An interdisciplinary collaboration updates clinical practice guidelines for mucositis

NEW ORLEANS—A systematic evaluation of the literature produced updated evidence-based clinical practice guidelines for preventing and treating mucositis, according to researchers at the Oncology Nursing Society 37th Annual Congress.

Mucositis is a clinically significant, dose-limiting toxicity of cancer therapy. Oncology nurses play a critical role in managing the condition and its associated symptoms and complications. Although various interventions have been recommended, the supporting evidence for many of them is weak.

The Mucositis Study Group of the Multinational Association for Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO), based in Farmington, Connecticut, published its first guidelines for the prevention and treatment of mucositis in 2004, updated them in 2007, and in 2011, has undertaken a comprehensive review and update of those guidelines.

A multidisciplinary group of approximately 100 members of MASCC/ISOO, which is based in Farmington, Connecticut, participated in an evaluation of the literature. The reviewers underwent training and calibration via a review of their evaluations of two sample papers to ensure all reviewers would apply the review criteria consistently.

The 8000 papers selected were indexed in Medline up to December 2010, and all the studies had defined inclusion/exclusion criteria. Each paper was independently evaluated by two reviewers who extracted the data onto a standard electronic form. The Hadorn criteria were used to evaluate each paper for major and minor flaws. Discrepancies were adjudicated by a third reviewer.

Review findings were integrated into guidelines based on the overall level of evidence for each intervention, using the Somerfield criteria, and classified as recommendations, suggestions, or no guideline possible. Additional distinctions were prevention or treatment of mucositis, cancer treatment modality, and route of administration of the intervention.

The use of lasers, doxepin and morphine mouth rinses, and transdermal fentanyl are recommended; however, use of chlorhexidine was found to be ineffective and is no longer recommended. Information is available at; nurses can also e-mail Rajesh V. Lalla, BDS, PhD, ( assistant professor, Division of Oral Medicine of the University of Connecticut Health Center, for more information.

This research was underwritten/funded by Helsinn Healthcare SA and BioAlliance Pharma.

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