Prevention and care of chemotherapy-induced gastrointestinal mucositis

In the last decades the survival of children with cancer has increased substantially, mainly due to more intensive treatment protocols. The drawback of the success is a tremendous increase in the side effects of the treatment. One of the major side effects of chemotherapeutic treatment, affecting both the quality of life as well as causing a suboptimal treatment, is gastrointestinal mucositis. Mucositis is a complex inflammatory reaction of the mucosa of the complete alimentary tract, and can be divided in oral and gastrointestinal (GI) mucositis. Children suffering from mucositis have symptoms like nausea, vomiting, abdominal pain, and diarrhea, leading to a decreased nutritional intake and a higher susceptibility to develop a bacteremia or sepsis. Side effects, like mucositis, may lead to a decrease in chemotherapeutic dosage, a delay of the next chemotherapeutic cycle, or even a discontinuation of the next chemotherapeutic cycle. Mucositis possibly influences the survival. In this thesis we interfered in three different ways in the pathophysiological model of mucositis. Unfortunately, we can conclude that the interventions presented in this thesis did not lead to a decrease in the severity of mucositis in rats. Therefore, the question arises if the currently used 5-phase pathophysiological model is correct for gastrointestinal mucositis. In the search for prevention or treatment of mucositis we suggest that future research should focus on multiple targets, thereby combining both the elucidation of the pathophysiology, and the search for targets to prevent or treat mucositis. Furthermore, patients are often unable to eat normally and their own intake decreases drastically. Based on our observational study and an international survey we conclude that there are discordances in the clinical practice concerning the feeding strategy during mucositis, as well as a lack of knowledge, therefore we are in need of clinical trials concerning feeding strategy during mucositis.