Quinn, B. (2013). Efficacy of a supersaturated calcium phosphate oral rinse for the prevention and treatment of oral mucositis in patients receiving high-dose cancer therapy: A review of current data. European Journal of Cancer Care, 22, 564–579. 

To summarize the literature on calcium phosphate oral rinse for the prevention and treatment of oral mucositis (OM)

• FINAL NUMBER STUDIES INCLUDED = 30
• TOTAL PATIENTS INCLUDED IN REVIEW = 1,392, of which 890 patients received Caphosol
• SAMPLE RANGE ACROSS STUDIES: Across 19 studies of patients undergoing hematopoietic stem cell transplant, 5–154; across 11 studies of patients with head and neck cancers, 11–218
• KEY SAMPLE CHARACTERISTICS: Studies measured grade and duration of OM, pain assessment and medication, total parenteral nutrition, patient satisfaction, treatment compliance, oral infection rates, duration of hospitalization, polyethylene glycol use, and swallowing. Most of the studies were from single centers and involved free Caphosol provided to the hospital. Observational studies were included. The abstracts and conference proceedings did not consistently provide details about standard treatments and study design.  

• PHASE OF CARE: Active antitumor treatment
• CLINICAL APPLICABILITY: Pediatrics

Caphosol was found to reduce OM grade, duration, or both in 24 out of 30 studies. Caphosol was associated with a reduction in OM-associated pain in 14 of 17 studies with more than 30 patients and 6 studies with fewer than 30 subjects. Data regarding nutrition, patient compliance, and length of hospitalization were conflicting, but the majority demonstrated a benefit with Caphosol. Two studies reported potential cost savings with the use of Caphosol. Three studies with 30 patients and three single-center studies with controls of standard mouth care and MuGard^® did not find significant differences in OM grade or duration. Two studies of more than 30 patients did not demonstrate a benefit associated with OM-related pain. One study did not find a significant difference in nausea or dysphasia for Caphosol-treated patients. Three studies failed to demonstrate any differences in length of stay.

The majority of the studies included in the review reported some benefit from Caphosol use. The data demonstrate the opportunity to further study the role of supersaturated calcium phosphate oral rinse in the prevention and treatment of OM.

• The studies were heterogeneous in their design, so data could not be pooled or consolidated.  
• The review was funded by EUSA Pharma.  
• Porterhouse Medical Ltd provided medical writing services and was funded by EUSA Pharma.  
• Only two full-length, peer-reviewed articles were included in this review.  
• At least 12 of the 30 studies included in the review were observational or retrospective studies.  
• The definition of standard oral care was not well defined in all of the studies, so determining the role of Caphosol in the improvements documented is difficult.

The effects from OM remain a significant challenge for patients receiving cancer treatment. Nursing involvement in prospective, randomized, blinded studies could provide the best practice data needed to recommend treatments for OM. The limitations for the studies included in this review are significant and do not provide rigorous scientific support for the use of Caphosol.