Interventions for preventing oral candidiasis for patients with cancer receiving treatment

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.

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 and or radiotherapy.

Electronic databases : Cochrane Oral Health Group Specialised Register, CCTR, MEDLINE and EMBASE were searched. Date of the most recent searches May 2001 (CCTR 2001, issue 3).

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 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 reviewers (HW & JC). The Cochrane Oral Health Group statistical guidelines were followed and relative risk values calculated using random effects models where significant heterogeneity was detected (P<0.1). Potential sources of heterogeneity were examined in random effects meta-regression analyses.

Twenty-seven trials involving 4,137 patients satisfied the inclusion criteria. Drugs absorbed and partially absorbed from the GI tract were found to prevent oral candidiasis when compared to a placebo, or a no treatment control group, with RR for absorbed drugs =0.45 (95%CI 0.31 to 0.64). 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 for drugs not absorbed from the GI tract.

There is strong evidence, from randomised controlled trials, that drugs absorbed or partially absorbed from the GI tract prevent oral candidiasis in patient 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.