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Erschienen in: Supportive Care in Cancer 1/2012

01.01.2012 | Original Article

Prevalence of clinically relevant oral mucositis in outpatients receiving myelosuppressive chemotherapy for solid tumors

verfasst von: Stefan Wuketich, Stefan A. Hienz, Christine Marosi

Erschienen in: Supportive Care in Cancer | Ausgabe 1/2012

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Abstract

Purpose

Chemotherapy-induced oral mucositis (CIOM) is a common side effect of cancer therapy that may lead to significant morbidity and interfere with the treatment plan. The present prospective, cross-sectional study intended to describe the prevalence of clinically relevant CIOM (CRCIOM) in outpatients receiving chemotherapy for solid tumors.

Methods

Intra-oral assessments were performed on 298 consecutively recruited patients, who had undergone at least 14 days of chemotherapy for solid tumors in our outpatient oncology department. The presence of CIOM was evaluated using the Oral Mucositis Assessment Scale. CRCIOM was defined as the presence of ulcers (≥1 cm2), severe erythema, and/or inability to eat solid foods (WHO grades 2–4). Furthermore, the current levels of oral hygiene and oral health were measured.

Results

A low prevalence (18 patients, 6%) of CRCIOM was found in the investigated patient collective, including 1% of patients with severe (WHO grade 3/4) CIOM. In the CRCIOM group, 16 patients were male, and two were female; 8 patients with CRCIOM had received head and neck radiotherapy. A higher prevalence of CRCIOM was found in smoking patients (12.7% vs. 4.5%, p < 0.05) and in the patients who have not had a dental checkup within the preceding 12 months (11.2% vs. 3.0%, p < 0.01). Diabetes mellitus and low WBC appeared not to be associated with higher CRCIOM rates. The plaque and gingival indexes were significantly increased (p < 0.01) in the CRCIOM group.

