What do systematic reviews say?

Cryotherapy (ice chips) 30 minutes vs Cryotherapy (ice chips) 60 minutes

It is very uncertain whether oral cryotherapy for 30 minutes changes oral mucositis (any severity) compared with oral cryotherapy for 60 minutes (very low certainty).

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: oral cryotherapy 2015 · Cochrane All outcomes
  RR 0.89 [0.62, 1.29]
  1 study · 178 participants
  Very low

Oral cryotherapy (ice chips, ice-cold water, ice cubes or crushed ice held in the mouth during cancer treatment) vs no intervention or control intervention (control)

Oral cryotherapy (ice chips, ice-cold water, ice cubes or crushed… showed no clear difference in oral mucositis (any severity) compared with control (no treatment or standard/usual oral care, e.g. saline rinse) (low certainty).

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: oral cryotherapy 2015 · Cochrane All outcomes

  High-dose melphalan-based treatment prior to HSCT (haematological cancers)
  RR 0.59 [0.35, 1.01]
  5 studies · 270 participants
  Low
• Interventions for preventing oral mucositis in patients with cancer receiving treatment: oral cryotherapy 2015 · Cochrane All outcomes

  Fluorouracil (5FU) treatment for solid cancers
  RR 0.61 [0.52, 0.72]
  5 studies · 444 participants
  Moderate
• Interventions for preventing oral mucositis in patients with cancer receiving treatment: oral cryotherapy 2015 · Cochrane All outcomes

  Low-dose methotrexate for GVHD prophylaxis after allogeneic HSCT
  RR 0.98 [0.90, 1.07]
  1 study · 122 participants
  Very low

Oral care protocol vs usual care or no treatment

Oral care protocol led to lower oral mucositis (any severity) compared with no treatment/usual care; GRADE not reported.

• Interventions for preventing oral mucositis for patients with cancer receiving treatment 2011 · Cochrane All outcomes

  Median 28 days
  RR 0.62 [0.43, 0.91]
  1 study · 30 participants
  GRADE not reported

Intestinal trefoil factor (ITF), oral spray vs placebo

Intestinal trefoil factor (ITF), oral spray led to lower oral mucositis (any severity) compared with placebo; GRADE not reported.

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes
  RR 0.52 [0.35, 0.79]
  1 study · 99 participants
  GRADE not reported

Oral cryotherapy (ice chips, ice-cold water, ice cubes or crushed ice held in the mouth during cancer treatment) vs Chlorhexidine rinse

It is very uncertain whether oral cryotherapy (ice chips, ice-cold water, ice cubes or crushed… changes oral mucositis (any severity) compared with chlorhexidine rinse (very low certainty).

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: oral cryotherapy 2015 · Cochrane All outcomes
  RR 0.97 [0.71, 1.32]
  1 study · 133 participants
  Very low

Oral cryotherapy (ice chips, ice-cold water, ice cubes or crushed ice held in the mouth during cancer treatment) vs Low-dose leucovorin rinse

It is very uncertain whether oral cryotherapy (ice chips, ice-cold water, ice cubes or crushed… changes oral mucositis (any severity) compared with low-dose leucovorin rinse (very low certainty).

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: oral cryotherapy 2015 · Cochrane All outcomes
  RR 0.67 [0.50, 0.90]
  1 study · 118 participants
  Very low

Oral cryotherapy (ice chips, ice-cold water, ice cubes or crushed ice held in the mouth during cancer treatment) vs High-dose leucovorin rinse

It is very uncertain whether oral cryotherapy (ice chips, ice-cold water, ice cubes or crushed… changes oral mucositis (any severity) compared with high-dose leucovorin rinse (very low certainty).

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: oral cryotherapy 2015 · Cochrane All outcomes
  RR 0.65 [0.47, 0.90]
  1 study · 81 participants
  Very low

Keratinocyte growth factor (KGF; palifermin or repifermin), intravenous vs placebo

Keratinocyte growth factor (KGF; palifermin or repifermin),… showed no clear difference in oral mucositis (any severity) compared with placebo; GRADE not reported.

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  BMT/SCT after conditioning for haematological cancers
  RR 0.96 [0.88, 1.05]
  4 studies · 655 participants
  GRADE not reported
• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  Children
  Two studies of KGF versus placebo in children were unclear in reporting; no usable data could be presented
  2 studies
  GRADE not reported
• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  RT to head and neck with cisplatin/fluorouracil
  RR 0.95 [0.90, 1.00]
  2 studies · 374 participants
  GRADE not reported

GM-CSF vs placebo or no treatment

Granulocyte-macrophage colony-stimulating factor (GM-CSF) showed no clear difference in oral mucositis (any severity) compared with placebo or no treatment; GRADE not reported.

