Read the above data and gadd the mocosoties management step wise approach and dose of drug Composition of magic mouth wajs and modified magic mouth washh

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python3 -c " from docx import Document doc = Document('/tmp/workspace/attachments/46d39c54-5d4e-4ce4-99d6-f33910739ce6/Mucositis_ESMO_Guideline_Summary.docx') for p in doc.paragraphs: style = p.style.name if p.style else 'None' if p.text.strip(): print(f'[{style}] {p.text}') "

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Management of Oral and Gastrointestinal Mucositis

ESMO Clinical Practice Guidelines — Enhanced Reference

Source: Peterson DE, Bensadoun R-J, Roila F; ESMO Guidelines Working Group. Ann Oncol. 2011;22(Suppl 6):vi78–vi84. doi:10.1093/annonc/mdr391

SECTION 1 — Introduction and Definition

Mucositis affecting the oral cavity and GI tract remains a major clinical problem with cancer therapy, particularly high-dose chemotherapy and radiation. It is defined as inflammatory and/or ulcerative injury of the oral and/or GI mucosa. "Alimentary tract mucositis" describes the full continuum from mouth to anus.

SECTION 2 — Mucositis: Step-Wise Management Approach

STEP 1 — Assessment and Grading

Assess every patient using the WHO Oral Toxicity Scale or NCI CTCAE v4.0:

Grade	WHO Description	NCI CTCAE Description
0	No mucositis	None
1	Soreness/erythema	Asymptomatic or mild symptoms
2	Erythema, ulcers, can eat solids	Moderate pain, not interfering with oral intake
3	Ulcers, requires liquid diet only	Severe pain, interfering with oral intake
4	Alimentation not possible	Life-threatening; urgent intervention required

STEP 2 — Basic Oral Care (ALL Patients, ALL Grades)

These foundational measures are mandatory regardless of grade:

Saline/sodium bicarbonate rinses 4-6 times/day (non-medicated, non-alcohol based) - [III, B]
Soft toothbrush, replaced regularly
Avoid alcohol-based mouth rinses
Screen all patients for nutritional risk; start early enteral nutrition if swallowing is impaired
Maintain oral hydration

STEP 3 — Grade-Based Pharmacological Step-Up

Grade 1 (Mild - Soreness/Erythema Only)

Bland mouthrinse: normal saline or sodium bicarbonate in water, "swish and spit" 4-6x/day
Avoid hard/rough/sharp foods, alcohol, smoking
Patient education on oral hygiene

Grade 2 (Moderate - Ulcers, Can Eat Solids)

Continue basic oral care (Step 2)
Add 2% viscous lidocaine solution to saline/sodium bicarbonate mouthrinse - "swish and spit"
Magic Mouthwash (see composition below) - swish for 1-2 min, expectorate or swallow
Topical mucosal protectants: Gelclair, Caphosol, Biotene (limited evidence but favorable safety profile)
Topical anesthetics as needed for pain relief

Grade 3-4 (Severe - Cannot Eat or Alimentation Impossible)

Continue all above measures
Patient-controlled analgesia (PCA) with morphine - recommended treatment of choice for oral mucositis pain in HSCT patients [I, A]
Doxepin mouthrinse (topical) for severe mucositis
Magic Mouthwash or Modified Magic Mouthwash (see below)
Consider opioid analgesia (morphine PCA preferred in HSCT)
Assess for dehydration, neutropenia, systemic infection
Expert consultation and hospitalization if: severe pain interfering with eating, dehydration, neutropenic fever, or suspected systemic infection
Enteral nutrition support (NG tube or gastrostomy) if oral intake is impossible
For radiation-induced mucositis: diphenhydramine/lidocaine/antacid mouthwash; dexamethasone mouthwash for mTOR inhibitor-induced mucositis

STEP 4 — Prevention Strategies (Disease/Context Specific)

Head & Neck Radiotherapy

Benzydamine oral rinse - recommended for prevention in moderate-dose RT [I, A]
Midline radiation blocks and 3D conformal planning to reduce mucosal exposure [II, B]
Do NOT use chlorhexidine for prevention [II, B]
Do NOT use antimicrobial lozenges [II, B]

Standard-dose Chemotherapy

Oral cryotherapy (ice chips) - recommended for bolus 5-FU [II, A]; also for bolus edatrexate [IV, B]
Ranitidine or omeprazole orally - to prevent epigastric pain with 5-FU/CMF regimens [II, A]
Do NOT use IV acyclovir to prevent mucositis [II, B]

High-dose Chemotherapy + HSCT

Palifermin (KGF-1) 60 µg/kg/day IV for 3 days before conditioning + 3 days post-transplant - recommended for haematologic malignancy with TBI + autologous HSCT [I, A]
Oral cryotherapy - for high-dose melphalan [II, A]
Low-level laser therapy (LLLT) - suggested to reduce incidence and pain before HSCT where technology/training is available [II, B]
Do NOT use topical pentoxifylline [II, B]
Do NOT use GM-CSF mouthwashes [II, C]

STEP 5 — GI Mucositis Management

Prevention

Sulfasalazine 500 mg orally twice daily - to reduce radiation-induced enteropathy with pelvic EBRT [II, B]
Intrarectal amifostine ≥340 mg/m² - to prevent radiation proctitis with rectal cancer RT [III, B]
Do NOT use oral sucralfate (causes more GI side effects and does not prevent diarrhea) [I, A]
Do NOT use 5-aminosalicylic acid/mesalazine/olsalazine [I, A]
IV amifostine - suggested to reduce esophagitis from concurrent chemoRT in NSCLC [III, C]

Treatment

Loperamide - first-line for chemotherapy-induced diarrhea
Octreotide ≥100 µg SC twice daily - when loperamide fails for diarrhea from standard or high-dose chemotherapy [II, A]
Sucralfate enemas - for chronic radiation-induced proctitis with rectal bleeding [III, B]
Maintain adequate hydration; assess for transient lactose intolerance and bacterial pathogens

SECTION 3 — Magic Mouthwash: Composition and Dosing

Standard / Classic Magic Mouthwash

Composition (equal parts of 3 ingredients):

Component	Role	Concentration
2% Viscous Lidocaine	Topical anesthetic	2% solution
Diphenhydramine elixir (12.5 mg/5 mL)	Antihistamine, mild anesthetic, anti-inflammatory	12.5 mg/5 mL
Maalox (Magnesium + Aluminum hydroxide)	Antacid/coating agent, suspending medium	Standard suspension

Source: Roberts and Hedges' Clinical Procedures in Emergency Medicine; Dermatology 2-Volume Set 5e

Dose and Administration:

Mix in equal parts (1:1:1)
Each 5 mL dose contains less than 50 mg of lidocaine
Dose: 5 mL (1 teaspoon) per use
Swish and hold in mouth for 1-2 minutes, then expectorate (spit out - do not swallow)
Frequency: every 4-6 hours as needed for pain

Important safety note: Viscous lidocaine 2% alone as a 5 mL dose contains 100 mg lidocaine. The magic mouthwash formulation (equal parts) reduces this to <50 mg per dose, lowering systemic toxicity risk. Do not swallow; repeated administration can cause systemic toxicity especially in children.

