Clinical practice guidelines for the prevention and treatment of cancer therapy–induced oral and gastrointestinal mucositis

Authors

  • Edward B. Rubenstein M.D.,

    1. Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
    Current affiliation:
    1. MGI Pharma, Bloomington, Minnesota
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    • Dr. Rubenstein has received research funding from and is a member of the speakers program and advisory board at Merck (Whitehouse Station, NJ); he owns common stock in and is a member of the advisory board at MGI Pharma; and he is a member of the advisory boards at Endo Pharmaceuticals, McNeil Consumer and Specialty Pharmaceuticals, and OSI Pharmaceuticals.

  • Douglas E. Peterson D.M.D., Ph.D.,

    1. Department of Oral Diagnosis, University of Connecticut Health Center, Farmington, Connecticut
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    • Dr. Peterson has served as a paid consultant for Aesgen, Inc. (Princeton, NJ).

  • Mark Schubert D.D.S., M.S.D.,

    1. Department of Oral Medicine, Fred Hutchinson Cancer Research Center, Seattle, Washington
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    • Dr. Schubert is a member of the advisory boards at Endo Pharmaceuticals, OSI Pharmaceuticals (Melville, NY), and McNeil Consumer and Specialty Pharmaceuticals.

  • Dorothy Keefe M.D.,

    Corresponding author
    1. Department of Medical Oncology, Royal Adelaide Hospital, Adelaide, Australia
    • Department of Medical Oncology, Royal Adelaide Hospital Cancer Center, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia
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    • Fax: (011) 618-8232-2148

    • Dr. Keefe has received research funding and speaker's honoraria from Amgen.

  • Deborah McGuire R.N., Ph.D.,

    1. School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Joel Epstein D.M.D., M.S.D.,

    1. Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, Chicago, Illinois
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  • Linda S. Elting Dr.P.H.,

    1. Department of Biostatistics and Applied Mathematics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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    • Dr. Elting has received speaker's honoraria from McNeil Consumer and Specialty Pharmaceuticals and from Endo Pharmaceuticals (Chadds Ford, PA).

  • Philip C. Fox D.D.S.,

    1. Department of Oral Medicine, Carolinas Medical Center, Charlotte, North Carolina
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  • Catherine Cooksley Ph.D.,

    1. Department of Biostatistics and Applied Mathematics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Stephen T. Sonis D.M.D., D.M.Sc.

    1. Division of Oral Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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    • Dr. Sonis has served as a consultant for Biomodels and Affiliates (Wellesley, MA).


  • Panelists included the following individuals: Andrei Barasch, D.M.D., M.D.Sc., University of Detroit Mercy School of Dentistry (Detroit, MI); B. Nebiyou Bekele, Ph.D., The University of Texas M. D. Anderson Cancer Center (Houston, TX); Rene-Jean Bensadoun, M.D., Center Antoine-Lacassagne (Nice, France); Michael Brennan, D.D.S., M.H.S., Carolinas Medical Center (Charlotte, NC); Mark Chambers, D.D.S., The University of Texas M. D. Anderson Cancer Center (Houston, TX); Catherine Cooksley, Ph.D., The University of Texas M. D. Anderson Cancer Center (Houston, TX); Marcio Da Fonseca, D.D.S., M.S., University of Michigan School of Dentistry (Ann Arbor, MI); Kathryn L. Damato, R.D.H., M.S., C.C.R.P., University of Connecticut Health Center (Farmington, CT); Betty Daniel, B.S.N., M.S., The University of Texas M. D. Anderson Cancer Center (Houston, TX); J. Peter Donnelly, Ph.D., University Hospital Nijmegen (Nijmegen, The Netherlands); Linda Elting, Dr.P.H., The University of Texas M. D. Anderson Cancer Center (Houston, TX); Loree Oberle-Edwards, R.D.H., M.S., Scripps Center for Dental Care (La Jolla, CA); Douglas Peterson, D.M.D., Ph.D., University of Connecticut Health Center (Farmington, CT); Judith Raber-Durlacher, D.D.S., Ph.D., Leiden University Medical Center (Leiden, The Netherlands); Ann Rose, Ph.D., Vicro (Washington, DC); Edward B. Rubenstein, M.D., The University of Texas M. D. Anderson Cancer Center (Houston, TX); Mark M. Schubert, D.D.S., M.S.D., Seattle Cancer Care Alliance (Seattle, WA); Sol Silverman, M.A., D.D.S., University of San Francisco (San Francisco, CA); Stephen T. Sonis, D.M.D., D.M.Sc., Brigham and Women's Hospital (Boston, MA); Fred Spijkervet, D.D.S., Ph.D., University Hospital Groningen (Groningen, The Netherlands); Diane Talentowski, D.D.S., Loyola University Medical Center (Maywood, Illinois); Inger von Bültzingslöwen, D.D.S., Ph.D., Göteborg University (Gothenburg, Sweden); and Ralph Wong, M.D., University of Manitoba (Winnipeg, MB, Canada).

Abstract

BACKGROUND

Oral and gastrointestinal (GI) mucositis can affect up to 100% of patients undergoing high-dose chemotherapy and hematopoietic stem cell transplantation, 80% of patients with malignancies of the head and neck receiving radiotherapy, and a wide range of patients receiving chemotherapy. Alimentary track mucositis increases mortality and morbidity and contributes to rising health care costs. Consequently, the Multinational Association of Supportive Care in Cancer and the International Society for Oral Oncology assembled an expert panel to evaluate the literature and to create evidence-based guidelines for preventing, evaluating, and treating mucositis.

METHODS

Thirty-six panelists reviewed literature published between January 1966 and May 2002. An initial meeting in January 2002 produced a preliminary draft of guidelines that was reviewed at a second meeting the same year. Thereafter, a writing committee produced a report on mucositis pathogenesis, epidemiology, and scoring (also included in this issue), as well as clinical practice guidelines.

RESULTS

Panelists created recommendations from higher levels of evidence and suggestions when evidence was of a lower level and there was a consensus regarding the interpretation of the evidence by the panel. Panelists identified gaps in evidence that made it impossible to recommend or not recommend use of specific agents.

CONCLUSIONS

Oral/GI mucositis is a common side effect of many anticancer therapies. Evidence-based clinical practice guidelines are presented as a benchmark for clinicians to use for routine care of appropriate patients and as a springboard to challenge clinical investigators to conduct high-quality trials geared toward areas in which data are either lacking or conflicting. Cancer 2004;100(9 Suppl):2026–2046. © 2004 American Cancer Society.

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