An Epidemiological Survey Of Chemotherapy-induced Mucositis And Analysis On Its Diagnostic And Treatment Status

Background:Mucositis is one of the common side effect of chemotherapy. Serious mucositis may influence the patient’s quality of life with the risk of worsening the patient prognosis. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy is published in2014. Although the guideline already exist, it is not widely used in the clinical practice. There is no survey of chemotherapy-induced mucositis in China.Objective:1.To evaluate the incidence of oral mucositis in patients received chemotherapy in TongJi hospital.2.To analysis the factors causing chemotherapy-induced oral mucositis.3.To evaluate the current status of the diagnosis and management of chemotherapy-induced oral mucositis.Methods:.1. A cross-sectional study was conducted in Wuhan Tongji hospital during Feb2014to Apr2014.Patients received chemotherapy were included. On admission, patients’ demographic data, including name, sex and age were collected. The questionnaire (OHIP-14) was used to measure oral health-related quality of life. 2. To observe the cleanness of oral cavity and collect the basic information, including sex, age, smoking, body height and weight, diagnosis and way of chemotherapy. Number of white blood cell, hemoglobin, albumin was recorded. Perform X2check on each factor, and select some factors on which have statistical differences to make a multi-factor logistic regression analysis. All these statistical analysis should be performed with the software SPSS19.0.3. Physicians were asked to determine whether their patients have oral mucositis. The therapy strategies of oral mucositis, oral care, nutritional support and the severity of oral pain were collected.NRS-2002was used to evaluate the risk of lack of nutrition.Results:1. Cross-Sectional study:(1) A total of317patients received chemotherapy were included. The incidence of chemotherapy-induced oral mucositis was18.3%,the incidence of Level I and Ⅱis12%(composition ratio:65.5%).(2) The erythema and edema in mild mucositis(Grade1to2) usually appears on the selected regions of the oral cavity:the buccal mucosa,the soft palate and the ventral and lateral tongue.The severe mucositis can be combined and covered with pseudomembrane with a risk of inflammation.(3) A total of309patients complete the OHIP-14questionnaire, compared with controls, patients with chemotherapy-induced oral mucositis showed significantly high scores which indicated that the global quality of life and the scales of functioning is significantly low.2. Correlation factor:In the X2check, the difference has statistical sense in BMI,ECOG, cleanness of oral cavity, MTX/Fluorouracil, WBC and the way of chemotherapy. Take factors above as the independent variable, the occurrence of oral mucositis as the dependent variable, and perform a multi-factor logistic regression analysis. The factors with statistical difference were BMI, cleanness of oral cavity, MTX/Fluorouracil and WBC.5. Diagnosis and management of patients with oral mucositis(1) Only24patients were classified as having oral mucositis. The false negative rate was as high as58.6%.Patients with leukemia (70%) and lymphoma (66.7%) got the highest positive rate.(2) The NRS scores of the patients with oral mucositis was in the interval of0to8.53.4%patients feel no pain,13.8%patents experienced mild pain, and8.6%patients suffered from severe pain. Among the27patients who experienced oral pain, there were only2patients (7.4%) received pain treatment. There were32.8%patients received oral care. In the diet,74.1%patients who had normal diet(all),24.1%patients had liquid food, and1.7%patients cannot eat. The percentage of NRS-2002scores larger than2was34.5%, while the patients who indeed received nutritional support was only15.5%.Conclusions:1. The incidence of chemotherapy-induced oral mucositis was high, most of which was mild mucositis. Oral mucositis appears to be associated with a reduced quality of life.2. The factors BMI, cleanness of oral cavity, MTX/Fluorouracil and WBC were associated with oral mucositis.3. The chemotherapy-induced oral mucositis was rarely recognized,prevented and treated sufficiently. The possible reason was that MASCC/ISOO guideline is not widely accepted and doctors was lack of awareness for early diagnosis and related knowledge.