Treatment Guidelines

The first step in treating oral mucositis (OM) is performing a thorough assessment of the patient’s oral status prior to cancer treatment.1 Nurses are key members of their patients’ health care teams, playing important roles in assessing patients’ oral status.1 This assessment will help provide a baseline for treatment should the patient develop OM during cancer therapy. Assessments should be continued routinely throughout therapy.1 There are several assessment tools available, including the following:

• Beck’s Oral Examination Guide
• Eiler’s Oral Assessment Guide
• Schubert et al’s Oral Mucositis Index
• Sonis’ Oral Mucositis Assessment Scale1

Treatment options are limited for patients who develop OM. Options such as mouth rinses, antimicrobials, growth factors and anti-inflammatory agents have been studied, but few have proven to be viable options for treating OM.1,2 Instead, recommendations focus on symptom management and continuation of protective measures throughout cancer therapy.3

In 2004 the Mucositis Study Section of the Multinational Association of Supportive Care in Cancer and the International Society for Oral Oncology comprehensively surveyed literature on oral and gastrointestinal mucositis and subsequently developed clinical guidelines for preventing and treating these conditions. The panel’s expertise and the scope of its review make these guidelines definitive.4 Guidelines for preventing and treating OM include the following:

• An oral care program should be defined for the patient, and the patient should be educated in following it. For oral care, the agents used are less important than adherence to conscientious oral care.4
• Palliative pain management is recommended. This includes systemic analgesics, with the strength of the analgesia escalating in parallel with the severity of OM pain. Patient-controlled analgesia (PCA) is recommended for severe OM; for hematopoietic stem-cell transplantation (HSCT) patients with severe pain, morphine is the recommended opioid.4 Although many topical analgesics have been investigated, none have proven to be consistently effective. Consequently, they are not recommended.4
• The panel recommends midline radiation blocks and three-dimensional radiation treatment to help prevent and limit injury to the oral tissues.4
• Cryotherapy is recommended 5 minutes before 5-FU bolus injection and continued for 30 minutes to help cool the oral cavity and prevent OM. The cooling causes vasoconstriction, which is thought to limit toxicity to the oral tissues.4
• In institutions where it is available, low-level radiation should be used in patients receiving high-dose chemotherapy or chemoradiotherapy before HSCT. This may help reduce the risk of OM and limit associated pain.4

Visit Managing Pain to read more about analgesics as well as other strategies for effectively managing OM pain.