Clifton P Thornton1, Mengchi Li2, Chakra Budhathoki2, Chao Hsing Yeh2, Kathy Ruble3. 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. Cliff@jhmi.edu. 2. Johns Hopkins School of Nursing, Baltimore, MD, USA. 3. Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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.
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.
Authors: T Sobue; M Bertolini; A Thompson; D E Peterson; P I Diaz; A Dongari-Bagtzoglou Journal: Mol Oral Microbiol Date: 2018-02-20 Impact factor: 3.563
Authors: Jeevendra Kanagalingam; Mohamed Ibrahim A Wahid; Jin-Ching Lin; Nonette A Cupino; Edward Liu; Jin-Hyoung Kang; Shouki Bazarbashi; Nicole Bender Moreira; Harsha Arumugam; Stefan Mueller; Hanlim Moon Journal: Support Care Cancer Date: 2018-01-31 Impact factor: 3.603
Authors: Claudio Pulito; Antonio Cristaudo; Caterina La Porta; Stefano Zapperi; Giovanni Blandino; Aldo Morrone; Sabrina Strano Journal: J Exp Clin Cancer Res Date: 2020-10-07