Skip to main content
Erschienen in: Supportive Care in Cancer 11/2010

01.11.2010 | Original Article

Severe oral mucositis associated with cancer therapy: impact on oral functional status and quality of life

verfasst von: Karis Kin-Fong Cheng, S. F. Leung, Raymond H. S. Liang, Josepha W. M. Tai, Rebecca M. W. Yeung, David R. Thompson

Erschienen in: Supportive Care in Cancer | Ausgabe 11/2010

Einloggen, um Zugang zu erhalten

Abstract

Goals of work

This study determined the incidence of severe oral mucositis (OM), patients’ self-reported moderate and severe oral symptoms, and change of quality of life (QoL), as well as examined whether OM severity and pain scores predicted the impairment of oral function and QoL.

Patients and methods

A multicenter approach was used and 137 patients treated with stomatotoxic chemotherapy (45%), high-dose myeloablative chemotherapy with or without concomitant total body irradiation (12%), head and neck irradiation with or without concomitant chemotherapy (44%) completed the OM-specific QoL measure (OMQoL) once or twice weekly over a 4- or 10-week period, along with concurrent measures of OM using WHO Mucositis Grading System and oral symptoms using 10 cm visual analog scale.

Main results

The incidence of severe OM was 50% (n = 68). About 77–80% of patients with severe OM reported moderate or severe mouth or throat pain, and 66–78% reported moderate or severe oral functional problems. The oral symptoms peak and area-under-the-curve (AUC) scores of patients with severe OM (peak 5.6 to 6.8; AUC 3.8 to 5.2) were significantly higher than those without OM and those with mild OM (p < 0.01). The OMQoL subscales peak and AUC scores of patients with severe OM (peak 47.9 to 62.1; AUC −40.1 to −25.8) were significantly lower than those without OM and those with mild OM (p < 0.01). Of those with severe OM, 88–94% had a drop in the OMQoL subscale scores to at least 10 points from the baseline. Pain resulting from OM, in particular throat pain, is most predictive of oral functional impairment (standardized β = 0.53–0.83).

