The Effect of Oral Care Intervention in Mucositis Management Among Pediatric Cancer Patients: An Updated Systematic Review

Abstract

Ikeu Nurhidayah,1,2 Nani Nurhaeni,3 Allenidekania Allenidekania,3 Dewi Gayatri,4 Henny Suzana Mediani1 1Pediatric Nursing Department, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia; 2Postgraduate Program, Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia; 3Pediatric Nursing Department, Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia; 4Basic Science and Fundamental Nursing Department, Faculty of Nursing, Universitas Indonesia, Depok, West Java, IndonesiaCorrespondence: Ikeu Nurhidayah, Pediatric Nursing Department, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia, Email [email protected]: Chemotherapy-induced mucositis is inflammation that develops in the oral mucosal due to anticancer treatment. Mucositis has negative consequences that may lead to distress in pediatric patients, resulting in escalated expenses, diminished quality of life, hindrance in cancer therapy, and decreased survival rates. However, despite the numerous methods, oral care protocols are suggested for implementation in the pediatric population despite a lack of high-level evidence studies, particularly regarding which appropriate oral care agents should be administered.Purpose: This systematic review aimed to identify the effect of oral care intervention in mucositis management among pediatric cancer patients.Methods: Studies were published between 2014 and 2023 from five databases: PubMed, Embase, Medline, ScienceDirect, and Scopus. They were identified using a search strategy to identify relevant studies that identify oral care interventions for managing mucositis in children with cancer. This study used the Joanna Briggs Institute (JBI) critical appraisal tools to assess the quality of the studies and followed the recommended reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.Results: Eight studies met the inclusion criteria, including seven RCTs and one quasi-experimental study. Oral care interventions involving tooth brushing, mouthwash, and lip care are performed entirely or partially. The frequency of oral care ranges from two to six times daily, and the duration of intervention is from 5 days to six weeks. Oral care interventions using honey, olive oil, Aloe Vera, Andiroba, and salivary enzyme toothpaste are beneficial to lower the severity of mucositis, reduce pain, minimize mucositis duration, and reduce the use of analgesics, but not significantly improve the child’s quality of life. However, Caphosol mouthwash did not significantly reduce mucositis.Conclusion: Our study highlights that oral care intervention using effective agents integratively, including honey, olive oil, Aloe vera, Andiroba, and salivary enzyme toothpaste, is essential to manage chemotherapy-induced mucositis among children.Systematic Review Registration: PROSPERO registration number was CRD42023456278.Keywords: children, cancer, chemotherapy, oral care, mucositis

Keywords

• children
• cancer
• chemotherapy
• oral care
• mucositis