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Anti-inflammatory mouthwashes for the prevention of oral mucositis in cancer therapy: an integrative review and meta-analysis

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Abstract

Purpose

Mucositis is severely painful and often reported as one of the most distressing adverse effects of cancer therapy; it is a significant threat to quality of life as well as life itself. Anti-inflammatory agents may modulate physiologic mechanisms that perpetuate mucositis and be useful in prevention efforts. Because systemic anti-inflammatory agents are not appropriate for many patients, locally acting agents (mouthwashes) may be more feasible for use. This review and meta-analysis evaluates the role that anti-inflammatory mouthwashes have in preventing or reducing oral mucositis associated with chemotherapy and radiation therapy.

Methods

A systematic literature review was conducted to identify studies evaluating the efficacy of anti-inflammatory mouthwashes to prevent therapy-associated mucositis. Meta-analysis was conducted to determine efficacy in preventing any mucositis and dose-limiting mucositis.

Results

Eight peer-reviewed publications were identified; corticosteroid and nonsteroidal anti-inflammatory mouthwashes are effective in reducing overall incidence of mucositis and are associated with lower severity of mucositis. Meta-analysis reveals significant reduction in symptomatic mucositis incidence (OR 6.00, 95% CI 4.39–8.20, p < 0.0001) and reduction of dose-limiting mucositis (OR 2.12, 95% CI 1.07–4.28, p = 0.032).

Conclusion

Mouthwashes containing anti-inflammatory agents are a potential effective means to prevent or reduce mucositis associated with cancer therapy. There are limited adverse effects from these agents, and adherence is high, indicating safety and feasibility of use. Anti-inflammatory mouthwashes should be considered for supportive care in persons at risk for mucositis and must be further evaluated to investigate efficacy across multiple chemotherapy agents, adverse effects, and impacts on symptoms, pain, and quality of life.

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Authors and Affiliations

  1. Pediatric Hematology/Oncology, Herman & Walter Samuelson Children’s Hospital at Sinai, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205, USA

    Clifton P. Thornton

  2. Johns Hopkins School of Nursing, Baltimore, MD, USA

    Mengchi Li, Chakra Budhathoki & Chao Hsing Yeh

  3. Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Kathy Ruble

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  2. Mengchi Li
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  3. Chakra Budhathoki
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  4. Chao Hsing Yeh
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  5. Kathy Ruble
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Contributions

Dr. CT devised the idea of this work and directed the overall conduct of this review and meta-analysis, was responsible for constructing and evaluating the search strategy, executing the search strategy, and organizing the research team, and performed primary data extraction from articles and drafting the manuscript. Ms. ML was responsible for 2nd execution of the search strategy, conducting review of identified articles to verify they met inclusion criteria, performed adjudication with Mr. T on article inclusion, and extracted data for 2nd check of validity of findings as well as verified agreement with article level of evidence and quality; she assisted with drafting and writing sections of the manuscript. Dr. CB provided biostatistical expertise and oversight to data extraction, exploring data amenable to meta-analysis, and conduct of the biostatistical modeling for the meta-analysis as well as reviewing findings and interpretation of quantitative results. Dr. CHY and Dr. KR provided primary oversight of this project, verifying adequate search strategy, clinical relevance, and offering expertise in oncology care and symptom science; they both provided final revisions to the manuscript and mentoring for conduct of this project throughout execution.

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Correspondence to Clifton P. Thornton.

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Thornton, C.P., Li, M., Budhathoki, C. et al. Anti-inflammatory mouthwashes for the prevention of oral mucositis in cancer therapy: an integrative review and meta-analysis. Support Care Cancer 30, 7205–7218 (2022). https://doi.org/10.1007/s00520-022-07068-5

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