TM The EPEC-O Project Education in Palliative and End-of-life Care - Oncology The EPECTM-O Curriculum is produced by the EPECTM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.
EPEC– Oncology Education in Palliative and End-of-life Care – Oncology Module 3o: Symptoms – Mucositis
Mucositis . . . • Definition: mucosal barrier injury • May affect the entire GI tract
. . . Mucositis Epidemiology. . . • Impact: • Oral erythema, ulceration, pain, infection • Diarrhea (if it affects entire GI tract) • Decreased oral intake • Raises 100-day mortality
. . . Mucositis . . . Epidemiology • Prevalence: • 40% of patients on chemotherapy • 100% if with stem cell transplant • Prognosis: • Usually self-limiting
Key points • Pathophysiology • Assessment • Management
Pathophysiology • Direct injury • Secondary infection • Graft versus host disease Plevova P. Oral Oncol. 1999.
Usual course • Starts 5 to 7 days after chemotherapy • Generalized desquamation days 11 through 14 • Resolution: • 2 days to several weeks • 6 weeks after radiation Wilkes JD. SeminOncol. 1998.
Assessment • History • Pain and its effect on the patient • Eating and drinking • Physical examination • Orthostatic blood pressure and pulse • Weight loss • Evaluate affected oral mucosa
Management . . . Potential for prevention • Diminish mucosal delivery of chemotherapy, e.g. use oral cryotherapy during treatment • Modify epithelial proliferation, e.g. use growth factors • Reduce infections, inflammatory complications • Reduce, inhibit pro-inflammatory cytokines
. . . Management • Oral hygiene • Diet (minimize contact with food irritants) • Local anesthetics • Systemic analgesics
Summary Use comprehensive assessment and pathophysiology-based therapy to treat the cause and improve the cancer experience.