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Evidence summaries

Prevention of Oral Mucositis in Patients Receiving Treatment for Cancer

Ice chips, keratinocyte growth factor and several other interventions may prevent oral mucositis associated with cancer treatment. Level of evidence: "C"

The quality of evidence is downgraded by study limitations (unclear allocation concealment), and by inconsistency (statistical heterogeneity).

Summary

A Cochrane review [Abstract] 1 included 131 studies with a total of 10 514 subjects to evaluate the effectiveness of prophylactic agents for oral mucositis in patients with cancer receiving treatment, compared with other potentially active interventions, placebo or no treatment. Cryotherapy (ice chips; 5 studies, n=472) prevented any (RR 0.74, 95% CI 0.57 to 0.95, statistical heterogeneity I2 =73%) and severe (RR 0.36, 95% CI 0.17 to 0.77; I2 =72%) mucositis. Keratinocyte growth factor prevented any (RR 0.82, 95% CI 0.71 to 0.94; 2 studies, n=160, I2 =90%) and severe (RR 0.72, 95% CI 0.58 to 0.9; 6 studies, n=559, I2 =52%) mucositis.

Sucralfate did not prevent any mucositis (RR 0.98, 95% CI 0.88 to 1.1; 3 studies, n=222) but prevented severe mucositis (RR 0.67, 95% CI 0.48 to 0.92; 7 studies, n=428), and a further 7 interventions showed weaker evidence of benefit: aloe vera, amifostine, intravenous glutamine, granulocyte-colony stimulating factor (G-CSF), honey, laser, and antibiotic lozenges containing polymixin/tobramycin/amphotericin (PTA). Chlorhexidine did not prevent any (RR 0.76, 95% CI 0.47 to 1.24; 4 studies, n=454, I2 =90%) or severe mucositis (RR 0.82, 95% CI 0.54 to 1.23; 4 studies, n=244, I2 =60%) compared to placebo/no treatment.

References

  • Worthington HV, Clarkson JE, Bryan G et al. Interventions for preventing oral mucositis for patients with cancer receiving treatment. Cochrane Database Syst Rev 2011;(4):CD000978. [PubMed]

Primary/Secondary Keywords