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Textbook of Palliative Care pp 317–333Cite as

Mucositis

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Abstract

Mucositis is an inflammatory reaction of the mucosa of the alimentary tract (AT) caused by chemotherapy, radiotherapy, and targeted therapy for cancer. It presents a significant burden not only to patient quality of life but also may result in diminished tumor control (through dose reductions) and increased treatment costs (due to extended hospital stays and supportive care). Mucositis symptoms may vary not only due to the treatment modality but also according to genetic predispositions of the patient toward developing toxicity (toxicogenomics). Management of mucositis is at present supportive only, with treatments that reduce incidence, severity, and duration of clinical symptoms, but do not prevent or cure mucositis altogether. A great deal of current research into the mechanisms involved in development and progression of mucositis is also being carried out; it is hoped that a clear understanding of mucositis pathophysiology, along with comprehensive toxicogenomics, will enable more preventative treatments to be developed.

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Abbreviations

5-FU:

5-fluorouracil

AT:

alimentary tract

BF:

Bayes factor

CAM:

complementary and alternative medicine

CT:

chemotherapy

GI:

gastrointestinal

GLP:

glucagon-like peptide

H2BT:

hydrogen breath test

HSCT:

hematopoietic stem cell transplantation

IL:

interleukin

LIL:

low-intensity laser

LLLT:

low-level laser therapy

MASCC/ISOO:

Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology

mAb:

monoclonal antibody

MMPs:

matrix metalloproteases

mTOR:

mechanistic target of rapamycin

NCI-CTCAE:

National Cancer Institute Common Terminology Criteria for Adverse Events

NF-κB:

nuclear factor kappa B

OM:

oral mucositis

PRO:

patient-reported outcome

QOL:

quality of life

RCT:

randomized controlled trial

RT:

radiotherapy

SBS:

short bowel syndrome

SBT:

13C-sucrose breath test

TAT:

targeted anticancer therapy

TBI:

total body irradiation

TKI:

tyrosine kinase inhibitor

TLR:

toll-like receptor

TNF:

tumour necrosis factor

WHO:

World Health Organization

References

  • Abimosleh SM, Tran CD, Howarth GS. Emu oil: a novel therapeutic for disorders of the gastrointestinal tract? J Gastroenterol Hepatol. 2012;27:857–61.

    CrossRef  CAS  PubMed  Google Scholar 

  • Abraham C, Cho JH. Inducing intestinal growth. N Engl J Med. 2005;353:2297–9.

    CrossRef  CAS  PubMed  Google Scholar 

  • Al-Dasooqi N, et al. Matrix metalloproteinases and their inhibitors are altered in a time-course model of irinotecan-induced mucositis. J Gastroenterol Hepatol. 2010;25(3):A2.

    Google Scholar 

  • Al-Dasooqi N, et al. Emerging evidence on the pathobiology of mucositis. Support Care Cancer. 2013;21:3233–41.

    CrossRef  PubMed  Google Scholar 

  • Al-Dasooqi N, Wardill HR, Gibson RJ. Gastrointestinal mucositis: the role of MMP-tight junction interactions in tissue injury. Pathol Oncol Res. 2014;20:485–91.

    CrossRef  CAS  PubMed  Google Scholar 

  • Allen S, Kilian C, Phelps J, Whelan HT. The use of hyperbaric oxygen for treating delayed radiation injuries in gynecologic malignancies: a review of literature and report of radiation injury incidence. Support Care Cancer. 2012;20:2467–72.

    CrossRef  PubMed  Google Scholar 

  • Al-Mamgani A, et al. The impact of treatment modality and radiation technique on outcomes and toxicity of patients with locally advanced oropharyngeal cancer. Laryngoscope. 2013;123:386–93.

    CrossRef  PubMed  Google Scholar 

  • Al-Waili N, Salom K, Al-Ghamdi AA. Honey for wound healing, ulcers, and burns; data supporting its use in clinical practice. ScientificWorldJournal. 2011;11:766–87.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  • Aprile G, Ramoni M, Keefe D, Sonis S. Application of distance matrices to define associations between acute toxicities in colorectal cancer patients receiving chemotherapy. Cancer. 2008;112:284–92.

