Interrater Reliability of Oral Mucositis Assessment in High-Dose Chemotherapy Patients

Overview

This multicenter study evaluated the interrater reliability of oral mucositis (OM) assessments between specialized dentists and registered nurses in patients undergoing high-dose chemotherapy (HDCT) prior to hematopoietic stem cell transplantation (HSCT). Moderate reliability was found between the two professions using the WHO oral toxicity scale, highlighting the potential for nurses to reliably assess OM with appropriate training.

Background

Oral mucositis is a common and debilitating complication affecting up to 80% of patients receiving HDCT before HSCT. It manifests as erythema and ulcerations in the oral mucosa, causing pain and difficulty in eating. Accurate assessment of OM severity is crucial for patient management, yet no consensus exists on which healthcare professionals should perform these evaluations. This study addresses the gap by comparing assessments made by dentists specialized in orofacial medicine and registered nurses.

Data Highlights

Key Findings

• OM affects a majority of patients undergoing HDCT for hematological malignancies.
• The WHO oral toxicity scale is a validated tool combining objective and subjective OM assessments.
• Specialized dentists demonstrated moderate interrater reliability (ICC=0.672) in OM scoring.
• Registered nurses received structured training to assess OM severity using the WHO scale.
• OM assessments by nurses and dentists were conducted thrice weekly but not simultaneously.
• Highest OM scores by dentists were compared with nurse assessments to evaluate reliability.

Clinical Implications

With structured training, registered nurses can reliably assess oral mucositis severity in HDCT patients, potentially allowing for more frequent and accessible monitoring in clinical settings. This supports the integration of nurse-led OM assessments into routine care, which may improve symptom management and timely interventions. However, dentists specialized in orofacial medicine remain important for confirmatory evaluations and complex cases.

Conclusion

The study demonstrates moderate interrater reliability between specialized dentists and trained nurses in assessing oral mucositis using the WHO scale. These findings support the feasibility of nurse-led OM assessments in high-dose chemotherapy patients, facilitating consistent and effective patient care.

Related Resources & Content

1. Study Authors/Multicenter Trial 2024 -- Assessment of Oral Mucositis in High-Dose Chemotherapy Patients