Wang, L., Gu, Z., Zhai, R., Zhao, S., Luo, L., Li, D., . . . Gao, C. (2015). Efficacy of oral cryotherapy on oral mucositis prevention in patients with hematological malignancies undergoing hematopoietic stem cell transplantation: A meta-analysis of randomized controlled trials. PloS One, 10, e0128763. 

DOI Link

Purpose

STUDY PURPOSE: To evaluate the effectiveness of oral cryotherapy in the prevention of oral mucositis (OM) for patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT)
 
TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: PubMed and the Cochrane Library
 
KEYWORDS: Cryotherapy, oral cooling, mucositis, and stomatitis
 
INCLUSION CRITERIA: Randomized controlled trials (RCTs) that used oral cryotherapy in patients with hematologic malignancies undergoing HSCT were included. The type of transplant, conditioning regimen, and patient characteristics were not selected out. The primary outcomes were the incidence, severity, and duration of OM in each study. Secondary outcomes included the use of analgesia, length of hospitalization, and use of total parenteral nutrition (TPN). 
 
EXCLUSION CRITERIA: Non-RCTs; studies with patients with other diagnoses; studies without primary and/or secondary outcomes

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 142
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Data bases were searched, and two independent researchers assessed the quality of the studies using the Cochrane Collaboration Reviewers’ Handbook. Studies were screened for bias based on standard guidelines. 

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 8 (with one study used twice) 
  • TOTAL PATIENTS INCLUDED IN REVIEW = 458
  • SAMPLE RANGE ACROSS STUDIES: 23–122 patients
  • KEY SAMPLE CHARACTERISTICS: Patients with hematologic malignancies     

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment
 
APPLICATIONS: Elder care

Results

There were statistically significant decreases in the incidence of severe OM in patients who used oral cryotherapy (RR = 0.52, 95% CI = 0.27–0.99; I2 = 66.1%, p = 0.011). A subgroup meta-analysis revealed that this was true for patients receiving high-dose melphalan as a conditioning therapy (RR = 0.25, 95% CI = 0.08–0.78). The incidence of severe mucositis was less certain for other conditioning regimens (RR = 0.90, 95% CI = 0.64–1.27). The three studies that reported the duration of OM did not show statistical significance (SMD = -0.13, 95% CI = -0.41–0.15). The two RTCs that reported the length of analgesic use did not show a significant improvement (SMD = -1.15, 95% CI = -2.5–0.27). The length of use of TPN decreased in the two studies that reported data on TPN use (SMD = -0.56, 95% CI = -0.92– -0.19). The length of hospital admission was reported in three RCTs, and cryotherapy positively affected length of stay (SMD = -0.44, 95% CI = -0.76– -0.13).

Conclusions

Oral cryotherapy for patients with hematologic malignancies receiving HSCTs with high-dose melphalan decreased the incidence of severe OM. Cryotherapy also may be helpful for patients receiving other preparative regimens. Cryotherapy may decrease the duration of TPN usage and shorten hospital stay. Oral cryotherapy did not appear to affect on the length of analgesic use.

Limitations

Limitations of this study included the small number of RTCs and the small sample sizes of those RCTs. The methodologic quality of the studies might have resulted in bias.

Nursing Implications

Oral cryotherapy is a low-cost, easy modality that demonstrated efficacy in decreasing the severity of OM in patients with hematologic malignancies receiving HSCTs. Additional studies on the efficacy of cryotherapy with other conditioning regimens are needed.

Legacy ID

5607