Duration of Mucositis: Far Longer than 2 to 4 Weeks and May Be Avoidable Altogether

COMMENTARY
Ricky Wayne McCullough ¹· ², MD, MSc

¹Translational Medicine Research Center of Mueller Medical International; Storrs-Mansfield CT 06268 USA; ²Department of Medicine & Emergency Medicine; Veterans Administration Medical Center, Teaching Hospital; Warren Alpert Medical School of Brown University; Providence, Rhode Island 02908 USA

*Corresponding author: Ricky W. McCullough MD, MSc at Mueller Medical International Translational Medicine Research Center 1768 Storrs Road, Storrs-Mansfield CT 06268; Department of Medicine and Emergency Medicine Providence Veterans Administration Hospital, Brown University Teaching Hospital, 830 Chalkstone Avenue, Providence RI. E-mail: glencopelph@aol.com , Phone: 860-477-0961

Published: December 23, 2014.

Abstract: 

Précis: The impression oral mucositis is a brief consequence of chemoradiation is misguided.  Patient-reported clinically significant oral mucositis may last 46 to 102 days depending on the cancer treatment, and may possibly be avoided with polymerized cross-linked sucralfate.

 

Keywords: 
Mucositis; Chemoradiation; Sucralfate; Polymerized Sucralfate.
References: 
  1. National Cancer Institute at the National Institutes of Health. April 2014. Cancer.gov Oral complications of chemotherapy and head and neck radiation. Health Professional Version.http://www.cancer.gov/ cancertopics/pdq/supportivecare/oralcomplications/HealthProfessional
  2. Medline Plus. A service of the US National Library of Medicine. National Institutes of Health. Oral Mucostitis. Updated by Dugdale DC, Chen YB, Zieve D June 5, 2014. http://www.nlm.nih.gov/medlineplus/ ency/patientinstructions/000047.htm
  3. Elting LS, Keefe DM, Sonis ST, Garden AS, Spijkervet FK, Basasch A, et al. Patient reported measurements of oral mucositis in head and neck cancer patients treated with radiotherapy with or without chemotherapy: demonstration of increased frequency, severity, resistance to palliation, and impact on quality of life.. Cancer 2008; 113(10):2704-13
  4. Elting LS, Cooksley CD, Chambers MS, Garden AS. Risk, outcomes, and costs of radiation-induced oral mucositis among patients with head-and-neck malignancies. Int J Radiat Oncol Bio Phys 2007; 68(4):1110-20.  DOI 10.1016/j-ijrobp.2007.01.053
  5. Sauders DP, Epstein JB, Elad S, Allemano J, Bossi P, van de Wetering MD, et al. Systemic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients. Supp Care Cancer 2013; 21(11):3191-207. DOI 10.1007/s00520-013-1871-y.
  6. Fromme EK, Eilers KM, Mori M, Hsieh YC, Beer TM. How accurate is clinician reporting of chemotherapy adverse effects? A comparison with patient-reported symptoms from the Quality-of-Life Questionnaire C30. J Clin Oncol 2004; 22(17):3485-90. DOI: 10.1200/JCO.2004.03.025] 
  7.  Trotti A, Bellm LA, Epstein JB, Frame D, Fuchs HJ, Gwede CK, et al. Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiather Oncol 2003; 66(3):253-62. DOI:10.1016/S0167-8140(02)00404-8 
  8.  Elting LS, Cooksley CD, Chambers MS, Cantor SB, Manzullo E, Rubenstein EB. The burdens of cancer therapy. Clinical and economic outcomes of chemotherapy-induced mucositis. Cancer 2003; 98:1531-9. DOI 10.1002/cncr.11671
  9. Chi KH, Chen CH, Chow KC, Chen SY, Yen SH, Chao JH, et al. Effect of granuclocyte-macrophage colony-stimulating factor on oral mucositis in head and neck cancer patients after cisplatin, fluorouracil and leucovorin chemotherapy. J Clin Oncol 1995; 13(10): 2620-8.
  10.  Stiff PJ, Emmanouilides C, Bensigner WI, Gentile T, Blazar B, Shea TC, et al. Palifermin reduces patient-reported mouth and throat soreness and improves patient functioning in the hematopoietic stem-cell transplantation setting. J Clin Oncol 2006; 24:5186-93. DOI:10.1200/JCO.2005.02.8340 
  11.  Kushner JA, Lwarence HP, Shoval I, Kiss TL, Devins GM, Lee L, Tenenbaum HC. Development and validation of a Patient-Reported Oral Mucositis Syptom (PROMS) scale.  J Can Dent Assoc 2008; 74(1): 59. 
  12. Hunter KU, Schipper M, Feng FY, Lyden T, Haxer M, Murdoch-Kinch CA, et al. Toxicities affecting quality of life after chemo-IMRT of oropharyngeal cancer: prospective study of patient-reported, observer-rated, and objective outcomes. Int J Radiation Oncol Biol Phys 2013; 85(4):935-40. http://dx.doi.org/10.1016/j.ijrobp.2012.08.030   
  13.  D’Olimpio J, Adams VR. Oral mucositis: causative regiments and pathways for treatment. Published for Clinical Oncology by McMahan Publishing, New York, 2008. www.clinicaloncology.com/ download/pg08114_mucositis_WM.pdf
  14. Brown CG, Wingard J. Clinical consequences of oral mucositis. Sem Oncol Nurs 2004; 20(1):16-21.
  15.  American Cancer Society. Cancer facts and figures, 2014.
  16. US Dept of Health and Human Services. Blood Cell Transplant. http://bloodcell.transplant.hrsa.gov/research/transplant_data/registry_tx_data/index.html 
  17. McCullough RW. High potency polymerized cross-linked sucralfate manages both oral and alimentary mucositis simultaneously. Abstract, June 2014 MASCC International Symposium.
  18. McCullough RW.  New category of evidence should permit the Multinational Association of Support in Cancer Care (MASCC) to review polymerized cross-linked sucralfate paste (ProThelial) for mucositis guidelines. Oncol Discov J  2:1-6. DOI:10.7243/2052-6199-2-1
  19. McCullough RW.  High-potency sucralfate prevents and rapidly reverses chemo-radiation mucositis in a patient with stage 4b head and neck cancer. World J Transl Med 2013; 2(2): 13-21, 2013. DOI: 10.5528/wjtm.v2.i2.13.
  20.  McCullough RW. ProThelial (Polymerized cross-linked high potency sucralfate): medical device therapy for treatment and prevention of mucositis. European Journal of Research in Medical Sciences 2014
  21. Glasziou P, Chalmers I, Rawlins M, McCullouch P. When are randomized trials unnecessary? Picking signal from noise.  BMJ 2007; 334(7589):349-51. DOI:10.1136/bmj.39070.527986.68

The fully formatted PDF version is available.        

Download Article

Int J Biomed. 2014; 4(4):194-197. © 2014 International Medical Research and Development Corporation. All rights reserved.