A systematic review of interventions to mitigate radiotherapy-induced oral mucositis in head and neck cancer patients

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ORIGINAL ARTICLE

A systematic review of interventions to mitigate radiotherapy-induced oral mucositis in head and neck cancer patients Catrina Davy 1

&

Sharron Heathcote 2

Received: 10 January 2020 / Accepted: 21 May 2020 # The Author(s) 2020

Abstract Background Oral mucositis is a debilitating consequence of radiotherapy in patients with head and neck cancers. Radiationinduced oral mucositis (RIOM) can cause pain and weight loss, reduce quality of life and affect treatment outcomes. Methods A systematic review was undertaken to identify and examine the efficacy of low-cost interventions to mitigate RIOM and to develop clinical guidelines based on the evidence. Results The author identified three interventions: benzydamine hydrochloride mouth rinse (BHM), honey and oral glutamine (OG). The search identified twenty-four studies in total. Four studies examined BHM; all findings were favourable, although only one had moderate methodological quality, and the rest were low. The product was poorly tolerated by some participants in one study. Twelve studies examined honey. Eleven of these had favourable results; two studies had moderate methodological quality, and the rest were low. Eight studies examined OG. Six of these had favourable results; two studies had moderate methodological quality, and the rest were low. Conclusion The author cannot recommend BHM to mitigate RIOM due to the overall low quality of the studies and poor tolerance to the product. The author cannot recommend honey to mitigate RIOM due to weak evidence supporting the intervention. The author can recommend OG to mitigate RIOM. There is a need for high-quality studies with a consensus of the methodology to reduce heterogeneity and examination of the cost-effectiveness of the interventions. Keywords Radiotherapy . Radiation therapy . Head and neck cancer . Oral mucositis

Introduction Oral mucositis (OM) is a painful condition, characterised by ulcers [1]. Rapid cell division in the oral tract makes mucosal cells particularly sensitive to damage by irradiation [2]. OM commonly occurs in head and neck cancer patients (HNCPs) who have had radiotherapy (RT). It can affect up to 100% of HNCPs [3], and it is therefore a significant problem for this group. Radiation-induced oral mucositis (RIOM) can have a detrimental effect on patients’ functioning and quality of life

* Sharron Heathcote [email protected] Catrina Davy [email protected] 1

London, UK

2

University Cardiff, Wales, United Kingdom

(QoL): The painful inflammation and ulceration may affect patients’ ability to eat, drink and talk [4]. It may cause nutritional deficiencies affecting patients’ energy which can cause weight loss [4]. If severe RIOM occurs, it can affect patients’ health outcomes due to missed radiotherapy treatments; in fact, RIOM is the most likely side effect of RT to the oral region, causing limited RT doses [5]. The model for OM pathogenesis includes five stages: firstly, direct cell damage to the DNA, followed by tissue damage to the submucosa and basal epithe