Aloe vera is a fleshy green cactus plant. A gel made from the plant is used as a complementary therapy for dry skin, cuts, and burns. Aloe vera gel may provide a protective effect on skin with increasing cumulative uses. It is described as having anti-inflammatory and antibacterial properties. It may reduce vasoconstriction as well as leukocyte and platelet aggregation at the site of injury. It is known to improve wound oxygenation, increase the rate of collagen formation, and decrease the amount of dead tissue at the wound site. Aloe vera preparations have been studied for radiodermatitis and mucositis.
Effectiveness Not Established
Edmonds, K., Hull, D., Spencer-Shaw, A., Koldenhof, J., Chrysou, M., Boers-Doets, C., & Molassiotis, A. (2012). Strategies for assessing and managing the adverse events of sorafenib and other targeted therapies in the treatment of renal cell and hepatocellular carcinoma: Recommendations from a European nursing task group. European Journal of Oncology Nursing, 16, 172–184.
PROFESSIONAL GROUP: Nursing task group; no formal association or description of how the group was brought together was described.doi:10.1016/j.ejon.2011.05.001
Purpose & Patient Population:
PURPOSE: To review effective strategies to assist nurses in caring for patients receiving sorafenib, with the focus on those adverse effects the group felt were most difficult to manage—hand-foot syndrome, diarrhea, fatigue, and oral complications
TYPES OF PATIENTS ADDRESSED: Patients receiving sorafenib for renal cell or hepatocellular cancer
Type of Resource/Evidence-Based Process:
RESOURCE TYPE: Evidence-based guideline
DATABASES USED: PubMed, Cochrane Library, and hand-searching of the Clinical Journal of Oncology Nursing and American Society of Clinical Oncology website
KEYWORDS: Side effect general terms, and specific terms for each side effect (e.g., altered taste, hand-foot syndrome); disease-related search terms included renal cancer, cancer of the kidneys, hepatocellular carcinoma, and liver cancer
INCLUSION CRITERIA: Evidence base included wider literature regarding the management of similar adverse events in patients with other types of cancer and other types of antitumor therapy. No other specific criteria were stated.
EXCLUSION CRITERIA: Not stated
Phase of Care and Clinical Applications:
- PHASE OF CARE: Active antitumor treatment
- APPLICATIONS: Late effects and survivorship
Results Provided in the Reference:
Out of 2,469 initial citations retrieved, 37 were included for review. No specific quality evaluation of citations was done due to the nature of the literature, with few clinical trials. No description of the group process used is provided. Findings from citations reviewed were outlined and a review of the literature was provided, but no actual synthesis of evidence exists. Noted is that most evidence in this area is from experience.
Guidelines & Recommendations:
Recommendations for mucositis include oral care, amifostine, and antibiotic paste for prophylaxis. For symptom management, recommendations include ice chips, topical lidocaine solutions, sage tea and baking soda oral rinses, and topical solution containing aloe vera, and advising patient to avoid tobacco, alcohol, and spicy foods, mucosal coating agents (e.g., Gelclair®), hydrolytic enzymes, and treatment interruption. For diarrhea, recommendations are patient education, loperamide, diphenoxylate, cholestyramine, probiotics, tincture of opium, and antidiarrheal agents, and avoidance of lactose, high roughage, fatty and spicy foods, fruit juice, and caffeine. For hand-foot syndrome, recommendations include use of emollients, wearing gloves, and avoiding constrictive footwear, hot water, urea- or salicylate-containing creams, and treatment interruptions. For fatigue, recommendations include encouraging activity, maintaining normal work and social schedules, providing supportive care, and considering antidepressants, methylphenidate, sleep medication, and treatment-free intervals.
This review adds nothing new to the limited body of evidence in this area, and does not include a huge body of literature related to the management of fatigue and diarrhea symptoms. Most evidence reviewed was of low quality and expert opinion. No process by which the group evaluated the evidence strength in order to make full recommendations is described, and the result is generally a listing of previously documented opinions related to the management of these symptoms.
This review provides recommended assessments and management approaches that are at the level of expert opinion only.
