# Oral mucositis management in hematopoietic cell transplantation in Australia and New Zealand (CAN EAT Survey)

## TL;DR

This survey examines how oral mucositis is managed in hematopoietic cell transplantation centers in Australia and New Zealand, finding that local guidelines are more commonly used than international ones.

## Contribution

The study provides the first evaluation of OM management practices in HCT centers in Australia and New Zealand.

## Key findings

- EviQ guidelines are more frequently used than MASCC/ISOO guidelines in the region.
- Palifermin and photobiomodulation are rarely used due to cost and access barriers.
- Oral care and cryotherapy are widely adopted for OM prevention.

## Abstract

The Multinational Association of Supportive Care in Cancer and the International Society of Oral Oncology (MASCC/ISOO) has published evidence-based international guidelines for the management of oral mucositis (OM). However, adherence to these guidelines has not been evaluated. This survey assessed OM management in hematopoietic cell transplantation (HCT) centers in Australia and New Zealand.

Specialist nurses in 41 transplant hospitals were invited to complete a survey. Questions covered general unit information, oral assessment (tools, assessors, frequency), prevention strategies (guidelines, oral care, cryotherapy, photobiomodulation, palifermin, and barriers to use), and treatment strategies (pain management and nutritional support).

Of 41 hospitals, 24 (59%) responded. All but one responder were specialized nurses. Oral assessment was primarily conducted by nurses (100%) and doctors (80%). The most commonly used tools were the World Health Organization grading scale (42%), pain scores (46%), and EviQ (Australian online cancer resource) (42%). EviQ guidelines (67%), which exclude palifermin and photobiomodulation, followed by institutional guidelines (29%) and MASCC/ISOO guidelines (17%). Oral care (100%) and cryotherapy with melphalan (96%) were widely adopted, while photobiomodulation and palifermin were rarely used due to cost and access barriers. For OM-related pain, as-needed opioids (100%), patient-controlled analgesia (58%), and topical analgesics (46%) were common. When OM impaired oral intake, supportive measures included supplemental drinks (88%), enteral nutrition (50%), and parenteral nutrition (67%).

In Australia and New Zealand, national EviQ guidelines are used more often than the MASCC/ISOO guidelines. Feasibility for implementing palifermin and photobiomodulation should be reassessed, and greater collaboration in developing guidelines is necessary.