Exploring Health Professionals’ Perceptions of Chemotherapy and Radiation Therapy-Related Oral Mucositis

Purpose Determine health professionals’ (HPs’) perceptions of oral mucositis (OM), including clinical presentation of chemotherapy (CT)-induced vs radiation therapy (RT)-induced OM, its assessment and management. Methods HPs involved in the care of head and neck cancer (HNC) patients receiving RT to the oral cavity/oropharynx and haematopoietic stem cell transplantation (HSCT) patients receiving mucositis-inducing CT regimens were invited to participate in a customised 20-question survey. Themes included OM presentation, assessment and management. Results Survey response rate was 81.4%. Most were nurses (33%) and specialist doctors/dentists (25%). Majority (45%) identified as part of the haematology service, followed by radiation oncology (32%). Most haematology and radiation oncology HPs (89% and 70%, respectively) agreed/strongly agreed that OM impacted patients’ ability to complete treatment. There was a significant association (p<0.01) between HPs’ specialty and their perceptions of OM manifestations. Most radiation oncology (85%) and all oral medicine HPs agreed/strongly agreed that clinical manifestations of CT-induced OM and RT-induced OM were different, whereas haematology HPs varied in their perceptions (11% disagreed, 41% were neutral and 48% agreed/strongly agreed). There was uncertainty regarding differences in management of CT vs RT-induced OM: 30% of haematology HPs and 45% of radiation oncology HPs agreed/strongly agreed but most (52% and 45%, respectively in each group) responded “neutral.” Conclusion OM was recognised to adversely impact HSCT and HNC RT patients’ ability to complete treatment. There were differences in HPs’ perceived understanding of OM manifestations and management. Interventions to address these may reduce unwanted variations in patient care and outcomes.

Evaluation of oral mucositis in pediatric cancer patients in Hiwa Hospital in Sulaymaniyah city, Kurdistan Region, Iraq

Background and objective: Oral mucositis is caused by the destruction of the oral mucosal epithelium and suppression of its growth secondary to antineoplastic treatment in the form of chemotherapeutic drugs, substances, or radiotherapy. This study aimed to evaluate oral mucositis in pediatric cancer patients because it is one of the common side effects of cancer therapy that influences the outcome. Methods: This is a cross-sectional study that enrolled 100 pediatric patients with both hematological and non-hematological cancer. The age of the patients ranged from 1-18 years, involving both genders. Cases admitted to Hiwa hospital were clinically evaluated for oral mucositis, and ethical permission was taken from parents. Risk factors were assessed, including age, sex, cancer type, type of chemotherapy, radiotherapy, number of cycles, complete blood count, interleukin-1 beta, interleukin-6, tumor necrosis factor-alpha, and tumor necrosis factor-beta. Results: Baseline serum cytokines levels showed significant correlation between Interleukin-6 and intensity of the oral mucositis (P = 0.003, rho = 0.314) and no correlation between severity of oral mucositis with tumor necrosis factor-alpha, tumor necrosis factor-beta nor interleukin-1 beta (P = 0.140 and rho = 0.258, P = 0.463 and rho = -0.079, and P = 0.706 and rho = -0.041, respectively). There was significant relationship between Hemoglobin level, neutropenia and type of non-hematological cancer with the intensity of oral mucositis respectively (P ≤0.001 and rho = -0.352, P = 0.027 and rho = -0.221, and P = 0.035 and rho = 0.095, respectively). Correlation between age, gender, white blood cell count, platelet count, type of hematological malignancy and past history with the intensity of the oral mucositis did not show significant result. Conclusion: Intensity of oral mucositis increased with anemia, neutropenia, high interleukin-6 level, and the type of non-hematological cancer. It is recommended to treat anemic, neutropenic patients as soon as possible before exacerbating the mucositis. Methotrexate is the most aggressive drug alone and in combined chemotherapy agents, which may cause mucositis and needs prophylaxis like topical nystatin suspension or other methods. Keywords: Oral mucositis; Pediatric cancer; Non-hematological; Hematological; Sulaymaniyah.

Management of Chemotherapy Induced Mucositis

Oral mucositis is a severe ailment that causes erythema, edema, and ulceration of the oral mucosa, as well as pain and oral intake restrictions. Chemotherapy and radiation therapy are the most often utilized cancer treatment options. Despite the fact that these treatments are used to improve a patient's quality of life, they are linked to a number of negative side effects. Oral mucositis is a common side effect in patients undergoing head and neck radiation therapy. While some chemotherapy-related side effects are being better managed, mucositis is becoming more common. Reducing patient risk factors, adopt proven preventative measures, and optimize supportive care practices targeted to the patients' needs and symptoms are all recommendations that can be made. In clinical practice and research, a variety of measures have been used to record the amount and severity of oral mucositis. The World Health Organization (WHO) scale is a simple, easy-to-use scale that can be used in clinical practice on a regular basis. There are multiple approaches for management of Mucositis. Cryotherapy, palifermin, and sucralfate are among the three therapies that showed statistically significant effect in avoiding or lowering the severity of mucositis according to reports. In this article we’ll be looking at Chemotherapy induced mucositis, its etiology, epidemiology, evaluation. And most importantly management.

miR-199b-3p Promotes Radiation-induced Oral Mucositis via DDIT4-mediated mTOR Signal Pathway

Background: Radiation-induced oral mucositis (RIOM) is an adverse reaction in patients of head and neck cancer after radiotherapy. However, the key regulatory factors in the pathogenesis of RIOM remain largely unclear. In this article, we discover a novel role of DNA damage-inducible transcript 4 (DDIT4) in regulating RIOM pathogenesis.Methods: We established RIOM in vitro and in vivo models to mimic the biological processes of RIOM. The level of DDIT4 in RIOM was analyzed by real-time PCR and Western blot. Through the bioinformatics analysis and luciferase assay, the relationship between miR-199b-3p and DDIT4 was performed. The level of mTOR signaling were explored by Western blot. Besides, Clone Formation and EDU assay were performed to investigate the effects of miR-199b-3p/DDIT4 on cell proliferation. H&E and immunohistochemistry experiments examined the effects of miR-199b-3p/DDIT4 on RIOM in vivo. Results: We found that the level of DDIT4 was significantly reduced during the RIOM formation, and up-regulated of DDIT4 suppressed the progression of RIOM in vitro and in vivo. Besides, we found DDIT4 was a direct target of miR-199b-3p. Ectopic expression of miR-199b-3p repressed the level of DDIT4 and activated mTOR signal conduction to promote RIOM progress, whereas the silencing of miR-199b-3p promoted the DDIT4-mediated RIOM regulation both in vitro and in vivo. Conclusion: Collectively, our studies not only identified the novel functional role of DDIT4 in modulating pathogenic processes of RIOM but also provided new directions and ideas for the future treatment of radiotherapy oral mucositis.