Supportive Care in Cancer

, Volume 18, Issue 8, pp 1039–1060 | Cite as

A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life

  • S. B. Jensen
  • A. M. L. Pedersen
  • A. Vissink
  • E. Andersen
  • C. G. Brown
  • A. N. Davies
  • J. Dutilh
  • J. S. Fulton
  • L. Jankovic
  • N. N. F. Lopes
  • A. L. S. Mello
  • L. V. Muniz
  • C. A. Murdoch-Kinch
  • R. G. Nair
  • J. J. Napeñas
  • A. Nogueira-Rodrigues
  • D. Saunders
  • B. Stirling
  • I. von Bültzingslöwen
  • D. S. Weikel
  • L. S. Elting
  • F. K. L. Spijkervet
  • M. T. Brennan
  • Salivary Gland Hypofunction/Xerostomia Section, Oral Care Study Group, Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO)
Original Article



This systematic review aimed to assess the literature for prevalence, severity, and impact on quality of life of salivary gland hypofunction and xerostomia induced by cancer therapies.


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. Two independent reviewers extracted information regarding study design, study population, interventions, outcome measures, results and conclusions for each article.


The inclusion criteria were met by 184 articles covering salivary gland hypofunction and xerostomia induced by conventional, 3D conformal radiotherapy or intensity-modulated radiotherapy in head and neck cancer patients, cancer chemotherapy, total body irradiation/hematopoietic stem cell transplantation, radioactive iodine treatment, and immunotherapy.


Salivary gland hypofunction and xerostomia are induced by radiotherapy in the head and neck region depending on the cumulative radiation dose to the gland tissue. Treatment focus should be on optimized/new approaches to further reduce the dose to the parotids, and particularly submandibular and minor salivary glands, as these glands are major contributors to moistening of oral tissues. Other cancer treatments also induce salivary gland hypofunction, although to a lesser severity, and in the case of chemotherapy and immunotherapy, the adverse effect is temporary. Fields of sparse literature included pediatric cancer populations, cancer chemotherapy, radioactive iodine treatment, total body irradiation/hematopoietic stem cell transplantation, and immunotherapy.


Cancer therapy Radiotherapy Chemotherapy Salivary gland hypofunction Xerostomia Quality of life 



We thank Research Librarian Susie Andersen, Deputy Head of the Panum Library, Faculty of Health Sciences, University of Copenhagen, Denmark, for expert assistance with the systematic literature search. We also thank Tainika Williams, Department of Oral Medicine, Carolinas Medical Center, North Carolina, USA, for her overall skills with literature search.

Conflicts of interest

The authors declared that they have no potential conflicts of interests.


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • S. B. Jensen
    • 1
  • A. M. L. Pedersen
    • 1
  • A. Vissink
    • 2
  • E. Andersen
    • 3
  • C. G. Brown
    • 4
  • A. N. Davies
    • 5
  • J. Dutilh
    • 6
  • J. S. Fulton
    • 7
  • L. Jankovic
    • 8
  • N. N. F. Lopes
    • 9
  • A. L. S. Mello
    • 10
  • L. V. Muniz
    • 11
  • C. A. Murdoch-Kinch
    • 12
  • R. G. Nair
    • 13
  • J. J. Napeñas
    • 14
  • A. Nogueira-Rodrigues
    • 15
  • D. Saunders
    • 16
  • B. Stirling
    • 14
  • I. von Bültzingslöwen
    • 17
  • D. S. Weikel
    • 18
  • L. S. Elting
    • 19
  • F. K. L. Spijkervet
    • 2
  • M. T. Brennan
    • 14
  • Salivary Gland Hypofunction/Xerostomia Section, Oral Care Study Group, Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO)
  1. 1.Department of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy, Institute of Odontology, Faculty of Health SciencesUniversity of CopenhagenCopenhagenDenmark
  2. 2.Department of Oral & Maxillofacial Surgery, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
  3. 3.Department of OncologyHerlev University HospitalHerlevDenmark
  4. 4.School of Nursing, College of Health SciencesUniversity of DelawareNewarkUSA
  5. 5.Department of Palliative MedicineRoyal Marsden HospitalSuttonUK
  6. 6.Dutilh Instituto de Reabilitação Facial e OralTaquaralBrazil
  7. 7.Department of Adult HealthIndiana University School of NursingIndianapolisUSA
  8. 8.Clinic for Periodontology and Oral Medicine, Faculty of StomatologyUniversity of BelgradeBelgradeSerbia
  9. 9.Pediatric Dentistry, Service of Oral Medicine, IOP-Pediatric Oncology Institute/GRAACCFederal University of São PauloSão PauloBrazil
  10. 10.Department of EndocrinologyFederal University of São Paulo, Medicine Paulista SchoolSão PauloBrazil
  11. 11.Department of Odontology, Associação do Combate ao Câncer do Centro Oeste de Minas Gerais, Instituto de Pesquisas Oncológicas Minas Gerais, IPOMHospital do Câncer Centro Oeste de Minas GeraisMinas GeraisBrazil
  12. 12.Department of Oral and Maxillofacial Surgery/Hospital Dentistry, School of DentistryUniversity of MichiganAnn ArborUSA
  13. 13.Centre for Medicine and Oral HealthGriffith University, Gold Coast CampusGold CoastAustralia
  14. 14.Department of Oral MedicineCarolinas Medical CenterCharlotteUSA
  15. 15.Department of Oncology and Research, Associação do Combate ao Câncer do Centro Oeste de Minas Gerais, Instituto de Pesquisas Oncológicas Minas Gerais, IPOMHospital do Câncer Centro Oeste de Minas GeraisMinas GeraisBrazil
  16. 16.Department of Dentistry, Sudbury Regional Hospital Cancer ProgramHôpital régional de Sudbury Regional HospitalSudburyCanada
  17. 17.Departments of Oral Immunology and Oral Medicine, Institute of Odontology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
  18. 18.Department of Pathology and Diagnostic SciencesUniversity of Maryland Dental School and Greenebaum Cancer CenterBaltimoreUSA
  19. 19.Department of BiostatisticsThe University of Texas M.D. Anderson Cancer CenterHoustonUSA

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