Impact of a standardized oral care protocol on oral mucositis severity in leukemia patients receiving induction chemotherapy

This study aimed to evaluate whether a standardized oral care protocol is associated with reduced oral mucositis (OM) severity among leukemia patients receiving induction chemotherapy. Baseline characteristics were comparable between groups. Severe OM occurred in 17/90 (18.9%) in the protocol group versus 30/90 (33.3%) with usual care (odds ratio 0.46; P = .027); the association remained significant after adjustment (adjusted odds ratio 0.50; P = .044). OM duration was shorter with the protocol (median 6 vs 8 days; P = .003), with faster time to resolution (14 vs 16 days; P = .04). The protocol group reported lower maximum pain (median 3 vs 5; P < .001), less opioid use (44.4% vs 60.0%; P = .036), lower morphine milligram equivalents (60 vs 120 mg; P = .006), and reduced parenteral nutrition use (13.3% vs 24.4%; P = .049). Febrile neutropenia, blood culture positivity, intensive care unit transfer, and length of stay did not differ significantly. A standardized oral care protocol was associated with reduced severe OM and meaningful improvements in OM duration and symptom burden during leukemia induction chemotherapy. Prospective studies are warranted to confirm effectiveness and implementation fidelity. We conducted a single-center retrospective cohort study including adult leukemia inpatients receiving induction chemotherapy. Patients were grouped by exposure to a standardized oral care protocol with per-shift documentation versus usual care (90 vs 90). OM was graded each shift using the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) v5.0 from induction day 1 to hospital discharge. The primary outcome was peak OM severity; severe OM was defined as CTCAE grade ≥ 3. Secondary outcomes included OM incidence (CTCAE ≥ 1), time to onset, duration, time to resolution, maximum oral pain score (0-10 Numeric Rating Scale), opioid use and cumulative morphine milligram equivalents, parenteral nutrition use, febrile neutropenia (temperature > 38.3°C with neutropenia), blood culture positivity, intensive care unit transfer, and length of stay. Group comparisons used Pearson χ2/Fisher exact tests and appropriate parametric/nonparametric tests. Multivariable logistic regression assessed the association between protocol exposure and severe OM.