Mucositis management

Patients who have experienced oral mucositis report it as the most bothersome side effect of cancer therapy. It can result in pain, infection, and nutritional deficits, and can interfere with appropriate cancer treatment. Many patients with mucositis are opiate-naive, presenting clinical challenges. * Assess the patient's risk for mucositis. Treatment-related factors that increase risk of mucositis include bone marrow or hematopoietic stem cell transplant, radiation to the head and neck (with risk increased further when radiation is concurrent with fluorouracil), and chemotherapy/biologic agents that interfere with DNA synthesis. Patient-related factors include prolonged neutropenia, previous history of severe herpes simplex infection, poor nutritional status, poor oral hygiene, periodontal disease, dental caries, ill-fitting dentures, and continued use of alcohol or tobacco. * Assess ability to swallow solids, soft foods, and liquids. Use the CTCAE v.3.0 scale (mucositis - functional/symptomatic): 0 = No symptoms; 1 = Minimal symptoms, normal diet; 2 = Symptomatic but can eat and swallow modified diet; 3 = Symptomatic and unable to adequately aliment or hydrate orally; 4 = Symptoms associated with lifethreatening consequences. The author wishes to acknowledge the exceptional dedication of the group who developed the mucositis standard at Memorial SIo an -Kettering Cancer Center: Joanne Frankel Kelvin, RN, MSN, AOCN, for her mentorship in this project, and Kristin Cawley, RN, MSN, OCN; Susan Derby, RN, MA, CGNP, ACHPN; Jody Oilman, MS, RD; Cathy Hydzik, RN, MS, AOCN; and Mary Montefusco, RN, MPA, OCN