Conclusions

Severe OM can cause profound pain and oral functional incapability and clinical significant impairment of QoL.
Literatur
2.
Zurück zum Zitat Cella D, Pulliam J, Fuchs H et al (2003) Evaluation of pain associated with oral mucositis during the acute period after administration of high-dose chemotherapy. Cancer 98:406–412CrossRefPubMed Cella D, Pulliam J, Fuchs H et al (2003) Evaluation of pain associated with oral mucositis during the acute period after administration of high-dose chemotherapy. Cancer 98:406–412CrossRefPubMed
3.
Zurück zum Zitat Cheng KKF (2007) Oral mucositis, dysfunction, and distress in patients undergoing cancer therapy. J Clin Nurs 16:2114–2121CrossRefPubMed Cheng KKF (2007) Oral mucositis, dysfunction, and distress in patients undergoing cancer therapy. J Clin Nurs 16:2114–2121CrossRefPubMed
4.
Zurück zum Zitat Spielberger R, Stiff P, Bensinger W et al (2004) Palifermin for oral mucositis after intensive therapy for hematologic cancers. New Engl J Med 351:2590–2598CrossRefPubMed Spielberger R, Stiff P, Bensinger W et al (2004) Palifermin for oral mucositis after intensive therapy for hematologic cancers. New Engl J Med 351:2590–2598CrossRefPubMed
5.
Zurück zum Zitat Stiff PJ, Erder H, Bensinger WI et al (2006) Reliability and validity of a patient self-administered daily questionnaire to assess impact of oral mucositis (OM) on pain and daily functioning in patients undergoing autologous hematopoietic stem cell transplantation (HSCT). Bone Marrow Transplant 37:393–401CrossRefPubMed Stiff PJ, Erder H, Bensinger WI et al (2006) Reliability and validity of a patient self-administered daily questionnaire to assess impact of oral mucositis (OM) on pain and daily functioning in patients undergoing autologous hematopoietic stem cell transplantation (HSCT). Bone Marrow Transplant 37:393–401CrossRefPubMed
6.
Zurück zum Zitat Epstein JB, Beaumont JL, Gwede CK et al (2007) Longitudinal evaluation of the oral mucositis weekly questionnaire-head and neck cancer, a patient-reported outcomes questionnaire. Cancer 109:1914–1922CrossRefPubMed Epstein JB, Beaumont JL, Gwede CK et al (2007) Longitudinal evaluation of the oral mucositis weekly questionnaire-head and neck cancer, a patient-reported outcomes questionnaire. Cancer 109:1914–1922CrossRefPubMed
7.
Zurück zum Zitat Kushner JA, Lawrence HP, Kiss TL et al (2008) Development and validation of a Patient-Reported Oral Mucositis Symptom (PROMS) Scale. JCDA 74(1):59a–59j Kushner JA, Lawrence HP, Kiss TL et al (2008) Development and validation of a Patient-Reported Oral Mucositis Symptom (PROMS) Scale. JCDA 74(1):59a–59j
8.
Zurück zum Zitat Cheng KKF, Leung SF, Thompson DR et al (2007) A new measure of health-related quality of life for patients with oropharyngeal mucositis (OMQoL): development and preliminary psychometric evaluation. Cancer 109:2590–2599CrossRefPubMed Cheng KKF, Leung SF, Thompson DR et al (2007) A new measure of health-related quality of life for patients with oropharyngeal mucositis (OMQoL): development and preliminary psychometric evaluation. Cancer 109:2590–2599CrossRefPubMed
9.
Zurück zum Zitat Cheng KKF, Leung SF, Liang RHS et al (2008) A patient-reported outcome instrument to assess the impact of oropharyngeal mucositis on health-related quality of life: a longitudinal psychometric evaluation. Support Care Cancer 17(4):289–298 Cheng KKF, Leung SF, Liang RHS et al (2008) A patient-reported outcome instrument to assess the impact of oropharyngeal mucositis on health-related quality of life: a longitudinal psychometric evaluation. Support Care Cancer 17(4):289–298
10.
Zurück zum Zitat Osoba D, Rodrigues G, Myles J et al (1998) Interpretating the significance of changes in health-related quality-of-life scores. J Clin Oncol 16:139–144PubMed Osoba D, Rodrigues G, Myles J et al (1998) Interpretating the significance of changes in health-related quality-of-life scores. J Clin Oncol 16:139–144PubMed
11.
Zurück zum Zitat Engels JM, Diehr P (2003) Imputation of missing of longitudinal data: a comparison of methods. J Clin Epidemiol 56:968–976CrossRefPubMed Engels JM, Diehr P (2003) Imputation of missing of longitudinal data: a comparison of methods. J Clin Epidemiol 56:968–976CrossRefPubMed
12.
Zurück zum Zitat Elting LS, Keefe DM, Sonis ST et al (2008) Patient-reported measurements of oral mucositis in head and neck cancer patients treated with radiotherapy with or without chemotherapy: demonstration of increased frequency, severity, resistance to palliation, and impact on quality of life. Cancer 113:2704–2713CrossRefPubMed Elting LS, Keefe DM, Sonis ST et al (2008) Patient-reported measurements of oral mucositis in head and neck cancer patients treated with radiotherapy with or without chemotherapy: demonstration of increased frequency, severity, resistance to palliation, and impact on quality of life. Cancer 113:2704–2713CrossRefPubMed
13.
Zurück zum Zitat Nonzee NJ, Dandade NA, Markossian T et al (2008) Evaluating the supportive care costs of severe radiochemotherapy-induced mucositis and pharyngitis. Cancer 113:1446–1452CrossRefPubMed Nonzee NJ, Dandade NA, Markossian T et al (2008) Evaluating the supportive care costs of severe radiochemotherapy-induced mucositis and pharyngitis. Cancer 113:1446–1452CrossRefPubMed
14.
Zurück zum Zitat Trottii A, Bellm LA, Epstein JB et al (2003) Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiother Oncol 66:253–262CrossRef Trottii A, Bellm LA, Epstein JB et al (2003) Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiother Oncol 66:253–262CrossRef
15.
Zurück zum Zitat Trotti A, Garden A, Warde P et al (2004) A multinational, randomized phase III trial of iseganan HCI oral solution for reducing the severity of oral mucositis in patients receiving radiotherapy for head-and-neck malignancy. Int J Radiat Oncol Biol Phys 58:674–681PubMed Trotti A, Garden A, Warde P et al (2004) A multinational, randomized phase III trial of iseganan HCI oral solution for reducing the severity of oral mucositis in patients receiving radiotherapy for head-and-neck malignancy. Int J Radiat Oncol Biol Phys 58:674–681PubMed
16.
Zurück zum Zitat Rosen LS, Abdi E, Davis ID et al (2006) Palifermin reduces the incidence of oral mucositis in patients with metastatic colorectal cancer treated with fluorouracil-based chemotherapy. J Clin Oncol 24:5194–5200CrossRefPubMed Rosen LS, Abdi E, Davis ID et al (2006) Palifermin reduces the incidence of oral mucositis in patients with metastatic colorectal cancer treated with fluorouracil-based chemotherapy. J Clin Oncol 24:5194–5200CrossRefPubMed
17.
