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A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact

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TLDR
There is evidence that salivary gland hypofunction and xerostomia induced by cancer therapies can be prevented or symptoms be minimized to some degree, depending on the type of cancer treatment.
Abstract
This systematic review aimed to assess the literature for management strategies and economic impact of salivary gland hypofunction and xerostomia induced by cancer therapies and to determine the quality of evidence-based management recommendations. The electronic databases of MEDLINE/PubMed and EMBASE were searched for articles published in English since the 1989 NIH Development Consensus Conference on the Oral Complications of Cancer Therapies until 2008 inclusive. For each article, two independent reviewers extracted information regarding study design, study population, interventions, outcome measures, results, and conclusions. Seventy-two interventional studies met the inclusion criteria. In addition, 49 intensity-modulated radiation therapy (IMRT) studies were included as a management strategy aiming for less salivary gland damage. Management guideline recommendations were drawn up for IMRT, amifostine, muscarinic agonist stimulation, oral mucosal lubricants, acupuncture, and submandibular gland transfer. There is evidence that salivary gland hypofunction and xerostomia induced by cancer therapies can be prevented or symptoms be minimized to some degree, depending on the type of cancer treatment. Management guideline recommendations are provided for IMRT, amifostine, muscarinic agonist stimulation, oral mucosal lubricants, acupuncture, and submandibular gland transfer. Fields of sparse literature identified included effects of gustatory and masticatory stimulation, specific oral mucosal lubricant formulas, submandibular gland transfer, acupuncture, hyperbaric oxygen treatment, management strategies in pediatric cancer populations, and the economic consequences of salivary gland hypofunction and xerostomia.

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Interventions for the management of dry mouth: topical therapies.

TL;DR: There is no strong evidence from this review that any topical therapy is effective for relieving the symptom of dry mouth, and both integrated mouthcare systems and oral reservoir devices show promising results but there is insufficient evidence at present to recommend their use.
Journal ArticleDOI

Treatment of late sequelae after radiotherapy for head and neck cancer

TL;DR: The available evidence on the use of different therapeutic strategies to alleviate common late sequelae of RT in head and neck cancer patients is reviewed, with a focus on the critical assessment of the treatment options for xerostomia, dysphagia, mandibular osteoradionecrosis, trismus, and hearing loss.
References
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Journal ArticleDOI

Effects of sucking acidic candies on saliva in unilaterally irradiated pharyngeal cancer patients.

TL;DR: Saliva became significantly more undersaturated with respect to HAp in irradiated patients, and failed to return to baseline values during the post-stimulatory period, which it normally does in healthy individuals, so prevention of dental breakdown in these patients should involve counseling regarding choice of stimulant for dry mouth relief.
Journal ArticleDOI

A Pilot Study of Salix SST (Saliva-stimulating Lozenges) in Post-irradiation Xerostomia

TL;DR: There was a marked and statistically significant improvement in the dryness and general comfort of the mouth, and beneficial effects on eating, sleeping and speech.
Journal ArticleDOI

Assessment of salivary function change in nasopharyngeal carcinoma treated by parotid-sparing radiotherapy.

TL;DR: With parotid-sparing radiotherapy for nasopharyngeal carcinoma, gland function can recover significantly 12 months after radiotherapy, and rank-order correlations between LENT/SOMA subjective and objective (analytic) grading scores at 6 to 18 months' follow-up were significant.

Oral complications of cancer therapies. Pretherapy interventions to modify salivary dysfunction.

TL;DR: Results of an ongoing study investigating the effects of pilocarpine on radiation-induced salivary gland dysfunction suggest that parotid function was preserved, but not submandibular/sublingual function.
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