Interventions for the Prevention of Oral Mucositis in Patients Receiving Cancer Treatment: Evidence from Randomised Controlled Trials

Abstract

Oral mucositis is a common and most debilitating complication associated with cancer therapy. Despite the significant clinical and economic impact of this condition, there is little to offer to patients with oral mucositis, and the medications used in its management are generally only palliative. Given that mucositis is ultimately a predictable and, therefore, potentially preventable condition, in this study we appraised the scientific literature to evaluate effective methods of prevention that have been tested in randomised controlled trials (RCTs). Published high-level evidence shows that multiple preventative methods are potentially effective in the prevention of oral mucositis induced by radiotherapy, chemotherapy, or both. Anti-inflammatory medications (including benzydamine), growth factors and cytokines (including palifermin), cryotherapy, laser-and-light therapy, herbal medicines and supplements, and mucoprotective agents (including oral pilocarpine) showed some degree of efficacy in preventing/reducing the severity of mucositis with most anticancer treatments. Allopurinol was potentially effective in the prevention of radiotherapy-induced oral mucositis; antimicrobial mouthwash and erythropoietin mouthwash were associated with a lower risk of development of severe oral mucositis induced by chemotherapy. The results of our review may assist in highlighting the efficacy and testing the effectiveness of low-cost, safe preventative measures for oral mucositis in cancer patients.

Oral cryotherapy by Kangfuxin for prophylaxis of oral mucositis in patients undergoing autologous hematopoietic stem cell transplantation

“…Currently, physiological saline mouthwash is the commonly used treatment method for oral mucositis in clinical practice [16] . It can reduce the residual amount of food in the oral cavity, avoid the reproduction of bacteria in the oral cavity, and also keep the oral cavity in a normal physiological environment, relieve the dryness of the mouth caused by reduced saliva secretion [6,7,16] . However, it has no antibacterial effect and the therapeutic effect on oral ulcers is not good [11,16] .…”

“…Oral mucositis can cause unbearable pain, broad ulceration, double the risk of infection, prolonged hospitalization, increased hospitalization costs, and other adverse factors [5,6] . Relevant studies have indicated that prophylactic medication and appropriate oral care can prevent or alleviate the occurrence of oral mucositis in patients, accelerate its healing, and improve patients' quality of life [5][6][7] . During the period of cytotoxic chemotherapy or head and neck radiotherapy, continuous mouth rinsing with ice cubes or ice chips or drinking ice-containing beverages can cause vasoconstriction of the oral mucosal blood vessels, reduce the oral distribution of cytotoxic drugs, and effectively reduce the incidence of oral mucositis [7,8] .…”

“…Relevant studies have indicated that prophylactic medication and appropriate oral care can prevent or alleviate the occurrence of oral mucositis in patients, accelerate its healing, and improve patients' quality of life [5][6][7] . During the period of cytotoxic chemotherapy or head and neck radiotherapy, continuous mouth rinsing with ice cubes or ice chips or drinking ice-containing beverages can cause vasoconstriction of the oral mucosal blood vessels, reduce the oral distribution of cytotoxic drugs, and effectively reduce the incidence of oral mucositis [7,8] . However, the cryogenic medium used in clinical practice is mostly pure water or sterile saline, which has no repairing effect on the oral mucosa.…”

Comparative study before and after the use of Episil ® oral liquid in patients with hematological malignancies

“…However, treatment for OM remains centered on oral care, mouthwashes, and the use of steroid ointments, and no new treatments have been found. Colella et al state that OM is a common and most debilitating complication associated with the treatment of malignancy and that despite the signi cant clinical and economic consequences of this condition, there is little to offer patients with OM and the medications used in its management are generally only palliative [3]. RV Lalla.…”

“…2 Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima, JAPAN. 3 Department of Oral Surgery, Hiroshima Red Cross & Atomicbomb Survivors Hospital, Hiroshima, JAPAN…”