Shining a Light on Mucositis

Shine on

St. Jude clinicians were determined to take mucositis prevention further.

The solution? Shine a light on it.

Although light therapy, or photobiomodulation therapy, has been used to manage mucositis in adult patients undergoing bone marrow transplant and head or neck radiation, its use in children has been limited.

“We first started talking with dentists familiar with light therapy to determine how we could implement this form of symptom management for our young transplant patients,” says Belinda Mandrell, PhD, of Nursing Research and the study’s primary investigator.

How does it work?

Chemotherapy or radiation therapy can cause inflammation and cell death. Light therapy helps reverse this process. When absorbed by the cell, the light increases cellular metabolism and decreases inflammation.

St. Jude Nursing Research staff developed a study designed specifically for bone marrow transplant (BMT) patients.

“We developed this as a prevention, not as a treatment,” Mandrell says. “We start light therapy on the first day of admission as a preventive measure.”

 The researchers want to see whether light therapy reduces oral mucositis in children and adolescents. All study participants are getting blood stem cell transplants from matched or unmatched donors. The researchers also want to explore whether the treatment works for those who receive their own cells as part of the transplant process.

Swift and painless

The daily low-level light therapy is given both inside and outside the mouth for one minute per site. The child receives treatments until engraftment of the new bone marrow occurs or for 20 days, whichever is earlier.

Patients can watch TV, read or play games during the light therapy.

“So much of cancer treatment may cause discomfort or pain,” Pritchard says. “This doesn’t cause pain. It’s like a flashlight on their cheek.”

Older patients may hold the light probe themselves, taking an active part in their own therapy.

“It’s reassuring to caregivers that this can be a passive treatment for their children, especially if they’re not feeling well,” Pritchard says.

For those who are school age and older, the light therapy may be given using a probe that resembles a lollipop that can be held in the mouth. Small dental light probes may be used under their tongue or along the gum line.

“We ask the patient their level of pain before and after the treatment. We also document their need for nutritional support, blood and oral cultures,” Pritchard says. “We hope this helps decrease days in the hospital and reduces associated blood infections.”

The protocol has been active for about a year, with no reported toxicity or adverse events.

“Sometimes a child might complain that something hurts before we can see anything going on in their mouth,” Pritchard says. “When we treat that area, they say it really helps with the pain.”