Systematic review of natural agents for the management of oral mucositis in cancer patients

Noam Yarom*, Anura Ariyawardana, Allan Hovan, Andrei Barasch, Virginia Jarvis, Siri Beier Jensen, Yehuda Zadik, Sharon Elad, Joanne Bowen, Rajesh V. Lalla

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

89 Scopus citations


Purpose: The aim of this study was to review the available literature and define clinical practice guidelines for the use of natural agents for the prevention and treatment of oral mucositis. Methods: A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology. The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, and no guideline possible. Results: A total of 49 papers across 15 interventions were examined. A new suggestion was developed in favor of systemic zinc supplements administered orally in the prevention of oral mucositis in oral cancer patients receiving radiation therapy or chemoradiation (Level III evidence). A recommendation was made against the use of intravenous glutamine for the prevention of oral mucositis in patients receiving high-dose chemotherapy prior to hematopoietic stem cell transplant (Level II evidence). No guideline was possible for any other agent, due to inadequate and/or conflicting evidence. Conclusions: Of the various natural agents reviewed here, the available evidence supported a guideline only for two agents: a suggestion in favor of zinc and a recommendation against glutamine, in the treatment settings listed above. Well-designed studies of other natural agents are warranted.

Original languageAmerican English
Pages (from-to)3209-3221
Number of pages13
JournalSupportive Care in Cancer
Issue number11
StatePublished - Nov 2013

Bibliographical note

Funding Information:
Disclosure The Mucositis Guidelines Update was sponsored by Helsinn Healthcare S.A, Switzerland and BioAlliance Pharma, France. Per MASCC/ISOO policy, no industry representatives had any role in the development of the guidelines.


  • Glutamine
  • Guidelines
  • Natural agents
  • Oral mucositis
  • Zinc


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