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Systematic review of basic oral care for the management of oral mucositis in cancer patients and clinical practice guidelines

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Abstract

Purpose

The aim of this study was to update the clinical practice guidelines for the use of basic oral care (BOC) interventions for the prevention and/or treatment of oral mucositis (OM).

Methods

A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO). The body of evidence for each intervention in each cancer treatment setting was assigned an evidence level. The findings were added to the database used to develop the 2013 MASCC/ISOO clinical practice guidelines. Based on the evidence level, one of the following three guideline determinations was possible: Recommendation, Suggestion, No guideline possible.

Results

A total of 17 new papers across six interventions were examined and merged with a previous database. Based on the literature, the following guidelines were possible. The panel suggests that the implementation of multi-agent combination oral care protocols is beneficial for the prevention of OM during chemotherapy, head and neck (H&N) radiation therapy (RT), and hematopoietic stem cell transplantation (Level of Evidence III). The panel suggests that chlorhexidine not be used to prevent OM in patients undergoing H&N RT (Level of Evidence III). No guideline was possible for professional oral care, patient education, saline, and sodium bicarbonate, and expert opinion complemented these guidelines.

Conclusions

The evidence supports the use of multi-agent combination oral care protocols in the specific populations listed above. Additional well-designed research is needed on the other BOC interventions prior to guideline formulation.

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Acknowledgements

The authors would like to gratefully acknowledge Mr. Eyal Zur, BSc Pharm, RPh, MBA, for the calculations of the hydrogen peroxide and sodium bicarbonate concentrations under the bland mouth rinses in the results section.The authors are also thankful for the medical librarians for their valuable contribution to this project: Lorraine Porcello, MSLIS, MSIM – Bibby Dental Library, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA; Daniel A. Castillo, MLIS – Edward G. Miner Library, University of Rochester Medical Center, Rochester, NY, USA.

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Authors and Affiliations

  1. Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore

    Catherine H. L. Hong

  2. Oral Medicine Unit, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil

    Luiz Alcino Gueiros

  3. Indiana University School of Nursing, Indianapolis, IN, USA

    Janet S. Fulton

  4. Alice Lee Center for Nursing Studies, National University of Singapore, Singapore, Singapore

    Karis Kin Fong Cheng

  5. Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India

    Abhishek Kandwal

  6. Dental School, University of Athens, Athens, Greece

    Dimitra Galiti

  7. Department of Professional Nursing Practice, Georgetown University School of Nursing & Health Studies, Washington, DC, USA

    Jane M. Fall-Dickson

  8. Department of Oncology, Odense University Hospital, Odense, Denmark

    Jorgen Johansen

  9. School of Nursing, Virginia Commonwealth University, Richmond, VA, USA

    Suzanne Ameringer

  10. Multi-institutional Clinical Trials Section, Research Management Division, Clinical Research Support Office, National Cancer Center Hospital, Tokyo, Japan

    Tomoko Kataoka

  11. Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, USA

    Dianna Weikel

  12. College of Nursing—Omaha Division, University of Nebraska Medical Center, Omaha, NE, USA

    June Eilers

  13. Department of Oral and Maxillofacial Surgery, The Mount Sinai Hospital, New York, NY, USA

    Vinasha Ranna

  14. Oral Medicine, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA

    Anusha Vaddi

  15. Section of Oral Medicine, University of Connecticut Health, Farmington, CT, USA

    Rajesh V. Lalla

  16. Department of Medical and Surgical Specialties, Radiological Sciences and Public Health—Medical Oncology, University of Brescia, ASST-Spedali Civili, Brescia, Italy

    Paolo Bossi

  17. Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA

    Sharon Elad

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  1. Catherine H. L. Hong
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Consortia

On behalf of the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO)

Corresponding author

Correspondence to Catherine H. L. Hong.

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Conflict of interest

Per the MASCC Guidelines Policy, employees of commercial entities were not eligible to serve on this MASCC Guidelines Panel. The following authors disclose no conflict of interest (CHLH, LAG, JF, KKFC, AK, DG, JMFD, JJ, SA, TK, DW, JE, VR, AV, SE). PB has served an advisory role for AstraZeneca, Helsinn, and Kyowa Kyrin and received grants from Merck, Kyowa Kyrin, and Roche. RVL has served as a consultant for Colgate Oral Pharmaceuticals, Galera Therapeutics, Ingalfarma SA, Monopar Therapeutics, Mundipharma, and Sucampo Pharma; has received research support to his institution from Galera Therapeutics, Novartis, Oragenics, and Sucampo Pharma; and has received stock in Logic Biosciences.

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Hong, C.H.L., Gueiros, L.A., Fulton, J. et al. Systematic review of basic oral care for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer 27, 3949–3967 (2019). https://doi.org/10.1007/s00520-019-04848-4

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