Mucositis
Factors Affecting Mucositis

A number of factors contribute to the likelihood of mucositis.

1. Treatment related factors
2. Individual related factors

Treatment related factors

Not all cancer treatments cause mucositis. Radiation therapy fields or treatment areas that include the oral cavity are likely to cause mucosal membrane changes, especially if the person is also receiving chemotherapy. If radiation therapy is given to an area of the body that does not include mucous membranes it will not cause mucositis.

When it comes to the medications or drugs that are used for cancer treatment (chemotherapy), the likelihood of mucositis depends on the specific drugs, dose, and schedule of how they are taken. Not all chemotherapy causes mucositis even when given in very high doses. Your healthcare provider will tell you if the drugs that you are taking or planning to take may put you at risk for developing mucositis

When drugs that can cause mucositis are given in higher doses and treatments that last over many days they are more likely to cause mucositis. For example, a one-time dose of 5 fluorouracil (5 FU) is not likely to cause mucositis. However, a treatment schedule that involves five days of therapy with 5 fluorouracil, or receiving it round-the-clock for up to 30 days is much more likely to cause oral mucositis. The length of recovery time between cancer treatments also affects mucositis. ¹, ², ³, ⁵, ⁶, ⁷, ⁸, ¹⁰

Factors related to the individual

Age - young children and people who are elderly are more likely to have problems with mucositis. The mucous membranes in the mouths of children seem to breakdown more rapidly because their cells are normally replaced at a faster rate. They also tend to heal or recover more rapidly. Elderly people may not experience breakdown as soon because their cells turn over at a slower rate. However healing tends to be slower and thus they take longer to recover.

Condition of the oral cavity prior to cancer treatment -- the healthier and cleaner the oral cavity is the less likely the person is to develop severe problems with mucositis. Along this same line, frequent oral care is also important. Doing good oral care regularly decreases the severity of mucositis problems. People who have had mucositis problems with cancer treatment in the past are more likely to have problems again. This is probably related both to increased sensitivity of the mucous membranes and the fact that the tissue may not have fully recovered from the earlier damage. Poor fitting dental prosthesis (dentures or partials) cause additional irritation and increase the chances of problems with mucositis.

In addition, people who have a dry mouth because the glands that make saliva are not working normally are more likely to have problems with mucositis. ¹, ², ³, ⁵, ⁶, ⁷, ⁸, ¹⁰

Additional individual factors

Genetic factors: a person's genetic make-up also is believed to make a difference in mucositis. Some people may be more sensitive to the mucositis damage caused by the cancer treatments.

Organ function: also can make a difference for mucositis. If a person's kidneys are not working well mucositis may be more likely and more severe.

Tobacco use: chewing and smoking tobacco causes oral cavity changes and increases the likelihood of problems with mucositis.

Gender: Women may also have a slightly increased risk of developing mucositis

Nutritional status: Body mass index as a measure that uses height, weight, age, and gender is an indication of the nutritional status of a person. - People who have a poorer nutrition status are more likely to develop problems and are less able to heal

Other medical treatments can also increase the chances of oral cavity changes including mucositis. These treatments include oxygen, steroids, and a special type of medications called anticholinergic agents. Your healthcare provider can tell you if you are on any anticholinergic medications. ¹, ², ³, ⁵, ⁶, ⁷, ⁸, ¹⁰

Understanding the risk factors that affect mucositis can help you to know if you are likely to develop problems in your mouth. Some of these risk factors such as oral care are controllable (that is you can change). You cannot change other risks such as what cancer medications you receive. If you focus on doing what you can, it will make a difference. You can decrease the problems you will experience with changes in your mouth.