Consequences of OM

Oral mucositis (OM) often is reported as the most debilitating side effect of cancer treatment,1 and these debilitating effects can produce far-reaching consequences.2 Once OM has developed it can significantly reduce patients’ quality of life (QOL) by inhibiting their ability to eat, drink, and communicate with family, friends and health care providers. This loss of QOL and function can have particularly debilitating psychological effects. Many patients feel that eating and drinking are among the few things they can focus on to help fight their cancer.3

Because nurses care for patients with OM more than anyone else on the health care team, and because patients with OM require special care, it is important for nurses to know the hardships that patients with OM may face. Nurses are the foundation of care in providing patient and family education, intensive oral care support, pain management and other support.4

The World Health Organization (WHO) and the National Cancer Institute (NCI) have developed scales for assessing the degree of OM, and both demonstrate the health consequences of OM.2 Both are 0-5 scales, with 0 denoting no disease and 5 denoting death due to toxicity.2

The NCI scale for chemotherapy patients describes grades 1-4 as follows:

• Grade 1 (mild) includes erythema and painless ulcers, or mild soreness with no lesions.
• Grade 2 (moderate) is characterized by some painful erythema, edema, or ulcers that do not prevent eating and swallowing.
• Grade 3 (severe) is marked by painful ulcers, erythema or edema, and requiring I.V. hydration.
• Grade 4 (life-threatening) includes severe ulceration requiring parenteral or enteral nutrition or prophylactic intubation.2

Patients with grade 3-4 OM are at risk for a broad range of significant consequences. For instance:

• 35% of these patients have delayed chemotherapy.
• 60% have reduced dosages.
• 30% have their therapy discontinued altogether.2

Of those patients receiving standard chemotherapy:

• 70% of those with grade 3-4 OM require feeding tubes.
• 60% develop fevers.
• 62% are hospitalized.2

These rates are even higher for adult hematopoietic stem-cell transplantation (HSCT) recipients and patients receiving HSCT with high-dose chemotherapy: 87% of them require feeding tubes, and 80% require opioids.2

When a patient has significant OM, coupled with neutropenia, the outcome could be life threatening. It is estimated that 40% - 60% of all patients that become septic die.3 In her study examining the outcomes of OM, Linda S. Elting (Associate Professor of Health Services Research and Associate Epidemiologist, University of Texas M.D. Anderson Cancer Center, Section of Health Services Research) found that in 73% of chemotherapy cycles, patients with mucositis developed infection. This incidence escalated to 93% for those with severe or life-threatening OM.5

Treatment costs also escalate as a result of OM, producing extensive financial consequences. In her study, Elting estimated that the average cost of hospitalization per cycle for patients without OM would have been $3,893, while typical cost per cycle for OM patients would have been nearly twice that amount at $6,277.5 Furthermore, Stephen T. Sonis reported in one study that the financial consequence for HSCT patients with oral ulcers was estimated at an additional $42,729 per patient.2

Visit Preventing Oral Mucositis to read how these consequences may be avoided.