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C.-C. Lai1, S.-Y. Chen2,3, Y.-K. Tu4, Y.-W. Ding4, J.-J. Lin1,5
1National Taiwan University Hospital, Department of Physical Medicine and Rehabilitation, Taipei, Taiwan, 2Taipei Medical University-Wan Fang Hospital, Department of Physical Medicine and Rehabilitation, Taipei, Taiwan, 3Taipei Medical University, School of Respiratory Therapy, College of Medicine, Taipei, Taiwan, 4National Taiwan University, Institute of Epidemiology and Preventive Medicine, College of Public Health, Taipei, Taiwan, 5National Taiwan University, School and Graduate Institute of Physical Therapy, College of Medicine, Taipei, Taiwan
Background: Oral mucositis (OM) is a significant complication in patients with cancer being treated with chemotherapy, and/or with radiation therapy. Previous literature demonstrates that laser and/or cryotherapy can reduce OM exacerbations compared with usual care. However, evidence is limited in comparison the treatment effects between the laser and cryotherapy for OM. Given that appropriate treatment option depending on many factors such as number, size of OM and patient’s status, information for the treatment option is important for the rehabilitation of this complication.
Purpose: The purpose of this network meta-analysis was to analyze the relative effects of laser and/or cryotherapy in cancer patients with OM.
Methods: This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if the population consist of patients with cancer or undergoing hematopoietic stem cell transplantation. Heterogeneity between studies was assessed using I2 statistics, and publication bias was evaluated by constructing a funnel plot.
Results: Twenty-six randomized controlled trials were included with enrolling 1830 patients with cancer. The outcome of mild OM is desirable, odds ratio more than 1 favors intervention group. Moderate or severe OM are defined as adverse outcomes, ORs less than 1 favors intervention group. Treatment effects with combined use of cryotherapy and laser was better than that with usual care for mild and severe OM (odds ratios ORs=106.23 [95%CI=12.15 to 929.17] and 0.01 [95%CI=0 to 0.57], respectively). Treatment effects with laser therapy was better than that with usual care for mild and severe OM (ORs=7.56 [95%CI=3.84 to 14.88] and 0.13 [95%CI=0.07 to 0.24], respectively). Treatment effects with cryotherapy was better than that with usual care for mild and severe and OM (ORs=3.13 [95%CI=1.56 to 6.27] and 0.25 [95%CI=0.11 to 0.54], respectively). Nevertheless, for patients with mild OM, treatment effects with combined use of cryotherapy and laser was better than that with only laser or cryotherapy (ORs=14.06 [95%CI=1.79 to 110.30] and 33.95 [95%CI=3.50 to 329.65], respectively). For patients with moderate OM, treatment effect did not reach statistical significance among comparisons.
Conclusion(s): Compared with no intervention, treatment effects with combined use of cryotherapy and laser, laser or cryotherapy alone are beneficial for decreasing the incidence of severe OM. There is no difference in treatment effects among cryotherapy and/or laser intervention in cancer patients with moderate OM.
Implications: We suggest that combined use of cryotherapy and laser, laser alone and cryotherapy alone are beneficial for decreasing the incidence of severe mucositis.
Funding, acknowledgements: Nil
Keywords: oral mucositis, laser, cryotherapy
Topic: Oncology, HIV & palliative care
Did this work require ethics approval? No
Institution: NA
Committee: NA
Reason: network meta-analysis
All authors, affiliations and abstracts have been published as submitted.
