Peng, H., Chen, B.B., Chen, L., Chen, Y.P., Liu, X., Tang, L.L., . . . Ma, J. (2017). A network meta-analysis in comparing prophylactic treatments of radiotherapy-induced oral mucositis for patients with head and neck cancers receiving radiotherapy. Oral Oncology, 75, 89-94.

• STUDY PURPOSE: To optimize the prophylactic treatment for radiotherapy-induced oral mucositis in patients with head and neck cancer receiving postoperative or definitive radiotherapy with or without chemotherapy
• TYPE OF STUDY: Network meta analysis and systematic review

• DATABASES USED: PubMed, Web of Science, Cochrane Library, and Chinese databases (WangFang, National Knowledge Infrastructure) 
• YEARS INCLUDED: (Overall for all databases) Authors stated the search was up to May 1, 2017. Supplemental material shows the oldest study included was 1989.  
• INCLUSION CRITERIA: Head and neck cancer or carcinoma or neoplasm, nasopharyngeal carcinoma or cancer or neoplasm, radiotherapy and mucositis 
• EXCLUSION CRITERIA: Not specified

TOTAL REFERENCES RETRIEVED: 112 randomized clinical trials were identified. 10 excluded that did not adopt the required criteria to evaluate oral mucositis, 28 studies or conference abstracts that did not provide a detailed number of responders and non-responders, 2 trials that recruited patients with previous chemotherapy, 5 studies that only evaluated mucositis-related pain, and 10 studies with the intention of treatment. 57 studies were eligible. 

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Randomization procedure, establishment of sample size, adoption of blinding in the study design, allocation of concealment if intention-to-treat analysis was followed, loss to follow-up, and dropout. Used the revised Jadad/Oxford quality scoring system to quantify study quality.

• FINAL NUMBER STUDIES INCLUDED: 57
• TOTAL PATIENTS INCLUDED IN REVIEW: 5,261 patients randomly assigned 
• SAMPLE RANGE ACROSS STUDIES: Not specified in this version of article.  
• KEY SAMPLE CHARACTERISTICS: Not specified in this version of article

PHASE OF CARE: Active anti-tumor treatment

• Direct meta analysis findings for grade 0–2 oral mucositis: Abs: SOC, AIS: PS, AVS: PS, CHS: PS, GFS: PS, GS: PS, GS: SOC, HS: SOC, LS: PS, LS: SOC, PS: SOC
• SOC and PS had worse effects and LS had better effects than most of the other treatments; details in supplementary materials
• In the network of 12 treatment arms, LS ranked as best and SOC as least effective in preventing grade 3 and 4 mucositis 

Abbreviations: SOC–standard oral care; ABS–antibiotics + SOC; AIS–anti-inflammatory + SOC; AVS–aloe vera + SOC, CAS–coating agents + SOC, CHS–Chinese herbs + SOC, GCS–granulocyte-macrophage colony–stimulating factor + SOC, GFS–growth factor + SOC, GS–glutamine + SOC, HS–honey + SOC, LS–laser + SOC, PS–placebo + SOC; NMT–non-medication treatment

Radiotherapy-induced oral mucositis in patients with head and neck cancer can be debilitating. This network meta-analysis compared prophylactic treatments in patients receiving postoperative radiation with or without chemotherapy. Low-level laser therapy in addition to standard of care may be more effective in reducing oral mucositis than standard care alone.

Limited information provided in the printed lack of control for or limit use of chemotherapy; not clear what constituted low-level laser therapy or the details regarding the other treatments.

Oral mucositis has been identified as a complex process; nurses should remain astute to changes in the oral cavity with the various treatments for cancer as well as changes over time. Interventions effective with a specific cancer treatment may not be universally effective. Study results should be read with a critical review process