Patient perceptions about chemotherapy-induced oral mucositis: implications for primary/secondary prophylaxis strategies

Abstract

Goals: Oral mucositis (OM), the painful inflammation of oropharyngeal tissues, is an economically costly chemotherapy toxicity. Several agents to prevent chemotherapy-induced OM are in development, with most studies conducted among transplantation subjects with a brief well-defined risk period. The potential value of these preventative agents among hematology-oncology populations receiving cyclic standard-dose therapy is unknown.

Patients and methods: Patients receiving standard-dose chemotherapy at an outpatient oncology center over a 2-week time-frame were invited to participate in an anonymous unprompted survey. The survey instrument consisted of six demographic questions and six questions regarding toxicities of chemotherapy.

Results: Of 514 patients providing completed surveys from among approximately 1625 patients (32% response rate), 167 (32%) reported experiencing OM. Factors associated with developing OM included number of chemotherapy cycles ( P=0.001), hematologic malignancy ( P=0.02), female gender ( P=0.03), age ( P=0.05), and treatment with anthracyclines ( P=0.001), vinca alkaloids ( P=0.001), cyclophosphamide ( P=0.001), fludarabine ( P=0.01), cis/carboplatin ( P=0.05) and radiotherapy ( P=0.005). Among patients experiencing OM, 69% considered OM to be an important toxicity with 7% rating their OM very severe, 18% severe, 36% moderate and 29% mild. Recurrent OM was reported by 87 patients (53%) and was judged similar in severity by 67%, milder by 27% and more severe by 6%. OM was considered the sixth most distressing complication behind (in descending order) fatigue, hair loss, nausea, numbness and diarrhea, and more important than anxiety and heartburn.

Conclusions: OM represents a common toxicity of standard-dose chemotherapy occurring in approximately one-third of patients. High-risk populations can be identified, permitting targeting of primary prophylaxis strategies whereby all patients possessing high-risk factors are treated to prevent OM. However, since OM was self-reported by only one-third of patients receiving standard-dose chemotherapy, but over half of those experiencing OM developed recurrent episodes, secondary prophylaxis strategies targeting recurrent OM episodes may be more appropriate.