Determinants of severe oral mucositis in paediatric cancer patients: a prospective study

Objective. To analyse the incidence and the determinants of severe oral mucositis (OM) in young cancer patients treated by standard chemotherapy. Methods. The study was carried out at the Pediatric Hemato-Oncology unit of Children's Hospital of Rabat. Patients under 16 years of age with malignant disease treated by chemotherapy between January 2001 and December 2006 were recorded. Results. Consecutive patients (n = 970) with malignant disease were studied. The age ranges from 2 months to 16 years (mean, 6.8 +/- 4.1 years). OM occurred in 540 (55.6%) patients, and 17.9% of them encountered severe grades. Mean time to onset of the lesions was 10.5 +/- 6.8 (range, 1-22 days) and mean duration was 6.8 +/- 3.1 (range, 2-23 days). All chemotherapeutic protocols were associated with OM development (range, 20-100%). Patients with severe OM were more likely to have undifferentiated carcinoma of nasopharyngeal type (RR = 2.6, 95% IC 1.1-6.1), non-Hodgkin lymphoma (RR = 2.1, 95% CI 1.2-2.4) and acute leukaemia (RR = 1.7, 95% CI 1.5-3.6). Methotrexate-based therapies were also associated with the worsening of OM (RR = 1.7, 95% IC 1.2-2.6). Conclusion. Underlying disease and chemotherapy regimens are the principal risk factors of OM development. This model can help in the identification of patients at risk for adequate preventive and therapeutic measures.