Mucositis is an inflammatory process that affects the mucous membranes of the oral cavity and gastrointestinal tract. ONS PEP resources focus on oral mucositis, which is estimated to occur in about 40% of patients secondary to chemotherapy and almost 100% of those receiving radiation for head and neck cancer. Approximately 80% of those undergoing hematopoietic stem cell transplantation will experience some level of oral mucositis. Oral mucositis can range in degree from mild changes in sensation to severe oral pain, infection, and ulcerative bleeding lesions. As a result of oral mucositis, patients can also experience anorexia, dehydration, weight loss, and malnutrition because of difficulty eating and drinking.
Oral mucositis is a dose-limiting side effect of cancer treatment, with more than one-third of patients discontinuing treatment because of the condition. Oral mucositis can be costly as well, necessitating hospitalization in 62% and tube feedings in 70% of patients with this symptom.
Immune-Related Adverse Events With Immunotherapy
Although oral effects of immunotherapies have not emerged as major toxicities, oral effects of some treatments have been observed. Oral involvement may be under-recorded, and clinicians may not be aware of the potential for immune-related adverse oral events (irAEs). Interventions for mucositis with immunotherapeutic agents have not been studied; however, good oral hygiene and use of a consistent oral care protocol have been recommended for prophylaxis (Jackson, Johnson, Sosman, Murphy, & Epstein, 2015).
Brahmer, J.R., Lacchetti, C., Schneider, B.J., Atkins, M.B., Brassil, K.J., Caterino, J.M., ... Hallmeyer, S. (2018). Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: American Society of Clinical Oncology Clinical Practice Guideline. Journal of Clinical Oncology, 36
, 1714–1768. https://doi.org/10.1200/JCO.2017.77.6385
Jackson, L.K., Johnson, D.B., Sosman, J.A., Murphy, B.A., & Epstein, J.B. (2015). Oral health in oncology: Impact of immunotherapy. Supportive Care in Cancer, 23
, 1–3. https://doi.org/10.1007/s00520-014-2434-6