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A systematic review of oral herpetic viral infections in cancer patients: commonly used outcome measures and interventions



To review the literature for outcome measures for oral viral infections in cancer patients. A secondary aim was to update the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) clinical practice guidelines for the management of oral viral infections in cancer patients.


Databases were searched for articles published in the English language, 1981–2013. Studies that met the eligibility criteria were reviewed systematically. The data about the outcome measures were classified according to the aim of the study: prevention, treatment, or non-interventional. The results of interventional studies were compared to the 2010 MASCC/ISOO publication.


Multiple clinical and laboratory tests were used to measure oral viral infections, with great variability between studies. Most of the studies were about Herpes Simplex Virus (HSV). The outcome measure that was most commonly used was the presence of HSV infection diagnosed based on a combination of suggestive clinical presentation with a positive laboratory result. HSV culture was the most commonly reported laboratory outcome measure. Acyclovir and valacyclovir were consistently reported to be efficacious in the management of oral herpetic infections. No new data on the quality of life and economic aspects was found.


Considering the variability in outcome measures reported to assess oral herpetic infections the researcher should select carefully the appropriate measures based on the objective of the study. Acyclovir and valacyclovir are effective in the management of oral herpetic infections in patients receiving treatment for cancer. Studies on newer anti-viral drugs may be useful to address the issue of anti-viral resistance.

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The authors would like to thank Doug Peterson, DMD PhD FDS RCSEd, Oral Health and Diagnostic Sciences, Uconn Health, for reviewing this paper and providing valuable guidance. Additionally, the authors would like to thank Girija Naidu, DDS, Advanced Education in General Dentistry Program, General Dentistry, Eastman Institute for Oral Health, Rochester, NY for her assistance with the early data compilation.

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Elad, S., Ranna, V., Ariyawardana, A. et al. A systematic review of oral herpetic viral infections in cancer patients: commonly used outcome measures and interventions. Support Care Cancer 25, 687–700 (2017).

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  • Oral viral infection
  • Outcome measures
  • Efficacy of intervention
  • Herpes virus
  • HSV
  • Cancer