Zurück zum Zitat Anderson KO, Giralt SA, Mendoza TR et al (2007) Symptom burden in patients undergoing autologous stem-cell transplanation. Bone Marrow Transplant 39:759–766CrossRefPubMed Anderson KO, Giralt SA, Mendoza TR et al (2007) Symptom burden in patients undergoing autologous stem-cell transplanation. Bone Marrow Transplant 39:759–766CrossRefPubMed
18.
Zurück zum Zitat Josting A, Sieniawski M, Glossmann JP et al (2005) High-dose sequential chemotherapy followed by autologous stem cell transplantation in relapsed and refractory aggressive non-Hodgkin’s lymphoma: results of a multicenter phase II study. Ann Oncol 16:1359–1365CrossRefPubMed Josting A, Sieniawski M, Glossmann JP et al (2005) High-dose sequential chemotherapy followed by autologous stem cell transplantation in relapsed and refractory aggressive non-Hodgkin’s lymphoma: results of a multicenter phase II study. Ann Oncol 16:1359–1365CrossRefPubMed
19.
Zurück zum Zitat Blijlevens N, Schwenkglenks M, Bacon P et al (2008) Prospective oral mucositis audit: oral mucositis in patients receiving high-dose melphalan or BEAM conditioning chemotherapy – European Blood and Marrow Transplantation Mucositis Advisory Group. J Clin Oncol 26:1519–1525CrossRefPubMed Blijlevens N, Schwenkglenks M, Bacon P et al (2008) Prospective oral mucositis audit: oral mucositis in patients receiving high-dose melphalan or BEAM conditioning chemotherapy – European Blood and Marrow Transplantation Mucositis Advisory Group. J Clin Oncol 26:1519–1525CrossRefPubMed
20.
Zurück zum Zitat Moreau P, Facon T, Attal M et al (2002) Comparison of 200 mg/m2 melphalan and 8 Gy total body irradiation plus 140 mg/m2 melphalan as conditioning regimens for peripheral blood stem cell transplantation in patients with newly diagnosed multiple myeloma: final analysis of the Intergroupe Francophone du. Myeloma 9502 randomized trial. Blood 99:731–735CrossRefPubMed Moreau P, Facon T, Attal M et al (2002) Comparison of 200 mg/m2 melphalan and 8 Gy total body irradiation plus 140 mg/m2 melphalan as conditioning regimens for peripheral blood stem cell transplantation in patients with newly diagnosed multiple myeloma: final analysis of the Intergroupe Francophone du. Myeloma 9502 randomized trial. Blood 99:731–735CrossRefPubMed
21.
Zurück zum Zitat Horsley P, Bauer JD, Mazkowiack R et al (2007) Palifermin improves severe mucositis, swallowing problems, nutrition impact symptoms, and length of stay in patients undergoing hematopoietic stem cell transplantation. Support Care Cancer 15:105–109CrossRefPubMed Horsley P, Bauer JD, Mazkowiack R et al (2007) Palifermin improves severe mucositis, swallowing problems, nutrition impact symptoms, and length of stay in patients undergoing hematopoietic stem cell transplantation. Support Care Cancer 15:105–109CrossRefPubMed
22.
Zurück zum Zitat Robien K, Schubert MM, Lloid ME et al (2004) Predictors of oral mucositis in patients receiving hematopoietic cell transplants for chronic myelogenous leukemia. J Clin Oncol 22:1268–1275CrossRefPubMed Robien K, Schubert MM, Lloid ME et al (2004) Predictors of oral mucositis in patients receiving hematopoietic cell transplants for chronic myelogenous leukemia. J Clin Oncol 22:1268–1275CrossRefPubMed
23.
Zurück zum Zitat Isitt J, Murphy BA, Beaumont JL et al (2007) Oral mucositis-related morbidities and resource utilization in a prospective study of head and neck cancer patients. J Support Oncol 5:54–55 Isitt J, Murphy BA, Beaumont JL et al (2007) Oral mucositis-related morbidities and resource utilization in a prospective study of head and neck cancer patients. J Support Oncol 5:54–55
24.
Zurück zum Zitat Rosenthal DI, Mendoza TR, Chambers MS et al (2008) The M.D. Anderson Symptom Inventory – head and neck module, a patient-reported outcome instrument, accurately predicts the severity of radiation-induced mucositis. Int J Radiat Oncol Biol Phys 72:1355–1361PubMed Rosenthal DI, Mendoza TR, Chambers MS et al (2008) The M.D. Anderson Symptom Inventory – head and neck module, a patient-reported outcome instrument, accurately predicts the severity of radiation-induced mucositis. Int J Radiat Oncol Biol Phys 72:1355–1361PubMed
25.
Zurück zum Zitat Keefe DM, Rassias G, O’Neil L et al (2007) Severe mucositis: how can nutrition help? Curr Opin Clin Nutr Metab Care 10:627–631CrossRefPubMed Keefe DM, Rassias G, O’Neil L et al (2007) Severe mucositis: how can nutrition help? Curr Opin Clin Nutr Metab Care 10:627–631CrossRefPubMed
26.
Zurück zum Zitat Elting LS, Cooksley C, Chambers M et al (2003) The burdens of cancer therapy: clinical and economic outcomes of chemotherapy-induced mucositis. Cancer 98:1531–1539CrossRefPubMed Elting LS, Cooksley C, Chambers M et al (2003) The burdens of cancer therapy: clinical and economic outcomes of chemotherapy-induced mucositis. Cancer 98:1531–1539CrossRefPubMed
27.
Zurück zum Zitat FallDickson JM, Ramsay ES, Castro K et al (2007) Oral mucositis-related oropharyngeal pain and correlative tumor necrosis factor-alpha expression in adult oncology patients undergoing hematopoietic stem cell transplantation. Clin Ther 29(Suppl):2547–2561CrossRef FallDickson JM, Ramsay ES, Castro K et al (2007) Oral mucositis-related oropharyngeal pain and correlative tumor necrosis factor-alpha expression in adult oncology patients undergoing hematopoietic stem cell transplantation. Clin Ther 29(Suppl):2547–2561CrossRef
28.
Zurück zum Zitat Epstein JB, Epstein JD, Epstein MS et al (2006) Oral doxepin rinse: the analgesic effect and duration of pain reduction in patients with oral mucositis due to cancer therapy. Anesth Analg 103:465–470CrossRefPubMed Epstein JB, Epstein JD, Epstein MS et al (2006) Oral doxepin rinse: the analgesic effect and duration of pain reduction in patients with oral mucositis due to cancer therapy. Anesth Analg 103:465–470CrossRefPubMed
29.
Zurück zum Zitat Bellm LA, Epstein JB, Rose-Ped P et al (2000) Patient reports of complications of bone marrow transplantation. Support Care Cancer 8:33–39PubMed Bellm LA, Epstein JB, Rose-Ped P et al (2000) Patient reports of complications of bone marrow transplantation. Support Care Cancer 8:33–39PubMed
30.
Zurück zum Zitat Borbasi S, Cameron K, Quested B et al (2002) More than a sore mouth: patients’ experience of oral mucositis. Oncol Nurs Forum 29:183–205CrossRef Borbasi S, Cameron K, Quested B et al (2002) More than a sore mouth: patients’ experience of oral mucositis. Oncol Nurs Forum 29:183–205CrossRef
Metadaten
Titel
Severe oral mucositis associated with cancer therapy: impact on oral functional status and quality of life
verfasst von
Karis Kin-Fong Cheng
S. F. Leung
Raymond H. S. Liang
Josepha W. M. Tai
Rebecca M. W. Yeung
David R. Thompson
Publikationsdatum
01.11.2010
Verlag
Springer-Verlag
Erschienen in
Supportive Care in Cancer / Ausgabe 11/2010
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-009-0771-7