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  BMT/SCT after conditioning for haematological cancers
  RR 0.91 [0.80, 1.04]
  1 study · 90 participants
  GRADE not reported
• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  RT to head and neck
  RR 1.01 [0.82, 1.23]
  1 study · 29 participants
  GRADE not reported

Granulocyte-colony stimulating factor (G-CSF; pegfilgrastim, single dose) vs Granulocyte-colony stimulating factor (G-CSF; filgrastim, multiple doses)

Granulocyte-colony stimulating factor (G-CSF; pegfilgrastim, single… showed no clear difference in oral mucositis (any severity) compared with granulocyte-colony stimulating factor (G-CSF; filgrastim, multiple…; GRADE not reported.

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  Children
  RR 1.02 [0.82, 1.27]
  1 study · 61 participants
  GRADE not reported

Keratinocyte growth factor (KGF; palifermin or repifermin), intravenous vs Chlorhexidine mouthwash

Keratinocyte growth factor (KGF), intravenous led to lower oral mucositis (any severity) compared with chlorhexidine mouthwash; GRADE not reported.

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  Children
  RR 0.67 [0.54, 0.85]
  1 study · 90 participants
  GRADE not reported

G‐CSF vs placebo or no treatment

Granulocyte-colony stimulating factor (G-CSF) led to lower oral mucositis (any severity) compared with placebo or no treatment; GRADE not reported.

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  Chemotherapy alone for lung cancer
  RR 0.59 [0.40, 0.87]
  1 study · 195 participants
  GRADE not reported
• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  RT to head and neck
  RR 1.02 [0.86, 1.22]
  2 studies · 54 participants
  GRADE not reported

Transforming growth factor-beta(2) (TGF-beta2) vs placebo

Transforming growth factor-beta(2) (TGF-beta2) showed no clear difference in oral mucositis (any severity) compared with placebo; GRADE not reported.

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes
  RR 0.10 [0.01, 1.71]
  1 study · 13 participants
  GRADE not reported

Keratinocyte growth factor (KGF), higher dose/regimen vs Keratinocyte growth factor (KGF), different (lower) dose/regimen

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes
  Some inconsistent evidence from which no conclusions can be drawn regarding different dosages of KGF (Analyses 2.1 to 2.8); no pooled estimate reported
  Studies not reported
  GRADE not reported

Intestinal trefoil factor (ITF), lower dose (336 mg) vs Intestinal trefoil factor (ITF), higher dose (2688 mg)

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes
  Insufficient evidence to determine whether lower (336 mg) or higher (2688 mg) dose performs better (Analyses 11.1 to 11.3); no pooled estimate reported
  1 study · 66 participants
  GRADE not reported

Erythropoietin mouthwash vs placebo

Erythropoietin mouthwash led to lower oral mucositis (any severity) compared with placebo; GRADE not reported.

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes
  RR 0.35 [0.21, 0.60]
  1 study · 80 participants
  GRADE not reported

Camomile vs placebo

Camomile showed no clear difference in oral mucositis (any severity) compared with placebo; GRADE not reported.

• Interventions for preventing oral mucositis for patients with cancer receiving treatment 2011 · Cochrane All outcomes

  Median 28 days
  RR 0.89 [0.62, 1.27]
  1 study · 164 participants
  GRADE not reported

Sucralfate vs placebo or usual care

Sucralfate showed no clear difference in oral mucositis (any severity) compared with placebo/usual care (moderate certainty).

• Interventions for preventing oral mucositis for patients with cancer receiving treatment 2011 · Cochrane All outcomes

  Median 28 days
  RR 0.98 [0.88, 1.1]
  3 studies · 222 participants
  Moderate

Glutamine vs placebo or usual care

Glutamine showed no clear difference in oral mucositis (any severity) compared with placebo/usual care; GRADE not reported.

• Interventions for preventing oral mucositis for patients with cancer receiving treatment 2011 · Cochrane All outcomes

  Median 28 days
  RR 0.78 [0.57, 1.08]
  5 studies
  GRADE not reported

Low‐level laser therapy vs Placebo or no active treatment

Laser (low level) showed no clear difference in oral mucositis (any severity) compared with placebo/sham/no treatment; GRADE not reported.

• Interventions for preventing oral mucositis for patients with cancer receiving treatment 2011 · Cochrane All outcomes

  Median 28 days
  RR 0.91 [0.71, 1.17]
  5 studies · 234 participants
  GRADE not reported