Modified Magic Mouthwash

The modified formulation adds antibacterial, antifungal, and anti-inflammatory components - particularly useful for radiation-induced mucositis:

Composition (Cummings Otolaryngology Head and Neck Surgery formulation):

Component	Role
Tetracycline	Antibacterial
Diphenhydramine	Antihistamine / mild anesthetic
Nystatin	Antifungal
Hydrocortisone	Anti-inflammatory / mucosal healing

Source: Cummings Otolaryngology Head and Neck Surgery

Dose and Administration:

Compounded solution obtained from a pharmacy
Dose: 2 teaspoons (10 mL)
Swished and gargled 3 times daily, then swallowed
Specifically indicated for radiation-induced stomatitis and pharyngitis

Alternative Formulation (Goldman-Cecil / Harrison's)

For radiation-induced mucositis and mTOR inhibitor-associated mucositis:

Component	Dose
Diphenhydramine	Standard elixir concentration
2% Lidocaine	Viscous solution
Antacid (Maalox/Mylanta)	Standard suspension
± Dexamethasone	0.5 mg/5 mL (dexamethasone elixir) - especially for mTOR inhibitor-induced mucositis

Dexamethasone mouthwash dose: 0.5 mg/5 mL elixir - swish and spit 5 mL BID-TID, leaving in mouth for 5 minutes.

Source: Goldman-Cecil Medicine; Harrison's Principles of Internal Medicine 22E

Comparison Summary: Magic vs. Modified Magic Mouthwash

Feature	Classic Magic Mouthwash	Modified Magic Mouthwash
Components	Lidocaine + Diphenhydramine + Maalox	Tetracycline + Diphenhydramine + Nystatin + Hydrocortisone
Antifungal	No	Yes (Nystatin)
Antibacterial	No	Yes (Tetracycline)
Anti-inflammatory	Mild (diphenhydramine)	Yes (Hydrocortisone)
Topical anesthetic	Yes (Lidocaine)	Indirect (Diphenhydramine)
Preparation	Equal parts (1:1:1)	Compounded by pharmacy
Dose	5 mL, swish 1-2 min, expectorate	10 mL (2 tsp), swish + gargle 3x/day, swallow
Best for	General mucositis pain relief, emergency use	Radiation-induced stomatitis + pharyngitis

SECTION 4 — Topical Drug Doses Quick Reference

Drug	Indication	Dose/Instructions
Benzydamine oral rinse	Prevention, moderate-dose RT to H&N	Rinse per product label
Palifermin (KGF-1)	Prevention, HSCT with TBI	60 µg/kg/day IV x3 days pre + 3 days post-transplant
2% Viscous Lidocaine	Topical analgesia	5 mL swish and spit; max 250-300 mg total dose
Morphine (PCA)	Severe pain, HSCT	PCA - patient-controlled dosing
Dexamethasone elixir	mTOR inhibitor mucositis	0.5 mg/5 mL; swish and spit 5 mL BID-TID x 5 min
Nystatin suspension	Secondary candidal infection	400,000-600,000 units, swish and swallow 4x/day
Clotrimazole troches	Secondary candidal infection	10 mg troches 4x/day
Chlorhexidine 0.12%	Secondary infection support	Swish and spit BID (not recommended for mucositis prevention)
Octreotide	Loperamide-refractory diarrhea	≥100 µg SC twice daily
Sulfasalazine	Prevention of radiation enteropathy	500 mg orally twice daily
Sucralfate enema	Chronic radiation proctitis with bleeding	Per enema preparation
Clobetasol 0.05% gel	Topical anti-inflammatory	Apply to lesions BID-TID
Triamcinolone 0.1% paste	Topical anti-inflammatory	Apply to lesions BID-TID

SECTION 5 — Key Evidence Levels

Recommendation	Evidence Level	Grade
PCA morphine for HSCT mucositis pain	I	A
Benzydamine rinse for moderate-dose H&N RT	I	A
Palifermin for HSCT with TBI	I	A
Oral cryotherapy for bolus 5-FU	II	A
Oral cryotherapy for high-dose melphalan	II	A
Ranitidine/omeprazole for 5-FU epigastric pain	II	A
Basic oral care protocols (saline rinses)	III	B
Low-level laser therapy (HSCT)	II	B
Octreotide for loperamide-refractory diarrhea	II	A
Sulfasalazine for pelvic RT enteropathy	II	B
Chlorhexidine NOT recommended for prevention	II	B (against)
Sucralfate NOT recommended for RT oral mucositis	II	A (against)

Enhanced reference document. Original ESMO guideline: Peterson DE et al., Ann Oncol 2011;22(Suppl 6):vi78-vi84. Textbook sources: Cummings Otolaryngology Head and Neck Surgery; Goldman-Cecil Medicine; Harrison's Principles of Internal Medicine 22E; Dermatology 2-Volume Set 5e; Roberts and Hedges' Clinical Procedures in Emergency Medicine.

Generate a quick reference pocket card (PDF) for mucositis grading and drug dosing

