Abstract
Data sources
The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, Medline and Embase were searched to April 2006. Reference lists from relevant articles were scanned and the authors of eligible studies were contacted to identify trials and obtain additional information.
Study selection
For inclusion, an article had to satisfy the following criteria: document a randomised controlled trial (RCT); participants should be people receiving chemotherapy or radiotherapy treatment for cancer; prescribe agents to prevent oral mucositis; and have the primary outcome of preventing mucositis.
Data extraction and synthesis
Data were extracted independently and in duplicate. Authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out. For dichotomous outcomes, risk ratios (RR) were calculated using a random-effects model.
Results
The search identified 202 articles, of which 71 studies had useable data comprising 5217 patients. Of the 29 interventions included in the trials, 10 studies showed some evidence of a weak benefit for preventing or reducing the severity of mucositis. Interventions where more than one trial in the meta-analysis found a significant difference compared with placebo/ no treatment were as follows:
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amifostine: provided minimal benefit in preventing moderate and severe mucositis (RR, 0.84 and 0.60, respectively);
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antibiotic paste or pastille: demonstrated moderate benefit in preventing mucositis (RR, 0.87);
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hydrolytic enzymes: reduced moderate and severe mucositis (RR, 0.52 and 0.17, respectively); and
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ice chips: prevented mucositis at all levels (RR, 0.63, 0.43 and 0.27).
 Other interventions showing some benefit in only one study were benzydamine, calcium phosphate, honey, oral care protocols, povidone and zinc sulphate.
Conclusions
Several of the interventions were found to have some benefit at 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 well-designed RCT with sufficient numbers of participants to perform subgroup analyses by type of disease and chemotherapeutic agent.
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References
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Authors and Affiliations
Additional information
Address for correspondence: Professor Helen Worthington, Co-ordinating Editor, Cochrane Oral Health Group, MANDEC, School of Dentistry, University of Manchester, Higher Cambridge Street, Manchester M15 6FH, UK. Email: helen.worthington@manchester.ac.uk.
Worthington HV, Clarkson JE, Eden OB. Interventions for preventing oral mucositis for patients with cancer receiving treatment. Cochrane Database of Systematic Review 2006; issue 2
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Sutherland, S. Several therapies may prevent or reduce the severity of oral mucositis associated with cancer treatment. Evid Based Dent 7, 104–105 (2006). https://doi.org/10.1038/sj.ebd.6400451
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DOI: https://doi.org/10.1038/sj.ebd.6400451
