Multidisciplinary Approach on Oral Side Effect of Chemotherapy Treatment: A Case Report

Abstract

Introduction: Chemotherapy is one of nasopharyngeal cancer treatment used to improve the patient's quality of life, but it can cause several side effects such as mucositis, salivary gland dysfunction, and pain, that might lead to secondary complications like dysgeusia and malnutrition. Objectives: This article will discusses a case of oral side effects of chemotherapy treated with multidisciplinary approach. Case Presentation: A 58-year-old male patient who underwent 4th time neoadjuvant chemotherapy for nasopharyngeal cancer was referred to oral medicine specialist of Dharmais Cancer Hospital from hemato-oncology division with mouth and throat pain and dysphagia since 3 days ago, with 5 kgs of weight loss in two weeks due to eating difficulties. Intraoral examination showed multiple ulcers surrounded by erythema on almost all oral mucosa, with white pseudomembranous on the gingiva, dorsum tongue and buccal mucosa. The working diagnosis were grade IV Oral Mucositis, pseudomembranous candidiasis, and mild malnutrition. Case Management: The patient was treated with multidisciplinary team of hemato-oncologist, nutrition specialist, nurse, and oral medicine specialist, while Nystatin oral suspension 100.000IU, NaCl 0.9% gargle, and methylprednisolone 4 mg were administered for oral lesions. After three days, patient’s clinical condition showed improvement in oral mucositis lesion and complete healing of oral candidiasis, restoring patient’s ability to talk and eat solid food. Conclusion: In managing oral side effects of chemotherapy, it is essential to apply multidisciplinary approach and patient compliance encouragement to follow proper instruction and perform follow-up visits.