Oral Mucositis in Cancer Patients: Prevention and Treatment

Abstract

Oral mucositis is a common and potentially severe complication of cancer therapy, particularly affecting high-risk populations such as pediatric patients, hematopoietic stem cell transplant recipients, and individuals with head and neck cancer. The incidence and severity of oral mucositis vary depending on cancer type, treatment modality, dose intensity, and patient-related factors, with the highest burden observed in head and neck cancer patients undergoing chemoradiotherapy. The pathogenesis of oral mucositis is complex and involves a multistep biological process characterized by epithelial injury, generation of reactive oxygen species, activation of pro-inflammatory cytokines, signal amplification, ulceration, and subsequent healing. These pathological changes compromise oral mucosal integrity and contribute to secondary infections and nutritional difficulties. Various preventive and therapeutic strategies have been investigated to mitigate oral mucositis. Evidence from randomized controlled trials and systematic reviews supports the use of preventive measures such as oral cryotherapy, low-level laser therapy (photobiomodulation), benzydamine mouthwash, and keratinocyte growth factor (palifermin) in selected patient populations. In addition, nutritional supplements and natural agents, including honey, glutamine, zinc, aloe vera, and probiotics, have demonstrated potential benefits, although clinical outcomes remain heterogeneous. Management of established oral mucositis is primarily supportive and focuses on pain control, maintenance of oral hygiene, prevention of infection, and preservation of nutritional status. Current international guidelines emphasize a multidisciplinary, evidence-based approach for optimal prevention and management. Despite advances in supportive care, oral mucositis continues to pose a significant clinical challenge, highlighting the need for standardized assessment tools, personalized interventions, and further high-quality research to improve patient outcomes.