Oral mucositis and the clinical and economic outcomes of hematopoietic stem-cell transplantation

Purpose: To explore the relationship between oral mucositis and selected cl inical and economic outcomes in blood and marrow transplant patients. Patients and Methods: Subjects consisted of 92 transplant patients from eig ht centers who participated in a multinational pilot study of a new oral mu cositis scoring system (Oral Mucositis Assessment Scale [OMAS]). In the pil ot study, patients were evaluated for erythema and ulceration/pseudomembran e formation beginning on the first day of conditioning and continuing for 2 8 days. We examined the relationship between patients' peak OMAS scores and days with fever (body temperature > 38.0 degreesC), the occurrence of sign ificant infection, days of total parenteral nutrition (TPN), and days of in jectable narcotic therapy tall over 28 days), days in hospital lover 60 day s), total hospital charges for the index admission, and vital status at 100 days. Results: Patients' peak OMAS scores spanned the full range of possible valu es (0 to 5) and were significantly (P < .05) correlated with all of the out comes of interest except days with fever (P = .21). In analyses controlling for type of graft tautologous v allogeneic) and study center, a 1-point in crease in peak OMAS score was associated with (1) 1.0 additional day with f ever (P < .01), (2) a 2.1-fold increase in risk of significant infection (P < .01), (3) 2.7 additional days of TPN (P < .0001), (4) 2.6 additional day s of injectable narcotic therapy (P < .0001), (5) 2.6 additional days in ho spital (P < .01), (6) $25,405 in additional hospital charges (P < .0001), a nd (7) a 3.9-fold increase in 100-day mortality risk (P < .01). Mean hospit al charges were $42,749 higher among patients with evidence of ulceration c ompared with those without (P = .06). Conclusion: Oral mucositis is associated with significantly worse clinical and economic outcomes in blood and marrow transplantation. (C) 2001 by Amer ican Society of Clinical Oncology.