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Streamlining Mucositis Quality Improvement Project

JoAnn Bolude, M.D., M.P.H., Hematology/Oncology Fellow

The Problem

QI Project: Streamlining Mucositis
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of the QI Project

Mucositis is characterized by erythema, atrophy and/or ulceration of mucosal lining of GI tract from mouth to anus. It is associated with pain, difficulty eating and swallowing and need for parenteral nutrition depending on the severity of condition.

  • Mucositis occurs in 20-40% of patients who receive conventional chemotherapy
  • Mucositis occurs in 80% of patients who undergo therapy with high-dose chemotherapy as conditioning for hematopoietic stem cell transplant (HSCT)
  • Nearly all patients who receive head and neck radiotherapy develop mucositis
  • Mucositis increases risk of bacteremia, hospitalizations, costs of healthcare and 100-day mortality.

Oral Health Care During Cancer Treatment (Video)


The membranes of mucosa have rapid epithelial turnover and maturation, making the tissue highly susceptible to adverse effects of chemotherapy. The rate of cell turnover in the pediatric population is much higher making mucositis a more frequent and unavoidable consequence for children who undergo treatment with chemotherapy. Current studies show most beneficial prevention modalities are cryotherapy, low laser light therapy (LLLT) and keratinocyte growth factor (KGF). The last two modalities are not available or preferred for most institutions, leaving excellent oral hygiene, cryotherapy and use of L-glutamine as better alternatives to prevention of mucositis.


After a careful chart review of mucositis cases, our institution is not documenting application of cryotherapy, brushing, etc. Additionally, while information is given to families that mucositis is one of the possible worse side effects of therapy, the details of mucositis how to prevent it or provide care for patients during this time is not routinely given beforehand. We have discovered from parental feedback that education regarding mucositis would be appreciated and possibly help to reduce the emotional burden by empowering our families with knowledge.

  • Our goal is to improve patient and/or family education through online and in-person resources.
  • We also want to improve our documentation of prevention practices and our identification of mucositis by appropriate grading as classified by World Health Organization.
  • We aim to reduce the incidence and/or severity of mucositis by employing best hygiene practices recommended by our dental experts.

For Families

Welcome to our families. Thank you for helping us serve you better and improve your care.


Our Hope

Our hope is if mucositis can be prevented it would reduce the pain and healthcare costs for high risk patients and reduce potential delays in their cancer treatment.

Fighting Mucositis Together


Collaboration - Pediatric Dentistry