Catherine H L Hong1, Luiz Alcino Gueiros2, Janet S Fulton3, Karis Kin Fong Cheng4, Abhishek Kandwal5, Dimitra Galiti6, Jane M Fall-Dickson7, Jorgen Johansen8, Suzanne Ameringer9, Tomoko Kataoka10, Dianna Weikel11, June Eilers12, Vinasha Ranna13, Anusha Vaddi14, Rajesh V Lalla15, Paolo Bossi16, Sharon Elad17. 1. Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore. denchhl@nus.edu.sg. 2. Oral Medicine Unit, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil. 3. Indiana University School of Nursing, Indianapolis, IN, USA. 4. Alice Lee Center for Nursing Studies, National University of Singapore, Singapore, Singapore. 5. Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India. 6. Dental School, University of Athens, Athens, Greece. 7. Department of Professional Nursing Practice, Georgetown University School of Nursing & Health Studies, Washington, DC, USA. 8. Department of Oncology, Odense University Hospital, Odense, Denmark. 9. School of Nursing, Virginia Commonwealth University, Richmond, VA, USA. 10. Multi-institutional Clinical Trials Section, Research Management Division, Clinical Research Support Office, National Cancer Center Hospital, Tokyo, Japan. 11. Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, USA. 12. College of Nursing-Omaha Division, University of Nebraska Medical Center, Omaha, NE, USA. 13. Department of Oral and Maxillofacial Surgery, The Mount Sinai Hospital, New York, NY, USA. 14. Oral Medicine, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA. 15. Section of Oral Medicine, University of Connecticut Health, Farmington, CT, USA. 16. Department of Medical and Surgical Specialties, Radiological Sciences and Public Health-Medical Oncology, University of Brescia, ASST-Spedali Civili, Brescia, Italy. 17. Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA.
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.
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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