Riley, P., Glenny, A.M., Worthington, H.V., Littlewood, A., Clarkson, J.E., & McCabe, M.G. (2015). Interventions for preventing oral mucositis in patients with cancer receiving treatment: Oral cryotherapy. Cochrane Database of Systematic Reviews, 12, CD011552. 

STUDY PURPOSE: To evaluate the evidence to assess the effects of oral cryotherapy for the prevention of oral mucositis (OM)

• DATABASES USED: MEDLINE, EMBASE, CINAHL, CANCERLIT, Cochrane Collaboration, National Institutes of Health (NIH) health trials registry, World Health Organization (WHO) clinical trials registry
• KEYWORDS: Explicit search terms per database are provided.
• INCLUSION CRITERIA: Randomized controlled trails comparing oral cryotherapy against any other treatment or no treatment; OM caused by chemotherapy, radiotherapy, or combination therapy
• EXCLUSION CRITERIA: Crossover design trials, interventions involving other approaches in addition to cryotherapy

• FINAL NUMBER STUDIES INCLUDED = 14 in qualitative review, 11 in meta-analysis
• TOTAL PATIENTS INCLUDED IN REVIEW = 1,316
• SAMPLE RANGE ACROSS STUDIES: 20–206 patients
• KEY SAMPLE CHARACTERISTICS: One study included a small number of children, one study involved patients with head and neck cancer receiving radiation therapy, and the rest involved patients receiving chemotherapy. Five studies involved treatment with high-dose melphalan.

PHASE OF CARE: Active antitumor treatment

Insufficient evidence exists to evaluate the effect of cryotherapy in patients receiving radiation therapy alone for head and neck cancer. Five studies in which 5-fluorouracil (5-FU) was administered showed that oral cryotherapy reduced the risk of OM development (RR = 0.61; 95% CI [0.52, 0.72]; p < 0.00001). Five studies involving treatment with high-dose melphalan risk of OM was also reduced (RR = 0.59; 95% CI [0.35, 1.01]; p = 0.05). OM risk was reduced in mild, moderate, and severe OM cases. Insufficient evidence existed to determine whether 30 minutes or 60 minutes of cryotherapy was more effective. One study with a high risk of bias showed no difference between oral cryotherapy and the use of prophylactic chlorhexidine.

Oral cryotherapy is effective in reducing OM in patients receiving 5-FU and high-dose melphalan.

Studies were of moderate quality based on the risk of bias assessment.

Strong evidence existed in support of effectiveness of oral cryotherapy to reduce the OM risk in patients receiving 5-FU treatment and moderately strong evidence of efficacy in patients given high-dose melphalan. Very limited evidence existed in children. This intervention is very low risk, so nurses can advocate for the use of oral cryotherapy for patients receiving chemotherapeutic agents with a short half-life. Ice chips could create a potential choking hazard for children; therefore, the use of iced drinks or popsicles may be better approaches to use in this population. Future research of head and neck trials of cryotherapy versus other effective interventions would be useful to further inform clinical practice.