Supportive Care in Cancer

, Volume 18, Issue 8, pp 1061–1079 | Cite as

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

  • 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)
Review Article



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.


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.


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.


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.


Cancer therapy Salivary gland hypofunction Xerostomia Management strategies Economic impact 


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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 CopenhagenCopenhagen NDenmark
  2. 2.Department of Oral & Maxillofacial SurgeryUniversity Medical Center Groningen, University 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 MedicineIOP–Pediatric Oncology Institute/GRAACC, Federal 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 GeraisInstituto de Pesquisas Oncológicas Minas Gerais, IPOM, Hospital 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 GeraisInstituto de Pesquisas Oncológicas Minas Gerais, IPOM, Hospital 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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