A Prospective Study Of Oral Mucositis In Acute Leukemia Receiving Chemotherapy And The Usefulness Of Oral Care In Preventing Mucositis

OBJECTIVEOral mucositis (OM) is an ulcerative, inflammatory process commonly seen in patients receiving chemotherapy and radiation as treatment forcancer. It is one of the most debilitating, agonizing, and painful side effects associated with cancer therapy. As many as75%of patients experience OM while undergoing intensive high-dose chemotherapy during bone marrow transplant, which is directly related to the high-dose chemotherapy regimens used for conditioning. Oral mucositis is a multifaceted problem that can cause symptoms such as pain, infection, bleeding and malnutrition, leading to a decrease in quality of life. Acute oral pain is a classic symptom of OM. There is few data about the occurrence of OM in patients with acute leukemia.To identify the clinical manifestations, risk factors, secondary complications, and assessment and management of oral mucositis in acute leukemia receiving chemotherapy.MATERIALS AND METHODS59acute leukemia patients who treated in Hematology Department of Shandong Provincial Hospital from Jan.2010to Dec.2011. At baseline and three times per week, for21days, patients had an oral examination performed using the Oral Mucositis Assessment Scale (OMAS); also, oral pain and difficulty to swallow were recorded using a visual analog scale. Analyzing the occurrence of OM and clinical characteristics and the risk factors. Intensive oral care protocol were used in one group of patients and to evaluate the effects in preventing oral mucositis. RESULTS59patients with acute leukemia were studied in our research.22(37.3%) developed OM, with a mean OMAS score of0.178(SD±0.56). The OM onset mean time was8.8(range3-23, SD±7.09)days, with a mean duration time8(range,3-18, SD±4.35) days. VAS score of pain and swallow difficulty in patients with OM were0.85±2.18(0-9),0.87±2.28(0-10), compared with patients without OM (the VAS scores were0.28±1.15,0.25±1.17respectively),there was a significant difference. The risk factors associated with OM was low BMI index. By using intensive oral care protocol to keep the oral cavity clean and moist, the occurrence of OM was decreased from46.8%to25.9%.CONCLUSIONSOM is a frequent and early side effect of chemotherapy in patients with acute leukemia, closely correlated with oral pain, difficulty to swallow, and impairment in food intake. The main risk factor is low BMI index. Intensive oral care protocol is effective in preventing the occurrence of OM. The education of nurses and patients should be emphasized, keeping the oral cavity clean and moist during the treatment period can effectively decrease the occurrence of OM, and guarantee good results.