Oral Thrush During Chemotherapy

Medications and Coping Methods for Thrush During Cancer Treatment

What are the symptoms and how can you cope with oral thrush during chemotherapy?. Credit: Istockphoto.com/Stock Photo©Adam88xx

If you've developed oral thrush during chemotherapy, or hear that it could happen, you may be wondering what the symptoms are, or how it is treated.  Thankfully oncologists are very familiar with treating this common side effect of chemotherapy.

Oral Thrush During Chemotherapy

Oral thrush can occur in people undergoing chemotherapy, especially in those who are prescribed steroids.

Thrush is caused by a fungus known as Candida albicans.

  This fungus is found naturally in small amounts on the body, but overgrowth can occur when the immune system is suppressed, or when antibiotic treatment gets rid of the "good bacteria" which normally inhabit the skin.

In addition, when the immune system is weakened, as in cancer treatment, the growth of the fungus is not as easily regulated by the body.

Causes of Thrush During Chemotherapy

As noted above, there are several reasons that an overgrowth of the Candida fungus may occur during chemo including:

  • Immune system suppression caused by steroids
  • Reduction of the normal good bacteria present in the mouth due to antibiotic treatment
  • Chemotherapy attacks rapidly dividing cells such as the mucous membranes in the mouth providing a setting for infection
  • Damage to mucous membranes due to mouth sores from chemotherapy
  • Diabetics with high blood sugar, and poorly fitting dentures also increase risk

    Symptoms of Oral Thrush

    Symptoms that suggest you may have thrush include:

    • White, creamy patches or lesions on the tongue or the inside of the mouth. Some people describe it as looking like cottage cheese or yogurt that is spread on the inside of the cheeks, tongue or back of the throat.
    • Burning sensation inside the mouth or throat. This causes the most discomfort in people with oral thrush.

      Treatment for Thrush

      Treatment for thrush usually uses a combination of a medication and supportive therapy. 

      The most common medications used include:

      •  Mycelex (clotrimazole) - Mycelex is a topical drug which It is prescribed as a lozenge, also called a troche. As the lozenge slowly dissolves in the mouth, the medicine is absorbed into the bloodstream. Each lozenge generally takes about 20 to 30 minutes to dissolve and is usually taken five times a day.
      • Nystatin is also commonly prescribed in a troche or liquid form. With liquid nystatin, you swish and swallow the medication. Some people report nystatin tasting bitter or acidic, but ask your pharmacist if he or she can add flavoring to it. Mint flavoring is a popular recommendation, as it works well to mask the bitterness.
      • Diflucan (fluconazole) is another medication used to treat thrush. For people undergoing chemotherapy, it is most often prescribed in a tablet form. Common side effects of Diflucan include headaches, nausea and dizziness, but these side effects are generally very mild. In some cases, Diflucan may be prescribed to prevent thrush in people undergoing cancer treatment.  While Diflucan is an excellent drug for treating oral thrush, it can be expensive for those who do not have health insurance or have maxed out on their prescription drug plan. There is a generic available, so be sure to ask your doctor before he or she writes the prescription. If you are paying out of pocket, be sure to shop around before filling the prescription. Some patients have found certain pharmacies to be be considerably less expensive than others. Some dental insurance plans will also pay for Diflucan.

        Magic Mouthwash for Thrush and Mouth Sores

        Doctors may also prescribe a mouthwash that is a combination of several medications to treat oral thrush. It is often referred to as "Magic Mouthwash" or "Mary's Magic Mouthwash," and consists of a mixture of several different drugs to treat the thrush and also to relieve discomfort caused by the infection.  It is important to note that Magic Mouthwash or Mary's Magic Mouthwash are not trade names, but nicknames for the formula. There are several different formulas and it is at a doctor's discretion to determine which drugs to include and the appropriate dosage. With a quick Google search, you can learn the formula for this mouthwash, but please do not attempt to make it at home. It's best to leave that work to a pharmacist.  Magic Mouthwash may also be prescribed to treat the dreaded chemotherapy-induced mouth sores.

        It is important to finish the medication you are prescribed, even if your symptoms improve or go away. If you decide to stop taking the medication before it is finished, please talk to your doctor beforehand.

        Coping with Thrush

        Some people find relief from the burning and itching sensation caused by thrush by eating and drinking cold foods and drinks. Popsicles, ice cream, smoothies and crushed ice beverages can temporarily help the burning sensation. Chilled soups make for excellent snacks or side dishes.

        If you have thrush, use a soft tooth brush until the infection clears. Avoid alcohol-based mouth washes as they may exacerbate the burning sensation.

        Thankfully, oral thrush isn't one of the long term side effects of chemotherapy, and usually disappears (with treatment) shortly after chemotherapy is finished.

        Complications of Thrush

        In addition to being painful on their own, thrush can lead to further complications including:

        • Dehydration and malnutrition due to discomfort with eating and drinking.
        • Secondary bacterial infections which can develop in areas already damaged by the fungus.
        • Mucositis - In addition to chemotherapy causing mouth sores on its own, oral thrush can break down the mucous membranes in the mouth leading to sores and ulcers.
        • Taste changes - Also in addition to the taste changes associated with chemotherapy (the notorious metal mouth) oral thrush can change a person's sense of taste.

        For Loved Ones

        If your loved one is coping with thrush, or other side effects of cancer treatment, check out these tips on supporting a loved one with cancer.  Yet these helpful hints are spoken of often.  If you are coping with the very common, but little spoken of resentment of your loved one's cancer, and all it does to create challenging moments between loved ones, help is here as well.

        Sources:

        National Cancer Institute. Oral Complications of Chemotherapy and Head/Neck Radiation – Patient Version (PDQ). Updated 01/22/16. http://www.cancer.gov/about-cancer/treatment/side-effects/mouth-throat/oral-complications-pdq

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