Impact of severe oral mucositis in pediatric cancer patients on resource utilization and cancer treatment plans

Abstract

Background: Oral mucositis is a common chemotherapy-related adverse event that may result in serious complications. Few studies have evaluated mucositis in pediatric patients. Objective: To evaluate the impact of severe mucositis on resource utilization and on treatment plans of pediatric cancer patients. Setting: Comprehensive cancer center in Amman, Jordan. Method: Retrospective study on pediatric patients undergoing active cancer treatment with a hospital admission diagnosis of severe oral mucositis (January 2015–December 2019). Patients undergoing bone marrow transplant were excluded. Severe oral mucositis was defined as interfering with oral intake and requiring intravenous opioids. Main outcome measure: We reviewed the electronic billing system and patient medical charts to determine the resources utilized during hospitalization, cost, and the impact on subsequent treatment protocols. Results: During the study period, 200 patients were eligible; the average age was 8.6±5.6 years (SD) and 45% had acute lymphoblastic leukemia. The median hospital stay was 6 days (range 2–21) with a total median cost of US$ 2,176 (range 635–13,976) per admission. The median medication cost was US$ 1,075 (range 135–9010), and 85% of the patients received antibiotics during hospitalization, at a median cost of US$ 487 (range 23–2,193). Modification of the chemotherapy treatment protocol was required in 110 patients, which included dose reduction (60%), delay (38%), and discontinuation (2%). Conclusion: Severe oral mucositis is associated with significant resource utilization and modification of the treatment protocols. Further studies are needed to identify strategies to reduce the impact of mucositis in this patient population.