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

Supportive Care in Cancer volume 18, pages 1061–1079 (2010)Cite this article

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.

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Acknowledgments

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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Authors and Affiliations

  1. Department of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy, Institute of Odontology, Faculty of Health Sciences, University of Copenhagen, Nørre Allé 20, 2200, Copenhagen N, Denmark

    S. B. Jensen & A. M. L. Pedersen

  2. Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands

    A. Vissink & F. K. L. Spijkervet

  3. Department of Oncology, Herlev University Hospital, Herlev Ringvej, 2730, Herlev, Denmark

    E. Andersen

  4. School of Nursing, College of Health Sciences, University of Delaware, Newark, DE, 19716, USA

    C. G. Brown

  5. Department of Palliative Medicine, Royal Marsden Hospital, Sutton, SM2 5P5, UK

    A. N. Davies

  6. Dutilh Instituto de Reabilitação Facial e Oral, R. Paula Bueno 307, Taquaral, Brazil

    J. Dutilh

  7. Department of Adult Health, Indiana University School of Nursing, 1111 Middle Drive, Indianapolis, IN, 46202, USA

    J. S. Fulton

  8. Clinic for Periodontology and Oral Medicine, Faculty of Stomatology, University of Belgrade, P.O. Box 506, 11000, Belgrade, Serbia

    L. Jankovic

  9. Pediatric Dentistry, Service of Oral Medicine, IOP–Pediatric Oncology Institute/GRAACC, Federal University of São Paulo, Rua Botucatu 743, CEP 04023-062, São Paulo, Brazil

    N. N. F. Lopes

  10. Department of Endocrinology, Federal University of São Paulo, Medicine Paulista School, Rua Pedro de Toledo 910, São Paulo, Brazil

    A. L. S. Mello

  11. Department 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, Minas Gerais, Brazil

    L. V. Muniz

  12. Department of Oral and Maxillofacial Surgery/Hospital Dentistry, School of Dentistry, University of Michigan, 1011 North University Avenue, Ann Arbor, MI, 48109-1078, USA

    C. A. Murdoch-Kinch

  13. Centre for Medicine and Oral Health, Griffith University, Gold Coast Campus, QLD 4222, Gold Coast, Australia

    R. G. Nair

  14. Department of Oral Medicine, Carolinas Medical Center, P.O. Box 32861, Charlotte, NC, 28232, USA

    J. J. Napeñas, B. Stirling & M. T. Brennan

  15. Department 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, Minas Gerais, Brazil

    A. Nogueira-Rodrigues

  16. Department of Dentistry, Sudbury Regional Hospital Cancer Program, Hôpital régional de Sudbury Regional Hospital, 41 Ramsey Lake Road, Sudbury, ON, P3E 5J1, Canada

    D. Saunders

  17. Departments of Oral Immunology and Oral Medicine, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Medicinaregaten 12, 413 90, Gothenburg, Sweden

    I. von Bültzingslöwen

  18. Department of Pathology and Diagnostic Sciences, University of Maryland Dental School and Greenebaum Cancer Center, Baltimore, MD, 21201, USA

    D. S. Weikel

  19. Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA

    L. S. Elting

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  1. S. B. Jensen
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  2. A. M. L. Pedersen
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  3. A. Vissink
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  15. J. J. Napeñas
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  22. F. K. L. Spijkervet
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  23. M. T. Brennan
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Consortia

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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Correspondence to S. B. Jensen.

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Jensen, S.B., Pedersen, A.M.L., Vissink, A. et al. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact. Support Care Cancer 18, 1061–1079 (2010). https://doi.org/10.1007/s00520-010-0837-6

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  • DOI: https://doi.org/10.1007/s00520-010-0837-6

Keywords

  • Cancer therapy
  • Salivary gland hypofunction
  • Xerostomia
  • Management strategies
  • Economic impact