatment protocols.…”

“…Patients with oral mucositis are significantly more likely to experience severe pain and weight loss. Severity of oral mucositis has been correlated with compromised swallowing function in patients, resulting in the requirement for feeding via a gastrostomy tube (4,5). Development of mucositis depends on a number of factors, related to both therapy and patient characteristics.…”