Investigators have examined whether a topical agent could help prevent the development of oral mucositis in patients undergoing cancer therapy.
Oral mucositis is a common side effect of cancer therapy—affecting nearly 100% of patients receiving radiotherapy, up to 80% of those receiving high-dose cancer therapy, and between 20% to 40% of those receiving conventional chemotherapy—and may impact treatment efficacy and patient quality of life. Patients with the condition may present with oral pain, superficial sore erythema, xerostomia, dysphagia, loss of taste, nausea, vomiting, loss of appetite, weight loss, and/or complete mucosal ulceration involving the gastrointestinal tract. As a result of these side effects, some patients may cease or delay further treatment, leading to poorer prognoses.
Previous studies have explored the preventive effects of treatments such as aloe vera, amifostine, cryotherapy, granulocyte colony–stimulating factor, intravenous glutamine, honey, keratinocyte growth factor, laser, polymyxin/tobramycin/amphotericin antibiotic pastille/paste, and sucralfate. However, the results have been limited and specific to certain cancer types.
In a systematic review and network meta-analysis, published in Oral Diseases, the investigators used PubMed, Scopus, Web of Science, and the Cochrane Database to identify 30 studies assessing outcomes in a total of 2,564 adult patients undergoing cancer therapy for solid tumors. The patients received either one of 19 topical agents, including mouthwash, gel, or topical formulations; standard therapy; or placebo to prevent or reduce the severity of oral mucositis.
The investigators noted that the most commonly used treatments were natural products followed by antimicrobial agents, coating agents, and basic oral care strategies. Among the 19 topical treatments, 13 of them did not demonstrate effectiveness in preventing oral mucositis (P > .05). Although curcumin did not prevent the overall incidence of oral mucositis, it did delay the onset of the condition following cancer therapy.
Among the treatments involved in the study, topical sucralfate was found to be the most effective at preventing oral mucositis following cancer therapy (odds ratio = 0.04, 95% confidence interval = 0.01–0.25, P = .001). Topical sucralfate was reported to have cytoprotective effects and is often an affordable treatment option. Further, the treatment is simple to self-administer and is not associated with significant adverse effects.
The investigators suggested that sucralfate mouthwash may provide benefit in patients at risk of developing cancer therapy–induced oral mucositis. They hope their findings can encourage the more widespread use of topical sucralfate in patients undergoing cancer therapy.
No conflicts of interest were disclosed.
