NEW ORLEANS--Oral pain and mucositis occur predictably after bone marrow transplant for leukemia, and although the pain is usually described as mild to moderate, it is unlikely to be completely relieved, Deborah B. McGuire, PhD, of Emory University, said at the Oncology Nursing Society's 22nd Annual Congress.
The Emory study consisted of 18 cancer patients admitted for a bone marrow 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 time periods (post-chemotherapy). Patients most commonly described the acute oral pain as "tender, irritating, and sore." The pain varied in 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, she said.
Mucositis was relatively mild, affecting mostly the lateral tongue and the buccal and labial mucosa. It worsened at the two post-chemotherapy time points.
A Yale University Cancer Center study, also reported at the meeting, found that mucositis and oropharyngeal pain occurred in 83% of patients treated for head and neck cancers with combination chemotherapy, most with radiation 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 Dennis L. Cooper, MD.
Supplemental nutrition was required by 60% of patients: 40% with a G-tube and 20% with total parenteral nutrition. Mean weight loss for the patients was 7.4 kg, peaking in the fifth week of radiotherapy.