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Oral Mucositis and the Clinical and Economic Outcomes of Hematopoietic Stem-Cell Transplantation

From Brigham and Women’s Hospital and Harvard School of Dental Medicine, Boston, and Policy Analysis, Inc, Brookline, MA; IntraBiotics Pharmaceuticals, Inc, Mountain View, and University of California, San Francisco, San Francisco, CA; University of Nebraska Medical Center, Omaha, NE; University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; Harper Hospital, Detroit, MI; Johns Hopkins Oncology Center, Baltimore, MD; University of Connecticut Health Center, Farmington, CT; University Hospital Groningen, Groningen, the Netherlands; and International Bone Marrow Transplant Registry, Milwaukee, WI.

Address reprint requests to Gerry Oster, PhD, Policy Analysis, Inc (PAI), Four Davis Court, Brookline, MA 02245.

PURPOSE: To explore the relationship between oral mucositis and selected clinical and economic outcomes in blood and marrow transplant patients.

PATIENTS AND METHODS: Subjects consisted of 92 transplant patients from eight centers who participated in a multinational pilot study of a new oral mucositis scoring system (Oral Mucositis Assessment Scale [OMAS]). In the pilot study, patients were evaluated for erythema and ulceration/pseudomembrane formation beginning on the first day of conditioning and continuing for 28 days. We examined the relationship between patients’ peak OMAS scores and days with fever (body temperature > 38.0°C), the occurrence of significant infection, days of total parenteral nutrition (TPN), and days of injectable narcotic therapy (all over 28 days), days in hospital (over 60 days), total hospital charges for the index admission, and vital status at 100 days.

RESULTS: Patients’ peak OMAS scores spanned the full range of possible values (0 to 5) and were significantly (P < .05) correlated with all of the outcomes of interest except days with fever (P = .21). In analyses controlling for type of graft (autologous v allogeneic) and study center, a 1-point increase in peak OMAS score was associated with (1) 1.0 additional day with fever (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 days of injectable narcotic therapy (P < .0001), (5) 2.6 additional days in hospital (P < .01), (6) $25,405 in additional hospital charges (P < .0001), and (7) a 3.9-fold increase in 100-day mortality risk (P < .01). Mean hospital charges were $42,749 higher among patients with evidence of ulceration compared with those without (P = .06).

CONCLUSION: Oral mucositis is associated with significantly worse clinical and economic outcomes in blood and marrow transplantation.

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