Review Article

Supportive Care in Cancer

, Volume 18, Issue 8, pp 1061-1079

A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact

  • S. B. JensenAffiliated withDepartment of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy, Institute of Odontology, Faculty of Health Sciences, University of Copenhagen Email author 
  • , A. M. L. PedersenAffiliated withDepartment of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy, Institute of Odontology, Faculty of Health Sciences, University of Copenhagen
  • , A. VissinkAffiliated withDepartment of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen
  • , E. AndersenAffiliated withDepartment of Oncology, Herlev University Hospital
  • , C. G. BrownAffiliated withSchool of Nursing, College of Health Sciences, University of Delaware
  • , A. N. DaviesAffiliated withDepartment of Palliative Medicine, Royal Marsden Hospital
  • , J. DutilhAffiliated withDutilh Instituto de Reabilitação Facial e Oral
  • , J. S. FultonAffiliated withDepartment of Adult Health, Indiana University School of Nursing
  • , L. JankovicAffiliated withClinic for Periodontology and Oral Medicine, Faculty of Stomatology, University of Belgrade
    • , N. N. F. LopesAffiliated withPediatric Dentistry, Service of Oral Medicine, IOP–Pediatric Oncology Institute/GRAACC, Federal University of São Paulo
    • , A. L. S. MelloAffiliated withDepartment of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy, Institute of Odontology, Faculty of Health Sciences, University of CopenhagenDepartment of Endocrinology, Federal University of São Paulo, Medicine Paulista School
    • , L. V. MunizAffiliated withDepartment of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy, Institute of Odontology, Faculty of Health Sciences, University of CopenhagenDepartment of Odontology, Associação do Combate ao Câncer do Centro Oeste de Minas Gerais, Instituto de Pesquisas Oncológicas Minas Gerais, IPOM, Hospital do Câncer Centro Oeste de Minas Gerais
    • , C. A. Murdoch-KinchAffiliated withDepartment of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy, Institute of Odontology, Faculty of Health Sciences, University of CopenhagenDepartment of Oral and Maxillofacial Surgery/Hospital Dentistry, School of Dentistry, University of Michigan
    • , R. G. NairAffiliated withDepartment of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy, Institute of Odontology, Faculty of Health Sciences, University of CopenhagenCentre for Medicine and Oral Health, Griffith University, Gold Coast Campus
    • , J. J. NapeñasAffiliated withDepartment of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy, Institute of Odontology, Faculty of Health Sciences, University of CopenhagenDepartment of Oral Medicine, Carolinas Medical Center
    • , A. Nogueira-RodriguesAffiliated withDepartment of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy, Institute of Odontology, Faculty of Health Sciences, University of CopenhagenDepartment of Oncology and Research, Associação do Combate ao Câncer do Centro Oeste de Minas Gerais, Instituto de Pesquisas Oncológicas Minas Gerais, IPOM, Hospital do Câncer Centro Oeste de Minas Gerais
    • , D. SaundersAffiliated withDepartment of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy, Institute of Odontology, Faculty of Health Sciences, University of CopenhagenDepartment of Dentistry, Sudbury Regional Hospital Cancer Program, Hôpital régional de Sudbury Regional Hospital
    • , B. StirlingAffiliated withDepartment of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy, Institute of Odontology, Faculty of Health Sciences, University of CopenhagenDepartment of Oral Medicine, Carolinas Medical Center
    • , I. von BültzingslöwenAffiliated withDepartment of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy, Institute of Odontology, Faculty of Health Sciences, University of CopenhagenDepartments of Oral Immunology and Oral Medicine, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg
    • , D. S. WeikelAffiliated withDepartment of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy, Institute of Odontology, Faculty of Health Sciences, University of CopenhagenDepartment of Pathology and Diagnostic Sciences, University of Maryland Dental School and Greenebaum Cancer Center
    • , L. S. EltingAffiliated withDepartment of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy, Institute of Odontology, Faculty of Health Sciences, University of CopenhagenDepartment of Biostatistics, The University of Texas M.D. Anderson Cancer Center
    • , F. K. L. SpijkervetAffiliated withDepartment of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen
    • , M. T. BrennanAffiliated withDepartment of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy, Institute of Odontology, Faculty of Health Sciences, University of CopenhagenDepartment of Oral Medicine, Carolinas Medical Center
    • , Salivary Gland Hypofunction/Xerostomia Section
    • , Oral Care Study Group
    • , Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO)

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Abstract

Purpose

This systematic review aimed to assess the literature for management strategies and economic impact of salivary gland hypofunction and xerostomia induced by cancer therapies and to determine the quality of evidence-based management recommendations.

Methods

The electronic databases of MEDLINE/PubMed and EMBASE were searched for articles published in English since the 1989 NIH Development Consensus Conference on the Oral Complications of Cancer Therapies until 2008 inclusive. For each article, two independent reviewers extracted information regarding study design, study population, interventions, outcome measures, results, and conclusions.

Results

Seventy-two interventional studies met the inclusion criteria. In addition, 49 intensity-modulated radiation therapy (IMRT) studies were included as a management strategy aiming for less salivary gland damage. Management guideline recommendations were drawn up for IMRT, amifostine, muscarinic agonist stimulation, oral mucosal lubricants, acupuncture, and submandibular gland transfer.

Conclusions

There is evidence that salivary gland hypofunction and xerostomia induced by cancer therapies can be prevented or symptoms be minimized to some degree, depending on the type of cancer treatment. Management guideline recommendations are provided for IMRT, amifostine, muscarinic agonist stimulation, oral mucosal lubricants, acupuncture, and submandibular gland transfer. Fields of sparse literature identified included effects of gustatory and masticatory stimulation, specific oral mucosal lubricant formulas, submandibular gland transfer, acupuncture, hyperbaric oxygen treatment, management strategies in pediatric cancer populations, and the economic consequences of salivary gland hypofunction and xerostomia.

Keywords

Cancer therapy Salivary gland hypofunction Xerostomia Management strategies Economic impact