While cytotoxic (chemotherapeutic) drugs and chemical agents provide cancer patients with symptoms reducing and/or curative treatments for their disease, these therapies can cause a broad spectrum of unwanted side-effects. One class of chemotherapy-caused patient discomfort is related to inflammations and/or ulcerations of the upper gastrointestinal (GI) tract that includes anatomical structures and surrounding soft tissues from the lips to the stomach. The medical terms for these chemotherapy side-effects are as noted below:
- Mucositis: This term refers to irritations to or perforations of all mucous linings within the upper GI tract
- Esophagitis: A reference to inflammations or ulcerations of the esophagus
- Stomatitis: Inflammations or open sores of the mouth
While some cancer patients who are receiving chemotherapy will not experience any of the medical conditions noted above, many other patients will have to cope with one or more of these upper GI disturbances. When such side-effects do present, it is essential for physicians and other health care professionals to treat and ameliorate the condition(s) as soon as possible. Mouth or other upper GI inflammations can escalate quickly into ulcerations that can lead to infection, a complication that must be avoided by cancer patients whose chemotherapeutic treatments have severely compromised their immune system.
Chemotherapy-caused mucositis, esophagitis, and stomatitis can have a negative impact on a cancer patient’s ability to communicate through speech, and simultaneously, interrupt a cancer patient’s oftentimes critically important nutrition program. Difficulties related to tasting, chewing, and swallowing must be addressed quickly and effectively in order to maintain a cancer patient’s ability to take nutrients by mouth.
Unfortunately, there exists no single medicinal agent or other treatment that can wholly prevent or cure mucositis, esophagitis, and stomatitis, though, fortunately, these are all self-limiting medical conditions that diminish naturally over time. It is the health care professional’s job to minimize the severity and duration of chemotherapeutic-caused upper GI disturbances, thus increasing a patient’s quality of life while avoiding dangerous infections prior to natural healing.
Preventive Measures that Help
As outlined below, there are a number of behaviors a cancer patient can adopt in order to minimize the onset, severity, and duration of chemotherapy-caused upper GI inflammations and ulcerations:
- Maximize oral hygiene: After each meal and before bedtime, clean the teeth and gums using a very soft toothbrush, which can be further softened by soaking the brush in hot or warm water. Some patients may use cotton mouth swabs or tongue depressors wrapped with surgical gauze as a teeth and gum tissue cleaning/massaging device. Thoroughly clean all dentures or removable partial dental appliances/plates after each meal-some patients will experience greater overall comfort by only utilizing their dentures or appliances for eating. Flossing should be done gently using unwaxed material, and a Water-Pik can be used by those chemotherapy patients whose blood is clotting normally.
- Keep lips and mouth moist: Chemotherapy patients should rinse their mouth with water every two hours during the day and whenever awakened during the night. Adding ½ to 1 teaspoon of salt or baking soda per 8 ounces of water is also recommended. For those patients who experience extreme dry mouth, the use of synthetic saliva can help, as can sucking on hard candies. Special care should be taken to keep the lips from becoming dry and cracked-lip moisturizers should be applied often, and patients should always avoid licking their lips.
- Products and foods to avoid: To minimize mucositis, esophagitis, and stomatitis occurrence and severity, chemotherapy patients should avoid the following: mouthwashes or medications that contain alcohol; glycerin swabs that contain lemon; course or rough textured foods; foods that are heavily spiced; very hot or cold foods or liquids; citrus foods or liquids-oranges, grapefruits, lemons, and juices thereof; foods high in citric acid such as tomatoes, and alcohol or tobacco use.
