The burdens of cancer therapy

Clinical and economic outcomes of chemotherapy-induced mucositis

Authors

  • Linda S. Elting Dr.P.H.,

    Corresponding author
    1. Section of Health Services Research, Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston Texas
    • Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 196, Houston, TX 77030-4009
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    • Fax: (713) 792-7990

    • Dr. Elting has received honoraria from Endo Pharmaceuticals.

  • Catherine Cooksley Dr.P.H.,

    1. Section of Health Services Research, Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston Texas
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  • Mark Chambers M.D.,

    1. Department of Head and Neck Oncology, The University of Texas M. D. Anderson Cancer Center, Houston Texas
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  • Scott B. Cantor Ph.D.,

    1. Section of Health Services Research, Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston Texas
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  • Ellen Manzullo M.D.,

    1. Department of General Internal Medicine, Ambulatory Treatment, and Emergency Care, The University of Texas M. D. Anderson Cancer Center, Houston Texas
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  • Edward B. Rubenstein M.D.

    1. Section of Medical Supportive Care, Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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Abstract

BACKGROUND

Mucositis is a common but poorly studied problem among patients with solid tumors. The authors examined the clinical and economic outcomes of oral and gastrointestinal (GI) mucositis among patients receiving myelosuppressive chemotherapy.

METHODS

A retrospective, random sample of 599 patients who developed chemotherapy-induced myelosuppression was followed for development of oral or GI mucositis and for development of subsequent episodes of bleeding or infection. Multilevel regression models of the risk of bleeding and infection were fit with chemotherapy cycles nested within patients.

RESULTS

Mucositis developed during 37% of 1236 cycles of chemotherapy. Episodes of bleeding were significantly more common during cycles with GI mucositis than during cycles without GI mucositis (13% vs. 8%; P = 0.04). Episodes of infection were significantly more common during cycles with mucositis (especially GI mucositis) than during cycles without mucositis (73% vs. 36%; P < 0.0001). The mean durations of hospitalization were 4 days, 6 days, and 12 days during cycles with no mucositis, oral mucositis, and GI mucositis, respectively. After accounting for the depth and duration of myelosuppression and for other predictive factors, GI mucositis was associated with both bleeding (odds ratio [OR], 2.0; P = 0.01) and infection (OR, 2.24; P < 0.0001), whereas oral mucositis was associated with infection only (OR, 2.4; P < 0.0001).

CONCLUSIONS

Mucositis was clinically and economically significant among patients with solid tumors who were receiving myelosuppressive chemotherapy. New preventive and therapeutic agents are needed. Cancer 2003;98:1531–9. © 2003 American Cancer Society.

DOI 10.1002/cncr.11671

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