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The EPEC-O Project Education in Palliative and End-of-life Care - Oncology

TM. The EPEC-O Project Education in Palliative and End-of-life Care - Oncology. The EPEC TM -O Curriculum is produced by the EPEC TM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.

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The EPEC-O Project Education in Palliative and End-of-life Care - Oncology

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  1. TM The EPEC-O Project Education in Palliative and End-of-life Care - Oncology The EPECTM-O Curriculum is produced by the EPECTM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.

  2. EPEC– Oncology Education in Palliative and End-of-life Care – Oncology Module 3o: Symptoms – Mucositis

  3. Mucositis . . . • Definition: mucosal barrier injury • May affect the entire GI tract

  4. . . . Mucositis Epidemiology. . . • Impact: • Oral erythema, ulceration, pain, infection • Diarrhea (if it affects entire GI tract) • Decreased oral intake • Raises 100-day mortality

  5. . . . Mucositis . . . Epidemiology • Prevalence: • 40% of patients on chemotherapy • 100% if with stem cell transplant • Prognosis: • Usually self-limiting

  6. Key points • Pathophysiology • Assessment • Management

  7. Pathophysiology • Direct injury • Secondary infection • Graft versus host disease Plevova P. Oral Oncol. 1999.

  8. Usual course • Starts 5 to 7 days after chemotherapy • Generalized desquamation days 11 through 14 • Resolution: • 2 days to several weeks • 6 weeks after radiation Wilkes JD. SeminOncol. 1998.

  9. Assessment • History • Pain and its effect on the patient • Eating and drinking • Physical examination • Orthostatic blood pressure and pulse • Weight loss • Evaluate affected oral mucosa

  10. Management . . . Potential for prevention • Diminish mucosal delivery of chemotherapy, e.g. use oral cryotherapy during treatment • Modify epithelial proliferation, e.g. use growth factors • Reduce infections, inflammatory complications • Reduce, inhibit pro-inflammatory cytokines

  11. . . . Management • Oral hygiene • Diet (minimize contact with food irritants) • Local anesthetics • Systemic analgesics

  12. Summary Use comprehensive assessment and pathophysiology-based therapy to treat the cause and improve the cancer experience.

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