Incidence and risk factors of oral mucositis in paediatric and adolescent patients undergoing chemotherapy

There is a dearth of studies with respect to oral mucositis (OM) in the paediatric and adolescent populations. The purpose of this prospective cohort study was to examine the incidence and risk factors associated with OM in paediatric and adolescent patients receiving chemotherapy.

OM assessments were made daily until 14 days after chemotherapy using the self-report Mouth and Throat Soreness-Related Questions of the Oral Mucositis Daily Questionnaire (OMDQ MTS). Potential risk factors included age, gender, prior OM, anxiety level, cancer diagnosis, nausea/vomiting, use of growth factor, neutrophil count, liver enzymes, and creatinine value. Multiple logistic, Cox proportional hazards, and ordinal regression analyses were used to determine risk factors for the incidence and time to onset of MTS scores of ⩾2, and MTS scores across 14 days by AUC categories, respectively, after adjusting for chemotherapy.

A total of 140 patients who were 6–18 years of age were evaluated. Forty-one percent (95% CI, 32.6–48.8%) developed OM; of these, 23% and 18% reported a maximum MTS score of 2 and 3–4 as the worst OM, respectively. The mean time to onset of OM was 4.7 ± 2.7 days with a mean duration of 6.3 ± 4 days. Prior OM (RR 1.90–3.94), a higher level of anxiety (RR 1.27–1.46), WHO grade 1–2 (RR 1.86–4.59) and 3–4 (RR 3.08–9.19) neutropenia were significantly associated with a higher probability of the incidence, earlier onset, and greater severity of OM, after controlling for chemotherapy (p < 0.01).

OM was associated with indirect cytotoxicity, prior OM, and anxiety level after controlling for chemotherapy where neutropenia was found to be the most important factor.