Patient perceptions about chemotherapy-induced oral mucositis: implications for primary/secondary prophylaxis strategies

Goals. Oral mucositis (OM), the painful inflammation of oropharyngeal tissues, is an economically costly chemotherapy toxicity. Several agents to prevent chemotherapy-induced OM are in development, with most studies conducted among transplantation subjects with a brief well-defined risk period. The potential value of these preventative agents among hematology-oncology populations receiving cyclic standard-dose therapy is unknown. Patients and methods. Patients receiving standard-dose chemotherapy at an outpatient oncology center over a 2-week time-frame were invited to participate in an anonymous unprompted survey. The survey instrument consisted of six demographic questions and six questions regarding toxicities of chemotherapy. Results. Of 514 patients providing completed surveys from among approximately 1625 patients (32% response rate), 167 (32%) reported experiencing OM. Factors associated with developing OM included number of chemotherapy cycles (P=0.001), hematologic malignancy (P=0.02), female gender (P=0.03), age (P=0.05), and treatment with anthracyclines (P=0.001), vinca alkaloids (P=0.001), cyclophosphamide (P=0.001), fludarabine (P=0.01), cis/carboplatin (P=0.05) and radiotherapy (P=0.005). Among patients experiencing OM, 69% considered OM to be an important toxicity with 7% rating their OM very severe, 18% severe, 36% moderate and 29% mild. Recurrent OM was reported by 87 patients (53%) and was judged similar in severity by 67%, milder by 27% and more severe by 6%. OM was considered the sixth most distressing complication behind (in descending order) fatigue, hair loss, nausea, numbness and diarrhea, and more important than anxiety and heartburn. Conclusions. OM represents a common toxicity of standard-dose chemotherapy occurring in approximately one-third of patients. High-risk populations can be identified, permitting targeting of primary prophylaxis strategies whereby all patients possessing high-risk factors are treated to prevent OM. However, since OM was self-reported by only one-third of patients receiving standard-dose chemotherapy, but over half of those experiencing OM developed recurrent episodes, secondary prophylaxis strategies targeting recurrent OM episodes may be more appropriate.