The Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) has updated its clinical practice guidelines for managing mucositis, a very common and often debilitating complication of cancer therapy.
Patients who experience mucositis often require enteral or parenteral nutrition, consume more opioids, and experience more interruptions to cancer therapy than patients who do not experience mucositis.
The MASCC/ISOO’s Mucositis Study Group, which comprised 250 experts from 33 counties, conducted the systematic review.
Led by Sharon Elad, DMD, MSc, professor at the University of Rochester Medical Center’s Eastman Institute for Oral Health, the Mucositis Study Group’s major goal is to improve outcomes of patients experiencing mucositis associated with cancer therapies.
Mucositis affects the inner lining of the oral and gastrointestinal tract. Oral mucositis often leads to difficulty eating and swallowing. Gastrointestinal mucositis is associated with nausea, vomiting, diarrhea, bloating, intestinal cramping, and anal pain.
For patients who are immunocompromised, oral mucositis is associated with greater risk for bacteremia, which has possible systemic implications.
The updated guidelines include additional recommendations for the use of photobiomodulation therapy and benzydamine, as well as a stronger guideline statement for cryotherapy. Each of these guidelines is defined for a specific setting and cancer patient population.
“Interestingly, natural honey had sufficient evidence, when used topically and then swallowed, to suggest possible mucositis prevention for patients with head and neck cancer who receive treatment with either radiotherapy or radio-chemotherapy,” said Elad.
“But it’s important to note that the long-term effect of this intervention is unclear at this point,” Elad added.
“Even with the best evidence-based interventions, we don’t have an ultimate guideline for mucositis in all clinical settings. Future research will hopefully identify better interventions that will relieve the patient’s pain and improve quality of life,” she said.
The summary paper highlights a series of frequently cited and detailed publications describing the approach to various categories of interventions. This includes eight categories for oral mucositis:
- Anti-inflammatory agents
- Photobiomodulation therapy
- Protocols categorized as basic oral care
- Growth factors and cytokines
- Antimicrobials, mucosal coating agents, anesthetics, and analgesics
- Vitamins, minerals, and nutritional supplements
- Natural and miscellaneous agents
Likewise, the summary paper includes a guidelines publication about all interventions for gastrointestinal mucositis.
According to the researchers, the 2019/20 guidelines update is a landmark paper on the evolution of the mucositis clinical practice guidelines. The first MASCC/ISOO guidelines paper was published in 2003 and updated in 2007 and 2014.
The continuous update of the guidelines is done by a large multidisciplinary group of clinicans and scientists using meticulous methods that incur validity and applicability, the researchers said.
The guidelines, “MASCC/ISOO Clinical Practice Guidelines for the Management of Mucositis Secondary to Cancer Therapy,” was published by Cancer.