Mucositis in palliative care
Mucositis is inflammation of the mucosal surfaces of the mouth or oral cavity, which commonly causes ulceration and results in significant problems with eating, drinking and taking oral drugs.
Patients with palliative care needs who have mucositis generally present with a painful mouth, but loss of appetite or altered taste may be the only initial complaint. Causes of mucositis include dry mouth, radiotherapy, chemotherapy and other drugs, and infections (fungal, viral or bacterial). In most instances, a history and careful examination clarifies the cause.
Management of mucositis includes treatment of both the cause and symptoms and depends on potential benefits and burdens of treatment and the patient’s prognosis, preferences and goals of care—see Principles of symptom management in palliative care. Treatments should involve all affected surfaces—mouthwashes or systemic treatments may be required.
Manage symptoms of dry mouth and treat oral candidiasis if present. If a topical anti-inflammatory or analgesic mouth solution is needed for mucositis in patients with palliative care needs, use:
1benzydamine 0.15% solution 15 mL rinsed in the mouth for 30 seconds then spat out, 1.5- to 3-hourly as necessary (dilute with 15 mL of water if stinging occurs) benzydamine
OR
2lidocaine 2% viscous solution, use the lowest dose necessary up to 15 mL, rinsed in the mouth for 30 seconds then spat out, 3-hourly as necessary; maximum 8 doses in 24 hours. lidocaine
Patients with severe mucositis may require opioid therapy (either parenterally or as a mouthwash), or ketamine mouthwash; seek specialist palliative care adviceSlatkin, 2003.