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Intervencije za prevenciju oralnog mukozitisa u pacijenata koji primaju terapiju za karcinom

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Background

Treatment of cancer is increasingly more effective but is associated with short and long term side effects. Oral side effects remain a major source of illness despite the use of a variety of agents to prevent them. One of these side effects is oral mucositis (mouth ulcers).

Objectives

To evaluate the effectiveness of prophylactic agents for oral mucositis in patients with cancer receiving treatment, compared with other potentially active interventions, placebo or no treatment.

Search methods

Electronic searches of Cochrane Oral Health Group and PaPaS Trials Registers (to 16 February 2011), CENTRAL (The Cochrane Library 2011, Issue 1), MEDLINE via OVID (1950 to 16 February 2011), EMBASE via OVID (1980 to 16 February 2011), CINAHL via EBSCO (1980 to 16 February 2011), CANCERLIT via PubMed (1950 to 16 February 2011), OpenSIGLE (1980 to 2005) and LILACS via the Virtual Health Library (1980 to 16 February 2011) were undertaken. Reference lists from relevant articles were searched and the authors of eligible trials were contacted to identify trials and obtain additional information.

Selection criteria

Randomised controlled trials of interventions to prevent oral mucositis in patients receiving treatment for cancer.

Data collection and analysis

Information regarding methods, participants, interventions, outcome measures, results and risk of bias were independently extracted, in duplicate, by two review authors. Authors were contacted for further details where these were unclear. The Cochrane Collaboration statistical guidelines were followed and risk ratios calculated using random‐effects models.

Main results

A total of 131 studies with 10,514 randomised participants are now included. Overall only 8% of these studies were assessed as being at low risk of bias. Ten interventions, where there was more than one trial in the meta‐analysis, showed some statistically significant evidence of a benefit (albeit sometimes weak) for either preventing or reducing the severity of mucositis, compared to either a placebo or no treatment. These ten interventions were: aloe vera, amifostine, cryotherapy, granulocyte‐colony stimulating factor (G‐CSF), intravenous glutamine, honey, keratinocyte growth factor, laser, polymixin/tobramycin/amphotericin (PTA) antibiotic pastille/paste and sucralfate.

Authors' conclusions

Ten interventions were found to have some benefit with regard to preventing or reducing the severity of mucositis associated with cancer treatment. The strength of the evidence was variable and implications for practice include consideration that benefits may be specific for certain cancer types and treatment. There is a need for further well designed, and conducted trials with sufficient numbers of participants to perform subgroup analyses by type of disease and chemotherapeutic agent.

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Postupci za sprječavanje upale sluznice usta (oralnog mukozitisa) u pacijenata koji primaju terapiju za karcinom

Liječenje karcinoma (uključujući presađivanje koštane srži) može uzrokovati oralni mukozitis (teške ulceracije u ustima). To bolno stanje može otežati jedenje, pijenje i gutanje, a može biti povezano s infekcijama zbog kojih može biti potrebno liječiti pacijenta dulje u bolnici. Koriste se različiti postupci da bi se spriječilo to stanje, a ovaj je Cochrane sustavni pregled utvrdio da su neke od njih učinkovite. Dvije intervencije, krioterapija (komadići leda, engl. ice chips) i keratinocitni faktor rasta (palifermin®), pokazale su pozitivan učinak u sprječavanju mukozitisa. Sukralfat može učinkovito smanjiti težinu mukozitisa, a ostalih sedam intervencija koje su dosad ispitane u kliničkim pokusima: aloe vera, amifostin, intravenozni glutamin, faktor stimulacije kolonija granulocita, med, laser i antibiotici uključujući polimiksin/tobramicin/amfotericin (PTA) su pokazale slabije dokaze učinkovitosti. Uspješnost tih postupaka ispitana je na pacijentima s različitim vrstama karcinoma koji su primali različite vrse liječenja za karcinom. Pozitivan učinak možda je ograničen na određene kombinacije bolesti i tipa liječenja koji se proučavaju.