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mkdir -p /tmp/workspace/mucositis-card && python3 << 'PYEOF' from reportlab.lib.pagesizes import A4 from reportlab.lib import colors from reportlab.lib.units import mm, cm from reportlab.platypus import ( SimpleDocTemplate, Table, TableStyle, Paragraph, Spacer, HRFlowable, KeepTogether ) from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_RIGHT from reportlab.lib.colors import HexColor # ── colour palette ────────────────────────────────────────────────────────── NAVY = HexColor("#1a3a5c") TEAL = HexColor("#0d7377") TEAL_LT = HexColor("#e0f4f4") AMBER = HexColor("#f59e0b") AMBER_LT = HexColor("#fef3c7") RED = HexColor("#dc2626") RED_LT = HexColor("#fee2e2") GREEN = HexColor("#16a34a") GREEN_LT = HexColor("#dcfce7") ORANGE = HexColor("#ea580c") ORANGE_LT = HexColor("#ffedd5") GREY_LT = HexColor("#f1f5f9") GREY_MED = HexColor("#cbd5e1") WHITE = colors.white BLACK = colors.black # ── document ──────────────────────────────────────────────────────────────── OUT = "/tmp/workspace/mucositis-card/Mucositis_Pocket_Card.pdf" doc = SimpleDocTemplate( OUT, pagesize=A4, leftMargin=12*mm, rightMargin=12*mm, topMargin=10*mm, bottomMargin=10*mm ) W = A4[0] - 24*mm # usable width styles = getSampleStyleSheet() def S(name, **kw): """Quick style builder.""" base = styles.get(name, styles["Normal"]) return ParagraphStyle(name + str(id(kw)), parent=base, **kw) # shared paragraph styles hdr_style = S("Normal", fontSize=7, textColor=WHITE, fontName="Helvetica-Bold", alignment=TA_CENTER, leading=9) body_style = S("Normal", fontSize=6.8, textColor=BLACK, fontName="Helvetica", leading=8.5) body_bold = S("Normal", fontSize=6.8, textColor=BLACK, fontName="Helvetica-Bold", leading=8.5) body_small = S("Normal", fontSize=6.2, textColor=BLACK, fontName="Helvetica", leading=7.8) note_style = S("Normal", fontSize=5.8, textColor=HexColor("#475569"), fontName="Helvetica-Oblique", leading=7) def P(txt, style=None): return Paragraph(txt, style or body_style) def PB(txt): return Paragraph(txt, body_bold) # ============================================================ # HELPER: section header row spanning all columns # ============================================================ def sec_hdr(text, bg=NAVY, cols=1): return [Paragraph(f"{text}", hdr_style)] + [""] * (cols - 1) # ============================================================ # TITLE BANNER # ============================================================ title_data = [[ Paragraph( "MUCOSITIS " "QUICK REFERENCE POCKET CARD", ParagraphStyle("title", fontSize=13, fontName="Helvetica-Bold", textColor=WHITE, alignment=TA_CENTER, leading=16) ) ]] title_tbl = Table(title_data, colWidths=[W]) title_tbl.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), NAVY), ("ROWPADDING", (0,0), (-1,-1), 7), ("TOPPADDING", (0,0), (-1,-1), 8), ("BOTTOMPADDING", (0,0), (-1,-1), 8), ("ROUNDEDCORNERS", [4]), ])) subtitle_data = [[ Paragraph( "ESMO Guidelines 2011 | MASCC/ISOO | For clinical reference only", ParagraphStyle("sub", fontSize=7, fontName="Helvetica-Oblique", textColor=HexColor("#64748b"), alignment=TA_CENTER) ) ]] subtitle_tbl = Table(subtitle_data, colWidths=[W]) # ============================================================ # TABLE 1 — GRADING (WHO + NCI CTCAE) # ============================================================ G = [ [sec_hdr("MUCOSITIS GRADING (WHO Oral Toxicity Scale + NCI CTCAE v4.0)", NAVY, 4)], [PB("Grade"), PB("WHO Description"), PB("NCI CTCAE v4.0 Description"), PB("Action")], [P("0"), P("No mucositis"), P("None"), P("Routine oral care")], [P("1"), P("Soreness / erythema only"), P("Asymptomatic or mild symptoms"), P("Saline/bicarb rinses, soft diet")], [P("2"), P("Erythema + ulcers; can eat solids"), P("Moderate pain, not interfering with oral intake"), P("Add topical analgesia, Magic Mouthwash")], [P("3"), P("Ulcers; liquid diet required"), P("Severe pain, interfering with oral intake"), P("Opioids, consider PCA morphine, nutrition support")], [P("4"), P("Alimentation impossible"), P("Life-threatening; urgent intervention"), P("ICU/HDU, IV fluids, hospitalise, IV opioids")], ] grade_col = [14*mm, 46*mm, 65*mm, W - 14*mm - 46*mm - 65*mm] grade_tbl = Table(G, colWidths=grade_col, repeatRows=2) grade_colors = [RED_LT, ORANGE_LT, AMBER_LT, GREEN_LT, TEAL_LT] grade_bg = [RED, ORANGE, AMBER, GREEN, TEAL ] grade_tbl.setStyle(TableStyle([ # header ("SPAN", (0,0), (3,0)), ("BACKGROUND", (0,0), (3,0), NAVY), ("BACKGROUND", (0,1), (3,1), HexColor("#334155")), ("TEXTCOLOR", (0,1), (3,1), WHITE), ("FONTNAME", (0,1), (3,1), "Helvetica-Bold"), ("FONTSIZE", (0,1), (3,1), 7), ("ALIGN", (0,0), (-1,-1), "LEFT"), ("VALIGN", (0,0), (-1,-1), "MIDDLE"), ("ROWPADDING", (0,0), (-1,-1), 4), ("TOPPADDING", (0,0), (-1,-1), 4), ("BOTTOMPADDING",(0,0),(-1,-1),4), ("GRID", (0,1), (-1,-1), 0.4, GREY_MED), ("LINEBELOW", (0,0), (-1,0), 0, WHITE), # grade row colours ("BACKGROUND", (0,2), (0,2), RED_LT), ("BACKGROUND", (0,3), (0,3), ORANGE_LT), ("BACKGROUND", (0,4), (0,4), AMBER_LT), ("BACKGROUND", (0,5), (0,5), GREEN_LT), ("BACKGROUND", (0,6), (0,6), TEAL_LT), ("FONTNAME", (0,2), (0,-1), "Helvetica-Bold"), ("FONTSIZE", (0,2), (0,-1), 8), ("ALIGN", (0,2), (0,-1), "CENTER"), ])) # ============================================================ # TABLE 2 — STEP-WISE MANAGEMENT # ============================================================ mgmt_cw = [18*mm, W - 18*mm] M = [ [sec_hdr("STEP-WISE MANAGEMENT APPROACH", TEAL, 2)], [PB("Step"), PB("Action")], [P("STEP 1\nAssess & Grade"), P("Use WHO or NCI CTCAE scale. Check CBC, hydration status, nutritional risk.")], [P("STEP 2\nBasic Oral Care\n(ALL grades)"), P("• Saline / sodium bicarbonate rinse 4–6×/day [III, B]\n" "• Soft toothbrush; NO alcohol-based rinse\n" "• Nutritional screening; enteral nutrition if swallowing impaired\n" "• Adequate oral hydration")], [P("STEP 3\nTopical Analgesia\n(Grade 2+)"), P("• 2% Viscous Lidocaine added to saline rinse – swish & spit\n" "• Magic Mouthwash (see box) – 5 mL, swish 1–2 min, expectorate\n" "• Topical protectants: Gelclair / Caphosol / Biotene\n" "• Doxepin mouthrinse for severe mucositis")], [P("STEP 4\nSystemic Analgesia\n(Grade 3–4)"), P("• PCA Morphine – treatment of choice in HSCT [I, A]\n" "• Regular pain assessment with validated self-report tools\n" "• Consider hospitalisation if: severe pain, dehydration, neutropenic fever, infection")], [P("STEP 5\nNutritional\nSupport"), P("• Early enteral nutrition (NG tube / gastrostomy) if oral intake impossible\n" "• Screen for malnutrition at each visit")], [P("STEP 6\nPrevention\n(Context-specific)"), P("• H&N RT: Benzydamine rinse [I, A] | 3D conformal planning [II, B]\n" "• Bolus 5-FU: Oral cryotherapy (ice chips) [II, A]\n" "• HSCT + TBI: Palifermin 60 µg/kg/day IV ×3 pre + ×3 post [I, A]\n" "• High-dose melphalan: Oral cryotherapy [II, A]\n" "• HSCT: Low-level laser therapy (where available) [II, B]")], [P("STEP 7\nGI Mucositis"), P("• First-line diarrhea: Loperamide\n" "• Loperamide failure: Octreotide ≥100 µg SC BD [II, A]\n" "• Pelvic RT enteropathy prevention: Sulfasalazine 500 mg BD [II, B]\n" "• Radiation proctitis + bleeding: Sucralfate enemas [III, B]")], ] mgmt_tbl = Table(M, colWidths=mgmt_cw, repeatRows=2) mgmt_tbl.setStyle(TableStyle([ ("SPAN", (0,0), (1,0)), ("BACKGROUND", (0,0), (-1,0), TEAL), ("BACKGROUND", (0,1), (-1,1), HexColor("#0f766e")), ("TEXTCOLOR", (0,1), (-1,1), WHITE), ("FONTNAME", (0,1), (-1,1), "Helvetica-Bold"), ("FONTSIZE", (0,1), (-1,1), 7), ("ALIGN", (0,0), (-1,-1), "LEFT"), ("VALIGN", (0,0), (-1,-1), "TOP"), ("ROWPADDING", (0,0), (-1,-1), 4), ("TOPPADDING", (0,0), (-1,-1), 4), ("BOTTOMPADDING", (0,0), (-1,-1), 4), ("GRID", (0,1), (-1,-1), 0.4, GREY_MED), ("LINEBELOW", (0,0), (-1,0), 0, WHITE), ("BACKGROUND", (0,2), (0,-1), TEAL_LT), ("FONTNAME", (0,2), (0,-1), "Helvetica-Bold"), ("FONTSIZE", (0,2), (0,-1), 6.5), ("ALIGN", (0,2), (0,-1), "CENTER"), ("VALIGN", (0,2), (0,-1), "MIDDLE"), # alternate row tints for readability ("BACKGROUND", (1,3), (1,3), GREY_LT), ("BACKGROUND", (1,5), (1,5), GREY_LT), ("BACKGROUND", (1,7), (1,7), GREY_LT), ("BACKGROUND", (1,9), (1,9), GREY_LT), ])) # ============================================================ # TABLE 3 — MAGIC MOUTHWASH (left) + MODIFIED (right) # ============================================================ mw_cw = [(W - 3*mm) / 2, (W - 3*mm) / 2] def mw_hdr(txt, bg): return Paragraph(f"{txt}", hdr_style) MWL = [ # Classic [mw_hdr("CLASSIC MAGIC MOUTHWASH", NAVY)], [P("Components (1:1:1 equal parts)")], [P("1. 2% Viscous Lidocaine")], [P("2. Diphenhydramine elixir 12.5 mg/5 mL")], [P("3. Maalox® (Mg + Al hydroxide suspension)")], [P("Dose: 5 mL per use")], [P("Lidocaine per dose: <50 mg (safe range)")], [P("Method: Swish & hold 1–2 min → EXPECTORATE")], [P("Frequency: Every 4–6 h as needed")], [P("Use: General mucositis pain relief; emergency use")], [P("⚠ Do not swallow – systemic toxicity risk,\nespecially in children", body_small)], ] MWR = [ # Modified [mw_hdr("MODIFIED MAGIC MOUTHWASH", HexColor("#7c3aed"))], [P("Components (compounded by pharmacy)")], [P("1. Tetracycline (antibacterial)")], [P("2. Diphenhydramine (antihistamine/anesthetic)")], [P("3. Nystatin (antifungal)")], [P("4. Hydrocortisone (anti-inflammatory)")], [P("Dose: 10 mL (2 teaspoons)")], [P("Method: Swish + gargle → SWALLOW")], [P("Frequency: 3 times daily")], [P("Use: Radiation-induced stomatitis & pharyngitis")], [P("Requires pharmacy compounding; covers\nbacterial + fungal secondary infection", body_small)], ] left_tbl = Table(MWL, colWidths=[mw_cw[0]]) right_tbl = Table(MWR, colWidths=[mw_cw[1]]) def mw_style(bg_hdr): return TableStyle([ ("BACKGROUND", (0,0), (-1,0), bg_hdr), ("ROWPADDING", (0,0), (-1,-1), 3), ("TOPPADDING", (0,0), (-1,-1), 3), ("BOTTOMPADDING", (0,0), (-1,-1), 3), ("ALIGN", (0,0), (-1,-1), "LEFT"), ("VALIGN", (0,0), (-1,-1), "TOP"), ("BACKGROUND", (0,1), (-1,1), HexColor("#f8fafc")), ("GRID", (0,0), (-1,-1), 0.4, GREY_MED), ("LINEBELOW", (0,0), (-1,0), 0, WHITE), ]) left_tbl.setStyle(mw_style(NAVY)) right_tbl.setStyle(mw_style(HexColor("#7c3aed"))) mw_outer = Table([[left_tbl, right_tbl]], colWidths=mw_cw, hAlign="LEFT", spaceBefore=0) mw_outer_hdr = Table( [[Paragraph("MAGIC MOUTHWASH COMPOSITIONS", hdr_style)]], colWidths=[W] ) mw_outer_hdr.