Conclusions

Although CRCIOM was a rare event in the investigated patient population, our results emphasize that pre-treatment dental therapy and primary preventive measures (including oral hygiene instructions) can be improved. Before starting chemotherapy, increased awareness of individual risk factors, such as male sex, tobacco smoking, low dental checkup frequency, poor oral hygiene, and a reduced oral health status, could help to prevent CRCIOM.
Literatur
1.
Zurück zum Zitat American Academy of Periodontology (1997) Periodontal considerations in the management of the cancer patient. Committee on Research, Science and Therapy of the American Academy of Periodontology. J Periodontol 68(8):791–801 American Academy of Periodontology (1997) Periodontal considerations in the management of the cancer patient. Committee on Research, Science and Therapy of the American Academy of Periodontology. J Periodontol 68(8):791–801
2.
Zurück zum Zitat Barasch A, Peterson DE (2003) Risk factors for ulcerative oral mucositis in cancer patients: unanswered questions. Oral Oncol 39(2):91–100PubMedCrossRef Barasch A, Peterson DE (2003) Risk factors for ulcerative oral mucositis in cancer patients: unanswered questions. Oral Oncol 39(2):91–100PubMedCrossRef
3.
Zurück zum Zitat Cella D, Pulliam J, Fuchs H, Miller C, Hurd D, Wingard JR, Sonis ST, Martin PJ, Giles F (2003) Evaluation of pain associated with oral mucositis during the acute period after administration of high-dose chemotherapy. Cancer 98(2):406–412PubMedCrossRef Cella D, Pulliam J, Fuchs H, Miller C, Hurd D, Wingard JR, Sonis ST, Martin PJ, Giles F (2003) Evaluation of pain associated with oral mucositis during the acute period after administration of high-dose chemotherapy. Cancer 98(2):406–412PubMedCrossRef
4.
Zurück zum Zitat Chansky K, Benedetti J, Macdonald JS (2005) Differences in toxicity between men and women treated with 5-fluorouracil therapy for colorectal carcinoma. Cancer 103(6):1165–1171PubMedCrossRef Chansky K, Benedetti J, Macdonald JS (2005) Differences in toxicity between men and women treated with 5-fluorouracil therapy for colorectal carcinoma. Cancer 103(6):1165–1171PubMedCrossRef
5.
Zurück zum Zitat Dodd MJ, Miaskowski C, Shiba GH, Dibble SL, Greenspan D, MacPhail L, Paul SM, Larson P (1999) Risk factors for chemotherapy-induced oral mucositis: dental appliances, oral hygiene, previous oral lesions, and history of smoking. Cancer Investig 17(4):278–284CrossRef Dodd MJ, Miaskowski C, Shiba GH, Dibble SL, Greenspan D, MacPhail L, Paul SM, Larson P (1999) Risk factors for chemotherapy-induced oral mucositis: dental appliances, oral hygiene, previous oral lesions, and history of smoking. Cancer Investig 17(4):278–284CrossRef
6.
Zurück zum Zitat Elting LS, Cooksley C, Chambers M, Cantor SB, Manzullo E, Rubenstein EB (2003) The burdens of cancer therapy. Clinical and economic outcomes of chemotherapy-induced mucositis. Cancer 98(7):1531–1539PubMedCrossRef Elting LS, Cooksley C, Chambers M, Cantor SB, Manzullo E, Rubenstein EB (2003) The burdens of cancer therapy. Clinical and economic outcomes of chemotherapy-induced mucositis. Cancer 98(7):1531–1539PubMedCrossRef
7.
Zurück zum Zitat Elting LS, Cooksley CD, Chambers MS, Garden AS (2007) Risk, outcomes, and costs of radiation-induced oral mucositis among patients with head-and-neck malignancies. Int J Radiat Oncol Biol Phys 68(4):1110–1120PubMedCrossRef Elting LS, Cooksley CD, Chambers MS, Garden AS (2007) Risk, outcomes, and costs of radiation-induced oral mucositis among patients with head-and-neck malignancies. Int J Radiat Oncol Biol Phys 68(4):1110–1120PubMedCrossRef
8.
Zurück zum Zitat Elting LS, Keefe DM, Sonis ST, Garden AS, Spijkervet FK, Barasch A, Tishler RB, Canty TP, Kudrimoti MK, Vera-Llonch M (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(10):2704–2713PubMedCrossRef Elting LS, Keefe DM, Sonis ST, Garden AS, Spijkervet FK, Barasch A, Tishler RB, Canty TP, Kudrimoti MK, Vera-Llonch M (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(10):2704–2713PubMedCrossRef
