Risk factors associated with mucositis in cancer patients receiving 5-fluorouracil

Oral mucositis is a dose-limiting toxicity of 5-fluorouracil (5-FU). This p rospective cohort study investigated factors associated with mucositis in p atients receiving 5-FU for cancer of the digestive tract. Sixty-three patie nts (mean age 65 years) completed self-administered questionnaires and had interviews, oral examinations and unstimulated whole salivary flow measurem ents at baseline and follow-up appointments. The duration of follow-up was 2 months. Predictor variables included sociodemographic data, body surface area, diabetes, smoking, alcohol consumption, salivary flow, oral hygiene, presence of prostheses, performance status, regimen of cytotoxic drugs, hem atological data, and herpes simplex virus antibody titer. Forty-six per cen t of patients developed at least one episode of oral mucositis during cytot oxic treatment. Pearson's chi-square analysis showed that mucositis was sig nificantly associated with xerostomia at baseline, xerostomia during chemot herapy, and lower baseline neutrophil counts (P less than or equal to 0.05) . Multiple logistic regression analysis indicated that xerostomia at baseli ne (odds ratio, OR = 10.0), or baseline neutrophil level under 4000 cells/m m(3) (OR = 3.9) were significant predictors of mucositis. Taking into accou nt the effect of neutrophil level at baseline, xerostomia during chemothera py (OR = 4.5) was also a significant predictor of mucositis. The results sh owed that xerostomia and lower baseline neutrophil levels are significantly associated with oral mucositis. These variables should be taken into consi deration in the design of intervention studies to reduce the frequency and severity of mucositis. More research is required to investigate the role of saliva and neutrophils in the pathogenesis of chemotherapy-induced mucosit is. (C) 1998 Elsevier Science Ltd. All rights reserved.