Interventions for preventing oral candidiasis for patients with cancer receiving treatment

 

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 methods

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: 3 August 2009: CENTRAL (The Cochrane Library 2009, Issue 3).

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 Collaboration 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 number needed to treat (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 tract.

 

Plain language summary

Interventions for preventing oral candidiasis for patients with cancer receiving treatment

There is strong evidence that some antifungal drugs prevent oral candidiasis (thrush) caused by cancer treatment, but nystatin does not appear to work.
Treatment for cancer can lead to severe fungal infections (thrush) in the mouth. This can cause discomfort, pain, difficulties in eating, longer stays in hospital and more worryingly, systemic infection and risk to life. Different drugs are used to try and prevent this condition. The review found strong evidence from a large number of trials that some of the antifungal drugs (those absorbed and partially absorbed into the body) help prevent fungal infections in the mouth. Some other commonly used drugs such as nystatin, which are not absorbed into the body, do not appear to work.

 

摘要

背景

防止接受癌症治療中患者產生口腔念珠菌感染之介入法

癌症的治療的效果是越來越好了，但是仍會產生短期或長期的副作用。口腔的副作用仍然是最主要的，即使是使用了許多藥物來防止及治療，其中一個副作用就是口腔念珠菌感染。

目標

評估對於接受化學治療或放射線治療或是兩者合併的癌症患者，其介入法對於防止口腔念珠菌感染的效果(其中也包括安慰劑或是不做治療)。

搜尋策略

我們使用電腦搜尋了Cochrane Oral Health Group、PAPAS Trials Registers、CENTRAL、MEDLINE、EMBASE、CINAHL、CANCERLIT、SIGLE 及LILACS。我們也搜尋了相關文獻所列出的參考資料，並聯絡合適試驗的作者，來確認試驗的內容及額外的資訊。最近的搜尋日期為2006年六月: CENTRAL (The Cochrane Library 2006, Issue 2)。

選擇標準

若試驗符合下列標準則可被選取：設計─隨機分配參與實驗者；參與實驗者─任何接受癌症化學治療或放射治療者；介入法─開立處方以防止口腔念珠菌感染；主要結果─防止口腔念珠菌感染。

資料收集與分析

若出現下列次要結果，則資料會被加以記錄：緩和疼痛，止痛的程度，緩和吞嚥困難，系統性感染的發生率，住院的時間(天數)，口腔照護的花費，患者的生活品質，死亡，使用經驗性的抗黴菌治療，毒性以及相容性。關於實驗方法，實驗參與者，介入法，結果的量測以及最終結果等資料，都由兩位評論作者獨立的且重複的檢視。並依據Cochrane Oral Health Group statistical guidelines及利用randomeffects model計算risk ratios (RR)。若有潛在異質性的來源，則使用randomeffects metaregression analysis來檢驗。

主要結論

28個試驗，總共4226位患者符合選擇的條件。用於防止口腔白色念珠菌感染且經由腸胃道吸收或部分吸收的藥物，與安慰劑，或是沒有治療的控制組作比較，吸收性藥物的risk ratio = 0.47 (95% confidence interval (CI) 0.29 to 0.78)。對於在20% incidence族群中的吸收性藥物 (控制組結果的mid range)，這暗示了9位需要治療的患者中(95% CI 7 to 13)有一位能避免口腔念珠菌感染。非腸胃道吸收的藥物並沒有顯現出顯著的益處。

作者結論

從隨機控制試驗中有強力的證據顯示，由消化道吸收或部分吸收的能防止接受癌症治療的患者產生口腔念珠菌感染。而這些證據也顯示這些藥物顯著的較非腸胃道吸收的藥物好。

翻譯人

本摘要由臺灣大學附設醫院唐宗凡翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

有強烈的證據指出有些抗真菌藥物能夠防止因癌症治療產生的口腔念珠菌感染(鵝口瘡)，但是nystatin並沒有顯現能有效治療因癌症引起的嚴重口腔真菌感染(鵝口瘡)。這可以造成不舒適、疼痛、進食困難、更擔心的是會造成系統性的感染以及生命危險。這篇review發現在大量的試驗中，有些抗真菌藥物(那些能被腸胃道吸收或部分吸收的)能夠防止口腔真菌的感染。有些常使用的藥物，如nystatin並不能被身體吸收，並不能有效的作用。