Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis.
BACKGROUND
Oral and gastrointestinal (GI) mucositis can affect up to 100% of patients undergoing high-dose chemotherapy and hematopoietic stem cell transplantation, 80% of patients with malignancies of the head and neck receiving radiotherapy, and a wide range of patients receiving chemotherapy. Alimentary track mucositis increases mortality and morbidity and contributes to rising health care costs. Consequently, the Multinational Association of Supportive Care in Cancer and the International Society for Oral Oncology assembled an expert panel to evaluate the literature and to create evidence-based guidelines for preventing, evaluating, and treating mucositis.


METHODS
Thirty-six panelists reviewed literature published between January 1966 and May 2002. An initial meeting in January 2002 produced a preliminary draft of guidelines that was reviewed at a second meeting the same year. Thereafter, a writing committee produced a report on mucositis pathogenesis, epidemiology, and scoring (also included in this issue), as well as clinical practice guidelines.


RESULTS
Panelists created recommendations from higher levels of evidence and suggestions when evidence was of a lower level and there was a consensus regarding the interpretation of the evidence by the panel. Panelists identified gaps in evidence that made it impossible to recommend or not recommend use of specific agents.


CONCLUSIONS
Oral/GI mucositis is a common side effect of many anticancer therapies. Evidence-based clinical practice guidelines are presented as a benchmark for clinicians to use for routine care of appropriate patients and as a springboard to challenge clinical investigators to conduct high-quality trials geared toward areas in which data are either lacking or conflicting.
Rubenstein
Edward B
EB
Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Peterson
Douglas E
DE
Schubert
Mark
M
Keefe
Dorothy
D
McGuire
Deborah
D
Epstein
Joel
J
Elting
Linda S
LS
Fox
Philip C
PC
Cooksley
Catherine
C
Sonis
Stephen T
ST
D000970:Antineoplastic Agents / Q000009:adverse effects*; D019317:Evidence-Based Medicine; D006801:Humans; D007413:Intestinal Mucosa; D009061:Mouth Mucosa; D009369:Neoplasms / Q000188:drug therapy / Q000532:radiotherapy; D013280:Stomatitis / Q000139:chemically induced* / Q000517:prevention & control*
D000970:Antineoplastic Agents