Studies on supportive care in oral mucositis: random or randomised?

Abstract

During the last decades, measures on supportive care are considered standard in everyday oncology practice. Supportive care measures not only prevent or ameliorate complications of antitumour therapy and thereby increase the patients' quality of life, they also make anti-tumour therapy in sufficient doses possible. Due to large-scaled clinical trials, the treatment of chemotherapy- and radiotherapy-induced nausea and vomiting has become evidence-based in current practice. The development of guidelines on the use of haematopoetic growth factors in chemotherapy-induced leucopenia and anaemia was also based on clinical trials. For the prevention and treatment of oral mucositis, however, scarcely any evidence exists. A recent review by the Cochrane Collaboration could identify just one measure, the application of ice chips, with some evidence that it could prevent chemotherapy-induced oral mucositis [1]. Nevertheless, the impact of mucositis in clinical practice is great. Approximately 40% of adult patients treated with standard cytotoxic chemotherapy develop oral mucositis. The incidence is higher in children, in patients with advanced cancer of the head and neck treated with concurrent chemotherapy and radiotherapy and in patients treated with high-dose chemotherapy and blood or bone marrow transplantation. A recent study in 92 blood and marrow transplant patients from eight study centres in the United States, Canada and Europe demonstrated that the extent and severity of oral mucositis was significantly correlated with the number of days injectable narcotics, total parenteral nutrition (TPN), and injectable antibiotics were given; and with the risk of significant infection; the number of hospital days; hospital charges; and even mortality. Total hospital charges were almost $43 000 higher among patients with ulceration in contrast to those without [2].