Intervention Review
Interventions for treating oral candidiasis for patients with cancer receiving treatment
Editorial Group: Cochrane Oral Health Group
Published Online: 7 JUL 2010
Assessed as up-to-date: 31 MAY 2010
DOI: 10.1002/14651858.CD001972.pub4
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Database Title
Additional Information
How to Cite
Worthington HV, Clarkson JE, Khalid T, Meyer S, McCabe M. Interventions for treating oral candidiasis for patients with cancer receiving treatment. Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD001972. DOI: 10.1002/14651858.CD001972.pub4.
Publication History
- Publication Status: New search for studies and content updated (no change to conclusions)
- Published Online: 7 JUL 2010
Abstract
Background
Treatment of cancer is increasingly effective but is associated with short and long term side effects. Oral and gastrointestinal side effects, including oral candidiasis, remain a major source of illness despite the use of a variety of agents to treat them.
Objectives
To assess the effectiveness of interventions for the treatment of oral candidiasis for patients with cancer receiving chemotherapy or radiotherapy or both.
Search methods
Computerised searches of Cochrane Oral Health Group and PaPaS Trials Registers (to 1 June 2010), CENTRAL via the Cochrane Library (Issue 2, 2010, 1 June 2010), MEDLINE via OVID (1 June 2010), EMBASE via OVID (1 June 2010), CINAHL via EBSCO (1 June 2010), CANCERLIT via PubMed (1 June 2010), OpenSIGLE (1 June 2010) and LILACS via Virtual Health Library (1 June 2010) 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
All randomised controlled trials comparing agents prescribed to treat oral candidiasis in people receiving chemotherapy or radiotherapy for cancer. The outcomes were eradication of oral candidiasis, dysphagia, systemic infection, amount of analgesia, length of hospitalisation, cost and patient quality of life.
Data collection and analysis
Data were independently extracted, in duplicate, by two review authors. Trial authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out. Risk ratios (RR) were calculated using fixed-effect models.
Main results
Ten trials involving 940 patients, satisfied the inclusion criteria and are included in this review. Drugs absorbed from the gastrointestinal (GI) tract were beneficial in eradication of oral candidiasis compared with drugs not absorbed from the GI tract (three trials: RR = 1.29, 95% confidence interval (CI) 1.09 to 1.52), however there was significant heterogeneity. A drug absorbed from the GI tract, ketoconazole, was more beneficial than placebo in eradicating oral candidiasis (one trial: RR = 3.61, 95% CI 1.47 to 8.88). Clotrimazole, at a higher dose of 50 mg was more effective than a lower 10 mg dose in eradicating oral candidiasis, when assessed mycologically (one trial: RR = 2.00, 95% CI 1.11 to 3.60). Only one of the ten trials was assessed as at low risk of bias.
Authors' conclusions
There is insufficient evidence to claim or refute a benefit for any antifungal agent in treating candidiasis. Further well designed, placebo-controlled trials assessing the effectiveness of old and new interventions for treating oral candidiasis are needed. Clinicians need to make a decision on whether to prevent or treat oral candidiasis in patients receiving treatment for cancer.
Plain language summary
Interventions for treating oral candidiasis for patients with cancer receiving treatment
Cancer treatment can lead to severe fungal infections (candidiasis, called thrush) in the mouth. This can cause pain, difficulties in eating and longer hospital stays. Infection can sometimes spread through the body and become life-threatening. Different drugs are used to try and relieve candidiasis. There is insufficient evidence that any of the antifungal drugs may cure fungal infections in the mouth for people with cancer and more research is needed.
摘要
背景
針對正接受癌症治療的病人之口腔白色念珠菌感染治療方式
癌症治療日漸有效但常附帶短期及長期之副作用。雖然以多種藥物治療，口腔之副作用，包含口腔白色念珠菌感染，雖然以多種藥物治療，仍是不適感的主要原因。
目標
評估針對正接受癌症放射線治療，化學治療或同時進行放射線治療及化學治療的病人之口腔白色念珠菌感染治療方式的效果
搜尋策略
採用電腦化搜尋Cochrane Oral Health Group and PaPaS Trials Registers, CENTRAL, MEDLINE, EMBASE, CINAHL, CANCERLIT, SIGLE 及 LILACS 等資料庫。我們搜尋了相關文章之參考清單並且也連絡合格試驗之作者以取得試驗及額外資訊。最近一次搜尋之日期:2006年6月:CENTRAL (The Cochrane Library 2006, Issue 2)資料庫。
選擇標準
所有比較正接受癌症化學治療或放射線治療的病人之口腔白色念珠菌感染治療處方之隨機對照試驗 (randomised controlled trials). 結果為消除口腔白色念珠菌感染,吞嚥困難,全身性感染,止痛程度,住院長短,費用及病人之生活品質.
資料收集與分析
資料由兩位回顧者各自萃取，1式2份。我們聯絡研究作者以獲知隨機化的細節及撤回並進行品質評估。我們並以隨機效果模型(randomeffects models)來計算風險比率(risk ratio)。
主要結論
共有9篇試驗計658位病人符合收錄條件並被收錄於本篇回顧中。僅兩種藥物，各在1篇試驗中，被發現對消除口腔白色念珠菌感染有效。在消除口腔白色念珠菌感染方面，1種經由消化道吸收的藥物，ketoconazole, 比安慰劑更為有效 (RR = 3.61, 95%CI = 1.47 to 8.88)。且若以黴菌學分析， clotrimazole在50毫克(mg)的較高劑量比10毫克的較低劑量更可消除口腔白色念珠菌感染(RR = 2.00, 95%CI = 1.11 to 3.60)。5篇收錄於這些統合分析(metaanalyses)的試驗中，3篇有高度偏差風險(risk of bias)，2篇有中度偏差風險。另1篇試驗顯示10毫克的部分吸收性藥物clotrimazole和安慰劑並無統計學上顯著性差異。比較不同完全吸收性藥物及比較完全吸收性藥物與不吸收性藥物並無差異。
作者結論
微弱且不可信賴的證據顯示，吸收型藥物ketoconazole 可消除口腔白色念珠菌感染，且較高劑量之部分吸收性藥物clotrimazole比10mg之較低劑量可能帶來更多好處.然而，比起治療，研究者應該會更希望去預防口腔白色念珠菌感染。我們需要更進一步經良好設計且具安慰劑對照的試驗來評估治療口腔白色念珠菌感染的新藥及舊藥。
翻譯人
本摘要由臺灣大學附設醫院王逸平翻譯。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
總結
抗黴菌藥物ketoconazole及clotrimazole可能可以治癒因癌症治療而引發之口腔白色念珠菌感染。 癌症治療可能會導致嚴重之口腔黴菌感染(白色念珠菌感染，又稱鵝口瘡)。此一感染會造成疼痛，進食困難及延長住院時間。 感染有時會蔓延全身而危及生命。有微弱的證據顯示一些抗黴菌藥物可能可治癒癌症病人的口腔黴菌感染。像ketoconazole 及 clotrimazole可完全(或部分)經由腸胃道吸收的藥物可能比不能吸收的藥物(如nystatin)更有效，但仍須更多的研究。