9.
Zurück zum Zitat Gallagher JG (1995) Mucositis. In: Klastersky J, Schimpff SC, Senn H-J (eds) Handbook of supportive care in cancer. Marcel Dekker, Inc., New York, pp 147–156 Gallagher JG (1995) Mucositis. In: Klastersky J, Schimpff SC, Senn H-J (eds) Handbook of supportive care in cancer. Marcel Dekker, Inc., New York, pp 147–156
10.
Zurück zum Zitat Goldberg SL, Chiang L, Selina N, Hamarman S (2004) Patient perceptions about chemotherapy-induced oral mucositis: implications for primary/secondary prophylaxis strategies. Support Care Cancer 12(7):526–530PubMedCrossRef Goldberg SL, Chiang L, Selina N, Hamarman S (2004) Patient perceptions about chemotherapy-induced oral mucositis: implications for primary/secondary prophylaxis strategies. Support Care Cancer 12(7):526–530PubMedCrossRef
12.
Zurück zum Zitat Jones JA, Avritscher EB, Cooksley CD, Michelet M, Bekele BN, Elting LS (2006) Epidemiology of treatment-associated mucosal injury after treatment with newer regimens for lymphoma, breast, lung, or colorectal cancer. Support Care Cancer 14(6):505–515PubMedCrossRef Jones JA, Avritscher EB, Cooksley CD, Michelet M, Bekele BN, Elting LS (2006) Epidemiology of treatment-associated mucosal injury after treatment with newer regimens for lymphoma, breast, lung, or colorectal cancer. Support Care Cancer 14(6):505–515PubMedCrossRef
13.
Zurück zum Zitat Keefe DM, Schubert MM, Elting LS, Sonis ST, Epstein JB, Raber-Durlacher JE, Migliorati CA, McGuire DB, Hutchins RD, Peterson DE (2007) Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer 109(5):820–831PubMedCrossRef Keefe DM, Schubert MM, Elting LS, Sonis ST, Epstein JB, Raber-Durlacher JE, Migliorati CA, McGuire DB, Hutchins RD, Peterson DE (2007) Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer 109(5):820–831PubMedCrossRef
14.
Zurück zum Zitat Kostler WJ, Hejna M, Wenzel C, Zielinski CC (2001) Oral mucositis complicating chemotherapy and/or radiotherapy: options for prevention and treatment. CA Cancer J Clin 51(5):290–315PubMedCrossRef Kostler WJ, Hejna M, Wenzel C, Zielinski CC (2001) Oral mucositis complicating chemotherapy and/or radiotherapy: options for prevention and treatment. CA Cancer J Clin 51(5):290–315PubMedCrossRef
15.
Zurück zum Zitat Lang WP, Farghaly MM, Ronis DL (1994) The relation of preventive dental behaviors to periodontal health status. J Clin Periodontol 21(3):194–198PubMedCrossRef Lang WP, Farghaly MM, Ronis DL (1994) The relation of preventive dental behaviors to periodontal health status. J Clin Periodontol 21(3):194–198PubMedCrossRef
16.
Zurück zum Zitat Lerner L, Weiner D, Katz R, Reznick AZ, Pollack S (2009) Increased pro-inflammatory activity and impairment of human monocyte differentiation induced by in vitro exposure to cigarette smoke. J Physiol Pharmacol 60(Suppl 5):81–86PubMed Lerner L, Weiner D, Katz R, Reznick AZ, Pollack S (2009) Increased pro-inflammatory activity and impairment of human monocyte differentiation induced by in vitro exposure to cigarette smoke. J Physiol Pharmacol 60(Suppl 5):81–86PubMed
17.
Zurück zum Zitat Loe H, Silness J (1963) Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 21:533–551PubMedCrossRef Loe H, Silness J (1963) Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 21:533–551PubMedCrossRef
18.
Zurück zum Zitat McCarthy GM, Awde JD, Ghandi H, Vincent M, Kocha WI (1998) Risk factors associated with mucositis in cancer patients receiving 5-fluorouracil. Oral Oncol 34(6):484–490PubMedCrossRef McCarthy GM, Awde JD, Ghandi H, Vincent M, Kocha WI (1998) Risk factors associated with mucositis in cancer patients receiving 5-fluorouracil. Oral Oncol 34(6):484–490PubMedCrossRef
19.
