Effects of oral supplementation in the management of oral mucositis in cancer patients: A meta‐analysis of randomized clinical trials

Abstract

Purpose To evaluate the effects of oral supplementation on the management of oral mucositis in patients with cancer undergoing chemo and/or radiation therapy. Method This is a systematic review and meta‐analysis. The search was performed at 6 databases, and in the gray literature. Methodology of included studies was evaluated by the Cochrane Collaboration Risk of Bias Tool, and evidence quality was assessed by GRADE instrument. Results Twelve randomized clinical trials were included in this review. The oral supplementation used was an oral elemental diet with amino acids and minerals (elental), glutamine, and zinc. The majority of the studies included in this review showed benefits in delaying the occurrence of OM by using glutamine and zinc, and in reducing the severity of OM with glutamine, zinc, and elental in patients receiving chemoradiotherapy. The meta‐analysis showed that the risk of oral mucositis in the zinc group was slightly lower than in the control (RR: 0.71, 95% CI: 0.53‐0.96, P = 0.02, n = 982) while the glutamine group presented the same risk as the control (RR: 0.91, 95% CI: 0.78‐1.05, P = 0.19, n = 314). The evidence quality suggested low confidence for zinc and glutamine studies in the estimated effect from the outcomes assessed. Conclusions Zinc is a promising strategy in the management of oral mucositis since it delayed the occurrence and reduced its severity. Glutamine and Elental, on the other hand, had no strong evidence in the prevention and/or treatment of oral mucositis in patients with cancer.

Effectiveness of sodium bicarbonate and zinc chloride mouthwashes in the treatment of oral mucositis and quality of life in patients with cancer under chemotherapy

“…Therefore, these studies showed that zinc‐based drugs can be effective in the prevention and treatment of oral mucositis in cancer patients through promoting the activity of immune cells, preventing tissue damage, including oral mucositis, increasing protein synthesis and nucleic acid processes, as well as promoting tissue damage healing (Lin et al., 2006). Therefore, the use of drugs containing zinc, especially mouthwashes, can comprehensively reduce the incidence and severity of oral mucositis in cancer patients undergoing chemotherapy because it is easier to use (Ana et al., 2020; Hewlings & Kalman, 2020; de Menêses et al., 2020).…”

IAPEN INDIA Consensus Statement on Nutritional Management in Head and Neck Cancers

“…(90) In a review of twelve RCTs majority of studies showed the benefits of glutamine and zinc supplementation in delaying the onset of OM and reducing the severity in HNC patients receiving chemoradiotherapy. (91)…”

Effectiveness of elemental diets to prevent oral mucositis associated with cancer therapy: A meta-analysis

“…A previous meta-analysis of randomized controlled trials on the management of oral mucositis [15] found that the evidence supporting the effectiveness of ED and glutamine supplementation for the prevention and treatment of oral mucositis was not strong. In contrast, a systematic review of the use of vitamins, minerals, and nutritional supplements to manage oral mucositis found evidence supporting the use of oral glutamine to manage oral mucositis in patients with head and neck cancer [34].…”

“…Although not all the results reached statistical significance, patients receiving ED had smaller reductions in body weight and lower incidences of oral mucositis compared with those who did not receive ED. A recent systematic review [14] on the use of an oligomeric enteral nutrition formula for undernutrition caused by oncological treatment-related diarrhea and a meta-analysis on the effects of supplementation for the management of oral mucositis in patients with cancer [15] mentioned the effectiveness of ED to improve these conditions. However, a specific meta-analysis of the effectiveness of ED to prevent the development of oral mucositis among patients with cancer undergoing cancer therapy has not been previously conducted.…”