    CrossRef  PubMed  Google Scholar 

  • Aprile G, Ramoni M, Keefe D, Sonis S. Links between regimen-related toxicities in patients being treated for colorectal cancer. Curr Opin Support Palliat Care. 2009;3:50–4.

    CrossRef  PubMed  Google Scholar 

  • Arbabi-kalati F, Arbabi-kalati F, Deghatipour M, Ansari Moghadam A. Evaluation of the efficacy of zinc sulfate in the prevention of chemotherapy-induced mucositis: a double-blind randomized clinical trial. Arch Iran Med. 2012;15:413–7.

    CAS  PubMed  Google Scholar 

  • Bateman E, Keefe D. Patient-reported outcomes in supportive care. Semin Oncol. 2011;38:358–61.

    CrossRef  PubMed  Google Scholar 

  • Bateman EH, Bowen JM, Wignall A, Keefe DMK. Development of a fractionated radiotherapy model to investigate acute and chronic radiation-induced gastrointestinal injury in a Dark Agouti rat model. Supportive Care Cancer. 2012;20:1–283.

    Google Scholar 

  • Bhanja P, et al. Protective role of R-spondin1, an intestinal stem cell growth factor, against radiation-induced gastrointestinal syndrome in mice. PLoS One. 2009;4:e8014.

    CrossRef  PubMed  PubMed Central  CAS  Google Scholar 

  • Blijlevens N, et al. In a high-dose melphalan setting, palifermin compared with placebo had no effect on oral mucositis or related patient’s burden. Bone Marrow Transplant. 2013;48:966–71.

    CrossRef  CAS  PubMed  Google Scholar 

  • Boushey RP, Yusta B, Drucker DJ. Glucagon-like peptide (GLP)-2 reduces chemotherapy-associated mortality and enhances cell survival in cells expressing a transfected GLP-2 receptor. Cancer Res. 2001;61:687–93.

    CAS  PubMed  Google Scholar 

  • Bowen JM. Development of the rat model of lapatinib-induced diarrhoea. Scientifica (Cairo). 2014;2014:194185.

    Google Scholar 

  • Bowen J, Gibson R, Cummins A, Tyskin A, Keefe D. Irinotecan changes gene expression in the small intestine of the rat with breast cancer. Support Care Cancer. 2006;14:629.

    CrossRef  Google Scholar 

  • Bowen JM, et al. VSL#3 probiotic treatment reduces chemotherapy-induced diarrhea and weight loss. Cancer Biol Ther. 2007;6:1449–54.

    CrossRef  PubMed  Google Scholar 

  • Bowen JM, et al. Determining the mechanisms of lapatinib-induced diarrhoea using a rat model. Cancer Chemother Pharmacol. 2014;74:617–27.

    CrossRef  CAS  PubMed  Google Scholar 

  • Carlotto A, Hogsett VL, Maiorini EM, Razulis JG, Sonis ST. The economic burden of toxicities associated with cancer treatment: review of the literature and analysis of nausea and vomiting, diarrhoea, oral mucositis and fatigue. PharmacoEconomics. 2013;31:753–66.

    CrossRef  PubMed  Google Scholar 

  • Cheah KY, Howarth GS, Bastian SE. Grape seed extract dose-responsively decreases disease severity in a rat model of mucositis; concomitantly enhancing chemotherapeutic effectiveness in colon cancer cells. PLoS One. 2014;9:e85184.

    CrossRef  PubMed  PubMed Central  CAS  Google Scholar 

  • Cho HK, Jeong YM, Lee HS, Lee YJ, Hwang SH. Effects of honey on oral mucositis in patients with head and neck cancer: a meta-analysis. Laryngoscope. 2015;125:2085–92.

    CrossRef  PubMed  Google Scholar 

  • Elad S, et al. Basic oral care for hematology-oncology patients and hematopoietic stem cell transplantation recipients: a position paper from the joint task force of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT). Support Care Cancer. 2015;23:223–36.

