New Guidelines Published for Oral Mucositis Relief

Researchers and clinicians from around the world have issued new guidelines for the treatment of oral mucositis in Supportive Care in Cancer that involve photobiomodulation therapy, a form of light therapy.

They based their recommendations on a systematic review of 33 research papers on photobiomodulation therapy for oral mucositis found in two scientific databases, PubMed and Web of Science.

Based on the papers, they found that light therapy reduced oral mucositis. And in some cases, when conducted before cancer treatment began, light therapy prevented oral mucositis from occurring. The therapy did not cause any adverse events, explained co-corresponding author Praveen Arany, DDS, PhD, assistant professor of oral biology at the University at Buffalo School of Dental Medicine. However, adjustments were needed for some skin changes.

The researchers, who are part of the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO), created guidelines for the prevention of oral mucositis in hematopoietic stem cell transplantation and in patients with head and neck cancer who were treated with radiation therapy with or without chemotherapy. For the three groups, MASCC/ISOO recommended that patients receive intra-oral photobiomodulation therapy using low-level lasers.

They were unable to create guidelines for the management of oral mucositis in patients treated with chemotherapy.

The amount of times light therapy would need to be received would be based on the need from patients, Arany said. For instance, someone may receive chemotherapy multiple times a week.

“A preventive treatment must be done every time you receive either radiation or chemotherapy. It should be done in a preventive therapy manner,” Arany said.

Light therapy is now an additional tool to help oncology nurses manage oral mucositis for patients. Currently, mucositis is treated with a special mouth wash or an expensive drug. For pain, patients will often be prescribed opioids. But Arany believes this can be lessened with the use of light therapy, which has been shown to directly reduce the amount of pain patients experience.

“Most importantly, [patients] will not have to discontinue treatment,” Arany said. “People discontinue treatment because they can’t handle the oral mucositis. They are not eating well. Their overall immunity is down. They can’t handle anymore treatments. It’s a real scenario where mucositis has led to discontinuation of treatment and death.”

Cost analysis has shown that oral mucositis costs anywhere from $4,000 to $12,000 depending on the clinic. Treatment prices using photobiomodulation therapy have not been determined, but will be up to policymakers, Arany explained.

“Mucositis is something that we create in our patients in the benefit of trying to get rid of the tumor,” Arany said. “The conversations we have had with some of the policymakers indicates that they are open to the fact that this would be a part of the bundled care. We know [patients] have to get this chemoradiation or these transplants, but can we mitigate some of the side effects by simply providing a non-invasive, non-pharmacological treatment?”