Oral Mucositis by the numbers: The Importance of Mitigating the Progression of Oral Mucositis

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Doctor explaining oral mucositis numbers

Cancer costs have significantly increased over the last decade, with some drugs more than tripling in price. Such an example is Novartis’ leukemia drug, Gleevec, which cost $26,000 when it launched in 2001, and reached a peak value of $146,000 during 2016 before it faced generic competition.1 According to an annual report published by the Quintiles IMS Institute in 2017, in the United States alone more than $44.1 billion is spent on oncology drugs per year, and an additional 11.1 billion on supportive care treatments needed to relieve the side effects of cancer treatment.2

While many costs are covered by health insurance, patient out-of-pocket costs remain high. Patients are responsible for twenty to thirty percent (20-30%) of drug costs in addition to deductibles and other fees not covered by insurance.3 The total cost of cancer treatment further increases when you consider loss of income from missed work, or job loss due to poor health from cancer and treatment side effects. Understanding the effects of added economic burden becomes important, as studies report that nearly fifty percent of patients fail to adhere to their treatment schedule because of cost.4

Incidence of Oral Mucositis

Oral mucositis (OM) can cause clinical complications and unscheduled hospitalizations that quickly add to the financial burden of patients going through cancer treatment. Whether or not a patient develops OM largely depends on the treatment location and type. Patients are more likely to develop OM when receiving radiation therapy (RT) to the head, neck, and chest, chemotherapy (Chemo-RT), and hematopoietic stem-cell transplantation (HSCT). Chemo-RT patients are more likely to develop OM than those who receive RT alone (98% vs. 85%),5 while HSCT patients can have an OM incidence rate between thirty-five and a hundred percent (35-100%) depending on factors such as grafting type and conditioning regimen.6

Increased Resource Utilization in Oral Mucositis Patients

Several independent studies have associated OM with increased resource utilization. Patients with OM see an increase in care costs and resources from pain management treatments, diet modifications, gastrostomy tube placement or total parenteral nutrition, management of secondary infections, as well as unplanned hospitalizations and visits to medical specialists.

A multicenter study by Murphy et al.7 examined resource utilization of cancer patients receiving radiation to the neck and head, with or without chemotherapy. The study found that approximately 30% of unplanned hospitalizations were directly related to mucositis complications. Moreover, 85% of patients who developed OM received analgesic treatments at least once during therapy, and approximately 51% patients had one or more feeding tubes placed at some point during therapy due to their inability to eat or swallow.

Another study evaluating HSCT patients found a correlation between peak mucositis scores and resource utilization. Patients with a single point increase in peak mucositis scores saw one additional day of fever, a 2.1-fold increase in risk of infection, 2.7 additional days of total parenteral nutrition, 2.6 additional days of injectable narcotic therapy, 2.6 additional days in hospital and a 3.9-fold increase in 100-day mortality risk.8

Overall, patients who receive RT and develop Grade 0-2 OM use less resources than patients with Grades 3-4 OM.5 And Chemo-RT patients see no significant differences in resources regardless of severity,5 while severity drives the cost for HSCT patients; who tend to develop Grades 2-4 OM about 70% of the time.8

Added Costs of Oral Mucositis

OM costs generally increase as a function of severity. A study published in 2007 by Elting et al. found that OM was associated with an incremental cost of $1,700-$6,000 depending on the grade of OM.5 RT-induced OM Grades 0-2 were associated with a $1900 increase, and Grades 2-4 were associated with a $2,100 – $2,200 increase.5 Additionally, the study reported that Chemo-RT induced OM Grades 0-2 were associated with a $2,200 – $2,400 increase compared to those without OM, while Grades 2-4 were associated with a $4,600 – $4,900 increase. However, more recent studies by Nomura et al. place the added cost of Chemo-RT induced OM closer to $17,000 per patient, per treatment cycle.9

Furthermore, the costs associated with HSCT induced OM tend to be significantly higher than those associated with RT and Chemo-RT induced OM. Because a single point increase in mucositis scores can more than double the length of hospital stays and treatment days in HSCT patients, the added costs associated with HSCT induced OM can range from $25,000-$43,000 per patient, per treatment cycle.8

The Importance of Mitigating Oral Mucositis

OM is clinically and economically significant for cancer patients. OM can lead to treatment interruptions that decrease survival rates and increase financial burden. Because the added costs of OM can prevent cancer patients from accessing and completing life-saving treatments, and it can add to the strain on the healthcare ecosystem, including preventative and clinically-proven options as part of the cancer treatment plan is critical for all patients likely to develop OM.

Recommending a strict oral hygiene routine, and the use of dietary supplements can help oncologists and patients manage the effects of OM. Clinically-proven dietary supplements designed to promote and maintain the health of the cells lining the mouth and digestive tract, can minimize costly complications and reduce the financial burden, particularly for patients going through cancer treatment.

 

Sources:

  1. Gorkin, L.; Kantarjian, H. Targeted Therapy: Generic imatinib – Impact on frontline and salvage therapy for CML. Nat Rev Clin Oncol.[Online] 2016, 13(5):270–272  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5450934/ (accessed Jul 24, 2018).
  2. Quintiles IMS Institute. Global Oncology Trends, 2017. Morning Consult. https://morningconsult.com/wp-content/uploads/2017/06/QuintilesIMS-Institute-Oncology-Report.pdf (accessed Jul 24, 2018).
  3. Glover, L. Oncologists Worry About Rising Costs of Cancer Treatment. U.S. News and World Report: Health [Online]. Jul 1, 2015. https://health.usnews.com/health-news/patient-advice/articles/2015/07/01/oncologists-worry-about-rising-costs-of-cancer-treatment (accessed Aug 1, 2018).
  4. Weintraub, A. Even Insured Patients Are Overwhelmed by the Cost of Cancer Care. Forbes [Online]. Aug 10, 2017. https://www.forbes.com/sites/arleneweintraub/2017/08/10/even-insured-patients-are-overwhelmed-by-the-cost-of-cancer-care/#24fc29ee51c4 (accessed Jul 24, 2018).
  5. Elting at al. Risk, outcomes, and costs of radiation-induced oral mucositis among patients with head-and-neck malignancies. Int J Radiat Oncol Biol Phys2007, 68(4):1110–1120.
  6. Crulli et al. Treatment of Oral Mucositis in Hematologic Patients Undergoing Autologous or Allogenic Transplantation of Peripheral Blood Stem Cells: a Prospective, Randomized Study with a Mouthwash Containing Camelia Sinensis Leaf Extract. Hematol Rep. 2013, 5(1):21– 25.
  7. Murphy et al. Mucositis-related morbidity and resource utilization in head and neck cancer patients receiving radiation therapy with or without chemotherapy. J Pain Symptom Manage.[Online] 2009, 38(4):522532. PubMed. https://www.ncbi.nlm.nih.gov/pubmed/19608377 (accessed Jul 24, 2018).
  8. Sonis et al. Oral mucositis and the clinical and economic outcomes of hematopoietic stem-cell transplantation. J Clin Oncol. 2001, 19(8):2201–2205.
  9. Nomura et al. Irsogladine maleate reduces the incidence of fluorouracil-based chemotherapy-induced oral mucositis. Ann Oncol. 2013, 24:1062–1066.