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From Your NavigatorSide-Effects ManagementChemotherapy

Understanding and Managing Mucositis

Nurse navigator Deborah Gomer explains the causes, symptoms, and prevention methods of mucositis, an oral and digestive system condition interfering with eating, swallowing, and talking and affecting roughly 50% of patients who receive chemotherapy.
August 2020 Vol 6 No 4
Deborah R. Gomer, BSN, RN, OCN, CCM, CHC
Oncology Care Manager, Optum, St. Johns, Florida; Author of The By-Your-Side Cancer Guide: Empowered, Proactive, Prepared

Some types of cancer treatments can irritate and damage the cells in the mouth, causing a condition known as mucositis. When mucositis occurs, inflammation and ulcers can develop in the mouth, throat, and along the entire gastrointestinal (or GI) tract, including the stomach and the small and large intestines.

Mucositis is one of the most common side effects of cancer treatment, affecting roughly half (50%) of the patients who receive chemotherapy. The percentage is higher among patients who are receiving radiation therapy to the head and neck, and patients who undergo blood and marrow transplants.

Mucositis presents a challenge for patients, because it can interfere with many daily activities, including eating, swallowing, drinking, and talking.

How Do Cancer Treatments Cause Mucositis?

Chemotherapy and radiation therapy damage the cells that divide and replicate very rapidly, which is typical of cancer cells. Because cancer cells multiply quickly in an uncontrolled fashion, they are subject to irreparable damage when exposed to chemotherapy and radiation therapy. Healthy cells are also affected by cancer treatment. Although the healthy cells can repair themselves, the temporary effects from cancer treatment can be debilitating.

The GI tract can be greatly affected by cancer therapy, which is why many people undergoing cancer treatment may have GI side effects, such as nausea and diarrhea, in addition to mucositis.

Mucositis that is caused by chemotherapy usually occurs a few days after the treatment, then it reaches a peak around day 7 after treatment, and it starts to resolve about 2 or 3 weeks after the end of treatment.

Mucositis that is caused by radiation occurs when the radiation therapy is aimed at the head and neck area. Mucositis begins within the first 2 to 3 weeks after the start of radiation therapy, it may then increase as the treatment progresses, and it will usually resolve about 6 weeks after the completion of radiation therapy.

What Are the Signs and Symptoms of Oral Mucositis?

Overall, the signs and symptoms that help to diagnose mucositis include:

  • Red, swollen gums
  • Sores or ulcers on the lips, gums, or tongue
  • Pain and/or burning of the mouth or throat
  • Difficulty with chewing or swallowing
  • White patches on the gums or tongue
  • Bleeding gums.

Redness, inflammation, and ulcers can develop along the entire length of the GI tract. The GI tract includes the lips, gums, mouth (stomatitis), esophagus (esophagitis), stomach, intestines, and the anus.

In addition to being painful, these ulcers are also an “attractive” source for infection.

Mucositis can interfere with chewing, talking, swallowing, taste, and quality of life. If not treated properly, these ulcers can result in weight loss, infection, and decreased quality of life for the patient.

Are All Patients with Cancer at Risk of Oral Mucositis?

Radiation to the head and neck area, certain chemotherapy drugs, as well as the new immunotherapy drugs can cause mucositis. But there are other factors that can increase the risk of mucositis or exacerbate the symptoms. These risk factors include:

  • Poor dental health
  • Smoking, chewing tobacco, and drinking alcohol
  • Poor nutrition
  • Dehydration
  • Irritation from oral hardware, such as dentures
  • Females and young people are also at increased risk.

Can Mucositis Be Prevented?

There is currently no way to prevent mucositis, but there are ways to decrease the risk of having mucositis. It is a good idea to see a dentist before cancer treatment. If you will be receiving radiation therapy to the head and neck area, you will be required to have a thorough dental exam before starting treatment.

The dentist will need to perform any necessary dental work before you can start radiation therapy to the head and neck. Having a good oral care regimen can help to keep the mouth and gums healthy and reduce the likelihood of infection.

Tips to further decrease your risk of mucositis include:

  • Brush your teeth 3 times a day, with a soft-bristle toothbrush.
  • Avoid using dental floss if it causes your gums to bleed.
  • Rinse your mouth before and after meals, and at bedtime, with either normal saline (1 teaspoon of table salt to 1 quart of water), or with salt and soda (1.5 teaspoons of salt and 2 tablespoons of sodium bicarbonate in 1 quart of warm water). You may also use a mouthwash without any alcohol.
  • Refrain from smoking and chewing tobacco.
  • Keep your lips moist, with lip balm.
  • Drink ample fluids to stay hydrated, and eat a diet that is high in protein.
  • Cryotherapy, which involves sucking on ice chips during chemotherapy administration, has shown some effect in preventing mucositis.
  • Inspect your mouth daily, and report any changes to your healthcare team promptly.

What Should You Do If You Have Mucositis?

Report any signs and symptoms of mucositis to your healthcare team as soon as you notice them. Below are some things you should do to relieve or heal the signs and symptoms of mucositis:

  • Over-the-counter analgesics (painkillers) and oral anesthetics can ease gum and lip irritation.
  • Some people find Manuka honey effective in healing oral ulcers. The honey can be applied to the ulcers with a cotton swab.
  • If you have pain, or notice white patches in your mouth, your healthcare team may prescribe a mixture of medications called Magic Mouthwash. Some physicians have their own versions, but most of these products contain something to coat and soothe, something to numb, and something to decrease the inflammation.
  • Avoid foods that are of an extreme temperature (very hot or very cold). Avoid spicy, acidic, and salty foods, too.
  • Try eating foods that are soft and easy to swallow. Gravy, applesauce, yogurt, and sauces work well to moisten food.
  • Stay well-hydrated by drinking a lot of liquids.

Talk to Your Care Team

If you are receiving cancer therapy, talk to your doctor, nurse, or navigator about your risk of mucositis. Have a plan in place before starting treatment. If you should have signs or symptoms of mucositis, inform your healthcare team as soon as possible, so they can immediately address those symptoms and manage them properly to avoid further complications.

Key Points

  • Mucositis, one of the most common side effects of cancer treatment, affects roughly half (50%) of the patients who receive chemotherapy
  • Patients receiving radiation therapy to the head and neck, and patients who undergo blood and marrow transplants, are more at risk for experiencing mucositis
  • Mucositis that is caused by chemotherapy usually occurs a few days after treatment, reaches a peak around day 7 after treatment, and starts to resolve about 2 or 3 weeks after treatment ends
  • Having good oral hygiene, including brushing your teeth 3 times a day, refraining from smoking and chewing tobacco, and drinking plenty of fluids, can help prevent mucositis

Patient Resources

American Cancer Society
www.cancer.org
CancerCare
www.cancercare.org
Chemocare
www.chemocare.com
The Oral Cancer Foundation
https://oralcancerfoundation.org

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Last modified: October 5, 2020

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