The Pain of Oral Mucositis

Over the past two decades, advances in the supportive care of oncology patients have permitted more aggressive treatment strategies that would otherwise not have been possible. However, the prevention and treatment of oral mucositis (OM) remains a dilemma. The American Cancer Society in 1999 estimated that approximately 400,000 patients annually will experience some type of oral complication as a result of their cancer treatment. The tissue trauma and associated pain of OM were identified as major clinical problems as far back as the 1970s, yet they remain a significant concern for the majority of patients undergoing cancer treatments. The National Cancer Institute estimated in 2005 that almost 100% of patients receiving radiation therapy for head and neck cancers experience OM, as do 80% of patients undergoing hematopoietic stem cell transplantation and 40% of patients receiving standard-dose chemotherapy. Most patients who have experienced OM report that it is the most bothersome side effect of their cancer treatment. OM is a multifaceted problem that can lead to a number of clinical complications. It can manifest itself in various ways, but pain is the hallmark symptom and may be the first indication that OM is developing. The inability to eat and drink can lead to problems with maintaining nutrition and subsequent weight loss. It may be necessary for patients to have a feeding tube placed to ensure adequate nutrition. Pain can significantly impact a patient’s quality of life and trigger a cluster of symptoms including fatigue and depression. OM is a doselimiting side effect that may result in treatment delays, dose reductions, or the stopping of treatment altogether. It is essential to have strategies in place to manage the pain associated with OM.