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Meta-Analysis
. 2007 Jan 24;2007(1):CD003807.
doi: 10.1002/14651858.CD003807.pub3.

Interventions for preventing oral candidiasis for patients with cancer receiving treatment

J E Clarkson  1 , H V Worthington, O B Eden
Affiliations
Meta-Analysis

Interventions for preventing oral candidiasis for patients with cancer receiving treatment

J E Clarkson et al. Cochrane Database Syst Rev. .

Abstract

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 and treat them. One of these side effects is oral candidiasis.

Objectives: To assess the effectiveness of interventions (which may include placebo or no treatment) for the prevention of oral candidiasis for patients with cancer receiving chemotherapy or radiotherapy or both.

Search strategy: Computerised searches of Cochrane Oral Health Group and PAPAS Trials Registers, CENTRAL, MEDLINE, EMBASE, CINAHL, CANCERLIT, SIGLE and LILACS were undertaken. Reference lists from relevant articles were searched and the authors of eligible trials were contacted to identify trials and obtain additional information. Date of the most recent searches: June 2006: CENTRAL (The Cochrane Library 2006, Issue 2).

Selection criteria: Trials were selected if they met the following criteria: design - random allocation of participants; participants - anyone receiving chemotherapy or radiotherapy treatment for cancer; interventions - agents prescribed to prevent oral candidiasis; primary outcome - prevention of oral candidiasis.

Data collection and analysis: Data were recorded on the following secondary outcomes if present: relief of pain, amount of analgesia, relief of dysphagia, incidence of systemic infection, duration of stay in hospital (days), cost of oral care, patient quality of life, death, use of empirical antifungal treatment, toxicity and compliance. Information regarding methods, participants, interventions, outcome measures and results were independently extracted, in duplicate, by two review authors. The Cochrane Oral Health Group statistical guidelines were followed and risk ratios (RR) calculated using random-effects models. Potential sources of heterogeneity were examined in random-effects metaregression analyses.

Main results: Twenty-eight trials involving 4226 patients satisfied the inclusion criteria. Drugs absorbed and partially absorbed from the gastrointestinal (GI) tract were found to prevent oral candidiasis when compared to a placebo, or a no treatment control group, with RR for absorbed drugs = 0.47 (95% confidence interval (CI) 0.29 to 0.78). For absorbed drugs in populations with an incidence of 20% (mid range of results in control groups), this implies a NNT of 9 (95% CI 7 to 13) patients need to be treated to avoid one patient getting oral candidiasis. There was no significant benefit shown for drugs not absorbed from the GI tract.

Authors' conclusions: There is strong evidence, from randomised controlled trials, that drugs absorbed or partially absorbed from the GI tract prevent oral candidiasis in patients receiving treatment for cancer. There is also evidence that these drugs are significantly better at preventing oral candidiasis than drugs not absorbed from the GI.

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Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Comparisons with placebo/no treatment for all drug types, Outcome 1 Oral candidiasis present.
1.2
1.2. Analysis
Comparison 1 Comparisons with placebo/no treatment for all drug types, Outcome 2 Systemic fungal infection.
1.3
1.3. Analysis
Comparison 1 Comparisons with placebo/no treatment for all drug types, Outcome 3 Death.
1.4
1.4. Analysis
Comparison 1 Comparisons with placebo/no treatment for all drug types, Outcome 4 Empirical antifungal treatment.
1.5
1.5. Analysis
Comparison 1 Comparisons with placebo/no treatment for all drug types, Outcome 5 Toxicity (adverse events 'probably due to drug').
1.6
1.6. Analysis
Comparison 1 Comparisons with placebo/no treatment for all drug types, Outcome 6 Good compliance.
2.1
2.1. Analysis
Comparison 2 Comparisons between drugs absorbed from GI tract and those not absorbed, Outcome 1 Oral candidiasis present.
2.2
2.2. Analysis
Comparison 2 Comparisons between drugs absorbed from GI tract and those not absorbed, Outcome 2 Systemic fungal infection.
2.3
2.3. Analysis
Comparison 2 Comparisons between drugs absorbed from GI tract and those not absorbed, Outcome 3 Death.
2.4
2.4. Analysis
Comparison 2 Comparisons between drugs absorbed from GI tract and those not absorbed, Outcome 4 Empirical antifungal treatment.
2.5
2.5. Analysis
Comparison 2 Comparisons between drugs absorbed from GI tract and those not absorbed, Outcome 5 Toxicity (adverse events 'probably due to drug').
2.6
2.6. Analysis
Comparison 2 Comparisons between drugs absorbed from GI tract and those not absorbed, Outcome 6 Good compliance.
3.1
3.1. Analysis
Comparison 3 Comparison of drugs absorbed from the GI tract, Outcome 1 Oral candidiasis present.
3.2
3.2. Analysis
Comparison 3 Comparison of drugs absorbed from the GI tract, Outcome 2 Systemic fungal infection.
3.3
3.3. Analysis
Comparison 3 Comparison of drugs absorbed from the GI tract, Outcome 3 Death.
3.4
3.4. Analysis
Comparison 3 Comparison of drugs absorbed from the GI tract, Outcome 4 Empirical antifungal treatment.
3.5
3.5. Analysis
Comparison 3 Comparison of drugs absorbed from the GI tract, Outcome 5 Toxicity (adverse events 'probably due to drug').
3.6
3.6. Analysis
Comparison 3 Comparison of drugs absorbed from the GI tract, Outcome 6 Good compliance.
4.1
4.1. Analysis
Comparison 4 Comparison of drugs not absorbed from GI tract, Outcome 1 Oral candidiasis present.
5.1
5.1. Analysis
Comparison 5 Comparisons with placebo/no treatment for not absorbed drug types, Outcome 1 Oral candidiasis present.
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References to studies awaiting assessment

Corvo 2008 {published data only}
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