Title

Guideline for the Prevention of Oral and Oropharyngeal Mucositis in Children Receiving Treatment for Cancer or Undergoing Haematopoietic Stem Cell Transplantation

Authors

Lillian Sung, University of Toronto
Paula Robinson, Pediatric Oncology Group of Ontario
Nathaniel Treister, Brigham and Women's Hospital
Tina Baggott, Stanford University
Paul Gibson, Western University
Wim Tissing, University of Groningen
John Wiernikowski, McMaster University
Jennifer Brinklow, Children's Hospital of Eastern Ontario
L Lee Dupuis, University of Toronto

Document Type

Article

Publication Date

3-2017

Journal

BMJ Supportive & Palliative Care

Volume

7

Issue

1

First Page

7

Last Page

16

URL with Digital Object Identifier

https://doi.org/10.1136/bmjspcare-2014-000804

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.