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Cryotherapy for oral mucositis in cancer: review of systematic reviews and meta-analysis
  1. Reza Amiri Khosroshahi1,
  2. Sepide Talebi1,
  3. Nikolaj Travica2 and
  4. Hamed Mohammadi3
  1. 1Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
  2. 2Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
  3. 3Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences School, Tehran, Iran (the Islamic Republic of)
  1. Correspondence to Dr Hamed Mohammadi, Department of Clinical nutrition School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences School of Nutritional Sciences and Dietetics, Tehran, Iran (the Islamic Republic of); mohamadihd{at}gmail.com

Abstract

Background One of the most common side effects of cancer treatment is oral mucositis. Although studies have shown that oral cryotherapy has a favourable effect on oral mucositis, the reliability of the results is questionable.

Objective The goal of this umbrella review was to provide insight into the effects of oral cryotherapy against oral mucositis in patients with cancer, as well as to assess the certainty of this evidence.

Method Studies were searched for through PubMed, Scopus and Web of Science, with no restrictions until August 2021. The risk ratio (RR) and 95% CI for each meta-analysis were recalculated using a random-effects model, and the certainty of the evidence was judged using Grading of Recommendations Assessment, Development and Evaluation.

Results Ten meta-analyses including 25 original RCTs that fit our inclusion criteria were included. The use of oral cryotherapy markedly reduced the occurrence of overall (RR 0.72, 95% CI 0.64 to 0.83, n=20 trials), moderate to severe (RR 0.60, 95% CI 0.45 to 0.80, n=16 trials) and severe oral mucositis (RR 0.48, 95% CI 0.34 to 0.67, n=16 trials), as well as average severity score of oral mucositis (standardised mean difference=−0.94, 95% CI −1.28 to −0.59, n=4 trials) in comparison to a control group; however, the certainty of evidence for all outcomes was rated very low.

Conclusion In patients with cancer, oral cryotherapy appears to greatly lower the severity and occurrence of oral mucositis, but, with very low certainty of evidence.

  • cancer
  • supportive care
  • symptoms and symptom management

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Footnotes

  • Contributors The details of the authors’ responsibility in this project were as follows. RAK and ST collected and analysed the data and wrote the initial version of the work. HM and NT carefully read the text, tables and revised. HM as the guarantor accepts full responsibility for the work. The final version was reviewed and approved by all authors.

  • Funding The project was funded by the Students’ Scientific Research Center (SSRC) of Tehran University of Medical Sciences (code: IR.TUMS.MEDICINE.REC.1400.1368 and 1400-3-125-55494).

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.