Oral Care for a Better Quality of Life: A Nursing Guideline to Prevent Oral Mucositis in Pediatric Cancer Patients
Keywords:
Oral care, Prevention of mucositis, Children with cancer, Chemotherapy, Oral mucositisAbstract
Oral mucositis is a common and severe side effect in pediatric cancer patients undergoing Oral mucositis is a common and severe side effect in pediatric cancer patients undergoing chemotherapy. It causes significant pain and discomfort, impacting eating, communication, and treatment plans and potentially leading to additional infections and even death. This academic article aimed to present nursing guidelines for preventing oral mucositis. The content included the mechanism of oral mucositis development, risk factors, risk assessment, and nursing guidelines for prevention and promoting oral care behaviors that can be applied to develop clinical practice guidelines to effectively reduce the incidence and severity of oral mucositis in pediatric cancer patients. These recommendations will also help improve the quality of life for pediatric cancer patients and their families.
References
Allen, G., Logan, R., Revesz, T., Keefe, D., & Gue, S. (2018). The prevalence and investigation of risk factors of oral mucositis in a pediatric oncology inpatient population: A prospective study. Journal of Pediatric Hematology/Oncology, 40(1), 15 - 21. https://doi.org/10.1097/ MPH.0000000000000970
Attaran, N., Sharma, A., Morris, M., Dudubo, O., & Macdonald, M. E. (2023). What are the impacts of oral complications from cancer therapy on the quality of life of children? A protocol to update a scoping review. PloS one, 18(11), 1 - 11. https://doi.org/10.1371/journal.pone.0290364
Attinà, G., Romano, A., Maurizi, P., D'Amuri, S., Mastrangelo, S., Capozza, M. A., Triarico, S., & Ruggiero, A. (2021). Management of oral mucositis in children with malignant solid tumors. Frontiers in Oncology, 11, 599243. https://doi.org/10.3389/fonc.2021.599243
Bielack, S. S., Soussain, C., Fox, C. P., Houillier, C., Murciano, T., Osborne, W., Zinzani, P. L., Rizzari, C., & Schwartz, S. (2024). A European consensus recommendation on the management of delayed methotrexate elimination: Supportive measures, leucovorin rescue and glucarpidase treatment. Journal of cancer research and clinical oncology, 150(10), 441. https://doi.org/10.1007/s00432-024-05945-6
Bowen, J. M., Gibson, R. J., Coller, J. K., Blijlevens, N., Bossi, P., Al-Dasooqi, N., Bateman, E. H., Chiang, K., de Mooij, C., Mayo, B., Stringer, A. M., Tissing, W., Wardill, H. R., van Sebille, Y. Z., Ranna, V., Vaddi, A., Keefe, D. M., Lalla, R. V., Cheng, K. K., & Elad, S. (2019). Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). (2019). Systematic review of agents for the management of cancer treatment-related gastrointestinal mucositis and clinical practice guidelines. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer, 27(10), 4011 - 4022. https://doi.org/10.1007/s00520-019-04892-0
Braguês, R., Marvão, M. F., Correia, P., & Silva, R. M. (2024). Oral mucositis management in children under cancer treatment: A systematic review. Cancers, 16(8), 1548. https://doi.org/10.3390/cancers16081548
Chen, C. F., Wang, R. H., Cheng, S. N., & Chang, Y. C. (2004). Assessment of chemotherapy-induced oral complications in children with cancer. Journal of Pediatric Oncology Nursing: Official Journal of the Association of Pediatric Oncology Nurses, 21(1), 33 - 39. https://doi.org/10.1177/1043454203259947
Cidon, E. U. (2018). Chemotherapy induced oral mucositis: Prevention is possible. Chinese Clinical Oncology, 7(1), 1 - 7. https://doi.org/10.21037/cco.2017.10.01
Curra, M., Gabriel, A. F., Ferreira, M. B. C., Martins, M. A. T., Brunetto, A. T., Gregianin, L. J., & Martins, M. D. (2021). Incidence and risk factors for oral mucositis in pediatric patients receiving chemotherapy. Supportive Care in Cancer, 29(11), 6243 - 6251. https://doi.org/10.1007/s00520-021-06199-5
Damascena, L., Lucena, E., Ribeiro, E., Pereira, A., Lima-Filho, J., & Valença, A. (2020). Impact of oral mucositis on quality of life in children with cancer undergoing chemotherapy. BMC Oral Health, 20(1), 1 - 7. https://doi.org/10.1186/s12903-020-01217-5
Docimo, R., Anastasio, M. D., & Bensi, C. (2022). Chemotherapy-induced oral mucositis in children and adolescents: A systematic review. European Archives of Paediatric Dentistry, 23(4), 501 - 511. https://doi.org/10.1007/s40368-022-00727-5
Elad, S., Cheng, K. K. F., Lalla, R. V., Yarom, N., Hong, C., Logan, R. M., Bowen, J., Gibson, R., Saunders, D. P., Zadik, Y., Ariyawardana, A., Correa, M. E., Ranna, V., & Bossi. P., (2020). Mucositis Guidelines Leadership Group of the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO). MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer, 127(19), 4423 - 4431. https://doi.org/10.1002/cncr.33100
Eilers, J., Berger, A. M., & Petersen, M. C. (1988). Development, testing, and application of the oral assessment guide. Oncology Nursing Forum, 15(3), 325 - 330.
