Transcript Module 11 - IPCRC.NET

The
EPEC-O
TM
Education in Palliative and End-of-life Care - Oncology
Project
The EPEC-O Curriculum is produced by the EPECTM Project with major funding
provided by NCI, with supplemental funding provided by the Lance Armstrong
Foundation.
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EPEC – Oncology
Education in Palliative and End-of-life Care – Oncology
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Module 3o
Symptoms – Mucositis
Mucositis . . .

Definition: mucosal barrier injury
It may affect the entire GI tract
. . . Mucositis
Epidemiology. . .

Impact:
Oral erythema, ulceration, pain,
infection
Diarrhea (if it affects entire GI tract)
Decreased oral intake
Raises 100-day mortality
. . . Mucositis
. . . Epidemiology

Prevalence:
40 % of patients on chemotherapy
100 % if with stem cell transplant

Prognosis:
Usually self-limiting
Key points
1. Pathophysiology
2. Assessment
3. Management
Pathophysiology

Direct injury

Secondary infection

Graft versus host disease
Plevova P. Oral Oncol, 1999.
Usual course

Starts 5 - 7 days after chemotherapy
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Generalized desquamation
days 11 - 14
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Resolution
2 days to 2 – 3 weeks
6 weeks after radiation
Wilkes JD. Semin Oncol, 1998.
Assessment

History
Pain and its effect on the patient
Eating and drinking
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Physical examination
Orthostatic blood pressure and pulse
Weight
Evaluate affected oral mucosa
Management . . .
Potential for prevention
1. Diminish mucosal delivery,
eg, oral cryotherapy
2. Modify epithelial proliferation,
eg, growth factors
3. Reduce infections, inflammatory
complications
4. Reduce, inhibit pro-inflammatory
cytokines
. . . Management

Oral hygiene

Diet (minimize contact with food)

Local anesthetics

Systemic analgesics
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Summary
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Use comprehensive
assessment and
pathophysiology-based therapy
to treat the cause and improve
the cancer experience