MUCOSITIS: PROBLEMS AND SOLUTIONS
Mucositis occurs when cancer treatments break down the rapidly divided epithelial cells lining the GI tract, particularly in the oral cavity, leaving the mucosal tissue open to ulceration and infection. Mucositis can occur anywhere along the digestive tract from the mouth to the anus. Oral mucositis is probably the most common, debilitating complication of cancer surgery, chemotherapy and radiation. It occurs in 20-40% of patients treated with chemotherapy alone and up to 50% of patients receiving combination radiation and chemotherapy. The consequences of mucositis can be mild, requiring little intervention, to severe (hypovolemia, electrolyte abnormalities, and malnutrition) that may result in fatal complications.
Taste loss tends to increase in proportion to the aggressiveness of treatment. Nausea, pain, vomiting, diarrhea, a sore or dry mouth may make eating difficult and a challenge to maintain adequate nutrition for cancer patients. Reduction of caloric intake can lead to weight loss, loss in muscle mass strength and other complications, including a decrease in immunity. Cancer patient education must include the risks and the underreporting of mucositis. Delayed or reduced medical treatment doses may limit chances for a cure. The potential impact of morbidity and mortality with oral mucositis should not be underestimated and requires active treatment.
Chemotherapy and radiation to the head and neck prevent cells in the mouth and GI tract from reproducing, which makes it hard for tissue to be repaired. The mouth has a delicate balance of natural bacteria and fungi, so if you receive any one or both of these therapies, it can lead to a decrease in salivation. This decrease in salivation upsets the natural balance of bacteria in the mouth causing infections, mouth sores and tooth decay.
It is important to know who is at risk of mucositis and to prevent complications to help improve quality of life and maximize your therapy. These risk factors include radiation to the head and neck, high dose chemotherapy, bone marrow transplantation, certain single agent anticancer drugs or a combination of these. Symptoms of mucositis should be treated as soon as they appear. It is important to be educated about proper nutrition and oral hygiene to help prevent or lessen these symptoms. Once you are aware of proper nutrition, you will be able to maintain adequate hydration, immunity and help prevent nausea, as well as protecting your teeth.
TOPICS TO DISCUSS WITH YOUR MEDICAL TEAM
1. Notify your doctor for any excessive bleeding, nausea, fever or pain associated with your mucositis.
2. Let your doctor know of all your medication allergies and a list of your current medications (including over-the-counter drugs, herbal products and vitamins).
3. Ask your medical team for dietary and nutritional needs tailored just for you.
4. Do not allow pain or nausea to get out of control. Take your medicine at the beginning of symptoms to prevent vomiting or excessive pain.
5. Make sure you have an emergency contact phone number from your medical team in case of any emergencies.
6. Keep your medical team well informed for any signs of infection. Also make sure you tell them of symptoms getting better or worse.
7. Keep a journal of your pain scale and when you have nausea so your medical team can make the best recommendations for you.
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