Research Evidence Summaries
Mansouri, P., Haghighi, M., Beheshtipour, N., & Ramzi, M. (2016). The effect of aloe vera solution on chemotherapy-induced stomatitis in clients with lymphoma and leukemia: A randomized controlled clinical trial. International Journal of Community Based Nursing and Midwifery, 4, 119–126. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876780
To assess the effect of aloe vera solution on stomatitis and its pain intensity in patients undergoing chemotherapeutic procedures
Intervention Characteristics/Basic Study Process:
In a randomized, controlled clinical trial, 64 patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) undergoing chemotherapy were randomly divided into a control and intervention group. The intervention group was asked to wash their mouths with 5 mls of aloe vera solution for two minutes twice a day for 14 days. The control group used the ordinary mouthwashes recommended in hematologic centers.
- N = 64
- AGE = Control: 47.78 years (SD = 18.28 years), intervention: 46.25 years (SD = 18.17)
- MALES: 100%
- CURRENT TREATMENT: Chemotherapy
- KEY DISEASE CHARACTERISTICS: Chemotherapy-induced stomatitis
- SITE: Single site
- SETTING TYPE: Outpatient
- LOCATION: Shahid Motahari Clinic
Phase of Care and Clinical Applications:
PHASE OF CARE: Active antitumor treatment
Randomized, controlled clinical trial patients were randomly divided into a control and an intervention group.
- World Health Organization stomatitis intensity survey checklist
- Visual analog scale (VAS), a standard tool for measuring pain intensity
Aloe vera solution mouthwash significantly reduced the intensity of stomatitis and its pain in the intervention group compared to the control group. On day one, no difference existed; on the other days, there was a significant difference (days 3–14: p = 0.001 for stomatitis intensity, p = 0.001 for pain).
Aloe vera solution might improve patients’ nutritional status, reduce stomatitis and its pain intensity, and lead to satisfaction.
- Risk of bias (no blinding)
- Unintended interventions or applicable interventions not described that would influence results
- Study participants were all male.
- No mention of the type of chemotherapy or specific protocols uses
- No information about use of pain medication or oral care procedures
Aloe vera mouthwash can be useful in preventing and treating stomatitis in patients with chemotherapy-induced stomatitis without any side effects.
Su, C.K., Mehta, V., Ravikumar, L., Shah, R., Pinto, H., Halpern, J., … Quynh-Tu, L. (2004). Phase II double-blind randomized study comparing oral aloe vera versus placebo to prevent radiation-related mucositis in patients with head-and-neck neoplasms. International Journal of Radiation Oncology, Biology, Physics, 60, 171–177.doi: 10.1016/j.ijrobp.2004.02.012
Intervention Characteristics/Basic Study Process:
Patients were given 20 mL aloe vera solution or placebo to swish and swallow four times per day beginning on the first day of radiation therapy (RT) and continuing throughout the treatment course. The solution consisted of 94.5% aloe juice, 5.0% pear juice concentrate, 0.4% lemon-lime flavor, and 0.1% citric acid. The placebo solution was taste-matched with identical astringency, consistency, and ingredients, except that the aloe vera juice was replaced with water.
The study reported on 58 patients with stage II-IV M0 head and neck cancer who were scheduled to receive radiation of at least 50 Gy to at least one site; 28 patients were given aloe vera, and 30 were given placebo.
The study was conducted from February 1999 through March 2002.
This was a double-blind, placebo-controlled, randomized trial.
- Researchers recorded incidence and duration of mucositis.
- Secondary endpoints were quality of life (QOL), weight loss, use of pain medications, need for IV hydration, oral infections, and duration of treatment interruptions.
- The toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and patient-completed QOL questionnaires were completed every two weeks.
- The aloe vera arm recorded a lower maximal mucositis severity grade; however, the difference was not statistically significant.
- Incidence of grade 2 or worse mucositis was not statistically significant between the groups. The treatment group had lower QOL scores, but the differences were not significant.
- Both arms had similar outcomes for other dimensions.
- The authors concluded that the addition of aloe vera did not improve tolerance to head-and-neck RT; decrease objective measurements of mucositis; or improve QOL ratings of health, soreness, or well-being.
Findings were not significant.
This study did not accrue adequate patients according to statistical analysis.