Laser Treatment Halts Oral Mucositis in Its Tracks

Fran Lowry

May 01, 2015

Spa-like treatment with a cool, low-level laser, similar to that use for wrinkles, vanquishes oral mucositis, one of the most debilitating toxicities of cancer therapy.

"I have been an oncology nurse for over 25 years, and in those 25 years, there has been nothing that helps prevent or is effective against the treatment for oral mucositis, until now," said Annette Quinn, RN, MSN, from the University of Pittsburgh Cancer Institute.

"Patients say they rank it higher than nausea and vomiting when it comes to adverse side effects, especially because we have good medications to control nausea and vomiting. But the low-level laser works better than we could have hoped," Quinn told Medscape Medical News.

She presented results from a pilot project at the Oncology Nursing Society (ONS) 40th Annual Congress in Orlando, Florida.

Oral mucositis affects virtually all head and neck cancer patients undergoing chemo and radiation therapy, and about 75% to 100% of patients undergoing stem cell transplantation with whole-body irradiation experience some degree of oral mucositis.

Low-level laser therapy (LLLT) has been used to treat oral mucositis for a decade in Europe and South America, but it has not made its way to the United States because there is no mechanism for reimbursement, Quinn reported.

She hopes this study will change that.

"Reimbursement is the main obstacle to its use in the United States, but for this study, I was able to secure the treatment through a grant. Treating oral mucositis could easily add $20,000 to the cost of patient care, but with the laser, we can decrease hospital readmissions and the use of pain medication, IV antibiotics, and feeding-tube placements. Even though we cannot receive reimbursement, laser treatment is still cost-effective," she said.

It is thought that LLLT works on the mitochondria to displace the nitric oxide that is generated as a result of radiation or chemotherapy, and helps to reoxygenate the cells, Quinn explained.

In the pilot project, 52 patients with head and neck cancer, all deemed to be at high risk for oral mucositis, received LLLT 830 nm wavelength three times a week, starting the first week of their radiation treatment and continuing throughout the course of their radiation therapy.

The initial intent was to see if the laser could control the oral mucositis so patients would not be forced to have a break in their treatment, Quinn explained.

"We know that patients who miss 5 days or more of radiation therapy have poorer survival, so we wanted to focus on how to get these patients through with no treatment breaks. We didn't realize that we would get them through with no mucositis. But we found that the very first patient we treated made it all the way through," she said.

None of the 52 patients treated with LLLT developed any oral mucositis.

When oncologists treating stem cell transplantation patients discovered these results, they brought 23 of their stem cell recipients for LLLT. These patients were treated until their absolute neutrophil count was above 1000 cell/nm³.

Again, results were excellent, although two patients developed grade 3 oral mucositis.

"Normally, 100% of stem cell patients develop oral mucositis. It's unbelievable what the therapy has done for oral mucositis," Quinn noted.

LLLT Simplicity Itself

"The treatment is administered immediately after the radiation therapy. It takes only about 6 to 8 minutes to administer, and is all done extraorally; none of the probes actually go into the mouth unless the patient develops a lesion inside the mouth that we need to target with the probe," Quinn explained.

 
It is simplicity itself, and it works so incredibly well. We just have to get the word out.
 

"We do five sites along their face, right along the jaw line, and then we do their tongue. The patients love it. We call it their spa time. It's the same laser they use in cosmetics to prevent wrinkles. We have not had one patient tell us they want to stop their treatment, and we have had no adverse side effects," she said.

The learning curve is very slight, Quinn added.

The training takes about half a day, and learning how to use the equipment only takes about 30 minutes. "It's just cold laser therapy, there's no heating, there's no cutting. Nothing. It is simplicity itself, and it works so incredibly well. We just have to get the word out," she said.

The poster generated a lot of buzz among the nurses attending the Congress, noted Ruth C. Gholz, RN, MSN, from the Cincinnati Veterans Administration Medical Center.

"There was a lot of excitement about the laser to treat oral mucositis. So many people were talking about it," Gholz told Medscape Medical News.

"Oral mucositis is a debilitating side effect that challenges us as we move forward with patients and providers. Low-level laser therapy has been a recognized treatment per guidelines, yet many have limited to no experience in its use," she said.

Gholz explained that these results challenge "all practices to incorporate low-level laser therapy into their armamentarium."

"The future is bright as we move forward in maximizing this therapy," she added.

Ms Quinn and Ms Gholz have disclosed no relevant financial relationships.

Oncology Nursing Society (ONS) 40th Annual Congress: Abstract 84. Presented April 24, 2015.

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