Mucosite oral em pacientes oncológicos pediátricos: ocorrência, escalas de mensuração, tempo de hospitalização e fatores associados

Abstract

Childhood cancer is the second leading cause of death in this population. Despite advances in oncological treatment, antineoplastic therapies have adverse effects on healthy tissues, causing anatomical and functional damage to patients. Oral mucositis (OM) is the most common adverse effect and its prevalence can reach 90% in the mild/moderate form and 35% in the most severe form, being higher in children and adolescents compared to adults. There are several instruments used to assess WM, however, few are intended for children and adolescents. The occurrence of OM has been associated, according to the literature, with factors inherent to individuals and the therapeutic regimen. The general objective of this study was to deepen the knowledge about OM in children and adolescents with cancer undergoing chemotherapy, by identifying the occurrence of OM, its measurement scales, the impact of this condition on the length of hospitalization, and associated factors in cancer patients. pediatric. For this, the present study was divided into four scientific articles. In article 1, through a series of cases, 9 cases of oncopediatric patients with leukemia were reported, who were followed up for 10 consecutive weeks and presented with severe oral mucositis (MOG) in the first week of treatment. Patients averaged 4.0 and 5.5 episodes of MO and MOG, respectively. Saliva and lips were the most affected items. In article 2, a systematic review was carried out according to the PRISMA and SWIM checklist, registered in PROSPERO, to verify whether the severity of OM influences the length of hospitalization of oncopediatric patients. Three studies were eligible for qualitative synthesis. All studies showed a low risk of bias in the domains assessed using the Newcastle-Ottawa scale. One study verified an increase of 4.6 days of hospitalization for each increase in one unit of the World Health Organization (WHO) scale for OM. The other studies also observed that patients with more severe scores required longer hospital stays. In article 3, a short communication was written about the instruments used to assess the oral condition of pediatric patients undergoing antineoplastic treatment. The main instruments for this purpose are the WHO scales, the National Cancer Institute - Common Terminology Criteria for Adverse Events (NCI-CTCAE), and the Oral Assessment Guide (OAG). All are capable of identifying and grading ulcerations, however, OAG stands out for evaluating the criteria that may be associated with the risk of occurrence of OM. In article 4, through a short-term prospective cohort, risk factors associated with the occurrence of OM were evaluated. The incidence varied between 50.5% and 64.8% and 16.2% and 31.4% for MO and MOG, respectively. The number of weeks with MO and MOG were 7.6 and 2.4; respectively. Saliva and lips were the most affected items with scores 2 and 3. Only the time since the last chemotherapy session is associated with the appearance of these lesions and the OAG score. In view of the above, it is concluded that although there is no standard scale to assess WM, the OAG is an excellent option to measure this complication in children and adolescents, since its analysis is not centered on the diagnosis of ulcers and, therefore, allows for the verification of other aspects that may influence the occurrence of OM. In addition, the literature needs studies that provide better evidence on the risk factors for OM and OMG and the impact of OM on the length of hospitalization of pediatric cancer patients. However, the longer the time since the last chemotherapy session, the lower the risk of OM occurrence and severity.