Mucositis associated with mesothelioma chemotherapy

Mucositis is an infection that impacts the digestive tract – from the mouth, through to the anal cavity. More than a third of all patients who receive chemotherapy contract Mucositis.

Mucositis can occur anywhere in the digestive tract. If the oral cavity is affected, this discomfort is characterized by a sore mouth and ulceration that can affect the soft tissue of the mouth (mucous membranes) and the throat, including the gullet through which food travels to the stomach. If the infection is lower down the digestive tract, symptoms such as diarrhea or constipation may occur.

Mucositis normally appears around the fourth or fifth day after a chemotherapy treatment. The condition normally worsens rapidly and reaches a peak between the tenth and twelfth day.

Because the upper digestive tract is the most common area for infection and causes the greatest discomfort, it will be the main focus of this section.

When speaking about Mucositis, doctors often mention the terms Stomatitis and Esophgitis. Stomatitis is the medical term used for the mouth ulcers and soreness the patient suffers from, and Esophgitis is the term used for food pipe ulceration. These are part of the patient’s Mucositis condition and should not be interpreted as being in addition to that which the patient is already suffering from. Mucositis makes it difficult for the patient to chew, swallow, talk, eat and drink. Fortunately the symptoms need not be chronic and respond well to treatment.

When treating Mucositis, the doctor will focus on reducing the severity of the symptoms and will in all likelihood treat for secondary infections as opposed to treating the condition itself. During this time, managing the condition properly will help to reduce the discomfort experienced by the patient and assist in preventing the development of secondary infections.

Management of Mucositis

There are basically three areas that will need to be managed while the patient is afflicted with Mucositis. These are 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.

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 your 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.

Healing can be accelerated by using the correct medicines, ointments and jellies. 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 your patient’s condition. The doctor will prescribe the most appropriate treatments with which to achieve maximum relief.

It is important to monitor the Mucositis symptoms closely. If it worsens, immediately call the doctor thus ensuring a timely intervention. As a guideline, 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.

When carefully managed, mucositis can be completely overcome within six to eight weeks, depending on the strength of the patient’s immune system.

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