A systematic review of oral fungal infections in patients receiving cancer therapy.
OBJECTIVE
The aims of this systematic review were to determine, in patients receiving cancer therapy, the prevalence of clinical oral fungal infection and fungal colonization, to determine the impact on quality of life and cost of care, and to review current management strategies for oral fungal infections.


METHODS
Thirty-nine articles that met the inclusion/exclusion criteria were independently reviewed by two calibrated reviewers, each using a standard form. Information was extracted on a number of variables, including study design, study population, sample size, interventions, blinding, outcome measures, methods, results, and conclusions for each article. Areas of discrepancy between the two reviews were resolved by consensus. Studies were weighted as to the quality of the study design, and recommendations were based on the relative strength of each paper. Statistical analyses were performed to determine the weighted prevalence of clinical oral fungal infection and fungal colonization.


RESULTS
For all cancer treatments, the weighted prevalence of clinical oral fungal infection was found to be 7.5% pre-treatment, 39.1% during treatment, and 32.6% after the end of cancer therapy. Head and neck radiotherapy and chemotherapy were each independently associated with a significantly increased risk for oral fungal infection. For all cancer treatments, the prevalence of oral colonization with fungal organisms was 48.2% before treatment, 72.2% during treatment, and 70.1% after treatment. The prophylactic use of fluconazole during cancer therapy resulted in a prevalence of clinical fungal infection of 1.9%. No information specific to oral fungal infections was found on quality of life or cost of care.


CONCLUSIONS
There is an increased risk of clinically significant oral fungal infection during cancer therapy. Systemic antifungals are effective in the prevention of clinical oral fungal infection in patients receiving cancer therapy. Currently available topical antifungal agents are less efficacious, suggesting a need for better topical agents.
Lalla
Rajesh V
RV
University of Connecticut Health Center, Farmington, CT 06030, USA. lalla@uchc.edu
Latortue
Marie C
MC
Hong
Catherine H
CH
Ariyawardana
Anura
A
D'Amato-Palumbo
Sandra
S
Fischer
Dena J
DJ
Martof
Andrew
A
Nicolatou-Galitis
Ourania
O
Patton
Lauren L
LL
Elting
Linda S
LS
Spijkervet
Fred K L
FK
Brennan
Michael T
MT
D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use; D002180:Candidiasis, Oral / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D017048:Health Care Costs; D006801:Humans; D009369:Neoplasms / Q000628:therapy*; D009960:Oropharynx / Q000382:microbiology; D010608:Pharyngeal Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D011788:Quality of Life; D012307:Risk Factors
D000935:Antifungal Agents
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