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| Pathophysiology |
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Oral mucositis may begin within 3 to 7 days after bone marrow transplant.
Pain may not be evident at first, but as oral mucositis escalates,
pain can elevate accordingly. Activities such as eating, drinking, swallowing, and talking may become difficult.1,2
Mucositis is a complex process that begins before patients feel pain.3-5 As oral mucositis progresses, narcotic drugs may be required to ease
the pain.1,6 Special dietary supplements
or feeding can help replace
nutrients if normal eating, drinking, and swallowing mechanisms are
no longer available.
Some patients may need IV pain medication and
IV nutritional support.
The inability to talk comfortably may lead some
patients with severe oral mucositis to suffer from depression.7
Figure 1. The 5 Phases of Mucositis6,7
Adapted from Sonis. Nat Rev Cancer. 2004;4:277-284.
Phase 1 (Initiation): radiation or chemotherapy causes DNA damage in basal epithelial cells
and generates reactive oxygen species (ROS), which further damage cells and blood vessels in the submucosa.6,7
Phase 2 (Signaling):
chemotherapy, radiation, and ROS induce apoptosis and upregulate inflammatory cytokines in cells.4,5
Phase 3 (Amplification):
inflammatory cytokines produce further tissue damage, amplifying signaling cascades and the injury process.4,5
Phase 4 (Ulceration): loss of mucosal integrity produces extremely painful lesions,
providing portals of entry for bacteria, viruses, and fungi.4,5
Phase 5 (Healing): proliferation, differentiation, and migration of epithelial
cells to restore the integrity of the mucosa.4,5
| 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 |
Borbasi S, Camerson 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. |
| 3 |
Stiff P. Mucositis associated with stem cell transplantation: current status and innovative approaches to management. Bone Marrow Transplant. 2001;27(suppl 2):S3-S11. |
| 4 |
Sonis ST. The pathobiology of mucositis. Nat Rev Cancer. 2004;4:277-284. |
| 5 |
Sonis ST, Elting LS, Keefe D, et al. Perspectives on cancer therapy induced mucosal injury: pathogenesis, measurement, epidemiology, and consequences for patients. Cancer. 2004;100(suppl 9):1995-2025. |
| 6 |
Shea TC, Bruner R, Wiley JM, et al. An expanded Phase I/II trial of cyclophosphamide, etoposide, and carboplatin plus total-body irradiation with autologous marrow or stem cell support for patients with ematologic malignancies. Biol Blood Marrow Transplant. 2003;9:443-452. |
| 7 |
National Cancer Institute. Oral complications of chemotherapy and head/neck radiation. Modified June
22, 2004. Available at: http://www.cancer.gov/cancerinfo/pdq/supportivecare/oralcomplications/healthprofessional.
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ABOUT ORAL MUCOSITIS
ABOUT KEPIVANCE®
TOOLS AND RESOURCES
FOR NURSES
FOR PHARMACISTS
IMPORTANT PRODUCT SAFETY INFORMATION
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