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 (moderate to severe) 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 0.68 [0.36, 1.30]
  1 study · 178 participants
  Very low

Intestinal trefoil factor (ITF), oral spray vs placebo

Intestinal trefoil factor (ITF), oral spray led to lower oral mucositis (moderate to severe) 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 0.22 [0.10, 0.48]
  1 study · 99 participants
  GRADE not reported

Erythropoietin mouthwash vs placebo

Erythropoietin mouthwash led to lower oral mucositis (moderate to severe) 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 0.43 [0.24, 0.79]
  1 study · 80 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 (moderate to severe) 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 0.78 [0.55, 1.11]
  1 study · 61 participants
  GRADE not reported

Epidermal growth factor (EGF), oral spray vs placebo

Epidermal growth factor (EGF), oral spray showed no clear difference in oral mucositis (moderate to severe) 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

  Chemoradiotherapy to the head and neck
  RR 1.06 [0.78, 1.43]
  1 study · 136 participants
  GRADE not reported
• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  Radiotherapy to the head and neck
  RR 0.67 [0.45, 0.99]
  1 study · 103 participants
  GRADE not reported

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

Keratinocyte growth factor (KGF; palifermin or repifermin),… may leads to lower oral mucositis (moderate to severe) compared with placebo (low certainty).

• 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 0.89 [0.80, 0.99]
  6 studies · 852 participants
  Low
• 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 0.91 [0.83, 1.00]
  3 studies · 471 participants
  Moderate
• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  Chemotherapy alone for mixed cancers
  RR 0.56 [0.45, 0.70]
  4 studies · 344 participants
  Moderate

GM-CSF vs placebo or no treatment

It is very uncertain whether granulocyte-macrophage colony-stimulating factor (GM-CSF) changes oral mucositis (moderate to severe) compared with placebo or no treatment (very low certainty).

• 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 0.72 [0.49, 1.06]
  1 study · 29 participants
  Very low
• 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 0.94 [0.79, 1.13]
  1 study · 109 participants
  Very low

Granulocyte-macrophage colony-stimulating factor (GM-CSF), mouthwash vs Sucralfate mouthwash

Granulocyte-macrophage colony-stimulating factor (GM-CSF), mouthwash showed no clear difference in oral mucositis (moderate to severe) compared with sucralfate mouthwash; 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 0.96 [0.80, 1.14]
  1 study · 40 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 (moderate to severe) 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 0.12 [0.05, 0.28]
  1 study · 90 participants
  GRADE not reported

G‐CSF vs placebo or no treatment

It is very uncertain whether granulocyte-colony stimulating factor (G-CSF) changes oral mucositis (moderate to severe) compared with placebo or no treatment (very low certainty).

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

  Chemotherapy alone for breast cancer
  RR 0.33 [0.12, 0.95]
  1 study · 14 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 (moderate to severe) 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 0.18 [0.01, 3.42]
  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 no intervention or control intervention (control)

Oral cryotherapy (ice chips, ice-cold water, ice cubes or crushed… showed no clear difference in oral mucositis (moderate to severe) 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 0.43 [0.17, 1.09]
  5 studies · 270 participants
  Low
• 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 1.01 [0.85, 1.20]
  1 study · 122 participants
  Very 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 0.52 [0.41, 0.65]
  5 studies · 444 participants
  Moderate

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 (moderate to severe) 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 0.89 [0.51, 1.56]
  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 High-dose leucovorin rinse

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: oral cryotherapy 2015 · Cochrane All outcomes
  Oral mucositis (moderate to severe). Not estimable - no participants had developed moderate or severe oral mucositis by the fourth day after chemotherapy when the data were reported (Zhang 2011, Analysis 4.2, subgroup…
  1 study · 81 participants
  GRADE not reported

Indigo wood root vs saline placebo

Indigo wood root showed no clear difference in oral mucositis (moderate to severe) compared with saline (placebo); GRADE not reported.

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

  Median 28 days
  RR 0.75 [0.5, 1.1]
  1 study · 20 participants
  GRADE not reported

Polaprezinc vs Azulene

Polaprezinc led to lower oral mucositis (moderate to severe) compared with azulene; GRADE not reported.

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

  Median 28 days
  RR 0.43 [0.22, 0.84]
  1 study · 31 participants
  GRADE not reported

Keratinocyte GF vs placebo

Keratinocyte GF led to lower oral mucositis (moderate to severe) 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 0.74 [0.62, 0.89]
  7 studies
  GRADE not reported

Shenqi-fanghou vs no treatment

Shenqi-fanghou led to lower oral mucositis (moderate to severe) compared with no treatment; GRADE not reported.

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

  Median 28 days
  RR 0.51 [0.38, 0.68]
  1 study · 140 participants
  GRADE not reported

Aloe vera vs placebo

Aloe vera led to lower oral mucositis (moderate to severe) 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 0.74 [0.58, 0.96]
  2 studies · 119 participants
  GRADE not reported

Radiotherapy (morning) vs Radiotherapy (afternoon/evening)

Radiotherapy (morning) showed no clear difference in oral mucositis (moderate to severe) compared with radiotherapy (afternoon/evening); GRADE not reported.

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

  Median 28 days
  RR 0.7 [0.48, 1.01]
  1 study · 177 participants
  GRADE not reported