Cancer treatment usually consists of radiation and chemotherapy. Although the treatments are extremely effective, they have their own severe side effects such as hair loss, inflammation, weight loss, and even oral mucositis or mouth sores. Oral mucositis is commonly observed in patients suffering from cancer of the oral cavity, nasopharynx, head, and neck. It is characterized by inflammation of the mouth and ulceration of the mucous membrane. This condition greatly affects the quality of life of the patient as well as the concerned family. Being painful may also alter speech and eating habits of the patient; along with causing local and systemic infection.
Ever since the introduction of radiation therapy, oral mucositis has been studied in depth by researchers and doctors in order to reduce its recurrence, this has led to many breakthrough discoveries. One such study by Mayo Clinic states that rinsing the mouth with anti-depressant doxepin helps considerably to ease the pain caused by oral mucositis in patients receiving radiation therapy for head and neck cancer.
Signs and Symptoms
Once the radiation therapy begins, patients may start showing symptoms as early as 5th or 6th day of treatment; but oral mucositis symptoms usually occur at the end of the second week and the condition may last up to 6 to 8 weeks.
Due to radiation, cell death occurs, leading to thinning of the mucosal lining in the mouth. After some time, the lining may slough off causing it to become inflamed, red, and ulcerated. These ulcers may be covered by a thin fibrin clot known as pseudomembrane. The size of the ulcer usually ranges from 0.5 cm to large 4 cm. Oral mucositis is extremely painful and the severity of pain is dependent on the extent of tissue damage. Patients usually feel a burning sensation along with redding of the ulcers. Effects of oral mucositis include;
- Severe pain
- Difficulty in speaking
- Inability to chew food, therefore liquid diet intake
- Difficulty in opening mouth
- Dysgeusia; alteration in taste perception
Curing Oral Mucositis: New Study
The painful oral mucositis does not have any cure and has to be endured by patients. But according to a new study by Mayo Clinic, an oral rinse with antidepressant doxepin can actually help alleviate the oral mucositis pain. The findings of this study were presented at the annual meeting of the American Society for Radiation Oncology at Boston. According to Robert Miller, M. D, and principal investigator, the new findings will help to raise the bar for the treatment of radiation side effects. Other researchers involved with the study included Rui Qin Ph. D, James Martenson, M.D, Robert Foote, M. D, and Charles Loprinzi, M. D.
Dr. Miller observes that rinsing with doxepin does not cause side effects which are usually associated with narcotic pain medication. The effectiveness of doxepin oral rinse was studied in comparison to placebo in 155 patients who were suffering from cancer and had thus received radiation therapy. A single-blinded dose of doxepin on day one was administered to patients, and on a subsequent day were crossed over to the opposite study arm. On a pain questionnaire with a scale from 0 to 10, patients reported pain due to oral mucositis at baseline and later at 5, 15, 30, 60, 120, and 240 minutes after an oral rinse with doxepin. 64% of patients continued the use of doxepin even after the end of the study. According to patient reports, doxepin was well tolerated although a few side effects were felt such as burning, stinging, and unpleasant taste along with drowsiness.
Oral mucositis is a painful condition and its treatment available is mainly supportive such as maintaining oral hygiene, lubricating the mouth with water jellies, salt mouthwash to soothe pain, and avoid infection due to food particles and increasing the intake of liquids. The above study and its results can be a major breakthrough in treating oral mucositis and thus providing relief to neck and head patients receiving radiation therapy.