Cochrane · intervention · CD001973
Interventions for treating oral mucositis for patients with cancer receiving treatment
Clarkson, JE, Worthington, HV, Furness, S, et al. · Cochrane Database of Systematic Reviews · 2010 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
52
current version
GRADE rated
0
No studies
0
Included studies
32
as reported
No studies 0 · 0%Ungraded 52 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Anyone with cancer who is receiving chemotherapy or radiotherapy or both and has oral mucositis | Adults (n=28 trials); Children (n=4 trials); Mixed leukaemia and solid tumours (n=14 trials); Head and neck cancer (n=8 trials); Solid cancers (n=6 trials); Leukaemia only (n=2 trials); Bone marrow/stem cell transplant recipients (n=11 trials); Chemotherapy only (n=22 trials); Radiotherapy only (n=8 trials) |
| Intervention | Any intervention for the treatment of oral mucositis or its associated pain | Allopurinol (n=44); Benzydamine HCl (n=102); Chlorhexidine; 'Magic' mouthwash; Debridement; Gelclair; GM-CSF; Human placental extract (n=120); Low level laser (n=57); Phenytoin mouthrinse (n=12); Polyvariant immunoglobulin (n=80); Sucralfate; Tetrachlorodecaoxide (n=62); Vitamin E (n=18); Vitamin E topical (n=63); Alfentanil (n=28); Sufentanil (n=60); Hydromorphone (n=56); Morphine PCA (n=113); Morphine PKPCA (n=35); Diclofenac (n=66); Therapist (n=69); Relaxation and imagery (n=46); Cognitive behaviour therapy (n=68); Hypnosis (n=22) |
| Comparison | Placebo; No treatment; Another active intervention | Placebo; No treatment; Salt and soda; Povidone iodine; Antimycotic mouthrinse; Disprin; Sucralfate and mucaine; Sham laser treatment; Morphine (comparator); Nortriptyline (tricyclic antidepressant); Hydromorphone (comparator); Morphine continuous infusion; Staff-controlled pethidine; Vitamin E (swallowed); Control (treatment as usual) |
| Outcomes | Mucositis at different levels of severity (including severe, >=grade 3); Days to heal (mean); Oral pain scores or categories; Relief of dysphagia; Incidence of systemic infection; Amount of analgesia; Days stay in hospital; Cost of oral care; Patient quality of life | Improvement in mucositis; Mucositis eradicated; Mucositis severity (mild to moderate); Time to heal mucositis (days); Days to clinical resolution; Average pain scores; Daily mean opiate intake per hour; Duration of pain control therapy (days); Quality of life |
| Study designs | Randomised controlled trials (RCTs) | RCT (n=32) |
| Timing | Not specified | Pain standardised to 7 days after start of treatment (nearest reported time point used; range days 2-28); opiate utilisation at day 7 |
Search date: 2010-06. Databases: Cochrane Oral Health Group Trials Register; Cochrane Pain, Palliative and Supportive Care (PaPaS) Group Trials Register; CENTRAL; MEDLINE; EMBASE; CINAHL; CANCERLIT via PubMed; OpenSIGLE; LILACS
Questions and results
Show all 4 versionsAllopurinol mouthwash vs Placebo
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in mucositis | RR 6.33 [2.18, 18.37] | 1 study · 44 participants | Ungraded |
Mucositis eradicated | RR 19.00 [1.17, 307.63] | 1 study · 44 participants | Ungraded |
Time to heal mucositis (days) | MD -4.50 [-5.77, -3.23] | 1 study · 44 participants | Ungraded |
Tetrachlorodecaoxide vs Placebo
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in mucositis | RR 1.24 [0.97, 1.58] | 1 study · 62 participants | Ungraded |
Benzydamine hydrochloride mouthwash vs Placebo
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in mucositis | RR 1.22 [0.94, 1.60] | 2 studies · 102 participants | Ungraded |
Sucralfate vs Placebo
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in mucositis | RR 0.93 [0.71, 1.24] | 1 study · 34 participants | Ungraded |
