Epidemiology and Burden of Oral Complications Following Breast Cancer Treatment - A Systematic Literature Review (PROSPERO CRD42021272130) - Mucositis and Stomatitis Incidence From Randomized Trials

OBJECTIVES: Breast cancer (BC), the most prevalent malignancy among women, has good survival rates given the numerous treatments available according to disease and patient characteristics. However, all pharmacological treatments are associated with several adverse effects (AE). Established evidence-based management guidelines are available for most AEs but not for oral complications (OC). Negative oral health is commonly reported during and after BC treatment and exerts a negative impact on quality of life, yet OCs are often overlooked or receive delayed interventions that are mostly performed empirically. This systematic literature review (SLR) aims to generate evidence that can provide the basis for the development of oral health management protocols for this particular population.

METHODS: Systematic searches on the epidemiology and burden of OCs after any pharmacological BC treatment were conducted in Embase, Medline, EconLit, NHSEED, CDSR, CENTRAL, and LILACS until April 2022. Articles were screened against pre-determined criteria and assessed for quality following the Cochrane Collaboration and PRISMA guidelines. Here, we present pooled data on the cumulative incidence of oral mucositis and stomatitis reported from randomized controlled trials (RCTs).

RESULTS: Out of the 6,084 unique records identified, 1,052 full-text articles were assessed for eligibility and 707 articles met all the inclusion criteria. Most articles (n=595) reported the proportion of BC patients with either mucositis or stomatitis, 106 of these inclusions reported data from 46,154 women with BC enrolled in 89 RCTs from 1987 to 2021. Most RCTs used the NCTC criteria to define mucositis or stomatitis. Overall, any grade mucositis and stomatitis occurred in 15% and 13% of the patients respectively.

CONCLUSIONS: This SLR shows that mucositis and stomatitis are the most commonly OCs reported following BC treatment. The incidence and risk factors for development of other OCs from other study designs plus treatment and burden of all OCs will be reported in the future.