Oberoi, S., Zamperlini-Netto, G., Beyene, J., Treister, N. S., & Sung, L. (2014). Effect of prophylactic low level laser therapy on oral mucositis: A systematic review and meta-analysis. PloS One, 9, e107418. 

DOI Link

Purpose

STUDY PURPOSE: To determine whether prophylactic low-level laser therapy (LLLT) reduces the risk of sever mucositis
 
TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: MEDLINE, EMBASE, Cochrane Web of Science, CINAHL, SCOPUS, and LILACS
 
KEYWORDS: Mucositis, laser therapy, low-level laser therapy, phototherapy, light-emitting diode, transplantation, chemotherapy, chemoradiotherapy
 
INCLUSION CRITERIA: Randomized, controlled trials and quasirandomized, controlled trials
 
EXCLUSION CRITERIA: Case control studies, cohort studies, case reports, case series, animal studies, letter to editors, editorials, review articles, commentaries, studies without placebo or no treatment group, studies with randomized chemotherapy cycles, and studies that used left and right buccal mucosa within a patient for control

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 2,446
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The Cochrane Collaboration's tool for risk of bias was used. All information was abstracted in duplicate by two authors. Multiple methods for data synthesis were used including relative risk (RR). Effect sizes of dichotomous and continuous outcomes were weighted by the Mantel-Haenzel and inverse variance methods, respectively. Publication bias was evaluated by assessing funnel plots. Heterogeneity was addressed by using stratified analysis. The meta-analysis was completed using Review Manager 5.2.

Sample Characteristics

FINAL NUMBER STUDIES INCLUDED = 19 
 
TOTAL PATIENTS INCLUDED IN REVIEW = 1,144 patients
 
KEY SAMPLE CHARACTERISTICS: 50% of the studies were from Brazil. Eight studies were of patients who had undergone hematopoietic stem cell transplantation. Eight studies were of patients with head and neck cancer receiving radiation or combination chemotherapy. Three studies were of patients who were receiving chemotherapy alone. One trial was of pediatric patients. Intramural laser therapy was used in all but two trials. Laser sources were INGaAIP for six trials and helium-neon for five trials.  

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment
 
APPLICATIONS: Pediatrics, elder care

Results

The primary outcome (overall severity of oral mucositis) of this analysis was that prophylactic LLLT reduced the overall risk of severe mucositis when compared to a placebo or no therapy (RR = .37, 95%, CI = .18–.67, p = .001). The absolute risk reduction was -.35 (95%, CI = -.48– -.2, p < .0001). Secondary outcomes included a decreased risk of severe mucositis at the time of expected worst severity with prophylactic LLLT (RR = .34, 95%, CI = .20–.59, p = .0001). Overall mean grade of mucositis: standardized mean difference = -1.49, 95%, CI = -2– -.95;=, p < .0001. Duration of severe (grade 3 or 4) mucositis: weighted mean difference = -5.32, 95%, CI = -9.45– -1.19, p = .01. Incidence of pain: RR = .89, 95%, CI = .76–1.04, p = .15. Incidence of severe pain: RR = .26, 95%, CI = .18–.37, p < .0001. Overall mean pain score: WMD = -2.46, 95%, CI = -4.4– -.77, p = .004. Number of patients needing opioid analgesia: RR = .47, 95%, CI = .37–.60, p < .0001. Unplanned interruption in radiation (from mucositis in patients with head and neck cancer): RR = .23, 95%, CI = .12–.44, p < .0001.

Conclusions

The overall risk of severe mucositis is decreased by the use of low-level laser therapy. The duration of mucositis, the risk of severe pain, the need for opioid analgesia, and radiation treatment interruption also is positively impacted by LLLT.

Limitations

There is heterogeneity to the laser schedules, mucositis assessment scales, laser parameters, intervals, and time points for assessment and outcome reporting (per the authors). It is difficult to generalize this study to the pediatric population. The feasibility of using laser therapy continues to be an issue in nursing.

Nursing Implications

Prophylactic LLLT shows benefit in the prevention of oral mucositis. Additional research to delineate the feasibility of this intervention and define best practice is needed.

Legacy ID

4924