Effects of Gastrointestinal mucositis
- Malabsorption/diarrhoea
- Higher intestinal permeability
- Increased risk of sepsis*
Mucositis – side effect of cancer treatment1-4
One of the unfortunate consequences of cancer treatment is the development of (oral) mucositis. It occurs after CT as well as radiotherapy:
Nearly 100 % of patients receiving head and neck radio therapy (RT), 80 % of patients receiving high-dose chemotherapy (CT) as conditioning for HSCT (Hematopoietic stem cell transplantation) and 20-40 % of patients receiving conventional CT are affected and up to 80% of patients receiving RT of the pelvic region (gastrointestinal symptoms).1
Effects of Oral mucositis
- Pain
- Erythema and ulcers
- Swallowing difficulties
- Decreased oral intake
- Increased risk of infections*
*particularly in immunocompromised patients (e.g. neutropenic patients)
Consequences for the patients
- Weight loss
- Impaired functional status
- Reduced quality of life
- Increased consumption of healthcare resources
- Reduction/cessation of treatment
- Less tumour control
- Longer/more frequent hospitalisations
- Impaired prognosis/higher mortality
As a consequence of mucositis, patients may suffer from pain and difficulties eating, which leads to weight loss because of (malnutrition and) reduced oral intake.
Thus, effective cancer treatment might be influenced. Management of mucositis is of utmost importance because it affects treatment, tolerability and overall quality of life.3
Early nutrition intervention to diminish treatment toxicities
• Less severe oral mucositis in patients meeting their protein-related goals8
• Fewer treatment interruptions for toxicity (e.g. mucositis) by early nutrition intervention9
Guideline recommendations:
ESMO Clinical Practice Guidelines2
Two key strategies for mitigation of oral mucosal injury before and during treatment:
1. Maintenance of optimal nutritional support
2. Daily oral hygiene
MASCC/ISOO 2015 recommend1:
All patients should be screened for
1. Nutritional risk
2. Swallowing difficulties, to initiate enteral feeding early
Supportive care for better treatment outcome
Nutritional support — important part of mucositis management strategy!
Oral glutamine – nutritional measure to support prevention and treatment of mucositis6
Gut tissue damage caused by radiation and/or chemotherapy might be worsened by glutamine deprivation. Oral glutamine supplementation as a measure of nutritional management may support anti-cancer treatment by contributing to reduce time of onset, severity and duration of mucositis.
A systematic review7 showed:
When oral glutamine supplementation is initiated before CT and/or RT at dose of 30g/d it significantly reduced mean grade 2,3,4 mucositis, trend to reduced duration, time of onset and maximum grade of mucositis.
Mucositis HCP Folder.pdf
- Filename
- Mucositis HCP Folder.pdf
- Size
- 4 MB
- Format
Mucositis Patient Brochure.pdf
- Filename
- Mucositis Patient Brochure.pdf
- Size
- 13 MB
- Format
See how nutritional support can help to manage the symptoms of your patients:
References:
1) Lalla RV et al. MASCC/ISOO Clinical Practice Guidelines for the Management of Mucositis Secondary to Cancer Therapy. Cancer. 2014;120(10):1453–61.
2) Peterson DE et al. Management of oral and gastrointestinal mucosal injury: ESMO Clinical Practice Guidelines for diagnosis, treatment, and follow-up. Annals of oncology: official journal of the European Society for Medical Oncology. 2015;26(Suppl 5):v139–51.
3) Remesh A. Toxicities of anticancer drugs and its management. International Journal of Basic & Clinical Pharmacology. 2012;1(1):2–12.
4) Jensen SE, Peterson DE. Oral mucosal injury caused by cancer therapies: current management and new frontiers in research. Journal of oral pathology & medicine: official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology. 2014;43(2):81–90.
5) Keefe DM et al. Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer. 2007;109(5):820–31.
6) Papanikolopoulou A et al. The Role of Glutamine Supplementation in Thoracic and Upper Aerodigestive Malignancies. Nutrition and Cancer. 2015;67(2):231–7.
7) Sayles C et al. Oral Glutamine in Preventing Treatment-Related Mucositis in Adult Patients With Cancer: A Systematic Review. Nutrition in clinical practice: official publication of the American Society for Parenteral and Enteral Nutrition. 2016;31(2):171–9.
8) Zahn KL et al. Relationship of protein and calorie intake to the severity of oral mucositis in patients with head and neck cancer receiving radiation therapy. Head & neck. 2012;34(5):655–62.
9) Paccagnella A et al. Early nutritional intervention improves treatment tolerance and outcomes in head and neck cancer patients undergoing concurrent chemoradiotherapy. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer. 2010;18(7):837–45.