Evaluation of pain associated with oral mucositis during the acute period after administration of high-dose chemotherapy.
BACKGROUND
No single oral mucositis (OM) assessment scale is universally accepted; the most commonly used scales are deficient because they combine subjective and objective measures and do not capture the patient's perspective. Because pain is the hallmark symptom of OM, the authors sought to determine whether a simple measure of patient-reported pain was correlated with objective, physician-assessed measures of OM. The findings of the current study may provide a clinical context for understanding the relation between objective indicators and patients' perceptions of OM.


METHODS
Three hundred twenty-three patients receiving stomatotoxic chemotherapy and randomized to receive either iseganan or placebo for treatment of OM underwent periodic objective and subjective evaluations of OM. Objective measures included clinician scoring of stomatitis and dysphagia using the National Cancer Institute Common Toxicity Criteria scales. A subjective measure was obtained by having patients complete a questionnaire (with questions based on an 11-point numeric scale) regarding oral pain.


RESULTS
More than 90% of scheduled oral assessments were obtained. Mouth pain scores were closely related to stomatitis and dysphagia; peak mouth pain coincided with peak stomatitis and dysphagia. Analgesic use increased by 0.7 days for each unit rise on the pain scale. Patients receiving iseganan had a significantly lower level of peak mouth pain than did patients receiving placebo (P=0.041).


CONCLUSIONS
A separate measurement of patient-reported pain was useful for capturing the patient's perspective on OM and was correlated with the physician's objective assessment. These findings support the use of a simple, patient-reported rating of mouth pain as a clinically relevant and responsive endpoint in clinical trials. This rating system also may provide a straightforward method of following OM in clinical practice.
Cella
David
D
Institute for Health Services Research and Policy Studies, Evanston Northwestern Healthcare and Northwestern University, Evanston, Illinois 60201, USA. d-cella@northwestern.edu
Pulliam
Janis
J
Fuchs
Henry
H
Miller
Carole
C
Hurd
David
D
Wingard
John R
JR
Sonis
Stephen T
ST
Martin
Paul J
PJ
Giles
Francis
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects; D023181:Antimicrobial Cationic Peptides; D002648:Child; D003680:Deglutition Disorders / Q000139:chemically induced; D005260:Female; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy; D008297:Male; D008727:Methotrexate / Q000009:adverse effects; D008875:Middle Aged; D009061:Mouth Mucosa; D010146:Pain / Q000139:chemically induced* / Q000175:diagnosis; D010147:Pain Measurement; D010455:Peptides; D011506:Proteins / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013280:Stomatitis / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome
D000964:Antimetabolites, Antineoplastic; D023181:Antimicrobial Cationic Peptides; D010455:Peptides; D011506:Proteins; C119872:antimicrobial peptide IB-367; D008727:Methotrexate