Guidelines for Complications of Cancer Treatment Vol VIII Part B

conditioning treatment and for 3 days posttransplantationfor the prevention of oral mucositis(Level I evidence, grade A recommendation)2. Cryotherapy can be used in patients receiving high-dosemelphalan (Level II evidence, grade A recommendation).3. Use of granulocyte- macrophage colony stimulatingfactor mouth-washes is not recommended by the panel.(Level II evidence, grade C recommendation).Treatment of oral mucositis1. Palliative care (including pain management) Palliationof mucositis and acute oral pain is an importantcomponent of patient care. Approaches include the useof systemic analgesics and other individual agents,coating agents, and topical anesthetics/analgesics. Thepanel recommends patient-controlled analgesia (PCA)with morphine as the treatment of choice for oralmucositis pain in patients undergoing HSCT (level ofevidence, I; grade of recommendation, A). Control ofmucositis-induced pain is achieved by PCA withintravascular morphine sulfate. Use of morphine in othersetting is not evidenced based, however analgesics canbe used as per the local clinical practice. The panel doesnot recommend the use of topical anesthetic basedmixtures in treatment of mucositis.2. The panel recommends that chlorhexidine not be usedto treat established oral mucositis (level of evidence, II;grade of recommendation, A)Prevention of gastrointestinal mucositisThe basic bowel care should include adequate hydration,consideration of lactose intolerance and bacterial colonization.459