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Oral Mucositis (OM) is a common side effect of chemotherapy or radiation therapy to the head and neck that causes inflammation and ulceration of the mucous membranes lining the mouth, gums, tongue and throat.
Lesions caused by oral mucositis can be very painful and can significantly affect patient’s nutrition, oral hygiene and overall quality of life:
- Eating and drinking is quite painful, resulting in poor nutrition. In some cases it is impossible, especially for children, necessitating intravenous nutritional supplements.
- The intense pain often leads to extensive use of narcotics.
- Patient morale is quickly depleted, potentially slowing their cancer recovery.
- In some cases, healing is complicated further when ulcers become infected by viruses, bacteria or fungi.
Complications of OM
The majority of patients receiving radiation therapy or chemotherapy for head and neck cancer are unable to continue eating by mouth due to oral mucositis pain and often receive nutrition through a gastrostomy tube or intravenous line. Because of their pain, patients with oral mucositis are more likely to have weight loss that can exceed 5% of their body weight. In some instances, patients have been hospitalized due to oral mucositis or have had to take unplanned breaks in their therapy. Oral mucositis is a major dose-limiting toxicity of cancer therapies to the head and neck region and have direct effects on patient survival.
Current Treatments & Issues
There are several treatment options for oral mucositis:
- Coating agents such as mouth rises and gels. These medications coat the entire lining of the mouth forming a film to protect the sores and minimize pain while eating or drinking. However, coating agents cannot effectively coat all areas and the pain relief is brief.
- Topical pain medications including lidocaine, benzocaine, and dyclonine hydrochloride (HCl), may increase the ability to eat while the anesthetic effects are working.
- Pain medications such as ibuprofen and acetaminophen can offer mild relief temporarily. In severe cases, patients may require opioids (i.e., morphine) for satisfactory pain relief. Systemic analgesics provide temporary pain relief and can have unpleasant side effects such as constipation, headache, itchy skin, and dizziness.
- Medication to repair mouth cells. Palifermin, a modified version of a naturally occurring human protein called keratinocyte growth factor (KGF), is an FDA-approved medication used to prevent and speed the healing of severe sores, but the applications are limited. It has not yet been shown to be safe and effective in patients being treated for forms of cancer other than leukemia or lymphoma.