Zurück zum Zitat McCollum AD, Catalano PJ, Haller DG, Mayer RJ, Macdonald JS, Benson AB 3rd, Fuchs CS (2002) Outcomes and toxicity in African-American and Caucasian patients in a randomized adjuvant chemotherapy trial for colon cancer. J Natl Cancer Inst 94(15):1160–1167PubMedCrossRef McCollum AD, Catalano PJ, Haller DG, Mayer RJ, Macdonald JS, Benson AB 3rd, Fuchs CS (2002) Outcomes and toxicity in African-American and Caucasian patients in a randomized adjuvant chemotherapy trial for colon cancer. J Natl Cancer Inst 94(15):1160–1167PubMedCrossRef
20.
Zurück zum Zitat McGuire DB, Correa ME, Johnson J, Wienandts P (2006) The role of basic oral care and good clinical practice principles in the management of oral mucositis. Support Care Cancer 14(6):541–547PubMedCrossRef McGuire DB, Correa ME, Johnson J, Wienandts P (2006) The role of basic oral care and good clinical practice principles in the management of oral mucositis. Support Care Cancer 14(6):541–547PubMedCrossRef
22.
Zurück zum Zitat Overholser CD, Peterson DE, Williams LT, Schimpff SC (1982) Periodontal infection in patients with acute nonlymphocyte leukemia. Prevalence of acute exacerbations. Arch Intern Med 142(3):551–554PubMedCrossRef Overholser CD, Peterson DE, Williams LT, Schimpff SC (1982) Periodontal infection in patients with acute nonlymphocyte leukemia. Prevalence of acute exacerbations. Arch Intern Med 142(3):551–554PubMedCrossRef
23.
Zurück zum Zitat Overholser CDJ (1995) Oral care for the cancer patient. In: Klastersky J, Schimpff SC, Senn H-J (eds) Handbook of supportive care in cancer. Marcel Dekker, Inc., New York, pp 125–145 Overholser CDJ (1995) Oral care for the cancer patient. In: Klastersky J, Schimpff SC, Senn H-J (eds) Handbook of supportive care in cancer. Marcel Dekker, Inc., New York, pp 125–145
24.
Zurück zum Zitat Peterson DE, Minah GE, Overholser CD, Suzuki JB, DePaola LG, Stansbury DM, Williams LT, Schimpff SC (1987) Microbiology of acute periodontal infection in myelosuppressed cancer patients. J Clin Oncol 5(9):1461–1468PubMed Peterson DE, Minah GE, Overholser CD, Suzuki JB, DePaola LG, Stansbury DM, Williams LT, Schimpff SC (1987) Microbiology of acute periodontal infection in myelosuppressed cancer patients. J Clin Oncol 5(9):1461–1468PubMed
25.
Zurück zum Zitat Raber-Durlacher JE, Weijl NI, Abu Saris M, de Koning B, Zwinderman AH, Osanto S (2000) Oral mucositis in patients treated with chemotherapy for solid tumors: a retrospective analysis of 150 cases. Support Care Cancer 8(5):366–371PubMedCrossRef Raber-Durlacher JE, Weijl NI, Abu Saris M, de Koning B, Zwinderman AH, Osanto S (2000) Oral mucositis in patients treated with chemotherapy for solid tumors: a retrospective analysis of 150 cases. Support Care Cancer 8(5):366–371PubMedCrossRef
26.
Zurück zum Zitat Robien K, Schubert MM, Bruemmer B, Lloid ME, Potter JD, Ulrich CM (2004) Predictors of oral mucositis in patients receiving hematopoietic cell transplants for chronic myelogenous leukemia. J Clin Oncol 22(7):1268–1275PubMedCrossRef Robien K, Schubert MM, Bruemmer B, Lloid ME, Potter JD, Ulrich CM (2004) Predictors of oral mucositis in patients receiving hematopoietic cell transplants for chronic myelogenous leukemia. J Clin Oncol 22(7):1268–1275PubMedCrossRef
27.
Zurück zum Zitat Ronis DL, Lang WP, Farghaly MM, Passow E (1993) Tooth brushing, flossing, and preventive dental visits by Detroit-area residents in relation to demographic and socioeconomic factors. J Public Health Dent 53(3):138–145PubMedCrossRef Ronis DL, Lang WP, Farghaly MM, Passow E (1993) Tooth brushing, flossing, and preventive dental visits by Detroit-area residents in relation to demographic and socioeconomic factors. J Public Health Dent 53(3):138–145PubMedCrossRef
28.
Zurück zum Zitat Silness J, Loe H (1964) Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 22:121–135PubMedCrossRef Silness J, Loe H (1964) Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 22:121–135PubMedCrossRef
29.
