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Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients and clinical practice guidelines

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Abstract

Purpose

To update the clinical practice guidelines for the use of antimicrobials, mucosal coating agents, anesthetics, and analgesics 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 of 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 2014 MASCC/ISOO clinical practice guidelines. Based on the evidence level, the following guidelines were determined: Recommendation, Suggestion, and No Guideline Possible.

Results

A total of 9 new papers were identified within the scope of this section, adding to the 62 papers reviewed in this section previously. A new Suggestion was made for topical 0.2% morphine for the treatment of OM-associated pain in head and neck (H&N) cancer patients treated with RT-CT (modification of previous guideline). A previous Recommendation against the use of sucralfate-combined systemic and topical formulation in the prevention of OM in solid cancer treatment with CT was changed from Recommendation Against to No Guideline Possible. Suggestion for doxepin and fentanyl for the treatment of mucositis-associated pain in H&N cancer patients was changed to No Guideline Possible.

Conclusions

Of the agents studied for the management of OM in this paper, the evidence supports a Suggestion in favor of topical morphine 0.2% in H&N cancer patients treated with RT-CT for the treatment of OM-associated pain.

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Acknowledgments

The authors are thankful for the medical librarians for their valuable contribution to this project: Lorraine Porcello, MSLIS, MSIM—Bibby Dental Library, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA; Daniel A. Castillo, MLIS—Edward G. Miner Library, University of Rochester Medical Center, Rochester, NY, USA.

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Authors and Affiliations

  1. Dental Oncology Program, Health Sciences North, North East Cancer Center, Northern Ontario School of Medicine, 41 Ramsey Lake Road, Sudbury, Ontario, P3E 5J1, Canada

    Deborah P. Saunders & Tanya Rouleau

  2. Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Karis Cheng

  3. Oral Medicine Unit, Sheba Medical Center, Tel Hashomer, Israel and School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel

    Noam Yarom

  4. Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himayalan University, Dehradun, Uttarakhand, India

    Abhishek Kandwal

  5. Clinical Pharmacy, Cancer Treatment Centers of America, Boca Raton, FL, USA

    Jamie Joy

  6. Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, İstanbul University, Istanbul, Turkey

    Kivanc Bektas Kayhan

  7. Paediatric Oncology Department, Emma Children’s Hospital, Academic Medical Centre, Amsterdam, The Netherlands

    Marianne van de Wetering

  8. Division of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Norman Brito-Dellan

  9. Multi-institutional Clinical Trials Section, Research Management Division, Clinical Research Support Office, National Cancer Center Hospital, Tokyo, Japan

    Tomoko Kataoka

  10. Pharmacy Department, St Vincent’s Hospital Melbourne, Electronic Medical Records Department, Melbourne Health, Jane Bell House, Melbourne, Victoria, Australia

    Karen Chiang

  11. Department of Oral and Maxillofacial Surgery, The Mount Sinai Hospital, New York, NY, USA

    Vinisha Ranna

  12. Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA

    Anusha Vaddi & Sharon Elad

  13. Cedars-Sinai Health System, Los Angeles CA and City of Hope National Medical Center, Duarte, CA, USA

    Joel Epstein

  14. Section of Oral Medicine, University of Connecticut School of Dental Medicine, Farmington, CT, USA

    Rajesh V. Lalla

  15. Medical Oncology, University of Brescia, ASST-Spedali Civili, Brescia, Italy

    Paolo Bossi

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  1. Deborah P. Saunders
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On behalf of the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO)

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Correspondence to Deborah P. Saunders.

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According to the MASCC Guideline Policy, employees of commercial entities were not eligible to serve on this MASCC Guideline Panel. All authors completed a Conflict of Interest disclosure form and conflicts are disclosed in the guideline’s publications. The authors disclose no conflict of interest (TR, AK, KKFC, NY, JJ, KB, MW, NBD, TK, KC, VR, AV, and SE). DPS has received research support to her institution from Galera Therapeutics. PB has served an advisory role for AstraZeneca, Helsinn, and Kyowa Kirin and received grants from Merck, Kyowa Kirin, and Roche. RVL has served as a consultant for Colgate Oral Pharmaceuticals, Galera Therapeutics, Ingalfarma SpA, Monopar Therapeutics, Mundipharma, and Sucampo Pharma; has received research support to his institution from Galera Therapeutics, Novartis, Oragenics, and Sucampo Pharma; and has received stock in Logic Biosciences. JE has received grants from Prysma Inc. for a funded trial.

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Saunders, D.P., Rouleau, T., Cheng, K. et al. Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer 28, 2473–2484 (2020). https://doi.org/10.1007/s00520-019-05181-6

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