MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy

Sharon Elad*, Karis Kin Fong Cheng, Rajesh V. Lalla, Noam Yarom, Catherine Hong, Richard M. Logan, Joanne Bowen, Rachel Gibson, Deborah P. Saunders, Yehuda Zadik, Anura Ariyawardana, Maria Elvira Correa, Vinisha Ranna, Paolo Bossi, Praveen Arany, Abdul Rahman Al-Azri, Nicole Blijlevens, Allan Hovan, Eduardo Fregnani, Janet FultonLuiz Alcino Gueiros, Tanya Rouleau, Janet K. Coller, Noor Al-Dasooqi, Hannah Wardill, Suzanne Ameringer, Héliton Spindola Antunes, Emma H. Bateman, Kivanc Bektas, René Jean Bensadoun, K. Ten Bohmer, Norman Brito-Dellan, Daniel Castillo, Karen Chiang, Charlotte de Mooij, June Eilers, Joel Epstein, Dimitra Galiti, Jane M. Fall-Dickson, Margherita Gobbo, Hanan Issa Hazboun, Siri Beier Jensen, Jorgen Johansen, Jamie Joy, K. Joy, Abhishek Kandwal, Tomoko Kataoka, Dorothy Keefe, Charles L. Loprinzi, Rachel Lubart, Anna Skripnik Lucas, Alessandra Majorana, Bronwen Mayo, Charlotte de Mooij, Takehiko Mori, Raj G. Nair, Narmin Nasr, Ourania Nicolatou-Galitis, Giulia Ottaviani, Cesar Migliorati, Monica Pentenero, Lorraine Porcello, Douglas Peterson, Carin Potting, Judith Raber-Durlacher, Ysabella Z.A. van Sebille, Yoshihiko Soga, Stephen Sonis, Andrea M. Stringer, Daniel Thorpe, Vanessa Tilly, Wim Tissing, Juan J. Toro, Nathaniel Simon Treister, Anusha Vaddi, Dianna Weikel, Marianne van de Wetering, Eyal Zur

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

295 Scopus citations


Background: Mucositis is a significant toxicity of cancer therapy with numerous systemic sequelae. The goal of this systematic review was to update the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) Clinical Practice Guidelines for the management of mucositis. Methods: The literature was reviewed systematically to identify interventions for mucositis. Studies were rated according to the presence of major and minor flaws according to previously published criteria. The body of evidence for each intervention and in each treatment setting was assigned a level of evidence based on previously published criteria. Guidelines were developed based on the level of evidence, with 3 possible guideline determinations: recommendation, suggestion, or no guideline possible. Results: The guideline covers evidence from 1197 publications related to oral or gastrointestinal mucositis. Thirteen new guidelines were developed for or against the use of various interventions in specific treatment settings, and 11 previous guidelines were confirmed after aa review of new evidence. Thirteen previously established guidelines were carried over because there was no new evidence for these interventions. Conclusions: The updated MASCC/ISOO Clinical Practice Guidelines for mucositis provide professional health caregivers with a clinical setting-specific, evidence-based tool to help with the management of mucositis in patients who have cancer.

Original languageAmerican English
Pages (from-to)4423-4431
Number of pages9
Issue number19
StatePublished - 1 Oct 2020

Bibliographical note

Funding Information:
According to Multinational Association of Supportive Care in Cancer (MASCC) guidelines policy, employees of commercial entities were not eligible to serve on this MASCC Guidelines Panel. Sharon Elad reports consultation fees from Falk Pharma, outside the submitted work. Rajesh V. Lalla reports institutional research support from Novartis, Oragenics, and Sucampo Pharma, outside the submitted work; grants and personal fees from Galera Therapeutics, outside the submitted work; personal fees from Alira Health, Colgate Oral Pharmaceuticals, Eagle Pharma, Enlivity, Ingalfarma SA, Meiji Seika Pharma, Monopar Therapeutics, Mundipharma, and Sucampo Pharma, outside the submitted work; stock ownership in Logic Biosciences; and has a patent pending (WO 2019/217536 A2; University of Connecticut, applicant). Deborah P. Saunders reports institutional research support from Galera Therapeutics. Paolo Bossi reports personal fees from Merck Serono, Roche, Sanofi, Merck Sharp & Dohme, Sun Pharma, AstraZeneca, Kyowa Hakko Kyrin, AstraZeneca, Bristol‐Myers Squibb, Helsinn, and Glaxo‐Smith‐Kline, outside the submitted work. The remaining authors made no disclosures.

Publisher Copyright:
© 2020 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.


  • Multinational Association of Supportive Care in Cancer and International Society for Oral Oncology (MASCC/ISOO)
  • cancer
  • gastrointestinal
  • guidelines
  • mucositis
  • oral


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