Treatments that Can Help
While chemotherapy-caused upper GI disturbances cannot always be prevented, outlined below are a number of over-the-counter and prescription treatments, as well as dietary suggestions, that have proven to be effective in decreasing patient discomfort:
- Mouth sore pain relief using liberal applications of topical agents such as Orajel or Zilactin-B
- Home compounded mouthwash made from equal parts of xylocaine solution, alcohol free Zovirax, and an antacid such as Mylanta or Maalox
- “Magic” mouthwash
- Healing analgesics such as Orabase or Ulcerase applied directly to sores of the mouth and lips
- Vitamin E applications to open sores of the mouth and lips
- Maintain a regular regimen of antacid use for burning in the stomach
- Consult with your physician about antifungal drugs such as nystatin, fluconozole, and clotrimizole
- Doctor recommended antiviral (infection preventing) drugs such acyclovir or famciclovir
- Prescription gastrointestinal agents such as sucralfate for severe stomach or mouth inflammations
- Prescription analgesics for severe pain
- Maintain a diet of high calorie/high protein foods that are soft or partially liquid such as lightly scrambled eggs, puddings, pureed foods, and liquid supplement drinks and shakes
Management of Mucositis
There are basically three areas that will need to be managed: oral hygiene, preventing discomfort, and avoiding those factors that can aggravate the symptoms or contribute to discomfort.
Oral hygiene
- Two hourly mouth rinses with water to which salt or baking soda is added. Ask your doctor which concentration would be most suitable for your patient.
- Keep the teeth and mouth clean by using a soft bristle tooth brush, especially after each meal. Be gentle. Toothbrushes used for babies are the softest and because the heads of these brushes are very small, it will alleviate the gagging that may be caused by introducing an object into the mouth.
- If the patient uses dentures, remove, clean, dry, and then replace these.
- Use wet cotton swabs or soft gauze instead of harsh materials to clean or wet the sores. Soft gauze is a probably a better option as it will leave no fluff behind, but if the patient is too sensitive you may have to use the cotton swabs instead.
It is important to monitor the mucositis symptoms closely. If it worsens, immediately call the doctor. Keep a lookout for the following indicators:
- Fever above 100 degrees F (38 degrees C)
- Increased discomfort during eating or swallowing
- Pain or dryness in the mouth in spite of precautions
- Any abnormal symptoms other than above.
Preventing discomfort
The patient should me made as comfortable as possible until the symptoms subside. Never underestimate the value of comfort. Comfort affects the emotional and mental state of the patient, and as such also the speed of recovery.
Several steps can be taken to make Mucositis more bearable. If your patient experiences saliva reduction, use one of the substitutes available at drugstores to keep the mouth and throat from feeling too dry. Commercial topical agents and non-irritating mouth washes can be used to numb the pain and uneasy feeling. Gargle with these solutions at least every two hours to keep the mouth and Esophagus wet, thus soothing the condition to a large extent.
Consult with the doctor if the mesothelioma patient requires saliva substitutes, topical agents and non-irritating mouthwashes.
What to avoid
- Never use a mouth wash that contains alcohol. To be on the safe side, use those recommended by the doctor only.
- Alcohol and tobacco are poisonous and should be completely avoided.
- Cough syrups that contain alcohol can irritate the mucous membranes. Soothing compounds or jellies can be used instead.
- Spicy-, acidy-, coarse- and roughage containing foods cause friction, and subsequently pain. Soft, bland foods are a better alternative.
- Very hot or very cold soft drinks, soda, tea, coffee and so forth are possible irritants. Only drink slightly warm or room temperature beverages. Eight to twelve glasses of room temperature water should be preferred over other beverages.
- Foods and liquids containing tomatoes, oranges, lemons and other citrus fruits will irritate the soft, sore tissues, and must not be taken while the Mucositis symptoms are prevalent.
Infection can be prevented by means of various antibiotic drugs and creams such as nystatin, fluconozole, antiseptics, other antivirals etc. Should gastrointestinal infections occur, it may become necessary to administer analgesics (pain killers) as well as soothing drugs to minimize the irritation of the mouth and stomach.
The rule here is that the type of supplements – drugs and ointments – as well as the frequency of administering these, will be specific to the patient’s condition. The doctor will prescribe the most appropriate treatments with which to achieve maximum relief.
