Prevention of oral mucositis in patients receiving treatment for cancer

There are several interventions that are at least of some benefit at preventing or reducing the severity of mucositis associated with cancer treatment, e.g. amifostine, Chinese medicine and hydrolytic enzymes for patients with head and neck cancer, and ice chips for patients undergoing chemotherapy with 5-FU.

A Cochrane review 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. Interventions where there was more than one trial in the meta-analysis finding a significant difference when compared with a placebo or no treatment:

• Amifostine provided minimal benefit in preventing moderate and severe mucositis (RR 0.95, 95% CI 0.92 to 0.96) and 0.88 (95% CI 0.80 to 0.98), respectively.
• Chinese medicine showed a benefit at all three dichotomies of mucositis with RR values of 0.44 (95% CI 0.20 to 0.96), 0.44 (95% CI 0.33 to 0.59) and 0.16 (95% CI 0.07 to 0.35) for increasing levels of mucositis severity;
• Hydrolytic enzymes reduced moderate and severe mucositis (RRs 0.52, 95% CI 0.36 to 0.74, and RR 0.17, 95% CI 0.06 to 0.52, respectively)
• Ice chips prevented mucositis at all levels (RR 0.64, 95% CI 0.50 to 0.82; RR 0.38, 95% CI 0.23 to 0.62; RR 0.24, 95% CI 0.12 to 0.48).

Other interventions showing some benefit with only one study were: benzydamine, calcium phosphate, etoposide bolus, honey, iseganan, oral care and zinc sulphate.

Ədəbiyyat

1. 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.