Adjunctive Treatments for the Prevention of Chemotherapy- and Radiotherapy-Induced Mucositis.

2018-08-23
Integrative cancer therapies 17(4)
- Michael Thomsen
- Luis Vitetta

PubMed: 30136590
DOI: 10.1177/1534735418794885

Study Design

Type: Review
Population: clinical studies examining various nutritional compounds and 20 examining probiotics
Methods: narrative literature review

Highly Cited

Background

Chemoradiotherapy-associated mucositis can manifest as pain, inflammation, dysphagia, diarrhea, weight loss, rectal bleeding, and infection. Mucositis is a major dose-limiting side effect of chemotherapy, affecting nutritional intake and oral and intestinal function. Despite several interventions being available, there is a need for safe and effective preventative and treatment options for treatment-induced mucositis. The goals of this review are to discuss interventions based on foods and natural products and present the research to date.

Methods

A narrative literature review identified 60 clinical studies examining various nutritional compounds and 20 examining probiotics. 9 studies on probiotics for the prevention of diarrhea were also assessed on methodological quality and limitations identified.

Results

Several compounds have been posited as useful adjuvants for cancer treatment-related mucositis. Probiotics demonstrate efficacy for the prevention and treatment of chemoradiotherapy-induced gastrointestinal toxicity without significant side effects. Glutamine and activated charcoal were reported to reduce chemotherapy-induced diarrhea but not radiation-induced intestinal mucositis. Honey has been reported to decrease treatment interruptions, weight loss, and delays the onset of oral mucositis. Zinc, glutamine, and topical vitamin E were demonstrated efficacy for oral mucositis.

Conclusion

There is plausible clinical evidence for the administration of several adjunctive treatments for the prevention and treatment of mucositis. Probiotics were reported to reduce the burden of intestinal mucositis and treatment-induced diarrhea. Activated charcoal and glutamine are beneficial for chemotherapy-induced diarrhea, whereas the administration of honey, zinc, and glutamine reduce the risk of developing oral mucositis during chemotherapy or radiotherapy.

Research Insights

Honey→Delayed Oral Mucositis Onset
Honey has been reported to decrease treatment interruptions, weight loss, and delays the onset of oral mucositis.
Effect
Beneficial
Effect size
Moderate
Honey→Reduced Treatment Interruption
Honey has been reported to decrease treatment interruptions, weight loss, and delays the onset of oral mucositis.
Effect
Beneficial
Effect size
Moderate
Honey→Reduced Weight Loss
Honey has been reported to decrease treatment interruptions, weight loss, and delays the onset of oral mucositis.
Effect
Beneficial
Effect size
Moderate
L-Glutamine→Reduced Diarrhea
Glutamine and activated charcoal were reported to reduce chemotherapy-induced diarrhea but not radiation-induced intestinal mucositis.
Effect
Beneficial
Effect size
Moderate
L-Glutamine→Reduced Intestinal Mucositis
Glutamine and activated charcoal were reported to reduce chemotherapy-induced diarrhea but not radiation-induced intestinal mucositis.
Effect
Neutral
Effect size
Small
L-Glutamine→Reduced Oral Mucositis
Zinc, glutamine, and topical vitamin E were demonstrated efficacy for oral mucositis.
Effect
Beneficial
Effect size
Moderate
Dose
topical
Vitamin E→Reduced Oral Mucositis
Zinc, glutamine, and topical vitamin E were demonstrated efficacy for oral mucositis.
Effect
Beneficial
Effect size
Moderate
Dose
topical
Zinc→Reduced Oral Mucositis
Zinc, glutamine, and topical vitamin E were demonstrated efficacy for oral mucositis.
Effect
Beneficial
Effect size
Moderate
Dose
topical