Howard, S. C., McCormick, J., Pui, C. H., Buddington, R. K., & Harvey, R. D. (2016). Preventing and managing Toxicities of high-dose methotrexate. The Oncologist, 21(12), 1471 - 1482. https://doi.org/10.1634/theoncologist.2015-0164
Hu, Z., Escalera-Joy, A. M., Ashcraft, E., Acharya, R., Jeha, S., Cheng, C., & Pui, C. H. (2024). Clinical risk factors for high-dose methotrexate-induced oral mucositis following individualized dosing. Cancer Medicine, 13(21), 1 - 15. https://doi.org/10.1002/cam4.70351
Hurrell, L., Burgoyne, L. L., Logan, R. M., Revesz, T., & Gue, S. (2022). Factors associated with oral mucositis severity in children who have received chemotherapy. Journal of Pediatric Hematology/Oncology, 44(8), e1016 - e1022. https://doi.org/10.1097/MPH.0000000000002392
Kostak, M. A., Semerci, R., Eren, T., Kocaaslan, E. N., & Yildiz, F. (2020). Effects of oral health care education on the severity of oral mucositis in pediatric oncology patients. Turkish Journal of Oncology, 35(4), 422 - 429. https://doi.org/10.5505/tjo.2020.2366
Kwiensungnoen, P., Kantawang, S., & Niyomka, S. (2020). Effect of oral mucositis management program on symptom status of children with cancer receiving chemotherapy. Nursing Journal, 47(1), 101 - 112. https://he02.tci-thaijo.org/index.php/cmunursing/article/view/240730
Lemos, F.B., Silva, A.C., Lima, F.P., Machado, F.C., Pereira, L.L., Caldas, A.F., Santos, B.B., & Figueiredo, A.C. (2024). Depressive symptoms and oral mucositis in children with oncological diseases: a cross-sectional study. Brazilian Oral Research, 38, e033. https://doi.org/10.1590/1807-3107bor-2024.vol38.0033
Lertwongpaopun, W. (2003). The effects of an oral care program on stomatitis in acute myeloid leukemia patients undergoing chemotherapy [Master’s thesis]. Mahidol University.
