Management of Mucositis Secondary to Cancer Therapy

Publication Date: June 30, 2020
Last Updated: March 14, 2022

Guidelines

Basic Oral Care

The panel suggests that implementation of multiagent combination oral care protocols is beneficial for the prevention of OM during CT. (Level III)
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The panel suggests that implementation of multiagent combination oral care protocols is beneficial for the prevention of OM during H&N RT. (Level III)
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The panel suggests that implementation of multiagent combination oral care protocols is beneficial for the prevention of OM during HSCT. (Level III)
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No guideline was possible regarding the use of professional oral care for the prevention of OM in patients with hematologic, solid, or H&N cancers because of limited and inconsistent data. (Level III)
  • An expert opinion complements this guideline: Although there was insufficient evidence to support the use of professional oral care for OM prevention, the panel is of the opinion that dental evaluation and treatment as indicated before cancer therapy are desirable to reduce risk for local and systemic infections from odontogenic sources.
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No guideline was possible regarding the use of patient education for the prevention of OM in patients with hematologic cancer during HSCT or CT because of limited and inconsistent data. (Level III)
  • An expert opinion complements this guideline: The panel is of the opinion that educating patients about the benefits of BOC strategies is still appropriate because this may improve self-management and adherence to the recommended oral care protocol during cancer treatment.
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No guideline was possible regarding the use of saline or sodium bicarbonate rinses in the prevention or treatment of OM in patients undergoing cancer therapy because of limited data. (Level III)
  • An expert opinion complements this guideline: Despite the limited data available for both saline and sodium bicarbonate, the panel recognizes that these are inert, bland rinses that increase oral clearance, which may be helpful for maintaining oral hygiene and improving patient comfort.
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The panel suggests that CHX not be used in the prevention of OM in patients undergoing H&N RT. (Level III)
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Table 2. Recommended Intraoral Photobiomodulation Therapy Protocols for the Prevention of Oral Mucositis

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Cancer Treatment Modality Wavelength, nm Power Density (Irradiance), mW/cm2 Time per Spot, s Energy Density (Fluence), J/cm2 Spot Size, cm2 No. of Sites Duration
HSCT 632.8 31.25 40 1.0 0.8 18 From the d after cessation of conditioning for 5 d
650 1000b 2 2.0 0.04 54-70 From the first d of conditioning to d + 2 post-HSCT (for 7-13 d)
RT 632.8 24 125 3.0 1.00 12 Entire RT course
RT-CT 660 417b 10 4.2 0.24 72 Entire RT course
660 625b 10 6.2 0.04 69 Entire RT course

Overview

Title

Management of Mucositis Secondary to Cancer Therapy

Authoring Organization

Multinational Association of Supportive Care in Cancer