Symptom: Sores in Mouth

Initial Grading Reminder

CTCAE grading of mouth sores:

Grade 2 (Moderate): Moderate pain; not interfering with oral intake; modified diet indicated
Grade 3 (Severe): Severe pain; interfering with oral intake
Grade 4 (Life-threatening): Urgent intervention required

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Do you have any history of cold sores?  Are you taking steroids? Is this a new or worsening symptom? Where are the sores (e.g., on your tongue, the inside or outside of your gums, your lips)? When did it start or get worse? Has it developed gradually or suddenly?

Grade the symptom

Ask the patient:

How much pain are you experiencing in your mouth? Is it leading you to alter your eating/drinking habits? Are you able to eat enough? How much fluid are you drinking per day? Are you able to swallow?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Are you feeling weak, dizzy, or confused? Are you in intense pain?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?