What do systematic reviews say?

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

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

Epidermal growth factor (EGF), oral spray vs placebo

Epidermal growth factor (EGF), oral spray showed no clear difference in interruptions to cancer treatment (radiotherapy breaks longer than… 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

  Radiotherapy to the head and neck
  RR 4.38 [0.25, 75.44]
  1 study · 113 participants
  GRADE not reported

Amifostine vs no treatment/placebo

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  End of RT to 12 months postRT
  Insufficient evidence of a difference in stimulated salivary flow at any time point: end of RT MD -0.09 (95% CI -1.48 to 1.30); 3 months MD 0.38 (95% CI -1.43 to 2.19); 12 months MD 0.82 (95% CI -0.47 to 2.11);…
  2 studies
  GRADE not reported

Antimicrobial lozenge vs placebo

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  Over 6 months
  Insufficient evidence of a difference: dryness in mouth RR 1.18 (95% CI 0.97 to 1.42), diarrhoea RR 1.97 (95% CI 0.51 to 7.54), constipation RR 0.91 (95% CI 0.59 to 1.42) (Duncan 2005)
  1 study
  GRADE not reported

Antiseptic mouthrinse vs placebo

The review found no eligible studies for this question.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  No data on xerostomia were reported.
  0 studies
  No studies found

Pilocarpine vs no treatment/placebo

Pilocarpine led to higher speech difficulties (VAS 0-100 mm) compared with no treatment/placebo; GRADE not reported.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  End of RT
  MD 20.20 [1.93, 38.47]
  1 study · 34 participants
  GRADE not reported

G‐CSF vs placebo or no treatment

Granulocyte-colony stimulating factor (G-CSF) showed no clear difference in normalcy of diet (percutaneous endoscopic gastrostomy) 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

  RT to head and neck
  RR 0.16 [0.01, 2.86]
  1 study · 40 participants
  GRADE not reported

Amifostine vs no treatment/placebo

Amifostine led to higher salivary flow rate (incidence of > 0.1 g saliva/5 min, unstimulated) compared with no treatment/placebo; GRADE not reported.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  12 months postRT
  RR 1.45 [1.13, 1.86]
  1 study · 175 participants
  GRADE not reported

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

Keratinocyte growth factor (KGF; palifermin or repifermin),… showed no clear difference in normalcy of diet (total parenteral nutrition) 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 0.89 [0.58, 1.34]
  4 studies · 714 participants
  GRADE not reported

Acupuncture vs sham control

• Interventions for managing taste disturbances 2017 · Cochrane All outcomes
  Results (health-related quality of life): Brandt 2008 assessed HRQoL in dysgeusia patients and reported significant improvement in psychological symptoms in the acupuncture group and increased quality of life in both…
  1 study
  GRADE not reported

Amifostine 200 mg/m2 three times weekly vs Amifostine 200 mg/m2 five times weekly

Amifostine 200 mg/m2 three times weekly showed no clear difference in vomiting (adverse effect) compared with amifostine 200 mg/m2 five times weekly; GRADE not reported.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  RR 0.25 [0.06, 1.08]
  1 study · 60 participants
  GRADE not reported

Pilocarpine vs no treatment/placebo

Pilocarpine may leads to higher sweating (adverse effect) compared with no treatment/placebo (low certainty).

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  RR 2.98 [1.43, 6.22]
  5 studies · 389 participants
  Low

Amifostine 200 mg/m2 three times weekly vs Amifostine 200 mg/m2 five times weekly

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  End of RT and 6, 12, 18, 24 months postRT
  No significant differences between the three treatment arms (Jellema 2006)
  1 study
  GRADE not reported

GM-CSF vs placebo or no treatment

Granulocyte-macrophage colony-stimulating factor (GM-CSF) showed no clear difference in normalcy of diet (tube feeding) 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

  RT to head and neck
  RR 0.31 [0.01, 7.09]
  1 study · 29 participants
  GRADE not reported

Erythropoietin mouthwash vs placebo

Erythropoietin mouthwash showed no clear difference in number of days in hospital 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
  MD -2.95 [-7.73, 1.83]
  1 study · 80 participants
  GRADE not reported

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

Keratinocyte growth factor (KGF; palifermin or repifermin),… showed no clear difference in number of days of treatment with opioid analgesics 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
  MD -1.41 [-3.33, 0.51]
  2 studies · 323 participants
  GRADE not reported

Zinc vs placebo

It is very uncertain whether zinc supplements (zinc sulphate, zinc gluconate, zinc picolinate,… changes adverse events compared with placebo (very low certainty).

• Interventions for managing taste disturbances 2017 · Cochrane All outcomes

  12 to 18 weeks
  RR 5.20 [0.90, 30.19]
  3 studies · 335 participants
  Very low

Venalot Depot (coumarin plus troxerutin) vs placebo

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  Sialometric data dropped to an unmeasurable level in both groups; abandoned as a marker of efficacy (Grotz 2001)
  1 study
  GRADE not reported

Amifostine vs no treatment/placebo

Amifostine may leads to higher hypotension (adverse effect) compared with no treatment/placebo (low certainty).

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  RR 9.20 [2.84, 29.83]
  3 studies · 376 participants
  Low