Management of oral mucositis in pediatric patients receiving cancer therapy: A systematic review and meta‐analysis

Abstract

Background One of the most common complications of cancer chemotherapy is oral mucositis (OM). OM affects more than 75% of patients undergoing chemotherapy and represents a significant burden to patients and caregivers. We performed a systematic review and meta­analysis of published studies to investigate the effects of agents and techniques in reducing OM. Procedure This systematic review investigated, critically appraised, and rated the evidence on agents used to manage OM in children undergoing cancer therapy. A comprehensive search of the relevant literature was performed from January 2006 to December 2017. MEDLINE, Scopus, the Cochrane Database of Systematic Reviews, EMBASE, and the Web of Science were searched. Nine eligible studies were identified. Using random­effects models, standardized mean difference was estimated between treated and control groups across all studies. The Cochran test and the I2 index were performed for heterogeneity between studies. The significance level was set at P = 0.05. Results Palifermin reduced the incidence (OR = 4.131, P = 0.000), duration (St diff mean = 0.803, P = 0.000), and severity (St diff mean = 0.637, P = 0.000) of OM in pediatric cancer patients significantly. However, the laser did not show significant efficacy in decreasing the incidence rate of OM (OR = 2.870, P = 0.364). Conclusion This review provided a comprehensive examination of available options for children who have OM. The results support the possibility of a positive effect of palifermin on reducing OM in children receiving cancer therapy.

Efficacy of keratinocyte growth factor in prevention of oral mucositis in children undergoing allogeneic hematopoietic cell transplantation

“…In the analysis of Mozaffari et al [3], including both children and adults, either after auto-or after allo-HCT, impact of palifermin was shown neither on duration and severity of OM nor on occurrence of aGVHD. On the contrary, in the study of children on conventional chemotherapy, palifermin significantly reduced incidence, duration, and severity of mucositis [5]. Findings that palifermin could be a valid therapeutic tool to improve the quality of life of children suffering from leukemia or lymphoma or undergoing HCT were confirmed by other studies [15,34,35,36], although the lack of effect was also documented [7,30,37].…”

“…The experience in pediatric setting is much lower: results of two studies carried out after auto-HCT showed lower incidence of grade III/IV° oral mucositis in patients receiving palifermin, although the other outcomes were inconclusive [32,33]. Recently, two metaanalyses on the use of palifermin were published [3,5]. In the analysis of Mozaffari et al [3], including both children and adults, either after auto-or after allo-HCT, impact of palifermin was shown neither on duration and severity of OM nor on occurrence of aGVHD.…”

“…OM is regarded by patients as one of the worst and debilitating complication of conditioning and transplantation [1,2]. The overall incidence of OM in HCT patients is reported to be from 75% to 100% [3][4][5][6][7].…”

Impact of Saliva and Cariogenic Microbiota on the Chemotherapy-Induced Oral Mucositis in Oncopediatric Patients: A Preliminary Longitudinal Study

“…OM lesions are characterized by inflammatory, ulcerative, and bleeding areas with painful clinic symptoms that are difficult for treatment with topic or systemic medications [ 10 ]. Commonly, OM manifests clinically 3 to 10 days following the start of chemotherapy; it depends on the kind of cancer and treatment procedure [ 11 ].…”

“…As OM cases are more severe in children, they compromise more rapidly speech, swallowing, oral hygiene and, consequently, delay treatment and increase mortality [ 12 ]. Approximately 80% of children and adolescents manifest OM at some stage of treatment [ 11 ]. For this reason, knowing the factors that may be related to the occurrence, progression, and duration of OM will aid in the development of more effective preventive and therapeutic protocols [ 8 ].…”