Preventive and therapeutic assessment program for mucositis in patients with cancer: promising advances in stomatological care

ABSTRACT

Objectives: We propose a preventive and therapeutic assessment program for mucositis in patients with cancer based on a comprehensive review of scientific evidence. Material and

Methods: This methodological study, designed as a non-systematic review, entails a thorough review of the scientific evidence on the management of mucositis in patients with cancer. The PICO method was used, allowing for a structured approach to explore and synthesize relevant evidence.

Results: Effective mucositis management requires regular assessments, dental exams, preventive strategies, and consideration of modifiable risk factors. Pharmacological therapies may be considered for severe cases, while oral antimicrobials, prophylactic antiviral and antifungal therapy can prevent infections. Topical anesthetics offer pain relief but require careful administration. A gradual management plan, from gentle rinses to analgesics, is recommended.

Conclusion: The suggested program may improve the identification, prevention, and management of this complication to achieve optimal management outcomes.

RESUMO

Objetivos: Propomos um programa de avaliação preventiva e terapêutica de mucosite em pacientes com câncer com base em uma revisão abrangente de evidências científicas.

Material e Métodos: Este estudo metodológico, concebido como uma revisão não sistemática, envolve uma revisão aprofundada da evidência científica sobre o manejo de mucosite em pacientes com câncer. Foi utilizado o método PICO, permitindo uma abordagem estruturada para explorar e sintetizar evidências relevantes.

Resultados: O manejo eficaz da mucosite requer avaliações regulares, exames odontológicos, estratégias preventivas e consideração de fatores de risco modificáveis. As terapias farmacológicas podem ser consideradas para casos graves, enquanto os antimicrobianos orais e a terapia antiviral e antifúngica profilática podem prevenir infecções. Os anestésicos tópicos oferecem alívio da dor, mas requerem administração cuidadosa. Recomenda-se uma administração gradual, desde enxágues suaves até analgésicos.

Conclusão: O programa sugerido pode melhorar a identificação, prevenção e manejo desta complicação para alcançar resultados de conduta ideais.

Keywords:

Mucositis - Outcome and process assessment - Health care - Review - Management indicators - Symptom assessment

Descritores:

Mucosite - Avaliação de resultados e processos - Assistência médica - Análise - Indicadores de gestão - Avaliação de sintomas

Publication History

Received: 11 October 2023

Accepted: 18 January 2024

Article published online:
25 March 2024

• REFERENCES

• 1 Brown TJ, Gupta A. Management of cancer therapy: associated oral mucositis. JCO Oncol Pract 2020; Mar 16 (03) 103-9
• 2 Elting LS, Cooksley C, Chambers M, Cantor SB, Manzullo E, Rubenstein EB. The burdens of cancer therapy. Clinical and economic outcomes of chemotherapy-induced mucositis. Cancer 2003; Oct 98 (07) 1531-9
• 3 Al-Dasooqi N, Sonis ST, Bowen JM, Bateman E, Blijlevens N, Gibson RJ. et al. Emerging evidence on the pathobiology of mucositis. Support Care Cancer 2013; Jul 21 (07) 3233-41
• 4 Pulito C, Cristaudo A, LaPorta C, Zapperi S, Blandino G, Morrone A. et al. Oral mucositis: the hidden side of cancer therapy. J Exp Clin Cancer Res 2020; Oct 39 (01) 210
• 5 Peterson DE, Boers-Doets CB, Bensadoun RJ, Herrstedt J. ESMO Guidelines Committee. Management of oral and gastrointestinal mucosal injury: ESMO Clinical Practice Guidelines for diagnosis, treatment, and follow-up. Ann Oncol 2015; Sep 26 Suppl 5 S139-S51
• 6 Bensinger W, Schubert M, Ang KK, Brizel D, Brown E, Eilers JG. et al. NCCN Task Force Report. prevention and management of mucositis in cancer care. J Natl Compr Canc Netw 2008; Jan 6 Suppl 1 S1-21 quiz:S22-S4
• 7 Sonis ST, Oster G, Fuchs H, Bellm L, Bradford WZ, Edelsberg J. et al. Oral mucositis and the clinical and economic outcomes of hematopoietic stem-cell transplantation. J Clin Oncol 2001; Apr 19 (08) 2201-5
• 8 Elting LS, Cooksley CD, Chambers MS, Garden AS. Risk, outcomes, and costs of radiation-induced oral mucositis among patients with head-and-neck malignancies. Int J Radiat Oncol Biol Phys 2007; Jul 68 (04) 1110-20
• 9 Campos TM, Silva CAPT, Sobral APT, Sobral SS, Rodrigues MFSD, Bussadori SK. et al. Photobiomodulation in oral mucositis in patients with head and neck cancer: a systematic review and meta-analysis followed by a cost-effectiveness analysis. Support Care Cancer 2020; 28 (12) 5649-59
• 10 Taylor JK, Mady LJ, Baddour K, Iheagwara UK, Zhai S, Ohr JP. et al. A phase Ⅱ prospective trial of photobiomodulation therapy in limiting oral mucositis in the treatment of locally advanced head and neck cancer patients. World J Otorhinolaryngol Head Neck Surg 2022; Dec 8 (04) 345-54
• 11 Robijns J, Nair RG, Lodewijckx J, Arany P, Barasch A, Bjordal JM. et al. Photobiomodulation therapy in management of cancer therapy-induced side effects: WALT position paper 2022. Front Oncol 2022; Aug 12: 927685
• 12 Lalla RV, Bowen J, Barasch A, Elting L, Epstein J, Keefe DM. et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer 2014; May 120 (10) 1453-61
• 13 Nekhlyudov L, Lacchetti C, Davis NB, Garvey TQ, Goldsterin DP, Nunnink JC. et al. Head and Neck Cancer Survivorship Care Guideline: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Cancer Society Guideline. J Clin Oncol 2017; May; 35 (14) 1606-21
• 14 Stone PW. Popping the (PICO) question in research and evidence-based practice. Appl Nurs Res 2002; Aug 15 (03) 197-8