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.
Mucositis: Perspectives and Clinical Practice Guidelines
Clinical practice guidelines for the prevention and treatment of cancer therapy–induced oral and gastrointestinal mucositis†
Article first published online: 19 APR 2004
Copyright © 2004 American Cancer Society
Volume 100, Issue S9, pages 2026–2046, 1 May 2004
How to Cite
Rubenstein, E. B., Peterson, D. E., Schubert, M., Keefe, D., McGuire, D., Epstein, J., Elting, L. S., Fox, P. C., Cooksley, C. and Sonis, S. T. (2004), Clinical practice guidelines for the prevention and treatment of cancer therapy–induced oral and gastrointestinal mucositis. Cancer, 100: 2026–2046. doi: 10.1002/cncr.20163
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).
- Issue published online: 19 APR 2004
- Article first published online: 19 APR 2004
- Manuscript Accepted: 22 JAN 2004
- Manuscript Received: 19 DEC 2003
- Mucositis Study Section of the Multinational Association of Supportive Care in Cancer (MASCC)
- International Society for Oral Oncology (ISOO)
- Amgen (Thousand Oaks, CA)
- GelTex Pharmaceuticals (Waltham, MA)
- Helsinn Healthcare SA (Pazzallo, Switzerland)
- Human Genome Sciences (Rockville, MD)
- McNeil Consumer and Specialty Pharmaceuticals (Fort Washington, PA)
- MGI Pharma (Bloomington, MN)
- MedImmune (Gaithersburg, MD)
- OraPharma (Warminster, PA)
- RxKinetix (Louisville, CO)
- oral mucositis;
- gastrointestinal mucositis;
- clinical practice guidelines
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.
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.
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.
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.