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), NAVY), ("ROWPADDING", (0,0), (-1,-1), 5), ])) mw_outer.setStyle(TableStyle([ ("VALIGN", (0,0), (-1,-1), "TOP"), ("LEFTPADDING", (0,0), (-1,-1), 0), ("RIGHTPADDING", (0,0), (-1,-1), 0), ("TOPPADDING", (0,0), (-1,-1), 0), ("BOTTOMPADDING",(0,0), (-1,-1), 0), ("INNERGRID", (0,0), (-1,-1), 2, WHITE), ])) # ============================================================ # TABLE 4 — DRUG DOSING QUICK REFERENCE # ============================================================ drug_cw = [40*mm, 32*mm, W - 40*mm - 32*mm] D = [ [sec_hdr("DRUG DOSING QUICK REFERENCE", HexColor("#b45309"), 3)], [PB("Drug"), PB("Dose / Route"), PB("Indication & Evidence")], # Topical [P("─ TOPICAL ─"), P(""), P("")], [P("2% Viscous Lidocaine"), P("5 mL, swish & spit\nMax 250–300 mg total"), P("Grade 2+ oral mucositis topical analgesia")], [P("Magic Mouthwash (classic)"), P("5 mL q4–6h, expectorate"), P("Grade 2–3 pain relief; <50 mg lidocaine/dose")], [P("Modified Magic Mouthwash"), P("10 mL (2 tsp) TID, swallow"), P("Radiation stomatitis/pharyngitis (compounded)")], [P("Benzydamine oral rinse"), P("Per product label"), P("Prevention – moderate-dose H&N RT [I, A]")], [P("Dexamethasone elixir"), P("0.5 mg/5 mL; 5 mL BID–TID\nswish & spit, hold 5 min"), P("mTOR inhibitor-induced mucositis; anti-inflammatory")], [P("Nystatin suspension"), P("400,000–600,000 U\nswish & swallow QID"), P("Secondary oral candidiasis")], [P("Clotrimazole troches"), P("10 mg troche QID"), P("Secondary oral candidiasis")], [P("Chlorhexidine 0.12%"), P("5 mL swish & spit BID"), P("Secondary infection support (NOT for prevention [II, B])")], [P("Clobetasol 0.05% gel"), P("Apply BID–TID"), P("Topical anti-inflammatory for erosions/ulcers")], [P("Triamcinolone 0.1% paste"), P("Apply BID–TID"), P("Topical anti-inflammatory for oral ulcers")], # Systemic [P("─ SYSTEMIC ─"), P(""), P("")], [P("Morphine PCA"), P("Patient-controlled dosing"), P("Severe mucositis pain, HSCT patients [I, A]")], [P("Palifermin (KGF-1)"), P("60 µg/kg/day IV ×3 days\npre + ×3 days post-HSCT"), P("Prevention – HSCT + TBI, haematologic malignancy [I, A]")], [P("Octreotide"), P("≥100 µg SC BD"), P("Loperamide-refractory chemo-diarrhea [II, A]")], [P("Sulfasalazine"), P("500 mg orally BD"), P("Prevention – radiation-induced enteropathy, pelvic EBRT [II, B]")], [P("Ranitidine / Omeprazole"), P("Standard oral doses"), P("Prevention – epigastric pain with 5-FU/CMF regimens [II, A]")], [P("Amifostine (IV)"), P("Standard IV infusion"), P("Reduce esophagitis – concurrent chemoRT in NSCLC [III, C]")], [P("Amifostine (intrarectal)"), P("≥340 mg/m² IR"), P("Prevention – radiation proctitis, rectal cancer RT [III, B]")], # NOT recommended [P("─ NOT RECOMMENDED ─"), P(""), P("")], [P("Chlorhexidine (prophylaxis)"), P("—"), P("NOT for prevention in H&N RT patients [II, B]")], [P("Oral sucralfate"), P("—"), P("NOT for RT oral mucositis; more GI side-effects [II, A]")], [P("5-ASA / Mesalazine"), P("—"), P("NOT for GI mucositis prevention [I, A]")], [P("Systemic glutamine"), P("—"), P("NOT recommended for GI mucositis prevention [II, C]")], ] drug_tbl = Table(D, colWidths=drug_cw, repeatRows=2) drug_tbl.setStyle(TableStyle([ ("SPAN", (0,0), (2,0)), ("BACKGROUND", (0,0), (-1,0), HexColor("#b45309")), ("BACKGROUND", (0,1), (-1,1), HexColor("#92400e")), ("TEXTCOLOR", (0,1), (-1,1), WHITE), ("FONTNAME", (0,1), (-1,1), "Helvetica-Bold"), ("FONTSIZE", (0,1), (-1,1), 7), ("ALIGN", (0,0), (-1,-1), "LEFT"), ("VALIGN", (0,0), (-1,-1), "TOP"), ("ROWPADDING", (0,0), (-1,-1), 3), ("TOPPADDING", (0,0), (-1,-1), 3), ("BOTTOMPADDING", (0,0), (-1,-1), 3), ("GRID", (0,1), (-1,-1), 0.4, GREY_MED), ("LINEBELOW", (0,0), (-1,0), 0, WHITE), # separator rows ("BACKGROUND", (0,2), (-1,2), HexColor("#f0fdf4")), ("FONTNAME", (0,2), (-1,2), "Helvetica-Oblique"), ("FONTSIZE", (0,2), (-1,2), 6.5), ("BACKGROUND", (0,12), (-1,12), HexColor("#f0fdf4")), ("FONTNAME", (0,12), (-1,12), "Helvetica-Oblique"), ("FONTSIZE", (0,12), (-1,12), 6.5), ("BACKGROUND", (0,19), (-1,19), RED_LT), ("FONTNAME", (0,19), (-1,19), "Helvetica-Oblique"), ("FONTSIZE", (0,19), (-1,19), 6.5), # alternate row tint ("BACKGROUND", (0,4), (-1,4), GREY_LT), ("BACKGROUND", (0,6), (-1,6), GREY_LT), ("BACKGROUND", (0,8), (-1,8), GREY_LT), ("BACKGROUND", (0,10), (-1,10), GREY_LT), ("BACKGROUND", (0,13), (-1,13), GREY_LT), ("BACKGROUND", (0,15), (-1,15), GREY_LT), ("BACKGROUND", (0,17), (-1,17), GREY_LT), ("BACKGROUND", (0,20), (-1,20), GREY_LT), ("BACKGROUND", (0,22), (-1,22), GREY_LT), # NOT recommended - red tint ("TEXTCOLOR", (0,20), (-1,23), RED), ("BACKGROUND", (0,20), (-1,23), RED_LT), ])) # ============================================================ # FOOTER # ============================================================ footer = Table([[ Paragraph( "Evidence grades: [I–V] level of evidence, [A–D] recommendation grade (ASCO convention) | " "Source: ESMO Clinical Practice Guidelines 2011 (Peterson DE et al., Ann Oncol 22:vi78–vi84) | " "For clinical reference only – verify doses before prescribing", note_style ) ]], colWidths=[W]) footer.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), HexColor("#1e293b")), ("ROWPADDING", (0,0), (-1,-1), 5), ("TOPPADDING", (0,0), (-1,-1), 5), ("BOTTOMPADDING", (0,0), (-1,-1), 5), ("TEXTCOLOR", (0,0), (-1,-1), HexColor("#94a3b8")), ])) # ============================================================ # BUILD # ============================================================ story = [ title_tbl, Spacer(1, 1.5*mm), subtitle_tbl, Spacer(1, 2*mm), grade_tbl, Spacer(1, 2.5*mm), mgmt_tbl, Spacer(1, 2.5*mm), mw_outer_hdr, mw_outer, Spacer(1, 2.5*mm), drug_tbl, Spacer(1, 3*mm), footer, ] doc.build(story) print("PDF generated:", OUT) PYEOF