Zurück zum Zitat Sonis ST, Eilers JP, Epstein JB, LeVeque FG, Liggett WH Jr, Mulagha MT, Peterson DE, Rose AH, Schubert MM, Spijkervet FK, Wittes JP (1999) Validation of a new scoring system for the assessment of clinical trial research of oral mucositis induced by radiation or chemotherapy. Mucositis study group. Cancer 85(10):2103–2113PubMedCrossRef Sonis ST, Eilers JP, Epstein JB, LeVeque FG, Liggett WH Jr, Mulagha MT, Peterson DE, Rose AH, Schubert MM, Spijkervet FK, Wittes JP (1999) Validation of a new scoring system for the assessment of clinical trial research of oral mucositis induced by radiation or chemotherapy. Mucositis study group. Cancer 85(10):2103–2113PubMedCrossRef
30.
Zurück zum Zitat Sonis ST (2004) A biological approach to mucositis. J Support Oncol 2(1):21–32, discussion 35-26PubMed Sonis ST (2004) A biological approach to mucositis. J Support Oncol 2(1):21–32, discussion 35-26PubMed
31.
Zurück zum Zitat Sonis ST, Elting LS, Keefe D, Peterson DE, Schubert M, Hauer-Jensen M, Bekele BN, Raber-Durlacher J, Donnelly JP, Rubenstein EB (2004) Perspectives on cancer therapy-induced mucosal injury: pathogenesis, measurement, epidemiology, and consequences for patients. Cancer 100(9 Suppl):1995–2025PubMedCrossRef Sonis ST, Elting LS, Keefe D, Peterson DE, Schubert M, Hauer-Jensen M, Bekele BN, Raber-Durlacher J, Donnelly JP, Rubenstein EB (2004) Perspectives on cancer therapy-induced mucosal injury: pathogenesis, measurement, epidemiology, and consequences for patients. Cancer 100(9 Suppl):1995–2025PubMedCrossRef
32.
Zurück zum Zitat Trotti A, Bellm LA, Epstein JB, Frame D, Fuchs HJ, Gwede CK, Komaroff E, Nalysnyk L, Zilberberg MD (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(3):253–262PubMedCrossRef Trotti A, Bellm LA, Epstein JB, Frame D, Fuchs HJ, Gwede CK, Komaroff E, Nalysnyk L, Zilberberg MD (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(3):253–262PubMedCrossRef
33.
Zurück zum Zitat Vokurka S, Bystricka E, Koza V, Scudlova J, Pavlicova V, Valentova D, Visokaiova M, Misaniova L (2006) Higher incidence of chemotherapy induced oral mucositis in females: a supplement of multivariate analysis to a randomized multicentre study. Support Care Cancer 14(9):974–976PubMedCrossRef Vokurka S, Bystricka E, Koza V, Scudlova J, Pavlicova V, Valentova D, Visokaiova M, Misaniova L (2006) Higher incidence of chemotherapy induced oral mucositis in females: a supplement of multivariate analysis to a randomized multicentre study. Support Care Cancer 14(9):974–976PubMedCrossRef
34.
Zurück zum Zitat Woolfolk MW, Lang WP, Borgnakke WS, Taylor GW, Ronis DL, Nyquist LV (1999) Determining dental checkup frequency. J Am Dent Assoc 130(5):715–723PubMed Woolfolk MW, Lang WP, Borgnakke WS, Taylor GW, Ronis DL, Nyquist LV (1999) Determining dental checkup frequency. J Am Dent Assoc 130(5):715–723PubMed
35.
Zurück zum Zitat World Health Organization (1997) Oral health surveys: basic methods, 4th edn. World Health Organization, Geneva, Switzerland World Health Organization (1997) Oral health surveys: basic methods, 4th edn. World Health Organization, Geneva, Switzerland
36.
Zurück zum Zitat Zalcberg J, Kerr D, Seymour L, Palmer M (1998) Haematological and non-haematological toxicity after 5-fluorouracil and leucovorin in patients with advanced colorectal cancer is significantly associated with gender, increasing age and cycle number. Tomudex International Study Group. Eur J Cancer 34(12):1871–1875PubMedCrossRef Zalcberg J, Kerr D, Seymour L, Palmer M (1998) Haematological and non-haematological toxicity after 5-fluorouracil and leucovorin in patients with advanced colorectal cancer is significantly associated with gender, increasing age and cycle number. Tomudex International Study Group. Eur J Cancer 34(12):1871–1875PubMedCrossRef
Metadaten
Titel
Prevalence of clinically relevant oral mucositis in outpatients receiving myelosuppressive chemotherapy for solid tumors
verfasst von
Stefan Wuketich
Stefan A. Hienz
Christine Marosi
Publikationsdatum
01.01.2012
Verlag
Springer-Verlag
Erschienen in
Supportive Care in Cancer / Ausgabe 1/2012
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-011-1107-y

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