Mucositis Pain Moderate After Transplant but Hard to Treat

NEW ORLEANS--Oral pain and mucositis occur predictably after bone marrowtransplant for leukemia, and although the pain is usually described asmild to moderate, it is unlikely to be completely relieved, Deborah B.McGuire, PhD, of Emory University, said at the Oncology Nursing Society's22nd Annual Congress.

The Emory study consisted of 18 cancer patients admitted for a bonemarrow transplant (14 patients) or high-dose chemotherapy (4 patients).Pain was assessed at four time intervals: baseline, during chemotherapy,seven days postchemo-therapy, and at least seven days postche-motherapy(to the study's end).

Two thirds of the patients reported pain at the third and fourth timeperiods (post-chemotherapy). Patients most commonly described the acuteoral pain as "tender, irritating, and sore." The pain variedin intensity from one interval to the next but never exceeded "moderate."

Despite numerous treatment strategies, the pain was only partially relieved,Dr. McGuire reported. Patients tended to use "mouth care" and"mental activity" as much as medication for pain relief, shesaid.

Mucositis was relatively mild, affecting mostly the lateral tongue andthe buccal and labial mucosa. It worsened at the two post-chemotherapytime points.

A Yale University Cancer Center study, also reported at the meeting,found that mucositis and oropharyngeal pain occurred in 83% of patientstreated for head and neck cancers with combination chemotherapy, most withradiation therapy as well.

Eighteen of the 35 patients in the study were hospitalized for dehydration,mucositis, and pain, said investigators Susan A. DiStasio, RN, and DennisL. Cooper, MD.

Supplemental nutrition was required by 60% of patients: 40% with a G-tubeand 20% with total parenteral nutrition. Mean weight loss for the patientswas 7.4 kg, peaking in the fifth week of radiotherapy.