Chemoradiotherapy and Hematopoietic Stem Cell Transplantation Patients
Management of mucositis
Prophylactic measures and treatment options should be employed by practitioners for patients in the appropriate clinical settings. Specific recommendations for minimizing oral mucositis include the following:
- Good oral hygiene.
- Avoidance of spicy, acidic, hard, and hot foods and beverages.
- Use of mild-flavored toothpastes.
- Use of saline-peroxide mouthwashes 3 or 4 times per day.
Updated guidelines from the American Society of Clinical Oncology for the prevention and treatment of mucositis were published in 2007  and include the following:
- Palifermin for oral mucositis associated with stem cell transplantation.
- Amifostine for radiation proctitis.
- Cryotherapy for high-dose-melphalan-induced mucositis.
Specific recommendations against specific practices include the following:
- No systemic glutamine for the prevention of gastrointestinal mucositis.
- No sucralfate or antibiotic lozenges for radiation-induced mucositis.
- No granulocyte-macrophage colony-stimulating factor mouthwashes.
Oral mucositis in hematopoietic stem cell transplantation patients produces clinically significant toxicities that require multiprofessional interventions.[18,19,20,21,22,23,24,25] The lesion can increase risk of systemic infection, produce clinically significant pain,[Level of evidence: II] and promote oral hemorrhage. It can also compromise the upper airway such that endotracheal intubation is required. Use of total parenteral nutrition is often necessary because of the patient's inability to receive enteral nutrition.
Once mucositis has developed, its severity and the patient's hematologic status govern appropriate oral management. Meticulous oral hygiene and palliation of symptoms are essential. Some established guidelines for oral care include oral assessments twice daily for hospitalized patients and frequent oral care (minimum of every 4 hours and at bedtime) that increases in frequency as the severity of mucositis increases.
Oral care protocols generally include atraumatically cleansing the oral mucosa, maintaining lubrication of the lips and oral tissues, and relieving pain and inflammation. Several health professional organizations have produced evidence-based oral mucositis guidelines. These organizations include but are not limited to the following:
- Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology 
- National Comprehensive Cancer Network 
- European Society of Medical Oncology 
- European Oncology Nursing Society
- The Cochrane Collaboration [28,29]