JL318. Collaborative Interventions in the Treatment of Chemotherapy-Induced Oral Mucositis With Low Level Laser Therapy (LLLT)–A Case Series
Cheryl E. Jones, CRNP, AOCN, Cynthia Castillo, ND, FABNO, Marie Winters, ND, FABNO, and Alexandra Louden, ND, Cancer Treatment Centers of America, Philadelphia, PA
Introduction: Oral mucositis refers to the damage of the mouth’s mucosa resulting from chemotherapy or radiation therapy. It is one of the most significantly debilitating, dose-limiting acute toxicities of cancer therapy that not only compromises cure rates, but increases the costs of supportive care. Oral mucositis occurs in approximately 40% of patients receiving standard therapy with drugs that affect DNA synthesis, such as 5-fluorouracil, capecitabine, gemcitabine, and pemetrexed. Incidence of oral mucositis ranges from 10–66% in patients receiving anthracyclines, taxanes, or platinum-based regimens. The collaborative, multidisciplinary efforts of advanced practitioners and Naturopathic Medicine providers afford us the opportunity to present three clinical case studies of adult cancer patients who each developed oral mucositis, and were treated with LLLT as part of their integrative cancer treatment regimen. Description: Two patients with carcinoma of unknown primary origin and one patient with lung adenocarcinoma were treated with three separate cancer treatment regimens: a fluorouracil-based regimen, a taxane-based regimen, and a tyrosine kinase inhibitor (TKI) regimen. Each of the patients developed oral mucositis in the week(s) subsequent to receiving conventional cancer treatment, which manifested as soreness or pain of the oral cavity or ulceration of the oral mucosa. Each of the patients were treated with LLLT either daily until mucositis had improved more than 50% compared to initial presentation or once every three weeks as preventative measure in the development of oral mucositis. Subjective pain, functional impairment and side effects were recorded at each visit. Patients reported improvement in severity of mucositis, delayed mucositis development and enhanced mucositis recovery time. No adverse reactions were reported secondary to use of LLLT. Discussion/Conclusion: Low level laser therapy is beneficial in both treating and preventing chemobiotherapy-induced oral mucositis in these three cases. This therapy is well tolerated and can significantly improve quality of life by reducing oral discomfort related to inflammation and ulceration from various cancer treatment regimens. While the prior clinical trials supporting use of LLLT in patients with cancer were completed in patients either undergoing hematopoietic stem cell transplantation or chemoradiation for head and neck cancer, this therapy could be considered as viable supportive care therapy for all cancer patients experiencing oral mucositis. This case series supports the need for prospective clinical trials to further elucidate the benefit of this treatment in a boarder patient population.
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