From the Guidelines
Mucositis relief treatments include cryotherapy, oral care protocols, and medications such as gabapentin and benzydamine.
Treatment Options
- Cryotherapy, which involves sucking on ice chips or holding ice water in the mouth before, during, and after certain cancer treatments, has been shown to be effective in preventing mucositis in patients receiving melphalan for multiple myeloma and 5-fluorouracil for solid tumors 1.
- Oral care protocols, including good oral hygiene and prophylactic mouth rinses, can help prevent mucositis 1.
- Gabapentin may be used in combination with opioid or nonopioid analgesics for treatment of mucositis, although studies on its effectiveness have reported mixed results 1.
- Benzydamine mouthwash has been recommended for preventing oral mucositis in patients with head and neck cancer receiving moderate dose radiation therapy 1.
- Patient-controlled analgesia with morphine is recommended for treating pain due to oral mucositis in patients undergoing hematopoietic stem cell transplantation (HSCT) 1.
Medications and Dosages
- Recombinant human keratinocyte growth factor-1 (KGF-1/palifermin) can be used to prevent oral mucositis at a dose of 60 μg/kg per day for 3 days before conditioning treatment and for 3 days after transplant in patients receiving high-dose chemotherapy and total body irradiation, followed by autologous stem cell transplantation, for a hematological malignancy 1.
- Low-level laser therapy (wavelength at 650 nm, power of 40 mW, and each square centimeter treated with the required time to a tissue energy dose of 2 J/cm2) can be used to prevent oral mucositis in patients receiving HSCT conditioned with high-dose chemotherapy, with or without total body irradiation 1.
From the Research
Treatments for Mucositis Relief
The following treatments have been identified as potential options for mucositis relief:
- Bioactive/growth factors, hormones, or interleukins to modify epithelial metabolism and reduce susceptibility to mucositis 2
- Cryotherapy to counteract or limit therapy-mediated effects 2, 3
- Topical agents such as analgesics, natural agents, antimicrobial agents, and growth factors to reduce the severity of mucositis lesions and pain intensity 4
- Methylene blue oral rinse to treat refractory pain from oral mucositis related to cancer treatment 5
- Granulocyte-macrophage colony-stimulating factor/granulocyte colony-stimulating factor or laser light therapy to aid restitution and repair 2
- Glutamine supplements to aid in the repair/recovery phase 2
- Mouthwashes, mouth coatings, antibiotics, and analgesics to manage symptoms and prevent infection 2, 4
- Palifermin (Kepivance) as a mucositis intervention in patients receiving conditioning regimens before haemopoietic stem cell transplants for the treatment of haematological malignancies 3
Prevention and Management
Preventive measures include:
- Elimination of dental problems or minimization of existing damage to the alimentary tract prior to therapy 2
- Reduction of flora in the tract before therapy 2
- Prophylactic administration of scavengers or anti-inflammatories to counteract or limit therapy-mediated effects 2
- Optimal oral hygiene and self-care 6
Treatment Outcomes
Studies have shown that these treatments can be effective in reducing the severity of mucositis and improving patient outcomes, including: