Prevalence of OM
The prevalence of oral mucositis (OM) is undetermined because there have
not been enough studies with sufficient statistical power to establish incidence
rates. Typically when OM prevalence is investigated, it is only as a secondary
objective in studies of chemotherapy and radiation therapy.1 Another
problem is that OM is widely underreported, which makes it difficult to determine
how many people actually suffer from OM.2 There are, however, some
useful reported ranges and informed estimates.
The overall incidence of OM for all patients with cancer is reported to
be 30%-40%. This incidence encompasses even patients who are receiving standard
chemotherapy for solid tumors and therefore considered at low risk of OM. Despite
their low risk, these patients develop OM in 37% of their treatment cycles.2
Up
to 100% of patients undergoing radiation therapy for head and neck cancers
develop OM due to the toxic effects of the treatment on their oral tissues.3 Patients
receiving hematopoietic stem-cell transplantation (HSCT) are also at a higher
risk, with up to 90% of them developing OM.3 For
HSCT recipients, OM has been shown to be the most frequently reported side
effect of their first 100 days of treatment.4
The incidence of OM varies in relation to several risk factors:5,5
- The patient: Patients younger than age 20 years are more likely
to develop OM, as are those over age 50 years.6 Patients with poor
renal function, diabetes or HIV are more vulnerable, as are those with poor
oral hygiene or existing oral problems. Patients who use tobacco or alcohol
also are more vulnerable.7
- The type of cancer: Hematologic malignancies are more likely to
contribute to the development of OM.7
- The type of therapy and therapy regimen: Radiation therapy of the
head or neck and higher doses or more frequent treatment schedules contribute
to the development of OM.7 Certain chemo-therapeutic
agents are known to be toxic to the oral tissues. For instance, anthracycline-based
regimens are associated with OM, especially when they include 5-FU. Etoposide
and irinotecan typically are associated with low rates of OM, unless combined
with 5-FU, which increases the toxicity to oral tissues. Regimens requiring
continuous infusion of 5-FU plus radiation therapy are especially toxic to
oral tissues.5,1
Visit the Patient’s
Perspective section to learn the profound
effect OM has on a patient’s quality of life.
References
- Sonis, ST, et al., Perspectives on cancer therapy-induced mucosal injury:
pathogenesis, measurement, epidemiology, and consequences for patients. Cancer 2004;
100(9 Suppl):1995-2025.
- Sonis, ST, A biological approach to mucositis. J Support Oncol 2004;
2(1):21-32.
- Epstein JB, Schubert MM. Oropharyngeal mucositis in cancer therapy.
Review of pathogenesis, diagnosis, and management. Oncology (Huntingt) 2003;
17:1767-79.
- Epstein JB, Schubert MM. Managing pain in mucositis. Semin Oncol Nurs 2004;
20:30-7.
- Avritscher EB, Cooksley CD, Elting LS. Scope and epidemiology of cancer
therapy-induced oral and gastrointestinal mucositis. Semin Oncol Nurs 2004;
20:3-10.
- Brown CG, Wingard J. Clinical consequences of oral mucositis. Semin
Oncol Nurs 2004; 20(1):16-21.
- Eilers J. When the mouth tells us more than it says-the impact of mucositis
on quality of life. Oncology Supportive Care Quarterly 2004; 1:31-43.
