Understanding oral mucositis and the role of the nurse

It is extremely painful and debilitating for patients and has a serious impact on their quality of life (Shetty et al, 2022; Singh and Singh, 2020).

Clinical significance

OM refers to erythematous and ulcerative lesions of the oral mucosa observed in patients with cancer being treated with chemotherapy, and/or with radiation therapy to areas involving the oral cavity. OM is often very painful and can compromise nutrition and oral hygiene, as well as increasing the risk for local and systemic infection. Thus, oral mucositis is a highly significant and sometimes dose-limiting complication of cancer therapy (Lalla et al, 2008).

Epidemiology

Patients undergoing head and neck radiotherapy, haematopoietic cell transplantation and chemotherapy are at high risk of developing oral mucositis. Studies have shown severe mucositis occurring in 29-66{33c86113bcc32821f63c6372852a0f501e07fff55ce3ce61b15b246c5f8c531c} of patients receiving radiation therapy for head and neck cancer. In these studies, the incidence of OM was especially high in patients with primary tumours in the oral cavity, oropharynx or nasopharynx; those who received concomitant chemotherapy; those who received a total dose of over 5000 cGy; and those treated with altered fractionation radiation schedules. For patients receiving high-dose chemotherapy prior to haematopoietic cell transplantation, oral mucositis has been reported to be the single most debilitating complication of transplantation (Lalla et al, 2008).

Role of the nurse in oral mucositis patient care

Nurses have a critical role in all aspects of managing OM, including assessment, teaching oral care, administering pharmacologic interventions, and helping patients cope with symptom distress (Harris et al, 2008).

Nurses have a number of responsibilities in managing OM: Effective assessment and monitoring of the oral cavity and symptoms; disease management, focusing on ensuring availability of appropriate intervention for patients; and oral care education. Nurses should also be involved in the development and implementation of standardised clinical practice guidelines.

There are certain universally accepted indications for oral care interventions, which include:

• Promoting patient compliance with oral care regimens;
• Regular assessment of the oral cavity;
• Patient education;
• Comfort measures;
• Initiating therapeutic interventions.

Therapeutic interventions

Cancer patients have a strong need for integrative, non-drug, self-management, and self-efficacy enhancing applications for alleviating symptoms of OM (Steinmann et al, 2021). These can include (Brown and Gupta, 2020):

• General oral care protocols;
• Washes, rinses, ice chips (cryotherapy);
• Topical anaesthetics;
• Analgesics;
• Mucoprotectants.

What is GelX®?

GelX® is a mucoprotectant oral spray containing polyvinylpyrrolidone (PVP), zinc and taurine indicated for both the treatment and prevention of OM (Galen, nd), providing effective pain relief, reducing inflammation, and helping patients take control.

In one study, prevention was achieved in 37.24{33c86113bcc32821f63c6372852a0f501e07fff55ce3ce61b15b246c5f8c531c} of patients using GelX®. Of the remaining patients, 93.4{33c86113bcc32821f63c6372852a0f501e07fff55ce3ce61b15b246c5f8c531c} had a complete remission of their symptoms (Niculita et al, 2020).

GelX® benefits

• Blocks exposed nerve endings and coats oral lesions to soothe and relieve pain (Galen, nd; Biswal, 2008);
• Helps patients in coping with OM and completing long-term treatment goals;
• Available on prescription.

MAT-GELX OS-UK-000055

Date of Preparation: November 2022

References

Biswal BM (2008) Current trends in the management of oral mucositis related to cancer treatment. Malaysian Journal of Medical Sciences; 15, 3:4-13.

Brown TJ, Gupta A (2020) Management of cancer therapy–associated oral mucositis. JCO Oncology Practice; 16: 3, 103-109.

Galen (nd) GelX® Oral Spray Instructions for Use.

Harris DJ et al (2008) Putting evidence into practice: evidence-based interventions for the management of oral mucositis. Clinical Journal of Oncology Nursing; 12: 1, 141-152.

Lalla RV et al (2008) Management of oral mucositis in patients who have cancer. Dental Clinics of North America; 52: 1, 61-77.

Niculita O et al (2020) The efficacy of Polyvinylpyrrolidone-Zn Gluconate and Taurine in the Prevention of Oral Mucositis in Haematological Patients. Revista De Chimie; 71, 8: 195-205.

Shetty SS et al (2022) Oral mucositis: current knowledge and future directions. Disease-a-Month; 68: 5, 101300.

Singh V, Singh AK (2020) Oral mucositis. National Journal of Maxillofacial Surgery; 11: 2, 159-168.

Steinmann D et al (2021) Nursing procedures for the prevention and treatment of mucositis induced by cancer therapies: clinical practice guideline based on an interdisciplinary consensus process and a systematic literature search. Integrative Cancer Therapies; 20: 1534735420940412.