Slide 1

Managing Mucositis Dr Barry Quinn RN Macmillan Consultant Lead Nurse Cancer & Palliative Care EBMT Meeting IET London 5 th October 2012 Slide 2 Oral Mucositis OM is defined as inflammation of the mucosa membrane. It is characterised by ulceration, which may result in pain, dysphagia and impairment of the ability to talk. Mucosal injury provides an opportunity for infection to flourish, placing the patient at risk of sepsis and septicaemia (Rubenstein et al, 2004) Slide 3 Damage to Oral Mucosa Patients with oral mucositis may suffer from Severe pain and discomfort 2,3 Inability to eat, drink, swallow, or talk 3 Risk of systemic infections 4 1 Pico JL, et al. Oncologist. 1998;3:446-451; 2 Shea TC, et al. Bone Marrow Transplant. 2003;9:443-452; 3 Bellm LA, et al. Support Care Cancer. 2000;8:33-39; 4 Sonis S. J Support Oncol. 2004;2:21-36. Mucosal BleedingUlceration and Candida Infection 1 Slide 4 Incidence rates of mucosal damage 1.Wardley AM et al. Br J Haematol 2000;110:292299 2. Elting LS, et al. Proceedings from the 17th MASCC/ISOO International Symposium 2005; Abstract #15-097 and oral presentation 3. Kalemkerian GP et al. Lung Cancer 1999;25:175182 4. Sonis ST et al. Cancer 2004;100(suppl 10):19952025 5. Elting LS et al. Cancer 2003;98:15311539 6. Blijlevens N et al. Bone Marrow Transplant 2006;37:S24S25 Oral and/or GI 37**11**Solid tumours Myelosuppressive chemotherapy 5 Oral87*44*Multiple myeloma, NHL High-dose melphalan, BEAM 6 GINo data42*NSCLCChemoradiotherapy 3 Oral GI No data 53* 39* GI malignancy Radiotherapy and 5-FU and CPT-11 4 Oral and/or GI 8898*6077* Head and neck cancer Radiotherapy chemotherapy 2 Oral99*6798* Solid and haematological Conditioning for HSCT 1 Mucosal damage All grades Grade 34 MalignancyTreatment Incidence *% of patients; **% of cycles Slide 5 1. Adapted from Bellm LA et al, Support Care Cancer 2000;8:339 Most debilitating side effects 45 Respondents (%) 40 35 30 25 20 15 10 5 0 Oral mucositis Nausea and vomiting Weakness and lethargy Diarrhoea Oral mucositis: rated by some patients as the worst complication of high-dose chemotherapy for HSCT 1 Slide 6 Treatment & Disease Hepatic toxicity Pain Infertility Infections Fatigue New roles Loss of privacy Nausea and vomiting DiarrhoeaConstipation Oral damage Weight loss