Among the many side effects that afflict chemotherapy patients, oral mucositis – a condition characterized by painful sores, bleeding, and inflammation inside the mouth – tops many patients’ lists of the worst parts of undergoing these treatments. Not only are the symptoms themselves quite unpleasant, but the clinical complications that can arise because of mucositis can threaten a patient’s recovery and even endanger their very life. For a physician to identify and treat oral mucositis, however, they must first have the means to judge its severity – easier said than done, as it turns out. So how are the grades of oral mucositis determined, and what exactly do they mean? Keep reading as the experts at Chemo Mouthpiece® explain.
Grading Scales for Oral Mucositis Symptoms
As it happens, several grading scales have been invented to define the severity of oral mucositis; the most prominent of which include the World Health Organization (WHO) scale, the Oral Mucositis Assessment Scale (OMAS), and the National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE). Each attempt to grade oral mucositis based on an objective scale that can be easily used by doctors in a variety of environments and in a variety or patients. Some details about each system are provided below:
World Health Organization (WHO) Scale
The WHO scale for grading mucositis symptoms is straightforward and widely used because of its very general thresholds, but those same generalizations leave out many of the nuances of oral mucositis. The scale reads as follows:
Grade 0 – No signs of oral mucositis
Grade 1 – Redness (erythema) and mild discomfort in the mouth
Grade 2 – Mouth sores present, but the patient can still consume solid foods
Grade 3 – Extensive mouth sores present, requiring the patient to switch to a liquid diet
Grade 4 – Severe mouth sores present, making oral nutrition in any form impossible
As described above, the WHO scale generally uses the severity of ulcers in the mouth and a patient’s ability to eat certain types of foods as criteria for grading mucositis symptoms. However, at least one study has shown that this scale fails to properly take into account the nutritional challenges a patient faces when afflicted with oral mucositis, at least compared with the OMAS scale.
Oral Mucositis Assessment Scale (OMAS)
Sometimes referred to as the “objective scoring system for site assessment,” the OMAS measures the degree of redness and ulceration in nine specific areas of the mouth: upper and lower lips, left and right cheeks, left and right sides of the tongue, floor of the mouth, soft palate, and hard palate. In each area, any lesions present are measured and scored; less than 1 cm2 rates a 1 on the scale, whereas 1-3 cm2 is a 2, and anything larger is a 3 on the scale. Redness is measured from 0-2, with 0 meaning no redness and 2 meaning severe redness. A study published in 1999 judged the OMAS to be especially useful in rating the severity of mucositis symptoms.
Common Terminology Criteria for Adverse Events (CTCAE)
The CTCAE is a scale devised and used by the National Cancer Institute (NCI), the CTCAE scale is updated by NIC with every new version published. Like the OMAS, the CTCAE is split into two parts; rather than addressing different symptoms, however, this scale is divided between clinical symptoms – as measured by a doctor – and functional symptoms – those reported by the patient themselves. The severity of symptoms on both scales is rated from 1-5, as shown below:
Clinical Examination
Grade 1 – Clearly visible redness of the mucous membranes
Grade 2 – Patchy lesions in the mouth
Grade 3 – Larger swaths of lesions or ulcers in the mouth, along with some bleeding
Grade 4 – Life-threatening symptoms, including significant bleeding and necrosis
Grade 5 – Patient has died
Patient Report of Symptoms
Grade 1 – Few signs of mucositis, able to eat normally
Grade 2 – Some symptoms, but able to eat some solid foods
Grade 3 – Severe symptoms, unable to take in food or liquids orally
Grade 4 – Symptoms threaten the patient’s life
Grade 5 – Death
Though this scale is a bit more complicated to implement than the WHO or OMAS systems, it incorporates both objective and subjective interpretations of a patient’s symptoms, and the fact that it is backed by the NCI lends the CTCAE significant weight as a tool for combating oral mucositis.
While the variety of grading scales used for oral mucositis gives doctors some flexibility in judging the symptoms of this condition, the lack of a consistent measuring system makes it more difficult to accurately gauge the severity of this illness from patient to patient in many cases. If you receive a judgement from your doctor concerning the extent of your mucositis symptoms, consider asking what scale they used and how best to mitigate any oral issues you may experience.
Reduce Oral Mucositis Symptoms with a Powerful Cryotherapy Device
Cryotherapy – the application of freezing or near-freezing temperatures to treat a condition – has been shown to be quite effective at reducing oral mucositis symptoms for many patients. If you are facing this ailment, consider a clinically proven cryotherapy device such as the Chemo Mouthpiece®. This tool offers proactive protection by cooling the entire oral cavity during chemotherapy treatments, shrinking the blood vessels of the mouth and keeping much of the toxic chemo drug out of the area. To learn more about how the Chemo Mouthpiece can help with your symptoms, visit us online or call (866) 496-8858 today.