Wanessa Miranda-Silva1, Wagner Gomes-Silva2,3, Yehuda Zadik4,5, Noam Yarom6,7, Abdul Rahman Al-Azri8,9, Catherine H L Hong10, Anura Ariyawardana11,12, Deborah P Saunders13, M Elvira Correa14, Praveen R Arany15, Joanne Bowen16, Karis Kin Fong Cheng17, Wim J E Tissing18, Paolo Bossi19, Sharon Elad20. 1. Instituto de Ensino e Pesquisa, Hospital Sírio Libanês, 69 Prof. Daher Cutait, Sao Paulo, SP, 01308-060, Brazil. wmswanessa@yahoo.com.br. 2. Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, Fundação Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil. 3. Medical School, Universidade Nove de Julho, Sao Paulo, Brazil. 4. Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel. 5. Department of Oral Medicine, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel. 6. Oral Medicine Unit, Sheba Medical Center, Tel Hashomer, Israel. 7. School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel. 8. Adelaide Dental School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia. 9. Dental and OMFS Department, Oral Pathology and Medicine, Al-Nahdha Hospital, Ministry of Health, Muscat, Oman. 10. Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, National University of Singapore, Singapore, Singapore. 11. College of Medicine and Dentistry, James Cook University, Cairns, Australia. 12. Metro South Oral Health, Brisbane, Australia. 13. Department of Dental Oncology, Health Sciences North, Northern Ontario School of Medicine, Sudbury, Ontario, Canada. 14. Oral Medicine, Post-Graduation Program, Oncology Department, School of Medicine Science, University of Campinas, Campinas, São Paulo, Brazil. 15. Department of Oral Biology and Biomedical Engineering, School of Dental Medicine, Engineering and Applied Science, University at Buffalo, Buffalo, NY, USA. 16. Adelaide Medical School, The University of Adelaide, Adelaide, Australia. 17. Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 18. Department of Pediatric Oncology, Univesity of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 19. Department of Medical and Surgical Specialties, Radiological Sciences and Public Health - Medical Oncology, ASST-Spedali Civili, University of Brescia, Brescia, Italy. 20. Division of Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA.
Abstract
OBJECTIVE: The aim of this sub-analysis was to highlight the MASCC/ISOO clinical practice guidelines for the management of oral mucositis (OM) in pediatric patients and to present unique considerations in this patient population. METHODS: This sub-analysis of the pediatric patient population is based on the systematic review conducted by the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISSO) published in 2019/2020. Studies were scored and assigned a level of evidence based on previously published criteria. Data regarding adverse effects and compliance was collected from the original publications. RESULTS: A total of 45 papers were included and assessed in this sub-analysis, including 21 randomized controlled trials (RCTs). Chewing gum was demonstrated to be not effective in preventing OM in pediatric cancer patients in 2 RCTs. The efficacy of all other interventions could not be determined based on the available literature. CONCLUSION: There is limited or conflicting evidence about interventions for the management of OM in pediatric cancer patients, except for chewing gum which was ineffective for prevention. Therefore, currently, data from adult studies may need to be extrapolated for the management of pediatric patients. Honey and photobiomodulation therapy in this patient population had encouraging potential. Implementation of a basic oral care protocol is advised amid lack of high level of evidence studies.
OBJECTIVE: The aim of this sub-analysis was to highlight the MASCC/ISOO clinical practice guidelines for the management of oral mucositis (OM) in pediatric patients and to present unique considerations in this patient population. METHODS: This sub-analysis of the pediatric patient population is based on the systematic review conducted by the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISSO) published in 2019/2020. Studies were scored and assigned a level of evidence based on previously published criteria. Data regarding adverse effects and compliance was collected from the original publications. RESULTS: A total of 45 papers were included and assessed in this sub-analysis, including 21 randomized controlled trials (RCTs). Chewing gum was demonstrated to be not effective in preventing OM in pediatric cancerpatients in 2 RCTs. The efficacy of all other interventions could not be determined based on the available literature. CONCLUSION: There is limited or conflicting evidence about interventions for the management of OM in pediatric cancerpatients, except for chewing gum which was ineffective for prevention. Therefore, currently, data from adult studies may need to be extrapolated for the management of pediatric patients. Honey and photobiomodulation therapy in this patient population had encouraging potential. Implementation of a basic oral care protocol is advised amid lack of high level of evidence studies.
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