Development of a staging system for chemotherapy-induced stomatitis

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Abstract
A staging system was developed to measure the progressive severity of chemotherapy-induced stomatitis. A panel of 15 experts from nursing, dentistry, and medicine were interviewed to elicit the criteria they used to evaluate progressive severity. This process was used to develop an instrument to measure the observable and functional dimensions of stomatitis. After pilot testing, the instrument was refined and evaluated with 53 cancer patients. Patients receiving stomatotoxic chemotherapy, or already exhibiting oral problems secondary to chemotherapy, were tested with three measures: the new Western Consortium for Cancer Nursing Research (WCCNR) Staging System, the Oral Assessment Guide (OAG), and the World Health Organization (WHO) Mucositis Grading System. Results indicated that the three scales were moderately correlated (0.57 to 0.76), indicating they were measuring the same general construct. The mean OAG scores were significantly different by WCCNR stage, and discriminant analysis demonstrated that the staging system did differentiate between the three stages of stomatitis as measured by the other two scales. The WCCNR Staging System is unique in that it reflects expert practice, encouraging clinicians to make a holistic assessment of the mouth's condition rather than summing scores on discrete aspects of the oral condition.

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