    CrossRef  PubMed  Google Scholar 

  • Flichy-Fernandez AJ, et al. The effect of orally administered probiotic Lactobacillus reuteri-containing tablets in peri-implant mucositis: a double-blind randomized controlled trial. J Periodontal Res. 2015;50:775–85.

    CrossRef  CAS  PubMed  Google Scholar 

  • Gibson RJ, Bowen JM. Biomarkers of regimen-related mucosal injury. Cancer Treat Rev. 2011;37:487–93.

    CrossRef  CAS  PubMed  Google Scholar 

  • Gibson RJ, Stringer AM. Chemotherapy-induced diarrhoea. Curr Opin Support Palliat Care. 2009;3:31–5.

    CrossRef  PubMed  Google Scholar 

  • Gibson RJ, et al. Effect of interleukin-11 on ameliorating intestinal damage after methotrexate treatment of breast cancer in rats. Dig Dis Sci. 2002;47:2751–7.

    CrossRef  CAS  PubMed  Google Scholar 

  • Gibson RJ, Bowen JM, Inglis MR, Cummins AG, Keefe DM. Irinotecan causes severe small intestinal damage, as well as colonic damage, in the rat with implanted breast cancer. J Gastroenterol Hepatol. 2003;18:1095–100.

    CrossRef  CAS  PubMed  Google Scholar 

  • Gibson R, Bowen J, Alvarez E, Keefe D. Detailed investigation and comparison of single dose irinotecan-induced diarrhoea in Dark Agouti rats with and without tumours. Support Care Cancer. 2005;13:401–83.

    CrossRef  Google Scholar 

  • Gibson RJ, et al. Systematic review of agents for the management of gastrointestinal mucositis in cancer patients. Support Care Cancer. 2013;21:313–26.

    CrossRef  PubMed  Google Scholar 

  • Gibson RJ, et al. Chemotherapy-induced gut toxicity and pain: involvement of TLRs. Support Care Cancer. 2016;24:2251–8.

    CrossRef  PubMed  Google Scholar 

  • Goldberg JD, et al. Palifermin is efficacious in recipients of TBI-based but not chemotherapy-based allogeneic hematopoietic stem cell transplants. Bone Marrow Transplant. 2013;48:99–104.

    CrossRef  CAS  PubMed  Google Scholar 

  • Hallstrom H, Lindgren S, Widen C, Renvert S, Twetman S. Probiotic supplements and debridement of peri-implant mucositis: a randomized controlled trial. Acta Odontol Scand. 2016;74:60–6.

    CrossRef  PubMed  CAS  Google Scholar 

  • Hawley P, Hovan A, McGahan CE, Saunders D. A randomized placebo-controlled trial of manuka honey for radiation-induced oral mucositis. Support Care Cancer. 2014;22:751–61.

    CrossRef  PubMed  Google Scholar 

  • Herbers AH, Feuth T, Donnelly JP, Blijlevens NM. Citrulline-based assessment score: first choice for measuring and monitoring intestinal failure after high-dose chemotherapy. Ann Oncol. 2010;21:1706–11.

    CrossRef  CAS  PubMed  Google Scholar 

  • Hoffmann M, et al. Long term results of postoperative Intensity-Modulated Radiation Therapy (IMRT) in the treatment of Squamous Cell Carcinoma (SCC) located in the oropharynx or oral cavity. Radiat Oncol. 2015;10:251.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  • Howarth GS, Tooley KL, Davidson GP, Butler RN. A non-invasive method for detection of intestinal mucositis induced by different classes of chemotherapy drugs in the rat. Cancer Biol Ther. 2006;5:1189–95.

    CrossRef  CAS  PubMed  Google Scholar 

  • Keefe DMK. Gastrointestinal mucositis: a new biological model. Support Care Cancer. 2004;12:6–9.

    CrossRef  PubMed  Google Scholar 

  • Keefe DM. Mucositis management in patients with cancer. Support Cancer Ther. 2006;3:154–7.

