de Melo Manzi, N., de Campos Pereira Silveira, R.C., & dos Reis, P.E. (2015). Prophylaxis for mucositis induced by ambulatory chemotherapy: Systematic review. Journal of Advanced Nursing, 72, 735–746.

STUDY PURPOSE: To systematically review evidence regarding interventions used to prevent chemotherapy-induced oral mucositis (OM)

• FINAL NUMBER STUDIES INCLUDED = 20
• TOTAL PATIENTS INCLUDED IN REVIEW = 1,626
• SAMPLE RANGE ACROSS STUDIES: 16–326 patients
• KEY SAMPLE CHARACTERISTICS: Various patient types

PHASE OF CARE: Active antitumor treatment

• Cryotherapy was evaluated in four studies. Cryotherapy reduced the seriousness and incidence of OM. Three of these were among patients receiving 5-fluorouracil (5-FU).   
• Limited research evidence for oral care in general and lack of consistent definition and components of oral care
• Two palifermin studies were included, showing its effectiveness for the prevention of OM; however, they were of small sample sizes.
• Two studies looked at allopurinol and had mixed results.
• Two studies examined the use of chlorhexidine and had mixed results.

Based on this review, the strongest evidence was in favor of cryotherapy in patients receiving 5-FU. The evidence was insufficient in other interventions to demonstrate a benefit.

Very few studies were included, and why this search did not yield a larger number of studies for some of these interventions was unclear. Exclusion criteria may have eliminated many. Most included studies had small sample sizes.

The findings support the use of cryotherapy for the prevention of OM in patients receiving 5-FU. Although not studied extensively, this intervention should have benefit in patients receiving any agent with a short half-life. The amount of ice chips, etc. used and the duration of the cryotherapy varied. Multinational Association of Supportive Care in Cancer guidelines recommend a 30-minute duration and an amount of ice that can easily be moved around in the mouth.