Lee, S. (2015). Mineral derivatives in alleviating oral mucositis during cancer therapy: A systematic review. PeerJ, 3, e765. 

DOI Link

Purpose

STUDY PURPOSE: To assess the general efficacy of mineral derivatives (a cost-effective agent) in alleviating oral mucositis (OM) during cancer therapy compared to standard care or a placebo (including a decision tree to aid healthcare workers)
 
TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: MEDLINE, OVID, EMBASE, CENTRAL, CANCERLIT, PubMed, CINAHL, and EBSCO (2000 to September 11, 2014)
 
KEYWORDS: Neoplasm, chemotherapy, radiotherapy, chemo-radiotherapy, hematopoietic stem cell transplantation, minerals, electrolytes, mineral derivatives, zinc, calcium phosphate, povidone-iodine, selenium, oral mucositis grading systems, adverse events, systematic review, meta-analysis, cost-effective, and decision analysis
 
INCLUSION CRITERIA: Randomized, controlled trials (participants, intervention, outcome, results, and risk of bias) of oral complications with mineral derivatives as the intervention
 
EXCLUSION CRITERIA: 100 studies were excluded (duplicates, no outcome data, nonrandomized, reviews, vitamins, animal studies, or noncancer-related).

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 1,027

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 16
  • TOTAL PATIENTS INCLUDED IN REVIEW = 1,120 
  • SAMPLE RANGE ACROSS STUDIES: 6–48 patients
  • KEY SAMPLE CHARACTERISTICS: Mean age was 49 years; various tumor types; cancer therapies consisted of chemotherapy, radiotherapy, chemoradiotherapy, and hematopoietic stem cell transplantation

Phase of Care and Clinical Applications

PHASE OF CARE: Multiple phases of care

Results

Outcome mineral derivatives included zinc (n = 549, seven studies), calcium phosphate (n = 227, three studies), povidone-iodine (n = 228, two studies), and selenium (n = 116, two studies). The severity of OM was measured across variable OM grading systems. In 13 studies, individuals in treatment groups (n = 958) experienced peak OM less than controls (g = −0.47,95% CI −0.7 to −0.2, p = 0.0006). In five studies, time to OM onset was significantly delayed in treatment versus controls (g = −0.51, 95% CI−0.8 to −0.2, p = 0.0002), but the mean duration of OM, pain incidence, and analgesic use was not significantly different. 

Conclusions

The general positive effect trend suggested that individuals taking mineral derivatives during cancer therapies were less likely to experience peak OM. However, the significant bias and heterogeneity in this analysis indicated the need for additional methods because of diverse protocols and novel recordings (serum mineral levels and cell signals) in estimating a uniform true effect. The decision analysis favored selenium.

Limitations

This review was limited in recommending a definitive mineral derivative to alleviate OM. Limitations included high heterogeneity implicated by variable conditions (i.e., different protocols, diverse cancer therapies). In addition, a placebo effect may have undermined nonblinded studies at a high risk of bias.

Nursing Implications

Future trials should consider serum levels and computer simulations when designing mineral tolerance thresholds to weigh benefits and harms.
 

Legacy ID

5622