    CrossRef  PubMed  Google Scholar 

  • Keefe DM, Bateman EH. Tumor control versus adverse events with targeted anticancer therapies. Nat Rev Clin Oncol. 2012;9:98–109.

    CrossRef  CAS  Google Scholar 

  • Keefe DMK, Bateman EH. Potential successes and challenges of targeted cancer therapies. J Natl Cancer Inst Monogr. In press.

    Google Scholar 

  • Kelly N, et al. The role of the glutathione antioxidant system in gut barrier failure in a rodent model of experimental necrotizing enterocolitis. Surgery. 2004;136:557–66.

    CrossRef  PubMed  Google Scholar 

  • Kim KA, et al. Mitogenic influence of human R-spondin1 on the intestinal epithelium. Science. 2005;309:1256–9.

    CrossRef  CAS  PubMed  Google Scholar 

  • Kissow H, et al. Exogenous glucagon-like peptide-2 (GLP-2) prevents chemotherapy-induced mucositis in rat small intestine. Cancer Chemother Pharmacol. 2012;70:39–48.

    CrossRef  CAS  PubMed  Google Scholar 

  • Kissow H, Hartmann B, Holst JJ, Poulsen SS. Glucagon-like peptide-1 as a treatment for chemotherapy-induced mucositis. Gut. 2013;62:1724–33.

    CrossRef  CAS  PubMed  Google Scholar 

  • Kuchay RA. A review of complementary therapies for chemotherapy induced gastrointestinal mucositis. Drug Discov Ther. 2017;10(6):292–99.

    CrossRef  CAS  Google Scholar 

  • Lalla RV, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2014;120:1453–61.

    CrossRef  PubMed  Google Scholar 

  • Lee J, et al. Maintenance of colonic homeostasis by distinctive apical TLR9 signalling in intestinal epithelial cells. Nat Cell Biol. 2006;8:1327–36.

    CrossRef  CAS  PubMed  Google Scholar 

  • Logan RM, et al. The role of pro-inflammatory cytokines in cancer treatment-induced alimentary tract mucositis: pathobiology, animal models and cytotoxic drugs. Cancer Treat Rev. 2007a;33:448–60.

    CrossRef  CAS  PubMed  Google Scholar 

  • Logan RM, Gibson RJ, Sonis ST, Keefe DM. Nuclear factor-kappaB (NF-kappaB) and cyclooxygenase-2 (COX-2) expression in the oral mucosa following cancer chemotherapy. Oral Oncol. 2007b;43:395–401.

    CrossRef  CAS  PubMed  Google Scholar 

  • Logan RM, et al. Serum levels of NFkappaB and pro-inflammatory cytokines following administration of mucotoxic drugs. Cancer Biol Ther. 2008;7:1139–45.

    CrossRef  CAS  PubMed  Google Scholar 

  • Lotfi-Jam K, et al. Nonpharmacologic strategies for managing common chemotherapy adverse effects: a systematic review. J Clin Oncol. 2008;26:5618–29.

    CrossRef  PubMed  Google Scholar 

  • Lutgens L, Lambin P. Biomarkers for radiation-induced small bowel epithelial damage: an emerging role for plasma Citrulline. World J Gastroenterol. 2007;13:3033–42.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  • Lutgens LC, et al. Citrulline: a physiologic marker enabling quantitation and monitoring of epithelial radiation-induced small bowel damage. Int J Radiat Oncol Biol Phys. 2003;57:1067–74.

    CrossRef  CAS  PubMed  Google Scholar 

  • Lutgens LC, et al. Plasma citrulline concentration: a surrogate end point for radiation-induced mucosal atrophy of the small bowel. A feasibility study in 23 patients. Int J Radiat Oncol Biol Phys. 2004;60:275–85.

    CrossRef  CAS  PubMed  Google Scholar 

  • Lutgens LC, et al. Monitoring myeloablative therapy-induced small bowel toxicity by serum citrulline concentration: a comparison with sugar permeability tests. Cancer. 2005;103:191–9.

