1.Who develops mucositis?
70%-100% of patients receiving chemotherapy and/or head-neck radiotherapy is expected to develop oral mucositis.
Oral mucositis is also associated with preparation for hematopoietic stem cell transplantation (HSCT).
Factors that may affect prevalence and severity of this pathogenic entity are:
Α. Therapy-related factors, such as:
-Type of chemotherapeutic agents used to date.
-Dose intensity.
-Duration of cancer treatment.
Perceptibly, mucosa toxic agents are Actinomycin D, Cisplatin, Docetaxel, Methotrexate, 5-Fluorouracil, Doxorubicin, Picamycin, Pembrolizumab, mTOR inhibitors (Everolimus) and many more.
Β. Patient-related factors, such as:
-Neutropenia
-Poor dental health.
-Hyposalivation- reduction of saliva’s buffering capacity and of oral IgA leads to the development of infectious oral flora.
-Vitamin D and B12 deficiencies.
-Diabetes
-HIV
-Gender – women more often develop mucositis than men.
-Smoking
-Alcohol
-Low body mass index ( BMI ).
2.When does oral mucositis occur?
It usually occurs 5-10 days after the initial administration of chemotherapy while for radiotherapy it takes 2-3 weeks to develop after the beginning of treatment.
A sense of burning, soreness and erythema may precede extended lesions.
3.How long does oral mucositis last?
Resolution of oral mucositis clinical signs is expected from one week to six or more after the administration of last chemotherapeutic dose and always depending on chemotherapeutic regimen, dose intensity, duration of treatment, the course of hepatopoietic recovery and the concomitance of other patient related factors.
Concerning radiotherapy related mucositis, the course of the disease is more chronic and healing is expected 2-5 weeks after the cessation of radiotherapy treatment, depending on radiation source, cumulative dose and patient’s immunocompetence.
4.What is the impact of Oral Mucositis?
Oral mucositis is the most serious complication of both cancer treatments, chemotherapy and radiotherapy involving head and neck.
-Pain
Patients suffering from Oral Mucositis are having to face with a cluster of symptoms where prevails severe pain that causes difficulties in chewing and swallowing.
As a consequence to that, patients are becoming eventually unable to eat, drink or even speak.
The subsequent restriction on food intake can lead in Η στthe use of feeding tubes trying to compensate for life-threatening weight loss, muscle mass reduction and electrolyte disorders.
Pain dramatically affects patients’ quality of life while it can also lead to depression.
-Cancer treatment interruption
Oral mucositis is a dose-limiting side effect that endangers anticancer treatment continuity, imposes modification or even more cessation of therapy while compromises treatment’s efficacy and patient’s life itself.
-Bacteria colonization
Oral mucositis compromises the integrity of oral mucosa so that ulcerations serve as an entry to pathogenic micro-organisms.
Very often oral mucositis and neutropenia which dilutes patient’s immunological response are concomitants.
That involves the risk of systemic infection as bacteria from a localized infection invade systemic bloodstream.
In many cases, neutropenic patients with oral mucositis develop oral infections with multi-drug resistant bacteria, something that complicates treatment.
-Extended hospitalization
One serious impact of oral mucositis is the necessity of hospital admission for parenteral nutrition and intravenous administration of strong analgesics and antibiotic treatment.
