E. Earnshaw, G. Yesudian, J. Short, D. Yeomanson

Sheffield Children's Hospital NHS Trust, UK


Oral mucositis is a significant consequence of chemotherapy, radiotherapy and haematopoietic stem cell transplantation, affecting 52 to 80% of children and young people receiving treatment for cancer (1). It is a complex condition that causes severe mouth and throat pain, oral ulceration, xerostomia and can lead to difficulties in eating and drinking, hospitalisation for hydration, pain relief and parenteral nutrition. It has become a major dose-limiting toxicity which can affect the delivery of effective anticancer therapy and impact quality of life.


Many strategies are used in the treatment of oral mucositis including oral rinses, cryotherapy, growth factors and opiates. A meta-analysis by Oberoi et al., highlighted the effectiveness another modality, Photobiomodulation (PBM) treatment (2). Oberoi stated that when used prophylactically, PBM treatment reduces the severity of oral mucositis and the need for opioid analgesia. However, PBM is rarely utilised in the paediatric population.

Strategy for change

Photobiomodulation (PBM) treatment was introduced to the Haematology/Oncology ward at Sheffield Children’s Hospital in January 2022. A Service Evaluation was undertaken to assess the thoughts and experiences of children and their carers on the effectiveness of this new intervention.

Measure of improvement

Grading of oral mucositis were undertaken in accordance with current WHO recommendations. PBM dose was determined by grade of mucositis, with pain scores recorded pre- and post-operatively. A free text option was offered to the child and their carers to capture their thoughts and experiences of this new intervention.

Lessons Learnt

Sixty patient episodes of PBM treatment were reported over a one-year period, with 21 children and young people engaging with the service. The age range was 3 to 16 years.

70% of patient episodes (18 patients) reported a positive impact on their oral mucositis, with significant reduction in their pain scores pre- and post-treatment. 15% (3 patients) requested prophylactic PBM treatment prior to commencement of their chemotherapy with one child stating they

‘liked to have it before chemo as it makes chemo not as bad’.


One child reported that it felt ‘tickly’ while another stated that the effect was ‘magical’. Two patients were unable to report their outcome due being upset at the time of treatment.

A parent reported the treatment was beneficial to their child as they were able to eat after treatment.

Message for others

This study highlights the beneficial effect of PBM in children and young people who experience oral mucositis as a result of their chemotherapy. NICE guidance (2018) exists for PBM but is largely based on adult evidence (3). A systematic review by Redman et al., (2022), highlighted a paucity of good quality studies to confirm its efficacy as a prevention or treatment tool for oral mucositis in children with cancer (4).


  1. Ethier MC, Regier DA, Tomlinson D, et al., Perspectives toward oral mucositis prevention from parents and health care professionals in paediatric cancer. Support Care Cancer 2012;20: 1771-7.
  2. Oberoi S, Zamperlini–Netto G, Beyene J, Treister NS, Sung L (2014) Effect of Prophylactic Low Level Laser Therapy on Oral Mucositis: A Systematic Review and Meta-Analysis. PLoS ONE 9(9):

e107418. https://doi.org/10.1371/journal.pone.0107418

  1. National Institute for Health and Care Excellence. Low-level laser therapy for preventing or treating oral mucositis caused by radiotherapy or chemotherapy, 2018. Available:


  1. Redman MG, Harris K, Phillips BS. Low-level laser therapy for oral mucositis in children with cancer. Archives of Disease Childhood 2022;107: 128-133.
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