Mucositis eradicated | RR 1.13 [0.66, 1.94] | 2 studies · 84 participants | Ungraded |
Vitamin E vs Placebo (not a true placebo)
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mucositis eradicated | RR 6.00 [0.89, 40.31] | 1 study · 18 participants | Ungraded |
Chlorhexidine mouthwash vs Salt and soda mouthwash
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Time to heal mucositis (days) | MD -0.40 [-1.49, 0.69] | 1 study · 100 participants | Ungraded |
Mucositis eradicated | RR 1.10 [0.90, 1.35] | 1 study · 138 participants | Ungraded |
Average pain scores (0-100 VAS) | MD -3.50 [-13.35, 6.35] | 1 study · 63 participants | Ungraded |
'Magic' mouthwash (lidocaine, diphenhydramine, aluminium hydroxide) vs Salt and soda mouthwash
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mucositis eradicated | RR 0.98 [0.78, 1.24] | 1 study · 133 participants | Ungraded |
Average pain scores (0-100 VAS) | MD -0.60 [-10.92, 9.72] | 1 study · 57 participants | Ungraded |
Time to heal mucositis (days) | MD 0.17 [-0.97, 1.31] | 1 study · 91 participants | Ungraded |
Alfentanil vs Morphine
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Daily mean opiate intake per hour | MD -3.90 [-6.42, -1.38] | 1 study · 28 participants | Ungraded |
Average pain scores (0-100 VAS) | MD 0.00 [-31.01, 31.01] | 1 study · 28 participants | Ungraded |
Sufentanil vs Morphine
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Average pain scores (0-100 VAS) | MD 5.40 [-3.10, 13.90] | 1 study · 60 participants | Ungraded |
Hydromorphone vs Morphine
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Average pain scores (0-100 VAS) | MD 0.60 [-9.24, 10.44] | 1 study · 56 participants | Ungraded |
Morphine via patient-controlled analgesia (PCA) vs Morphine via continuous infusion (CI)
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Daily mean opiate intake per hour | MD -0.65 [-1.20, -0.09] | 3 studies · 113 participants | Ungraded |
Average pain scores (0-100 VAS) | MD -2.49 [-12.28, 7.29] | 3 studies · 113 participants | Ungraded |
Duration of pain control therapy (days) | MD -1.87 [-3.49, -0.25] | 3 studies · 113 participants | Ungraded |
Morphine via pharmacokinetically based PCA (PKPCA) vs Morphine via patient-controlled analgesia (PCA)
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Daily mean opiate intake per hour | MD 3.60 [1.47, 5.73] | 1 study · 35 participants | Ungraded |
Average pain scores (0-100 VAS) | MD -18.00 [-31.62, -4.38] | 1 study · 35 participants | Ungraded |
Therapist support (visits) vs Control (treatment as usual)
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Average pain scores (0-100 VAS) | MD -5.61 [-17.25, 6.02] | 2 studies · 69 participants | Ungraded |
Daily mean opiate intake per hour | MD 0.20 [-4.18, 4.58] | 1 study · 22 participants | Ungraded |
Relaxation and imagery training vs Control (treatment as usual)
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Average pain scores (0-100 VAS) | MD -8.22 [-21.79, 5.35] | 1 study · 46 participants | Ungraded |
Cognitive behavioural therapy vs Control (treatment as usual)
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Daily mean opiate intake per hour | MD -0.20 [-4.29, 3.89] | 1 study · 21 participants | Ungraded |
Average pain scores (0-100 VAS) | MD -7.29 [-17.40, 2.83] | 2 studies · 68 participants | Ungraded |
Hypnosis vs Control (treatment as usual)
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Average pain scores (0-100 VAS) | MD -10.50 [-36.05, 15.05] | 1 study · 22 participants | Ungraded |
Daily mean opiate intake per hour | MD -0.45 [-4.42, 3.52] | 1 study · 22 participants | Ungraded |
Granulocyte macrophage-colony stimulating factor (GM-CSF) vs Placebo or no treatment
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in mucositis 14 days | RR 2.09 [0.77, 5.68] | 1 study · 51 participants | Ungraded |