Mazhari, F., Shirazi, A. S., & Shabzendehdar, M. (2019). Management of oral mucositis in pediatric patients receiving cancer therapy: A systematic review and meta-analysis. Pediatric Blood & Cancer, 66(3), 1 - 16. https://doi.org/10.1002/pbc.27403
Niyomkha, S. (2020). Basic knowledge and nursing care for pediatric cancer patients. [Master’s thesis]. Chiang Mai University
Otmani, N., & Hattad, S. (2021). Clinical outcome in children with chemotherapy-induced mucositis. Seminars in Oncology Nursing, 37(3), 151160. https://doi.org/10.1016/j.soncn. 2021.151160
Paiva, B.S., Barroso, E.M., Cadamuro, S.A., Paula, L.A., Pirola, W.E., Serrano, C. V., & Paiva, C.E. (2018). The children’s international mucositis evaluation scale is valid and reliable for the assessment of mucositis among Brazilian children with cancer. Journal of Pain and Symptom Management, 56(5), 774 - 780.e2. https://doi.org/10.1016/j.jpainsymman.2018.07.015
Paprom, W., & Tangvoraphonkchai, J. (2014). The effect of an oral mucositis care innovation on caregivers' care behavior among pre-school children with leukemia receiving consolidation phase chemotherapy. Journal of Nursing Science & Health, 37(1), 21 - 29. https://he01.tci-thaijo.org/index.php/nah/article/view/19745
Patel, P., Robinson, P. D., Baggott, C., Gibson, P., Ljungman, G., Massey, N., Ottaviani, G., Phillips, R., Revon-Rivière, G., Treister, N., White, M., Cabral, S., Dupuis, L., & Sung, L. (2021). Clinical practice guideline for the prevention of oral and oropharyngeal mucositis in pediatric cancer and hematopoietic stem cell transplant patients: 2021 update. European Journal of Cancer (Oxford, England: 1990), 154, 92-101. https://doi.org/10.1016/j.ejca.2021.05.013
Pulito, C., Cristaudo, A., Porta, L. C., Zapperi, S., Blandino, G., Morrone, A., & Strano, S. (2020). Oral mucositis: The hidden side of cancer therapy. Journal of Experimental & Clinical Cancer Research, 39(1), 210. https://doi.org/10.1186/s13046-020-01715-7
Sirisamut, T., (2022). Toxicity of methotrexate. Thai Journal of Hospital Pharmacy, 32(2), 126 - 132. https://he02.tci-thaijo.org/index.php/TJHP/article/view/254773
Soares, J. B., de Farias Gabriel, A., Kirschnick, L. B., Carrard, V. C., Curra, M., Schuch, L. F., Martins, M. A. T., & Martins, M. D. (2025). Oral mucositis assessment in pediatric and adolescent oncological patients: A systematic review. Pediatric Blood & Cancer, 72(1), e31388. https://doi.org/10.1002/pbc.31388
Sonis, S. T. (2004). The pathobiology of mucositis. Nature Reviews Cancer, 4(4), 277 - 284. https://doi.org/10.1038/nrc1318
Thailek, T., Wiroonpanich, W., & Punthmatharith, B. (2021). Effects of mobile application for enhancing oral care self-efficacy on preventive behavior and occurrence of oral mucositis in school-aged children with cancer receiving chemotherapy. Songklanagarind Journal of Nursing, 41(1), 37 - 53. https://he02.tci-thaijo.org/index.php/nur-psu/article/view/247167
Tomlinson, D., Gibson, F., Treister, N., Baggott, C., Judd, P., Hendershot, E., Maloney, A. M., Doyle, J., Feldman, B., & Sung, L. (2009). Designing an oral mucositis assessment instrument for use in children: generating items using a nominal group technique. Supportive care in cancer: Official journal of the Multinational Association of Supportive Care in Cancer, 17(5), 555 - 562. https://doi.org/10.1007/s00520-008-0523-0
Traivaree, C., Likasitthananon, N., Monsereenusorn, C., & Rujkijyanont, P. (2018). The effect of intravenous hydration strategy on plasma methotrexate clearance during intravenous high-dose methotrexate administration in pediatric oncology patients. Cancer Management and Research, 10, 4471 - 4478. https://doi.org/10.2147/CMAR.S172117
Valer, J. B., Curra, M., Gabriel, A. F., Schmidt, T. R., Ferreira, M., Roesler, R., Evangelista, J., Martins, M., Gregianin, L., & Martins, M. D. (2021). Impact of an oral care program on oral mucositis in cancer schoolchildren being treated with chemotherapy. International Journal of Pediatrics Dentistry, 31(2), 238 - 246. https://doi.org/10.1111/ipd.12718
Valéra, M. C., Noirrit-Esclassan, E., Pasquet, M., & Vaysse, F. (2015). Oral complications and dental care in children with acute lymphoblastic leukaemia. Journal of Oral Pathology & Medicine, 44(7), 483 - 489. https://doi.org/10.1111/jop.12266
Vetcho, S., Hongchayangkoo, K., Orapiriyaku, R., & Wongchanchailert, M. (2014). Effects of oral health care program on oral mucositis in school-age children with cancer receiving chemotherapy. Thai Journal of Nursing Council, 29(2), 61-71. https://he02.tci-thaijo.org/ index.php/TJONC/article/view/21119
World Health Organization. (1979). WHO handbook for reporting results of cancer treatment. Author.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Princess of Naradhiwas University Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
