Guidelines for Complications of Cancer Treatment Vol VIII Part B

Mucositis and GastrointestinalToxicities of ChemotherapyIntroduction and epidemiology -Advent of intensivechemotherapy regimens including high dose chemotherapy toimprove the cure rates in malignancies has led to higherincidence of hematological and non-hematological toxicities.Increasing use of growth factors take care of hematologicaltoxicity to a certain extent thus making non-hematologicaltoxicity an important concern for medical oncologists. Nonhematologicaltoxicities such as mucositis (oral andgastrointestinal), diarrhea are well recognized with severalstandard dose chemotherapy regimens and high dosechemotherapy. They can be debilitating due to severe pain,bleeding, increase frequency of infections, poor oral intakeand weight loss and thus lead to chemotherapy delays anddose reduction compromising the cure. For patients receivinghigh dose chemotherapy treatment, a 1-point increase in anoral mucositis score has been found to be associated with asignificant increase in days with fever, risk of infection,additional days of total parenteral nutrition, use of intravenousnarcotic analgesics, total hospital charges, and 100-daymortality. Apart from physical effects mucositis can havemarked psychological effects and may become an importantbarrier for continuation of chemotherapy.454