Treatment of cancer is increasingly more effective but is associated with short and long term side effects. Oral side effects remain a major source of illness despite the use of a variety of agents to prevent them. One of these side effects is oral mucositis (mouth ulcers).
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.
Electronic searches of Cochrane Oral Health Group and PaPaS Trials Registers (to 1 June 2010), CENTRAL (The Cochrane Library 2010, Issue 2), MEDLINE via OVID (1950 to 1 June 2010), EMBASE via OVID (1980 to 1 June 2010), CINAHL via EBSCO (1980 to 1 June 2010), CANCERLIT via PubMed (1950 to 1 June 2010), OpenSIGLE (1980 to 2005) and LILACS via the Virtual Health Library (1980 to 1 June 2010) were undertaken. Reference lists from relevant articles were searched and the authors of eligible trials were contacted to identify trials and obtain additional information.
Randomised controlled trials of interventions to prevent oral mucositis in patients receiving treatment for cancer.
Data collection and analysis
Information regarding methods, participants, interventions, outcome measures, results and risk of bias were independently extracted, in duplicate, by two review authors. Authors were contacted for further details where these were unclear. The Cochrane Collaboration statistical guidelines were followed and risk ratios calculated using random-effects models.
A total of 131 studies with 10,514 randomised participants are now included. Nine interventions, where there was more than one trial in the meta-analysis, showed some statistically significant evidence of a benefit (albeit sometimes weak) for either preventing or reducing the severity of mucositis, compared to either a placebo or no treatment. These nine interventions were: allopurinol, aloe vera, amifostine, cryotherapy, glutamine (intravenous), honey, keratinocyte growth factor, laser, and polymixin/tobramycin/amphotericin (PTA) antibiotic pastille/paste.
Nine interventions were found to have some benefit with regard to preventing or reducing the severity of mucositis associated with cancer treatment. The strength of the evidence was variable and implications for practice include consideration that benefits may be specific for certain cancer types and treatment. There is a need for further well designed, and conducted trials with sufficient numbers of participants to perform subgroup analyses by type of disease and chemotherapeutic agent.
This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2010, Issue 12. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.
- Antifungal Agents [therapeutic use]
- Antineoplastic Agents [adverse effects]
- Candidiasis, Oral [etiology; prevention & control]
- Drugs, Chinese Herbal [therapeutic use]
- Mouth Mucosa
- Neoplasms [drug therapy; radiotherapy]
- Randomized Controlled Trials as Topic
- Stomatitis [etiology; prevention & control]
- STEM-CELL TRANSPLANTATION
- COLONY-STIMULATING FACTOR
- RADIATION-INDUCED MUCOSITIS
- PLACEBO-CONTROLLED TRIAL
- HIGH-DOSE CHEMOTHERAPY
- RANDOMIZED PHASE-II
- METASTATIC COLORECTAL-CANCER
- LOCALLY ADVANCED HEAD
- GLUTAMINE DIPEPTIDE SUPPLEMENTATION