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		Impact, Prevalence & Management   Video Watch a Biological  Video online...   Impact and Prevalence Oral mucositis is a common and potentially serious side effect of high-dose chemotherapy (CT) and/or radiotherapy (RT) regimens often manifested as erythema and painful ulcerative lesions of the mouth and throat. The degree of injury to mucosal tissue is directly related to the type, dose, or dose intensity of the CT and/or RT regimens employed. Therapies associated with the greatest degree of mucosal toxicity include myelotoxic conditioning regimens required prior to hematopoietic stem cell transplantation (HSCT).2 Approximately 70%–80% of patients with hematologic malignancies undergoing HSCT suffer from oral mucositis.1,2 Oral mucositis has been identified as the most debilitating side effect of anticancer therapy by patients who experienced it while undergoing myelotoxic therapy for HSCT.1,2 Daily activities such as eating, drinking, swallowing, and talking may be difficult or impossible for patients with severe oral mucositis.1,3 The limitations to patients’ basic daily activities can begin when ulcers first appear.1,2 (See Figure 1) Figure 1. World Health Organization (WHO) Oral Toxicity Scale4 Adapted from WHO oral toxicity scale. The National Cancer Institute Common Toxicity Criteria (NCI-CTC) scale measures anatomical and functional components of mucositis similar to those measured by the WHO oral toxicity scale.5 Consequent morbidities of severe oral mucositis can include1,3: Pain severe enough to require opioid analgesia. Difficulty or inability to swallow due to ulcerations in the mouth and throat, which, if severe, may necessitate total parenteral nutrition (TPN) and rehydration. Difficulty or inability to talk, which can hinder patients' abilities to communicate. Back to top Oral mucositis can have serious clinical consequences. In a study of HSCT patients (N = 92), each worsening grade of mucositis on the Oral Mucositis Assessment Scale (OMAS) scale led to 2.6 additional days of opioid use (P < 0.001) and 2.7 additional days of total parenteral nutrition (TPN) (P < 0.001).6 Figure 2. Consequences of Oral Mucositis Associated with a 1-Point Increase in Peak OMAS Score6 Adapted from Sonis et al. J Clin Oncol. 2001;19:2201-2205. Results based on the Oral Mucositis Assessment Scale (OMAS). Patients were evaluated for erythema and ulceration/pseudomembrane formation beginning on the first day of conditioning and continuing for 28 days.6 *  P < 0.001. Managing Oral Mucositis Managing oral mucositis is not easy. There are many different methods to help relieve the pain, including: Ice chips. Sucking on ice cubes may make oral mucositis less painful. Antioxidants. "Natural supplement" therapies such as betacarotene, vitamin E, and glutamine mouthwash have been tried to treat oral mucositis.7 Mouth rinses. Several mouth rinses are available that combine antihistamines, anesthetics, anti-inflammatory medications (such as corticosteroids), antibiotics, and antifungals.7 Pain medications. Narcotic analgesics may prove to help relieve the pain.7 Other methods Other ways to treat the symptoms of oral mucositis include: Antimicrobials Anti-inflammatories Good oral care Brushing with a soft toothbrush 2 to 3 times a day. Flossing between teeth once a day. Use of an alcohol-free mouthwash. Frequent checks of mouth for redness, swelling, sores, or areas of pain. Good nutrition Foods that irritate the mouth or throat should be avoided. Solid foods should be cooked until tender. Eat soft, bland foods, or even a liquid or pureed diet. Eat foods such as applesauce, custard, strained cream soup, pudding, gelatin, eggs, cooked cereal, and mashed potatoes. Frozen foods (ice cream, popsicles, and milkshakes). Drinks should be cool or room-temperature. Tomatoes, citrus and other acidic foods, rough foods, alcohol, and tobacco should be avoided. 1 Bellm LA, Epstein JB, Rose-Ped A, et al. Patient reports of complications of bone marrow transplantation. Support Care Cancer. 2000;8:33-39. 2 Stiff P. Mucositis associated with stem cell transplantation: current status and innovative approaches to management. Bone Marrow Transplant. 2001;27(suppl 2):S3-S11. 3 Borbasi S, Cameron K, Quested B, Olver I, To B, Evans E. More than a sore mouth: patients' experience of oral mucositis. Oncol Nurs Forum. 2002;29:1051-1057. 4 World Health Organization. Handbook for reporting results of cancer treatment. Geneva, Switzerland: World Health Organization; 1979:15-22. 5 National Cancer Institute Common Toxicity Criteria. Version 2.0, June 1, 1999. Available at: http://ctep.info.nih.gov. Accessed January 20, 2005. 6 Sonis ST, Oster G, Fuchs H, et al. Oral mucositis and the clinical and economic outcomes of hematopoietic stem-cell transplantation. J Clin Oncol. 2001;19:2201-2205. 7 Woo S-B, Treister N. Chemotherapy-induced oral mucositis. Modified November 19, 2003. Available at: http://www.emedicine.come/derm/topic682.htm. Accessed February 12, 2004. Back to top ABOUT ORAL MUCOSITIS ABOUT KEPIVANCE® TOOLS AND RESOURCES FOR NURSES FOR PHARMACISTS IMPORTANT PRODUCT SAFETY INFORMATION
	Kepivance® is indicated to decrease the incidence and duration of severe oral mucositis in patients with hematologic malignancies receiving myelotoxic therapy requiring hematopoietic stem cell support. The safety and efficacy of Kepivance® have not been established in patients with non-hematologic malignancies. Important Safety Information In patients with hematologic malignancies, the most common serious adverse reaction in clinical trials attributed to Kepivance® was skin rash reported in less than 1% of patients.   Contact | Reimbursement | Biovitrum.com | Site Map Prescribing Information © 2008 Biovitrum AB (publ). All rights reserved.