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Guideline for the prevention of oral and oropharyngeal mucositis in children receiving treatment for cancer or undergoing haematopoietic stem cell transplantation
  1. Lillian Sung1,
  2. Paula Robinson2,
  3. Nathaniel Treister3,
  4. Tina Baggott4,
  5. Paul Gibson5,
  6. Wim Tissing6,
  7. John Wiernikowski7,
  8. Jennifer Brinklow8 and
  9. L Lee Dupuis1
  1. 1Division of Haematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
  2. 2Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada
  3. 3Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, USA
  4. 4Cancer Clinical Trials Office, Stanford University, Stanford, California, USA
  5. 5Section of Hematology and Oncology, Children's Hospital, Western University, London, Ontario, Canada
  6. 6Department of Pediatric Oncology/Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  7. 7Division of Pediatric Hematology/Oncology, McMaster University, McMaster Children's Hospital, Hamilton, Ontario, Canada
  8. 8Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
  1. Correspondence to Dr Lillian Sung, Division of Haematology/Oncology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G1X8; lillian.sung{at}sickkids.ca

Abstract

Purpose To develop an evidence-based clinical practice guideline for the prevention of oral mucositis in children (0–18 years) receiving treatment for cancer or undergoing haematopoietic stem cell transplantation (HSCT).

Methods The Mucositis Prevention Guideline Development Group was interdisciplinary and included internationally recognised experts in paediatric mucositis. For the evidence review, we included randomised controlled trials (RCTs) conducted in either children or adults evaluating the following interventions selected according to prespecified criteria: cryotherapy, low level light therapy (LLLT) and keratinocyte growth factor (KGF). We also examined RCTs of any intervention conducted in children. For all systematic reviews, we synthesised the occurrence of severe oral mucositis. The Grades of Recommendation, Assessment, Development and Evaluation approach was used to describe quality of evidence and strength of recommendations.

Results We suggest cryotherapy or LLLT may be offered to cooperative children receiving chemotherapy or HSCT conditioning with regimens associated with a high rate of mucositis. We also suggest KGF may be offered to children receiving HSCT conditioning with regimens associated with a high rate of severe mucositis. However, KGF use merits caution as there is a lack of efficacy and toxicity data in children, and a lack of long-term follow-up data in paediatric cancers. No other interventions were recommended for oral mucositis prevention in children.

Conclusions All three specific interventions evaluated in this clinical practice guideline were associated with a weak recommendation for use. There may be important organisational and cost barriers to the adoption of LLLT and KGF. Considerations for implementation and key research gaps are highlighted.

  • mucositis
  • prevention
  • clinical practice guideline
  • cryotherapy
  • low level light therapy

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

http://dx.doi.org/10.1136/bmjspcare-2014-000804

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    • Correction notice This article has been corrected since it published Online First. The Open Access licence has now been added.

    • Contributors LS, PR and LLD contributed to the conception and design, collection and assembly of data, data analysis and interpretation, and manuscript writing. NT, TB, PG, WT, JW and JB contributed to the interpretation and manuscript writing. All authors approved the final manuscript.

    • Funding Funding support was provided by the Pediatric Oncology Group of Ontario. LS is supported by a New Investigator Award from the Canadian Institutes of Health Research (Grant no. 87719).

    • Competing interests None.

    • Provenance and peer review Not commissioned; externally peer-reviewed.

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    Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/