Abstract
Objective
The aim of this sub-analysis was to highlight the MASCC/ISOO clinical practice guidelines for the management of oral mucositis (OM) in pediatric patients and to present unique considerations in this patient population.
Methods
This sub-analysis of the pediatric patient population is based on the systematic review conducted by the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISSO) published in 2019/2020. Studies were scored and assigned a level of evidence based on previously published criteria. Data regarding adverse effects and compliance was collected from the original publications.
Results
A total of 45 papers were included and assessed in this sub-analysis, including 21 randomized controlled trials (RCTs). Chewing gum was demonstrated to be not effective in preventing OM in pediatric cancer patients in 2 RCTs. The efficacy of all other interventions could not be determined based on the available literature.
Conclusion
There is limited or conflicting evidence about interventions for the management of OM in pediatric cancer patients, except for chewing gum which was ineffective for prevention. Therefore, currently, data from adult studies may need to be extrapolated for the management of pediatric patients. Honey and photobiomodulation therapy in this patient population had encouraging potential. Implementation of a basic oral care protocol is advised amid lack of high level of evidence studies.
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Acknowledgments
The authors would like to thank the members of the Mucositis Study Group of MASC/ISOO who contributed to the guidelines development. The authors thank Rachel Lubart, PhD, and Lilach Gavish, PhD, for advising on laser physics.
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PRA has received grants and personal fees from PhotomedTech, personal fees from Kerber Applied Research, personal fees from Seaborough, personal fees from Shepherd University, non-financial support from National Institute of Aging, NIH, personal fees from Curalaser, personal fees and non-financial support from Vielight, personal fees from Zoovv, non-financial support from Thor Photomedicine, non-financial support from Weber Medical, non-financial support from K laser (Summa), non-financial support from Biolase, non-financial support from Irradia, non-financial support from Quasar Biotech, and non-financial support from Light scalpel, outside the submitted work; In addition, PRA has a patent light-based dental systems issued.
PB has served an advisory role for Merck Serono, Sanofi, Merck Sharp & Dohme, Sun Pharma, Angelini, Astra Zeneca, Bristol-Myers-Squibb, Helsinn, and GSK and received grants from Merck, Kyowa Hakko Kirin, and Roche. WMS, WGS, YZ, NY, ARAA, CHLH, AA, DPS, MEC, JB, KKFC, WJET, and SE declare that they have no conflict of interest.
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Miranda-Silva, W., Gomes-Silva, W., Zadik, Y. et al. MASCC/ISOO clinical practice guidelines for the management of mucositis: sub-analysis of current interventions for the management of oral mucositis in pediatric cancer patients. Support Care Cancer 29, 3539–3562 (2021). https://doi.org/10.1007/s00520-020-05803-4
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DOI: https://doi.org/10.1007/s00520-020-05803-4