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      Prevention and Management of Mucositis in Patients with Cancer: a Review Article

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          Abstract

          After chemo/radiation therapy, mucositis is one of the most common side effects, so timely nursing care and instructed home care, significantly could decrease cost of medical care, and then increase quality of life. This review summarizes preventive and therapeutic intervention of mucositis (localized or systemic), between some of patients with cancer.

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          Updated clinical practice guidelines for the prevention and treatment of mucositis.

          Mark Schubert, , Linda S. Elting … (2007)
          Considerable progress in research and clinical application has been made since the original guidelines for managing mucositis in cancer patients were published in 2004, and the first active drug for the prevention and treatment of this condition has been approved by the United States Food and Drug Administration and other regulatory agencies in Europe and Australia. These changes necessitate an updated review of the literature and guidelines. Panel members reviewed the biomedical literature on mucositis published in English between January 2002 and May 2005 and reached a consensus based on the criteria of the American Society of Clinical Oncology. Changes in the guidelines included recommendations for the use of palifermin for oral mucositis associated with stem cell transplantation, amifostine for radiation proctitis, and cryotherapy for mucositis associated with high-dose melphalan. Recommendations against specific practices were introduced: Systemic glutamine was not recommended for the prevention of gastrointestinal mucositis, and sucralfate and antimicrobial lozenges were not recommended for radiation-induced oral mucositis. Furthermore, new guidelines suggested that granulocyte-macrophage-colony stimulating factor mouthwashes not be used for oral mucositis prevention in the transplantation population. Advances in mucositis treatment and research have been complemented by an increased rate of publication on mucosal injury in cancer. However, additional and sustained efforts will be required to gain a fuller understanding of the pathobiology, impact on overall patient status, optimal therapeutic strategies, and improved educational programs for health professionals, patients, and caregivers. These efforts are likely to have significant clinical and economic impact on the treatment of cancer patients. Cancer 2007;109:820-31. (c) 2007 American Cancer Society.
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            Mucositis: The impact, biology and therapeutic opportunities of oral mucositis.

            Stephen T. Sonis (2009)
            The history of mucositis is as old as radiation- and chemotherapy. Despite being regularly reported and documented as one of the worst side effects of cancer therapy, relatively little was appreciated about the complexities of mucositis' pathogenesis until relatively recently. More frustrating for patients and clinicians, no effective treatment existed. Fortunately, the situation is changing; ongoing research is leading to a comprehensive understanding of the biology of mucositis, which has resulted in the development of novel interventions. While the FDA's approval of palifermin in 2004 was limited to only a small percentage of the at-risk population, the fact that the first registered anti-OM agent derived its efficacy from its pleotropic activities was conceptually demonstrative of the therapeutic potential of drugs that selectively interfere with mucositis' pathogenesis. A number of eclectic molecules, all designed to interfere with pathways that lead to injury are in pre-clinical and clinical development.
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              Mucositis as a biological process: a new hypothesis for the development of chemotherapy-induced stomatotoxicity.

              Stephen T. Sonis (1997)
              Mucositis induced by antineoplastic drugs is an important, dose-limiting and costly side effect of cancer therapy. The ulcerative lesions which result are frequent systemic portals of entry for microorganisms which inhabit the mouth and consequently are often sources of systemic infection in the myelosuppressed patient. A number of clinical observations and the inconsistency of responses to a broad range of treatment modalities suggests a physiological complexity to mucositis which has not previously been comprehensively considered. We now propose a hypothesis as to the mechanism by which mucositis develops and resolves, which is based on four phases: an initial inflammatory/vascular phase; an epithelial phase; an ulcerative/bacteriological phase; and a healing phase. The role of cytokines as initiators and ampliers of the process is discussed, as is the potential influence of genetic factors in establishing risk and modifying the course of stomatotoxicity.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Iran J Cancer Prev
                Journal ID (iso-abbrev): Iran J Cancer Prev
                Journal ID (publisher-id): IJCP
                Title: Iranian Journal of Cancer Prevention
                Publisher: Cancer Research Center, Shahid Beheshti University of Medical Sciences
                ISSN (Print): 2008-2398
                ISSN (Electronic): 2008-2401
                Publication date (Print): Autumn 2012
                Volume: 5
                Issue: 4
                Pages: 216-220
                Affiliations
                [1 ]Dept. of Oral Medicine, Yazd Shahid Sadoughi University of Medical Sciences, Yazd, Iran
                [2 ]Burn hospital, Yazd Shahid Sadoughi University of Medical Sciences, Yazd, Iran
                Author notes
                Corresponding Author: Seid kazem Kazemeini, MD; Tel: 0351 52 47 180 Email: dr.olia@ 123456ssu.ac.ir
                Article
                Publisher ID: IJCP-05-216
                PMC ID: 4209575
                PubMed ID: 25352973
                SO-VID: c2e5057c-a5ed-4939-810f-968ecbc14d64
                Copyright © © 2014 Cancer Research Center, Shahid Beheshti University of Medical Sciences
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

                History
                Date received : 11 April 2012
                Date accepted : 28 July 2012
                Categories
                Subject: Review Article

                Keywords: mucositis,radiotherapy,primary prevention,therapeutics
                Data availability:
                Keywords: mucositis, radiotherapy, primary prevention, therapeutics

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