Korean J Adult Nurs.  2018 Aug;30(4):362-375. 10.7475/kjan.2018.30.4.362.

Effect of Oral Cryotherapy for Reducing Oral Mucositis in Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-analysis

• Park SH
• Han SH

• KMID: 2418979
• DOI: http://doi.org/10.7475/kjan.2018.30.4.362

Abstract

PURPOSE
This systematic review and meta-analysis provided scientific evidence for oral cryotherapy as a nursing intervention for the prevention of Oral Mucositis (OM) associated with Hematopoietic Stem Cell Transplantation (HSCT).
METHODS
The literature search was carried out in July and October 2017. The MEDLINE, EMBASE, Cochrane Library, CINAHL, and KoreaMed electronic databases were searched using the MeSH keywords "mucositis" and "cryotherapy." The Cochrane's Risk of Bias tool was used to assess the internal validity of the Randomized Controlled Trials (RCTs). The selected studies were included in the meta-analysis using Review Manager 5.3.
RESULTS
Among seven RCTs with 264 patients, oral cryotherapy significantly decreased the incidence of OM (Relative Risk [RR]=0.46, 95% Confidence Interval [CI]=0.31~0.66), including severe OM (grade 2~4: RR=0.33, 95% CI=0.21~0.52; grade 3~4: RR=0.34, 95% CI, 0.22~0.53), and also reduced the OM severity score (Standardized Mean Difference [SMD]=−0.92, 95% CI=−1.25~−0.58). In addition, the need of intravenous narcotics therapy (RR=0.19, 95% CI=0.07~0.51) and the total parenteral nutrition (RR=0.54, 95% CI=0.35~0.84) were reduced. These results were associated with a significantly reduced length of hospitalization (Weighted Mean Difference [WMD]=−1.22, 95% CI=−2.37~−0.07).
CONCLUSION
Oral cryotherapy is effective and well-tolerated nursing intervention to alleviate OM among patients receiving myeloablative therapy before HSCT. Nurses caring for patients treated with myeloablative therapy should place high priority to prevent OM based on this evidence.

MeSH Terms

Bias (Epidemiology)
Cryotherapy*
Hematopoietic Stem Cell Transplantation*
Hematopoietic Stem Cells*
Hospitalization
Humans
Incidence
Mucositis
Narcotics
Nursing
Parenteral Nutrition, Total
Stem Cell Transplantation
Stomatitis*
Narcotics

Figure

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  Figure 1 Flow diagram of study selection.

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  Figure 2 The results of risk of bias.

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  Figure 3 The effect of oral cryotherapy and funnel plot.

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