    CrossRef  PubMed  Google Scholar 

  • Mahood DJ, et al. Inhibition of fluorouracil-induced stomatitis by oral cryotherapy. J Clin Oncol. 1991;9:449–52.

    CrossRef  CAS  PubMed  Google Scholar 

  • Mashtoub S, et al. Emu oil combined with Lyprinol reduces small intestinal damage in a rat model of chemotherapy-induced mucositis. Nutr Cancer. 2016;68:1171–80.

    CrossRef  CAS  PubMed  Google Scholar 

  • McGuire DB, Correa ME, Johnson J, Wienandts P. The role of basic oral care and good clinical practice principles in the management of oral mucositis. Support Care Cancer. 2006;14:541–7.

    CrossRef  PubMed  Google Scholar 

  • McGuire DB, et al. Systematic review of basic oral care for the management of oral mucositis in cancer patients. Support Care Cancer. 2013;21:3165–77.

    CrossRef  PubMed  Google Scholar 

  • Mehdipour M, Zenoz AT, Kermani IA, Hosseinpour A. A comparison between zinc sulfate and chlorhexidine gluconate mouthwashes in the prevention of chemotherapy-induced oral mucositis. Daru. 2011;19:71.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Metri K, Bhargav H, Chowdhury P, Koka PS. Ayurveda for chemo-radiotherapy induced side effects in cancer patients. J Stem Cells. 2013;8:115–29.

    PubMed  Google Scholar 

  • Migliorati C, et al. Systematic review of laser and other light therapy for the management of oral mucositis in cancer patients. Support Care Cancer. 2013;21:333–41.

    CrossRef  PubMed  Google Scholar 

  • Pan CX, Morrison RS, Ness J, Fugh-Berman A, Leipzig RM. Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life. A systematic review. J Pain Symptom Manag. 2000;20:374–87.

    CrossRef  CAS  Google Scholar 

  • Pelton NS, Tivey DR, Howarth GS, Davidson GP, Butler RN. A novel breath test for the non-invasive assessment of small intestinal mucosal injury following methotrexate administration in the rat. Scand J Gastroenterol. 2004;39:1015–6.

    CrossRef  CAS  PubMed  Google Scholar 

  • Peterson DE, et al. Systematic review of oral cryotherapy for management of oral mucositis caused by cancer therapy. Support Care Cancer. 2013;21:327–32.

    CrossRef  PubMed  Google Scholar 

  • Peterson DE, et al. Oral mucosal injury caused by mammalian target of rapamycin inhibitors: emerging perspectives on pathobiology and impact on clinical practice. Cancer Med. 2016;5:1897–907.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  • Prisciandaro LD, Geier MS, Butler RN, Cummins AG, Howarth GS. Evidence supporting the use of probiotics for the prevention and treatment of chemotherapy-induced intestinal mucositis. Crit Rev Food Sci Nutr. 2011;51:239–47.

    CrossRef  PubMed  Google Scholar 

  • Raber-Durlacher JE, et al. Systematic review of cytokines and growth factors for the management of oral mucositis in cancer patients. Support Care Cancer. 2013;21:343–55.

    CrossRef  PubMed  Google Scholar 

  • Rakoff-Nahoum S, Paglino J, Eslami-Varzaneh F, Edberg S, Medzhitov R. Recognition of commensal microflora by toll-like receptors is required for intestinal homeostasis. Cell. 2004;118:229–41.

    CrossRef  CAS  PubMed  Google Scholar 

  • Rangwala F, Zafar SY, Abernethy AP. Gastrointestinal symptoms in cancer patients with advanced disease: new methodologies, insights, and a proposed approach. Curr Opin Support Palliat Care. 2012;6:69–76.

    CrossRef  PubMed  Google Scholar 

  • Rasmussen AR, et al. The intestinotrophic peptide, GLP-2, counteracts the gastrointestinal atrophy in mice induced by the epidermal growth factor receptor inhibitor, erlotinib, and cisplatin. Dig Dis Sci. 2010;55:2785–96.

    CrossRef  CAS  PubMed  Google Scholar 

  • Rubenstein EB, et al. Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis. Cancer. 2004;100:2026–46.

