BACKGROUND AND OBJECTIVE: Oral mucositis is a common side effect of cancer therapy that may lead to significant morbidity and interfere with the treatment plan. The present cross-sectional study intended to describe the prevalence of clinically relevant oral mucositis in outpatients receiving chemotherapy for solid tumors. There are currently no prospective studies available, which evaluate the prevalence of oral mucositis in this patient collective. As a secondary objective, the association of predefined predictor variables with mucositis prevalence was evaluated in order to aid the development of a patient-related risk profile. It was hypothesized that current tobacco smoking, the presence of diabetes mellitus, low white blood cell counts (WBC) and low dental check up frequency might influence the susceptibility to oral mucositis.
MATERIALS AND METHODS: Oral assessments and data collection regarding medical and oncological history were performed on 298 consecutively recruited patients, who had undergone at least 14 days of chemotherapy for solid tumors in our outpatient oncology department. The presence of oral mucositis was evaluated using the Oral Mucositis Assessment Scale (OMAS). Clinically relevant oral mucositis was defined as the presence of ulcers (>=1 cm squ.), severe erythema and/or inability to eat solid foods (WHO grades 2 - 4). Furthermore, the current levels of oral hygiene and oral health were measured using the Silness - Loe Plaque Index, Loe - Silness Gingival Index and the DMF-T index. As an indicator for awareness of dental health, each patient's dental check up frequency was assessed. Descriptive and bivariate statistical analyses were performed; statistical significance was tested using the Pearson chi-square test, Fisher's exact test and the Mann-Whitney U test. To compensate type one errors following multiple testing, significance levels were adjusted according to the Bonferroni method. RESULTS: A low prevalence (6%) of clinically relevant oral mucositis was found in the investigated patient collective, including 1% of patients with severe (WHO grades 3 & 4) oral mucositis; 16 patients in the mucositis group were male, and two were female. Of the 18 patients with clinically relevant oral mucositis, eight (44%) patients had received radiotherapy to the head and neck prior to or at the time of the assessment. Among patients who were currently smoking, a higher prevalence of clinically relevant oral mucositis was found (12.7% vs.
4.5%, p < 0.05). The mean time since a patient's last dental visit was almost twice as high among patients with clinically relevant oral mucositis (41.0 62.1 vs. 22.6 53.0 months, p = 0.005). Diabetes mellitus and WBC appeared not to be associated with higher oral mucositis rates. Oral pain, dysphagia (p = 0.000) and the use of topical analgesics (p = 0.001) were more common and the Plaque Index and Ginigval Index were significantly increased (p = 0.000) in the oral mucositis group. For the DMF-T index, a statistically non-significant higher mean value among the patients with oral mucositis was observed.
CONCLUSIONS: Although clinically relevant oral mucositis appears not to be a common complication in the investigated patient population, pre-treatment dental therapy and primary preventive measures (including oral hygiene instructions) should be emphasized. Within the statistical limitations of this study, the results suggest the following factors to be integrated into an individual risk profile for solid tumor patients:
male sex, current smoking, low dental check up frequency, poor oral hygiene, a reduced oral health status and the administration of irinotecan with prior or concurrent head and neck radiotherapy. In order to validate these findings for outpatients treated in other oncology centers or with other chemotherapy regimens, further research is needed.