Running Command

python3 << 'PYEOF' from reportlab.lib.pagesizes import A4 from reportlab.lib import colors from reportlab.lib.units import mm from reportlab.platypus import SimpleDocTemplate, Table, TableStyle, Paragraph, Spacer from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.enums import TA_CENTER, TA_LEFT from reportlab.lib.colors import HexColor # ── colour palette ────────────────────────────────────────────────────────── NAVY = HexColor("#1a3a5c") TEAL = HexColor("#0d7377") TEAL_LT = HexColor("#e0f4f4") AMBER_LT = HexColor("#fef3c7") RED = HexColor("#dc2626") RED_LT = HexColor("#fee2e2") GREEN_LT = HexColor("#dcfce7") ORANGE_LT = HexColor("#ffedd5") GREY_LT = HexColor("#f1f5f9") GREY_MED = HexColor("#cbd5e1") PURPLE = HexColor("#7c3aed") AMBER_DK = HexColor("#b45309") WHITE = colors.white BLACK = colors.black SLATE = HexColor("#334155") OUT = "/tmp/workspace/mucositis-card/Mucositis_Pocket_Card.pdf" doc = SimpleDocTemplate(OUT, pagesize=A4, leftMargin=12*mm, rightMargin=12*mm, topMargin=10*mm, bottomMargin=10*mm) W = A4[0] - 24*mm styles = getSampleStyleSheet() def S(base_name, **kw): import random return ParagraphStyle("s"+str(random.random()), parent=styles.get(base_name, styles["Normal"]), **kw) hdr_st = S("Normal", fontSize=7, fontName="Helvetica-Bold", textColor=WHITE, alignment=TA_CENTER, leading=9) body_st = S("Normal", fontSize=6.8, fontName="Helvetica", textColor=BLACK, leading=8.5) bold_st = S("Normal", fontSize=6.8, fontName="Helvetica-Bold", textColor=BLACK, leading=8.5) sml_st = S("Normal", fontSize=6.2, fontName="Helvetica", textColor=BLACK, leading=7.5) note_st = S("Normal", fontSize=5.8, fontName="Helvetica-Oblique", textColor=HexColor("#94a3b8"), leading=7) def P(t, st=None): return Paragraph(t, st or body_st) def PB(t): return Paragraph(t, bold_st) def PE(): return Paragraph("", body_st) # empty placeholder # ─── TITLE ─────────────────────────────────────────────────────────────────── title_st = S("Normal", fontSize=13, fontName="Helvetica-Bold", textColor=WHITE, alignment=TA_CENTER, leading=17) sub_st = S("Normal", fontSize=7, fontName="Helvetica-Oblique", textColor=HexColor("#64748b"), alignment=TA_CENTER) title_tbl = Table([[Paragraph( "MUCOSITIS " "QUICK REFERENCE POCKET CARD", title_st) ]], colWidths=[W]) title_tbl.setStyle(TableStyle([ ("BACKGROUND", (0,0),(-1,-1), NAVY), ("TOPPADDING", (0,0),(-1,-1), 8), ("BOTTOMPADDING", (0,0),(-1,-1), 8), ])) sub_tbl = Table([[Paragraph( "ESMO Guidelines 2011 | MASCC/ISOO | For clinical reference only", sub_st) ]], colWidths=[W]) # ─── GRADING ──────────────────────────────────────────────────────────────── gc = [13*mm, 44*mm, 62*mm, W-119*mm] grade_data = [ # row 0: section header [Paragraph("MUCOSITIS GRADING — WHO Oral Toxicity Scale + NCI CTCAE v4.0", hdr_st), PE(), PE(), PE()], # row 1: col headers [PB("Grade"), PB("WHO Description"), PB("NCI CTCAE v4.0 Description"), PB("Immediate Action")], [P("0"), P("No mucositis"), P("None"), P("Routine oral care")], [P("1"), P("Soreness/erythema"), P("Asymptomatic or mild symptoms"), P("Saline/bicarb rinses, soft diet")], [P("2"), P("Erythema + ulcers; can eat"),P("Moderate pain; not interfering with intake"), P("Add Magic Mouthwash, topical analgesia")], [P("3"), P("Ulcers; liquid diet only"), P("Severe pain; interfering with intake"), P("PCA morphine, nutrition support")], [P("4"), P("Alimentation impossible"), P("Life-threatening; urgent intervention needed"), P("Hospitalise, IV opioids, IV fluids")], ] grade_tbl = Table(grade_data, colWidths=gc, repeatRows=2) grade_tbl.setStyle(TableStyle([ ("SPAN", (0,0),(3,0)), ("BACKGROUND", (0,0),(3,0), NAVY), ("BACKGROUND", (0,1),(3,1), SLATE), ("TEXTCOLOR", (0,1),(3,1), WHITE), ("FONTNAME", (0,1),(3,1), "Helvetica-Bold"), ("ALIGN", (0,0),(-1,-1), "LEFT"), ("VALIGN", (0,0),(-1,-1), "MIDDLE"), ("TOPPADDING", (0,0),(-1,-1), 4), ("BOTTOMPADDING", (0,0),(-1,-1), 4), ("LEFTPADDING", (0,0),(-1,-1), 4), ("GRID", (0,1),(-1,-1), 0.4, GREY_MED), # grade cell backgrounds ("BACKGROUND", (0,2),(0,2), GREY_LT), ("BACKGROUND", (0,3),(0,3), GREEN_LT), ("BACKGROUND", (0,4),(0,4), AMBER_LT), ("BACKGROUND", (0,5),(0,5), ORANGE_LT), ("BACKGROUND", (0,6),(0,6), RED_LT), ("FONTNAME", (0,2),(0,-1), "Helvetica-Bold"), ("FONTSIZE", (0,2),(0,-1), 9), ("ALIGN", (0,2),(0,-1), "CENTER"), ])) # ─── STEP-WISE MANAGEMENT ─────────────────────────────────────────────────── mc = [20*mm, W-20*mm] mgmt_data = [ [Paragraph("STEP-WISE MANAGEMENT APPROACH", hdr_st), PE()], [PB("Step"), PB("Actions")], [P("STEP 1\nAssess\n& Grade"), P("Use WHO or NCI CTCAE scale | Check: CBC, hydration, nutritional status, pain score")], [P("STEP 2\nBasic Oral\nCare (ALL)"), P("• Saline / sodium bicarbonate rinse 4–6×/day [III, B] " "• Soft toothbrush, replace