    CrossRef  PubMed  Google Scholar 

  • Samdariya S, Lewis S, Kauser H, Ahmed I, Kumar D. A randomized controlled trial evaluating the role of honey in reducing pain due to radiation induced mucositis in head and neck cancer patients. Indian J Palliat Care. 2015;21:268–73.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  • Schwartz LK, et al. Long-term teduglutide for the treatment of patients with intestinal failure associated with short bowel syndrome. Clin Transl Gastroenterol. 2016;7:e142.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  • Smith K. The photobiological basis of low level laser radiation therapy. Laser Ther. 1991;3:19–24.

    CrossRef  Google Scholar 

  • Song JJ, Twumasi-Ankrah P, Salcido R. Systematic review and meta-analysis on the use of honey to protect from the effects of radiation-induced oral mucositis. Adv Skin Wound Care. 2012;25:23–8.

    CrossRef  PubMed  Google Scholar 

  • Sonis ST. A biological approach to mucositis. J Support Oncol. 2004;2:21–32; discussion 35–6.

    PubMed  Google Scholar 

  • Sonis ST. Oral mucositis. Anti-Cancer Drugs. 2011;22:607–12.

    CrossRef  CAS  PubMed  Google Scholar 

  • Spielberger R, et al. Palifermin for oral mucositis after intensive therapy for hematologic cancers. N Engl J Med. 2004;351:2590–8.

    CrossRef  CAS  PubMed  Google Scholar 

  • Stringer AM. Interaction between host cells and microbes in chemotherapy-induced mucositis. Forum Nutr. 2013;5:1488–99.

    CAS  Google Scholar 

  • Stringer A, et al. Mucositis, microflora and mucins: the effect of fluorouracil. Support Care Cancer. 2008;15:651–797.

    Google Scholar 

  • Stringer AM, et al. Irinotecan-induced mucositis manifesting as diarrhoea corresponds with an amended intestinal flora and mucin profile. Int J Exp Pathol. 2009a;90:489–99.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  • Stringer AM, Gibson RJ, Bowen JM, Keefe DM. Chemotherapy-induced modifications to gastrointestinal microflora: evidence and implications of change. Curr Drug Metab. 2009b;10:79–83.

    CrossRef  CAS  PubMed  Google Scholar 

  • Stubbe CE, Valero M. Complementary strategies for the management of radiation therapy side effects. J Adv Pract Oncol. 2013;4:219–31.

    PubMed  PubMed Central  Google Scholar 

  • Tooley KL, Howarth GS, Butler RN. Mucositis and non-invasive markers of small intestinal function. Cancer Biol Ther. 2009;8:753–8.

    CrossRef  CAS  PubMed  Google Scholar 

  • Van Sebille YZ, Gibson RJ, Wardill HR, Bowen JM. ErbB small molecule tyrosine kinase inhibitor (TKI) induced diarrhoea: chloride secretion as a mechanistic hypothesis. Cancer Treat Rev. 2015;41:646–52.

    CrossRef  PubMed  CAS  Google Scholar 

  • van Vliet MJ, et al. Citrulline as a marker for chemotherapy induced mucosal barrier injury in pediatric patients. Pediatr Blood Cancer. 2009;53:1188–94.

    CrossRef  PubMed  Google Scholar 

  • Walsh D, Rybicki L. Symptom clustering in advanced cancer. Support Care Cancer. 2006;14:831–6.

    CrossRef  PubMed  Google Scholar 

  • Wardill HR, et al. Irinotecan disrupts tight junction proteins within the gut: implications for chemotherapy-induced gut toxicity. Cancer Biol Ther. 2014a;15:236–44.

    CrossRef  CAS  PubMed  Google Scholar 

  • Wardill HR, Gibson RJ, Logan RM, Bowen JM. TLR4/PKC-mediated tight junction modulation: a clinical marker of chemotherapy-induced gut toxicity? Int J Cancer. 2014b;135:2483–92.