Weitere Artikel der Ausgabe 11/2010

Supportive Care in Cancer 11/2010 Zur Ausgabe

Adjuvante Immuntherapie verlängert Leben bei RCC

25.04.2024 Nierenkarzinom Nachrichten

Nun gibt es auch Resultate zum Gesamtüberleben: Eine adjuvante Pembrolizumab-Therapie konnte in einer Phase-3-Studie das Leben von Menschen mit Nierenzellkarzinom deutlich verlängern. Die Sterberate war im Vergleich zu Placebo um 38% geringer.

Alectinib verbessert krankheitsfreies Überleben bei ALK-positivem NSCLC

25.04.2024 NSCLC Nachrichten

Das Risiko für Rezidiv oder Tod von Patienten und Patientinnen mit reseziertem ALK-positivem NSCLC ist unter einer adjuvanten Therapie mit dem Tyrosinkinase-Inhibitor Alectinib signifikant geringer als unter platinbasierter Chemotherapie.

Bei Senioren mit Prostatakarzinom auf Anämie achten!

24.04.2024 DGIM 2024 Nachrichten

Patienten, die zur Behandlung ihres Prostatakarzinoms eine Androgendeprivationstherapie erhalten, entwickeln nicht selten eine Anämie. Wer ältere Patienten internistisch mitbetreut, sollte auf diese Nebenwirkung achten.

ICI-Therapie in der Schwangerschaft wird gut toleriert

Müssen sich Schwangere einer Krebstherapie unterziehen, rufen Immuncheckpointinhibitoren offenbar nicht mehr unerwünschte Wirkungen hervor als andere Mittel gegen Krebs.

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.