Background Mucositis is a common complication for head and neck cancer patients receiving radical therapy. It impacts on quality of life, causes pain, limits ability to eat, and contributes to weight loss. As a joint collaboration between Specialist Palliative Care and Head and Neck Oncology teams, our aims were to:

1. Review current guidelines focused on the mucositis treatment

2. Evaluate symptom burden and current mucositis management for head and neck cancer patients undergoing radical radiotherapy in Sheffield.

Methods The Multinational Association of Supportive Care in Cancer (MASCC) guidelines for mucositis were reviewed and the level of evidence for each oral agent was assessed. Prospective data was collected at baseline (week 1), week 4 and week 7 detailing: mucositis grade (using Common Terminology Criteria for Adverse Effects); mouth care products used; pain scores (0–10); analgesia use; weight and hospital admissions.

Results The evidence base for oral agents was limited, with most support for benzydamine and Gelclair. Other treatments included: basic oral care, chlorhexidine, caphasol and thyme honey rinse. Twenty consecutive patients were included. Between baseline and week 7, average weight loss was 9.5%; mean pain scores increased from 1.6/10 to 6/10 and opioid use increased from 11% to 56%. By week 7, 17/20 patients reported grade 3 mucositis. The use of mouth care products was variable and Gelclair was infrequently used. There was little change in the quantity of mouth care products used between weeks 4 & 7 despite worsening mucositis. 40% had at least 1 hospital admission (totalling 42 inpatient nights), all related to treatment side effects.

Conclusions Joint multidisciplinary working enhanced this service evaluation and informed the:

1. Development of a clinical guideline flow chart to aid standardisation of treatment.

2. Introduction of Gelclair with supporting patient/healthcare professional information and a clear pathway to ensure ease of use.