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A systematic review of oral fungal infections in patients receiving cancer therapy

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Abstract

Purpose

The aims of this systematic review were to determine, in patients receiving cancer therapy, the prevalence of clinical oral fungal infection and fungal colonization, to determine the impact on quality of life and cost of care, and to review current management strategies for oral fungal infections.

Methods

Thirty-nine articles that met the inclusion/exclusion criteria were independently reviewed by two calibrated reviewers, each using a standard form. Information was extracted on a number of variables, including study design, study population, sample size, interventions, blinding, outcome measures, methods, results, and conclusions for each article. Areas of discrepancy between the two reviews were resolved by consensus. Studies were weighted as to the quality of the study design, and recommendations were based on the relative strength of each paper. Statistical analyses were performed to determine the weighted prevalence of clinical oral fungal infection and fungal colonization.

Results

For all cancer treatments, the weighted prevalence of clinical oral fungal infection was found to be 7.5% pre-treatment, 39.1% during treatment, and 32.6% after the end of cancer therapy. Head and neck radiotherapy and chemotherapy were each independently associated with a significantly increased risk for oral fungal infection. For all cancer treatments, the prevalence of oral colonization with fungal organisms was 48.2% before treatment, 72.2% during treatment, and 70.1% after treatment. The prophylactic use of fluconazole during cancer therapy resulted in a prevalence of clinical fungal infection of 1.9%. No information specific to oral fungal infections was found on quality of life or cost of care.

Conclusions

There is an increased risk of clinically significant oral fungal infection during cancer therapy. Systemic antifungals are effective in the prevention of clinical oral fungal infection in patients receiving cancer therapy. Currently available topical antifungal agents are less efficacious, suggesting a need for better topical agents.

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Acknowledgement

We would like to thank Ms. Bridget Loven, MLIS, of the Information Resource Center at Carolinas Medical Center, Charlotte, NC, USA, for conducting the literature searches.

Conflict of interest statement

None to declare.

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Authors and Affiliations

  1. Section of Oral Medicine, MC1605, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT, 06030, USA

    Rajesh V. Lalla & Marie C. Latortue

  2. Department of Oral Medicine, Carolinas Medical Center, P.O. Box 32861, Charlotte, NC, 28232, USA

    Catherine H. Hong & Michael T. Brennan

  3. Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, 20400, Sri Lanka

    Anura Ariyawardana

  4. Dental Hygiene Program, College of Arts and Sciences, University of New Haven, 300 Boston Post Road, West Haven, CT, 06516, USA

    Sandra D’Amato-Palumbo

  5. Department of Oral Medicine and Diagnostic Sciences, University of Illinois at Chicago, 801 S. Paulina Street, Chicago, IL, 60612, USA

    Dena J. Fischer

  6. Department of Dentistry, University of Virginia Health System, Box 800740, Charlottesville, VA, 22908, USA

    Andrew Martof

  7. Clinic of Hospital Dentistry, University of Athens, Dental School, 2 Thivon St, Athens, 115 27, Greece

    Ourania Nicolatou-Galitis

  8. Department of Dental Ecology, University of North Carolina School of Dentistry, CB 7450, Chapel Hill, NC, 27599, USA

    Lauren L. Patton

  9. Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Linda S. Elting

  10. Department of Oral & Maxillofacial Surgery, University Hospital Groningen, Groningen, The Netherlands

    Fred K. L. Spijkervet

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  1. Rajesh V. Lalla
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  2. Marie C. Latortue
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  3. Catherine H. Hong
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  4. Anura Ariyawardana
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  5. Sandra D’Amato-Palumbo
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  6. Dena J. Fischer
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  7. Andrew Martof
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  8. Ourania Nicolatou-Galitis
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  9. Lauren L. Patton
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  10. Linda S. Elting
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  11. Fred K. L. Spijkervet
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  12. Michael T. Brennan
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Consortia

Fungal Infections Section, Oral Care Study Group, Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO)

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Correspondence to Rajesh V. Lalla.

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Lalla, R.V., Latortue, M.C., Hong, C.H. et al. A systematic review of oral fungal infections in patients receiving cancer therapy. Support Care Cancer 18, 985–992 (2010). https://doi.org/10.1007/s00520-010-0892-z

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  • DOI: https://doi.org/10.1007/s00520-010-0892-z

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