regularly; NO alcohol-based rinses " "• Screen for malnutrition; start enteral nutrition early if swallowing impaired " "• Maintain adequate oral hydration")], [P("STEP 3\nGrade 2+\nTopical Rx"), P("• 2% Viscous Lidocaine in saline/bicarb rinse – swish & spit " "• Magic Mouthwash (classic) – 5 mL, hold 1–2 min, expectorate " "• Mucosal protectants: Gelclair / Caphosol / Biotene (limited evidence, good safety) " "• Doxepin mouthrinse for severe mucositis")], [P("STEP 4\nGrade 3–4\nSystemic Rx"), P("• PCA Morphine – treatment of choice for HSCT mucositis pain [I, A] " "• Regular pain scoring with validated self-report tool " "• Consider hospitalisation if: severe pain, dehydration, neutropenic fever, or infection")], [P("STEP 5\nNutrition"), P("• Early enteral nutrition (NG tube / gastrostomy) when oral intake is impossible " "• Nutritional screening at every visit; opioid analgesia to preserve diet intake")], [P("STEP 6\nPrevention"), P("• H&N RT: Benzydamine rinse [I, A] | 3D conformal/VMAT planning [II, B] " "• Bolus 5-FU / edatrexate: Oral cryotherapy (ice chips) [II, A] " "• HSCT + TBI: Palifermin 60 µg/kg/day IV ×3 pre + ×3 post-transplant [I, A] " "• High-dose melphalan: Oral cryotherapy [II, A] " "• HSCT centres: Low-level laser therapy (LLLT) where available [II, B]")], [P("STEP 7\nGI Mucositis"), P("• First-line diarrhoea: Loperamide (standard dose) " "• Loperamide failure: Octreotide ≥100 µg SC BD [II, A] " "• Pelvic RT prevention: Sulfasalazine 500 mg BD [II, B] " "• Radiation proctitis + bleeding: Sucralfate enemas [III, B] " "• IV amifostine for chemoRT esophagitis (NSCLC) [III, C]")], ] mgmt_tbl = Table(mgmt_data, colWidths=mc, repeatRows=2) mgmt_tbl.setStyle(TableStyle([ ("SPAN", (0,0),(1,0)), ("BACKGROUND", (0,0),(1,0), TEAL), ("BACKGROUND", (0,1),(1,1), HexColor("#0f766e")), ("TEXTCOLOR", (0,1),(1,1), WHITE), ("FONTNAME", (0,1),(1,1), "Helvetica-Bold"), ("ALIGN", (0,0),(-1,-1), "LEFT"), ("VALIGN", (0,0),(-1,-1), "TOP"), ("TOPPADDING", (0,0),(-1,-1), 4), ("BOTTOMPADDING", (0,0),(-1,-1), 4), ("LEFTPADDING", (0,0),(-1,-1), 4), ("GRID", (0,1),(-1,-1), 0.4, GREY_MED), ("BACKGROUND", (0,2),(0,-1), TEAL_LT), ("FONTNAME", (0,2),(0,-1), "Helvetica-Bold"), ("FONTSIZE", (0,2),(0,-1), 6.2), ("ALIGN", (0,2),(0,-1), "CENTER"), ("VALIGN", (0,2),(0,-1), "MIDDLE"), # alternate rows ("BACKGROUND", (1,3),(1,3), GREY_LT), ("BACKGROUND", (1,5),(1,5), GREY_LT), ("BACKGROUND", (1,7),(1,7), GREY_LT), ("BACKGROUND", (1,9),(1,9), GREY_LT), ])) # ─── MAGIC MOUTHWASH BOXES ────────────────────────────────────────────────── hw = (W - 3*mm) / 2 mw_hdr_tbl = Table( [[Paragraph("MAGIC MOUTHWASH COMPOSITIONS", hdr_st)]], colWidths=[W]) mw_hdr_tbl.setStyle(TableStyle([ ("BACKGROUND", (0,0),(-1,-1), NAVY), ("TOPPADDING", (0,0),(-1,-1), 5), ("BOTTOMPADDING",(0,0),(-1,-1),5), ])) def mw_box(rows, bg_hdr): t = Table([[P(r, sml_st)] for r in rows], colWidths=[hw]) t.setStyle(TableStyle([ ("BACKGROUND", (0,0),(-1,0), bg_hdr), ("TOPPADDING", (0,0),(-1,-1), 3), ("BOTTOMPADDING", (0,0),(-1,-1), 3), ("LEFTPADDING", (0,0),(-1,-1), 4), ("GRID", (0,0),(-1,-1), 0.4, GREY_MED), ("BACKGROUND", (0,1),(-1,1), HexColor("#f8fafc")), ("FONTNAME", (0,1),(-1,1), "Helvetica-Bold"), ("FONTSIZE", (0,1),(-1,1), 6.5), ])) return t classic_rows = [ "CLASSIC MAGIC MOUTHWASH", "Components (1 : 1 : 1 equal parts)", "1. 2% Viscous Lidocaine", "2. Diphenhydramine elixir 12.5 mg/5 mL", "3. Maalox® (Mg + Al hydroxide suspension)", "Dose: 5 mL per use | Lidocaine/dose: <50 mg", "Method: Swish & hold 1–2 min → EXPECTORATE (do NOT swallow)", "Frequency: Every 4–6 h as needed for pain", "Use: Grade 2–3 oral mucositis; emergency pain relief", "⚠ Do NOT swallow – systemic toxicity risk (esp. children)", ] modified_rows = [ "MODIFIED MAGIC MOUTHWASH", "Components (pharmacy-compounded)", "1. Tetracycline (antibacterial)", "2. Diphenhydramine (antihistamine / mild anaesthetic)", "3. Nystatin (antifungal)", "4. Hydrocortisone (anti-inflammatory)", "Dose: 10 mL (2 teaspoons)", "Method: Swish + gargle → SWALLOW", "Frequency: 3 times daily", "Use: Radiation stomatitis & pharyngitis; covers bacterial + fungal infection", ] classic_tbl = mw_box(classic_rows, NAVY) modified_tbl = mw_box(modified_rows, PURPLE) mw_side_by_side = Table([[classic_tbl, modified_tbl]], colWidths=[hw, hw]) mw_side_by_side.setStyle(TableStyle([ ("VALIGN", (0,0),(-1,-1), "TOP"), ("LEFTPADDING", (0,0),(-1,-1), 0), ("RIGHTPADDING", (0,0),(-1,-1), 0), ("TOPPADDING", (0,0),(-1,-1), 0), ("BOTTOMPADDING", (0,0),(-1,-1), 0), ("INNERGRID", (0,0),(-1,-1), 3, WHITE), ])) # ─── DRUG DOSING TABLE ────────────────────────────────────────────────────── dc = [42*mm, 35*mm, W-77*mm] drug_data = [ [Paragraph("DRUG DOSING QUICK REFERENCE", hdr_st), PE(), PE()], [PB("Drug / Agent"), PB("Dose & Route"), PB("Indication [Evidence Grade]")], # TOPICAL header [P("── TOPICAL ──", sml_st), PE(), PE()], [P("2% Viscous Lidocaine"), P("5 mL swish & spit\nMax total 250–300 mg"), P("Oral mucositis analgesia, Grade 2+")], [P("Magic Mouthwash (classic)"), P("5 mL q4–6h, expectorate"), P("Pain relief; <50 mg lidocaine/dose")], [P("Modified Magic Mouthwash"), P("10 mL (2 tsp) TID, swallow"), P("Radiation stomatitis/pharyngitis (compounded)")], [P("Benzydamine oral rinse"), P("Per product label"), P("Prevention – moderate-dose H&N RT [I, A]")], [P("Dexamethasone elixir"), P("0.5 mg/5 mL; 5 mL BID–TID\nSwish & spit, hold 5 min"), P("mTOR inhibitor-induced mucositis")], [P("Nystatin suspension"), P("400,000–600,000 U\nSwish & swallow QID"), P("Secondary oral candidiasis")], [P("Clotrimazole troche"), P("10 mg QID"), P("Secondary oral candidiasis")], [P("Chlorhexidine 0.12%"), P("5 mL swish & spit BID"), P("Secondary infection support (NOT prevention [II, B])") ], [P("Clobetasol 0.05% gel"), P("Apply BID–TID"), P("Topical anti-inflammatory, erosions/ulcers")], [P("Triamcinolone 0.1% paste"), P("Apply BID–TID"), P("Topical anti-inflammatory, oral ulcers")], # SYSTEMIC header [P("── SYSTEMIC ──", sml_st), PE(), PE()], [P("Morphine (PCA)"), P("Patient-controlled dosing"), P("Severe mucositis pain, HSCT [I, A]")], [P("Palifermin (KGF-1)"), P("60 µg/kg/day IV\n×3 pre + ×3 post-HSCT"), P("Prevention – HSCT + TBI, haematologic malignancy [I, A]")], [P("Octreotide"), P("≥100 µg SC BD"), P("Loperamide-refractory chemo-diarrhoea [II, A]")], [P("Sulfasalazine"), P("500 mg orally BD"), P("Prevention – radiation enteropathy, pelvic EBRT [II, B]")], [P("Ranitidine / Omeprazole"), P("Standard oral doses"), P("Epigastric pain prevention – 5-FU/CMF regimens [II, A]")], [P("Amifostine IV"), P("Standard IV infusion"), P("Esophagitis – concurrent chemoRT, NSCLC [III, C]")], [P("Amifostine intrarectal"), P("≥340 mg/m² IR"), P("Radiation proctitis prevention, rectal cancer RT [III, B]")], # NOT RECOMMENDED header [P("── NOT RECOMMENDED ──", sml_st), PE(), PE()], [P("Chlorhexidine prophylaxis"),P("—"), P("H&N RT prevention: NOT recommended [II, B]")], [P("Oral sucralfate"), P("—"), P("RT oral mucositis: NOT recommended (↑GI SEs) [II, A]")], [P("5-ASA / Mesalazine"), P("—"), P("GI mucositis prevention: NOT recommended [I, A]")], [P("Systemic glutamine"), P("—"), P("GI mucositis prevention: NOT recommended [II, C]")], ] drug_tbl = Table(drug_data, colWidths=dc, repeatRows=2) drug_tbl.setStyle(TableStyle([ ("SPAN", (0,0),(2,0)), ("BACKGROUND", (0,0),(2,0), AMBER_DK), ("BACKGROUND", (0,1),(2,1), HexColor("#92400e")), ("TEXTCOLOR", (0,1),(2,1), WHITE), ("FONTNAME", (0,1),(2,1), "Helvetica-Bold"), ("ALIGN", (0,0),(-1,-1), "LEFT"), ("VALIGN", (0,0),(-1,-1), "TOP"), ("TOPPADDING", (0,0),(-1,-1), 3), ("BOTTOMPADDING", (0,0),(-1,-1), 3), ("LEFTPADDING", (0,0),(-1,-1), 4), ("GRID", (0,1),(-1,-1), 0.4, GREY_MED), # section separator rows ("SPAN", (0,2),(2,2)), ("BACKGROUND", (0,2),(2,2), GREEN_LT), ("FONTNAME", (0,2),(2,2), "Helvetica-BoldOblique"), ("SPAN", (0,12),(2,12)), ("BACKGROUND", (0,12),(2,12), TEAL_LT), ("FONTNAME", (0,12),(2,12), "Helvetica-BoldOblique"), ("SPAN", (0,19),(2,19)), ("BACKGROUND", (0,19),(2,19), RED_LT), ("FONTNAME", (0,19),(2,19), "Helvetica-BoldOblique"), # NOT recommended rows – red text ("TEXTCOLOR", (0,20),(-1,23), RED), ("BACKGROUND", (0,20),(-1,23), RED_LT), # alternate row tint (non-separator rows) ("BACKGROUND", (0,4),(-1,4), GREY_LT), ("BACKGROUND", (0,6),(-1,6), GREY_LT), ("BACKGROUND", (0,8),(-1,8), GREY_LT), ("BACKGROUND", (0,10),(-1,10), GREY_LT), ("BACKGROUND", (0,13),(-1,13), GREY_LT), ("BACKGROUND", (0,15),(-1,15), GREY_LT), ("BACKGROUND", (0,17),(-1,17), GREY_LT), ])) # ─── FOOTER ────────────────────────────────────────────────────────────────── footer_tbl = Table([[Paragraph( "Evidence: [I–V] level of evidence, [A–D] recommendation grade (ASCO convention) | " "Source: ESMO Clinical Practice Guidelines 2011 – Peterson DE et al., Ann Oncol 22:vi78–vi84 | " "For clinical reference only. Always verify doses before prescribing.", note_st)]], colWidths=[W]) footer_tbl.setStyle(TableStyle([ ("BACKGROUND", (0,0),(-1,-1), HexColor("#1e293b")), ("TOPPADDING", (0,0),(-1,-1), 5), ("BOTTOMPADDING", (0,0),(-1,-1), 5), ("LEFTPADDING", (0,0),(-1,-1), 6), ])) # ─── ASSEMBLE ──────────────────────────────────────────────────────────────── story = [ title_tbl, Spacer(1, 1.5*mm), sub_tbl, Spacer(1, 2*mm), grade_tbl, Spacer(1, 2.5*mm), mgmt_tbl, Spacer(1, 2.5*mm), mw_hdr_tbl, mw_side_by_side, Spacer(1, 2.5*mm), drug_tbl, Spacer(1, 3*mm), footer_tbl, ] doc.build(story) print("SUCCESS:", OUT) PYEOF

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