title: Systematic review of natural agents for the management of oral mucositis in cancer patients.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Sheba Medical Center, Tel-Hashomer, Israel, noamyar@post.tau.ac.il.
authors.forename: Noam
authors.initials: N
authors.lastname: Yarom
authors.forename: Anura
authors.initials: A
authors.lastname: Ariyawardana
authors.forename: Allan
authors.initials: A
authors.lastname: Hovan
authors.forename: Andrei
authors.initials: A
authors.lastname: Barasch
authors.forename: Virginia
authors.initials: V
authors.lastname: Jarvis
authors.forename: Siri Beier
authors.initials: SB
authors.lastname: Jensen
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Zadik
authors.forename: Sharon
authors.initials: S
authors.lastname: Elad
authors.forename: Joanne
authors.initials: J
authors.lastname: Bowen
authors.forename: Rajesh V
authors.initials: RV
authors.lastname: Lalla
mesh_terms: D059248:Chemoradiotherapy / Q000009:adverse effects; D005973:Glutamine / Q000627:therapeutic use*; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000628:therapy; D006722:Honey; D006801:Humans; D017410:Practice Guidelines as Topic; D013280:Stomatitis / Q000188:drug therapy* / Q000517:prevention & control; D014131:Trace Elements / Q000627:therapeutic use; D014815:Vitamins / Q000627:therapeutic use*; D015032:Zinc / Q000627:therapeutic use*
chemical_list: D014131:Trace Elements; D014815:Vitamins; D005973:Glutamine; D015032:Zinc