Oral mucositis is a common treatment-limiting side effect of
cancer therapy that may have a significant impact on quality of life and on the cost of care.
Oral mucositis is the most distressing complication of
cancer therapy as reported by
head and neck cancer patients, in patients receiving dose-dense myelosuppressive
chemotherapy and in patients receiving haematopoietic stem cell transplant.
Mucositis may increase the risk of local and systemic
infection, particularly in myelosuppressed patients. Severe
oral mucositis can lead to the need to interrupt or discontinue
cancer therapy, and thus may impact cure of the primary disease. Current care of patients with
mucositis is essentially palliative, and includes appropriate
oral hygiene, nonirritating diet and oral care products, topical palliative
mouth rinses, topical anaesthetics and use of systemic
opioid analgesics. Emerging approaches for prevention and treatment of
oral mucositis are developing based on an increasing understanding of the pathobiology of mucosal damage and repair. New interventions are expected to be administered based on the mechanisms of initiation, progression and resolution of the condition. The approval by the FDA of
keratinocyte growth factor (
palifermin; Amgen) in 2004 represents a new step in prevention of
oral mucositis in stem cell transplant patients based on the increasing understanding of the pathogenesis of
mucositis. Progress in the prevention and management of
mucositis will improve quality of life, reduce cost of care and facilitate completion of more intensive
cancer chemotherapy and
radiotherapy protocols. Improved management of
mucositis may allow implementation of
cancer treatment protocols that are currently excessively mucotoxic, but have potentially higher cure rates of the malignant disease.