Summary of Evidence-based Clinical Practice Guidelines for Care of Patients with Oral and Gastrointestinal Mucositis (2005 Update)
ORAL MUCOSITIS FOUNDATIONS OF CARE PREVIOUS GUIDELINE UPDATED OR NEW GUIDELINE
protocols that include patient education
be used to attempt to reduce the severity protocols, and patient and staff education in of mucositis from chemotherapy or
severity of oral mucositis from chemotherapy and/or radiation therapy. As part of the protocols, the panel suggests the use of a soft toothbrush that is replaced on a regular basis. Elements of good clinical practice should include the use of validated tools to regularly assess oral pain and oral cavity health. The inclusion of dental professionals is vital throughout the treatment and follow-up phases.
The panel recommends patient-controlled The panel recommends patient-controlled analgesia with morphine as the
analgesia with morphine as the treatment of
choice for oral mucositis pain in patients
transplantation (HSCT). Regular oral pain
assessment using validated instruments for
RADIATION THERAPY - PREVENTION PREVIOUS GUIDELINE UPDATED OR NEW GUIDELINE
The panel recommends that sucralfate not be
used for the prevention of radiation-induced oral mucositis.
lozenges not be used for the prevention of radiation-induced oral mucositis.
2005 Multinational Association of Supportive Care in Cancer TM All Rights Reserved Worldwide. 1
midline radiation blocks and three dimensional radiation treatment to reduce mucosal injury.
prevention of radiation-induced mucositis in patients with head and neck cancer receiving moderate-dose radiation therapy.
chlorhexidine not be used to prevent oral mucositis in patients with solid tumors of the head and neck who are undergoing radiotherapy.
STANDARD-DOSE CHEMOTHERAPY—PREVENTION PREVIOUS GUIDELINE UPDATED OR NEW GUIDELINE
receiving bolus 5-fluorouracil (5-FU) chemotherapy undergo 30 minutes of oral cryotherapy to prevent oral mucositis. The panel suggests that 20 to 30 minutes of oral cryotherapy be used to attempt to decrease mucositis in patients treated with bolus doses of edatrexate.
and its analogues not be used routinely to prevent mucositis.
STANDARD-DOSE CHEMOTHERAPY—TREATMENT PREVIOUS GUIDELINE UPDATED OR NEW GUIDELINE
chlorhexidine not be used to treat established oral mucositis.
2005 Multinational Association of Supportive Care in Cancer TM All Rights Reserved Worldwide. 2 HIGH-DOSE CHEMOTHERAPY WITH OR WITHOUT TOTAL BODY IRRADIATION PLUS HEMATOPOIETIC CELL TRANSPLANTATION—PREVENTION PREVIOUS GUIDELINE UPDATED OR NEW GUIDELINE
In patients with hematological malignancies receiving high dose chemotherapy and total body irradiation with autologous stem cell transplant, the panel recommends the use of Keratinocyte Growth Factor-1 (Palifermin) in a dose of 60 µg/kg/day for 3 days prior to conditioning treatment and for 3 days post-transplant for the prevention of oral mucositis.
The panel suggests the use of cryotherapy to prevent oral mucositis in patients receiving high-dose melphalan.
of pentoxifylline to prevent mucositis in patients undergoing HSCT. None
mouthwashes not be used for the prevention
of oral mucositis in patients undergoing hematopoietic stem cell transplantation.
expensive equipment and specialized training. Because of interoperator variability, clinical trials are difficult to conduct, and their results are difficult to compare; nevertheless, the panel is encouraged by the accumulating evidence in support of LLLT. The panel suggests that, for centers able to support the necessary technology and training, LLLT be used to attempt to reduce the incidence of oral mucositis and its associated pain in patients receiving high-dose chemotherapy or chemoradiotherapy before HSCT.
2005 Multinational Association of Supportive Care in Cancer TM All Rights Reserved Worldwide. 3 GASTROINTESTINAL MUCOSITIS BASIC BOWEL CARE AND GOOD CLINICAL PRACTICES PREVIOUS GUIDELINE UPDATED OR NEW GUIDELINE
The panel suggests that basic bowel care should include the maintenance of adequate hydration, and that consideration should be given to the potential for transient lactose intolerance and the presence of bacterial pathogens.
RADIATION THERAPY—PREVENTION PREVIOUS GUIDELINE UPDATED OR NEW GUIDELINE
It is suggested that amifostine in a dose of at least 340 mg/m2 may prevent radiation proctitis in those receiving standard dose RT for rectal cancer.
sulfasalazine orally twice daily be used to help reduce the incidence and severity of radiation-induced enteropathy in patients receiving external beam radiotherapy to the pelvis.
diarrhea in patients with pelvic malignancies undergoing external beam radiotherapy, and compared with placebo it is associated with more gastrointestinal side effects, including rectal bleeding; consequently, the panel recommends that oral sucralfate not be used.
salicylic acid and its related compounds mesalazine and olsalazine not be used to prevent GI mucositis.
2005 Multinational Association of Supportive Care in Cancer TM All Rights Reserved Worldwide. 4 RADIATION THERAPY—TREATMENT PREVIOUS GUIDELINE UPDATED OR NEW GUIDELINE
enemas be used to help manage chronic radiation-induced proctitis inpatients who have rectal bleeding.
STANDARD-DOSE AND HIGH-DOSE CHEMOTHERAPY—PREVENTION PREVIOUS GUIDELINE UPDATED OR NEW GUIDELINE
or omeprazole for the prevention of epigastric pain following treatment with cyclophosphamide, methotrexate, and 5FU or treatment with 5FU with or without folinic acid chemotherapy.
The panel recommends that systemic glutamine not be used for the prevention of GI mucositis.
STANDARD-DOSE AND HIGH-DOSE CHEMOTHERAPY—TREATMENT PREVIOUS GUIDELINE UPDATED OR NEW GUIDELINE
When loperamide fails to control diarrhea No change induced by standard-dose or high-dose chemotherapy associated with HSCT, the panel recommends octreotide at a dose of at least 100 µg subcutaneously twice daily.
2005 Multinational Association of Supportive Care in Cancer TM All Rights Reserved Worldwide. 5 COMBINED CHEMOTHERAPY AND RADIATION THERAPY—PREVENTION PREVIOUS GUIDELINE UPDATED OR NEW GUIDELINE
used to reduce esophagitis induced by concomitant chemotherapy and radiotherapy in patients with non–small cell lung cancer.
2005 Multinational Association of Supportive Care in Cancer TM All Rights Reserved Worldwide. 6
Specialty Drug List by Disease State Specialty Medications on This List Require Prior Authorization Please fax Specialty Medication Authorization Form and supporting medical records to Delaware Physicians Care at 1-877-861-2611 • This list applies only to medications administered in a physician’s office. • Self-administered injectable medications and home infusion medicati
CLOZARIL: Starting a Patient 1. Call the CLOZARIL National Registry (CNR) to obtain a rechallenge number and to confirm that you and your pharmacy are registered. 2 . Obtain a baseline WBC with ANC from patient. If within normal limits, WBC ≥ 3500/ mm3, ANC ≥ 2000/ mm3, prescribe CLOZARIL tablets. 3. Submit WBC and ANC information to the registered pharmacy. 4. Please be pre