    CrossRef  CAS  PubMed  Google Scholar 

  • Wardill HR, Gibson RJ, Logan RM, Bowen JM. Does TLR4/PKC signalling drive chemotherapy induced barrier dysfunction and mucositis? Support Care Cancer. 2014c;22:S96.

    Google Scholar 

  • Wardill H, et al. TLR4 deletion attenuates irinotecan-induced gut toxicity and barrier dysfunction in the Balb/C mouse offering a new therapeutic target. Support Care Cancer. 2015a;23(Suppl 1):1–388.

    Google Scholar 

  • Wardill HR, et al. Toll-like receptor 4 signaling: a common biological mechanism of regimen-related toxicities: an emerging hypothesis for neuropathy and gastrointestinal toxicity. Cancer Treat Rev. 2015b;41:122–8.

    CrossRef  CAS  PubMed  Google Scholar 

  • Wardill HR, et al. Irinotecan-induced gastrointestinal dysfunction and pain are mediated by common TLR4-dependent mechanisms. Mol Cancer Ther. 2016a;15:1376–86.

    CrossRef  CAS  PubMed  Google Scholar 

  • Wardill HR, et al. TLR4-dependent claudin-1 internalization and secretagogue-mediated chloride secretion regulate irinotecan-induced diarrhea. Mol Cancer Ther. 2016b.

    Google Scholar 

  • Xu JL, et al. Effects of honey use on the management of radio/chemotherapy-induced mucositis: a meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg. 2016.

    Google Scholar 

  • Yao Q, et al. Protective effect of curcumin on chemotherapy-induced intestinal dysfunction. Int J Clin Exp Pathol. 2013;6:2342–9.

    PubMed  PubMed Central  Google Scholar 

  • Yarom N, et al. Systematic review of natural agents for the management of oral mucositis in cancer patients. Support Care Cancer. 2013;21:3209–21.

    CrossRef  PubMed  Google Scholar 

  • Yeoh AS, et al. A novel animal model to investigate fractionated radiotherapy-induced alimentary mucositis: the role of apoptosis, p53, nuclear factor-kappaB, COX-1, and COX-2. Mol Cancer Ther. 2007;6:2319–27.

    CrossRef  CAS  PubMed  Google Scholar 

  • Yokomizo H, et al. Prophylactic efficacy of allopurinol ice ball for leucovorin/5-fluorouracil therapy-induced stomatitis. Anticancer Res. 2004;24:1131–4.

    CAS  PubMed  Google Scholar 

  • Zhao J, et al. R-Spondin1 protects mice from chemotherapy or radiation-induced oral mucositis through the canonical Wnt/beta-catenin pathway. Proc Natl Acad Sci U S A. 2009;106:2331–6.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  • Zhou WJ, Geng ZH, Spence JR, Geng JG. Induction of intestinal stem cells by R-spondin 1 and Slit2 augments chemoradioprotection. Nature. 2013;501:107–11.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Cancer Treatment Toxicities Group, School of Medicine, University of Adelaide, Adelaide, SA, Australia

    Emma Bateman, Richard Logan, Rachel Gibson & Dorothy Keefe

  2. School of Dentistry, University of Adelaide, Adelaide, SA, Australia

    Richard Logan

  3. Division of Health Sciences, University of South Australia, Adelaide, SA, Australia

    Rachel Gibson

Authors
  1. Emma Bateman
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  2. Richard Logan
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  3. Rachel Gibson
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  4. Dorothy Keefe
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Corresponding author

Correspondence to Dorothy Keefe .

Editor information

Editors and Affiliations

  1. School of Medicine,Palliative Care, HammondCare, The University of Sydney School of Medicine, Sydney, Australia

    Prof. Roderick Duncan MacLeod

  2. VUB-UGhent End-of-Life Care Research Group, Department of Family Medicine and Chronic Care and Department of Clinical Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium

    Prof. Lieve Van den Block

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Bateman, E., Logan, R., Gibson, R., Keefe, D. (2019). Mucositis. In: MacLeod, R., Van den Block, L. (eds) Textbook of Palliative Care. Springer, Cham. https://doi.org/10.1007/978-3-319-77740-5_17

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