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Epidemiology, patient adherence, and costs of oral mucositis in routine care in stem cell transplantation

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Abstract

Purpose

Limited data about oral mucositis (OM) in stem cell transplant patients with underlying hematological disease is available in Germany. The purpose of this feasibility study was to determine the incidence, treatment patterns, patients’ adherence, and costs of OM.

Methods

Prospective, noninterventional single-center observational study. Inclusion criteria: allogenic/autologous stem cell transplant patients ≥ 18 years, high-dose chemotherapy. OM assessment: WHO Oral Toxicity Scale. Adherence was measured in patient interviews. Preventive and therapeutic measures were extracted from patients’ charts.

Results

Forty-five patients (25 allogenic, 20 autologous) were enrolled. Twenty-six (58%) patients developed OM (54% grade I/II, 46% grade III/IV). Age ≥ 65 (31% vs 69%, p = 0.021) was associated with a lower OM incidence. A positive history of smoking (1.77 vs 2.69, p = 0.036) was associated with a lower OM grade, patients with unrelated donors (2.63 vs 1.29, p = 0.014) were associated with higher OM grades and females (80% vs 47%, RR = 1.71, p = 0.035) with a higher incidence. OM patients were less adherent to recommended daily mouth rinses (35% vs 68%, p = 0.027). More analgesic treatment (80% vs 32%, p = 0.001) and intravenous opioids (24% vs 0%, p = 0.023) were prescribed in OM patients. Total drug treatment and nutrition costs were 824€ (p = 0.037) higher in autologous transplanted patients.

Conclusion

Initial risk and consecutive OM assessment, determination of patients’ adherence, resource consumption, and costs are prerequisites to evaluate OM care. In the best case, several centers will follow the same methodological approach and the collected data will serve as a basis for benchmarking analyses to optimize OM care where required.

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Author notes

  1. K. Berger and T. Staudenmaier contributed equally to this work.

Authors and Affiliations

  1. Department of Medicine III, University Hospital, LMU Munich, Munich, Germany

    K. Berger, T. Staudenmaier, I. Cenzer & H. Ostermann

  2. Institute of Medical Data Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany

    A. Crispin

  3. University Hospital of Munich, Hospital Pharmacy, Munich, Germany

    D. Strobach

  4. Department of Hematology/Oncology, University Hospital of Munich, Marchioninistraße 15, 81377, Munich, Germany

    H. Ostermann

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  1. K. Berger
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Ethics committee of the Faculty of Medicine, Ludwig-Maximilians-University Munich, 345-16) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Berger, K., Staudenmaier, T., Cenzer, I. et al. Epidemiology, patient adherence, and costs of oral mucositis in routine care in stem cell transplantation. Support Care Cancer 28, 3113–3123 (2020). https://doi.org/10.1007/s00520-019-05107-2

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