Chemotherapy-Induced and Radiotherapy-Induced Oral Mucositis

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Many patients who receive chemotherapy or radiotherapy as a part of their treatment for cancer develop oral mucositis, which is a painful, debilitating condition.
Many patients who receive chemotherapy or radiotherapy as a part of their treatment for cancer develop oral mucositis, which is a painful, debilitating condition.

Mucositis is a painful, debilitating condition that affects a large percentage of patients with cancer who receive chemotherapy or radiotherapy. The prevalence of mucositis varies depending on the specific treatment regimen.1

Between 20% and 40% of patients treated with conventional chemotherapy will develop mucositis compared with approximately 80% of patients who receive high-dose myeloablative chemotherapy prior to hematopoietic stem cell transplant (HSCT) and 100% of patients who undergo radiotherapy for head and neck cancer (HNC).2 Damage to mucosal tissue from chemotherapy and radiation can occur throughout the alimentary tract but is most common in the oral cavity and small intestine.1,3 Patients with oral mucositis (OM) experience inflammation and ulceration of the mouth's mucosal lining.2,3

Although stomatitis is often used interchangeably with OM, stomatitis refers to inflammation anywhere in the oral cavity due to any cause.3 Stomatitis encompasses OM, but stomatitis is a more accurate term for oral toxicities due to targeted agents and immune checkpoint inhibitors used to treat cancer.3-5 The pathogenesis and clinical presentation of stomatitis attributable to targeted anticancer agents differs from those associated with OM, but some of the same management approaches are used for both conditions.3,5

Oral mucositis affects patients of all ages and can affect a patients' physical and psychological well-being.6-9 In a study of adults who underwent myeloablative therapy prior to transplant, 42% named mouth sores as the most debilitating adverse effect of treatment.10

Oral mucositis can compromise nutritional intake and predispose patients to infection, especially if they are immunocompromised.6 It can also lead to treatment interruption, dose reductions, or even discontinuation. In addition, OM represents a significant burden on the health care system, as it is estimated to increase the cost of treating HNC by more than $17,000 per patient.11 Prompt recognition and management of OM can reduce the risk of complications and lessen the effect of symptoms on a patient's quality of life.

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