Improvement in mucositis End of radiotherapy | RR 4.23 [1.35, 13.24] | 1 study · 61 participants | Ungraded |
Time to heal mucositis (days) | MD -1.10 [-3.59, 1.39] | 1 study · 35 participants | Ungraded |
Granulocyte macrophage-colony stimulating factor (GM-CSF) vs Povidone iodine
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Time to heal mucositis (days) | MD -3.50 [-4.14, -2.86] | 1 study · 31 participants | Ungraded |
Granulocyte macrophage-colony stimulating factor (GM-CSF) vs Antimycotic mouthrinse
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Time to heal mucositis (days) | MD -2.40 [-4.15, -0.65] | 1 study · 40 participants | Ungraded |
Human placental extract vs Disprin (aspirin/betamethasone)
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in mucositis | RR 4.50 [2.29, 8.86] | 1 study · 120 participants | Ungraded |
Polyvariant intramuscular immunoglobulin vs Placebo
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in mucositis | RR 1.81 [1.24, 2.65] | 1 study · 80 participants | Ungraded |
Sucralfate vs Salt and soda mouthwash
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Time to heal mucositis (days) | MD 13.10 [-6.30, 32.50] | 1 study · 28 participants | Ungraded |
Average pain scores (0-100 VAS) | MD -0.30 [-1.03, 0.43] | 1 study · 29 participants | Ungraded |
Morphine vs Tricyclic antidepressant (nortriptyline)
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Average pain scores (0-100 VAS) | MD -19.10 [-31.01, -7.19] | 1 study · 39 participants | Ungraded |
Sufentanil vs Hydromorphone
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Average pain scores (0-100 VAS) | Sufentanil vs hydromorphone (Coda 1997): no statistically significant difference; no separate estimate reported | 1 study | Ungraded |
Patient-controlled analgesia (PCA) pethidine vs Staff-controlled delivery of pethidine
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Average pain scores (0-100 VAS) | MD -21.00 [-45.79, 3.79] | 1 study · 20 participants | Ungraded |
Daily mean opiate intake per hour | MD -4.00 [-10.14, 2.14] | 1 study · 20 participants | Ungraded |
Diclofenac vs Placebo
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Average pain scores (0-100 VAS) | MD -0.30 [-0.86, 0.26] | 1 study · 66 participants | Ungraded |
Debridement vs No debridement
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mucositis severity (mild to moderate) | Debridement vs no debridement (Cubukcu 2007): statistically significant benefit for decreased mucositis severity; no numeric estimate reported | 1 study | Ungraded |
Days to clinical resolution | Debridement vs no debridement (Cubukcu 2007): statistically significant benefit for debridement for days to clinical resolution; no numeric estimate reported | 1 study | Ungraded |
Gelclair vs Sucralfate and mucaine
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mucositis severity (mild to moderate) | RR 0.50 [0.17, 1.46] | 1 study · 20 participants | Ungraded |
Low level laser therapy vs Sham (placebo) laser treatment
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mucositis severity (mild to moderate) | RR 5.28 [2.30, 12.13] | 2 studies · 57 participants | Ungraded |
Phenytoin mouthrinse vs Placebo
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Average pain scores (0-100 VAS) | MD -1.70 [-3.85, 0.45] | 1 study · 12 participants | Ungraded |
Quality of life 7 days | MD -15.10 [-26.04, -4.16] | 1 study · 12 participants | Ungraded |
Vitamin E (topical) vs Vitamin E (swallowed)
Population: People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in mucositis 5 days | RR 15.40 [4.01, 59.21] | 1 study · 63 participants | Ungraded |
Mucositis eradicated | RR 53.74 [3.41, 846.84] | 1 study · 63 participants | Ungraded |