Severe OM (SOM) occurs in almost 75% of these patients and is among the most debilitating and painful side effects related to treatment (Elting et al., 2009). SOM is associated with increased opioid use, weight loss, reliance on supplemental feeding and hydration, breaks in treatment, unplanned office, or emergency room visits and frequent hospitalizations resulting in an incremental cost of $18,000 per patient (Nonzee et al., 2008).