Table 3.
Trials with complementary and integrative approaches to cancer treatment-related xerostomia
| Author (Reference) | Year | Country | Design | Intervention | Patients and participants | Study groups | Outcomes |
|---|---|---|---|---|---|---|---|
| Garcia et al. [134] | 2019 | USA and China | RCT | Acupuncture | Head and neck cancer patients (339 patients) |
- Standard care control (SCC): 112 patients - Intervention group (True acupuncture): 112 patients - Control group (Sham acupuncture): 115 patients |
Xerostomia in the intervention group was significantly lower than in the SCC group, but the difference with the control group was not statistically significant. Symptoms were fewer and less severe 1 year after treatment compared to SCC |
| Simcock et al. [135] | 2012 | UK | Crossover RCT | Acupuncture | Patients with chronic radiation-induced xerostomia (145 patients) |
- Educational oral care program - Weekly group acupuncture (8 sessions) |
Acupuncture provided significantly better symptom management for patients suffering from chronic radiation-induced xerostomia. However, no significant changes were observed in objective saliva measurements |
| Meng et al. [136] | 2011 | China | RCT | Acupuncture | Nasopharyngeal carcinoma patients undergoing radiotherapy (86 Patients) |
- Intervention group: 40 patients - Control group: 46 patients |
The acupuncture group had a significantly lower prevalence of xerostomia and showed a preventing potential, leading to improved quality of life |
| Forner et al. [137] | 2011 | Denmark | Uncontrolled pilot study | Hyperbaric oxygen | Irradiated head and neck cancer patients (80 patients) | - Intervention group: 80 patients | Subjective improvement was reported among the patients with hyposalivation and xerostomia |
| Palma et al. [138] | 2017 | Brazil | Clinical trial | Photobiomodulation | Head and neck cancer patients with radiation-induced xerostomia (29 patients) | - Intervention group (Low-level laser therapy for 24 sessions in 3 months): 29 patients | Salivary flow rates and quality of life were improved |
| Louzeiro et al. [139] | 2020 | Brazil | RCT | Photobiomodulation | Head and neck patients undergoing radiotherapy (21 patients) |
- Intervention group: 10 patients - Control group (sham group): 11 patients |
The salivary flow deteriorated in both groups. No difference was observed between groups regarding salivary flow and composition, xerostomia, or quality of life |
| de Carvalho e Silva et al. [140] | 2023 | Brazil | RCT | Photobiomodulation and artificial saliva | Patients with head and neck squamous cell carcinoma (53 patients) |
- Intervention group (artificial saliva and photobiomodulation) - Control group (artificial saliva and sham laser simulation) |
The intervention group experienced a significantly improved state of xerostomia and quality of life. The groups had no significant difference in the DMFT index or periodontal charts |
| Nuchit et al. [141] | 2020 | Thailand | RCT | Saliva substitutes (Oral moisturizing jelly versus a topical saliva gel) | Post-radiation head and neck cancer patients (62 patients) |
- Intervention group 1 (OMJ): 31 patients - Intervention group 2: 31 patients |
Continuous use of saliva substitutes (OMJ or SG) for over 1 month improves xerostomia, enhancing the swallowing ability. Edible OMJ is superior to topical SG |
| Apperley et al. [142] | 2017 | New Zealand | Crossover RCT | Emulsion of rice bran oil, soy lecithin, and propylene glycol | Patients treated with head and neck radiotherapy (40 patients) |
- Intervention group (emulsion) - Control group 1 (methylcellulose) - Control group 2 (water) |
None of the products showed a significant difference in patient outcomes |
| Rupe et al. [143] | 2023 | Italy | Crossover RCT | Sodium-hyaluronate mouthwash | Patients with head and neck cancer (39 patients) |
- Intervention group (GUM Hydral®) - Control group (Placebo) |
The intervention significantly reduced the symptoms of xerostomia. The intervention group had higher reported satisfaction levels among the patients |
| Beuth et al. [144] | 2013 | Germany | Clinical trial | A combination of sodium selenite, proteolytic plant enzymes (bromelain and papain), and Lens culinaris lectin | Breast cancer patients undergoing adjuvant hormone therapy (310 patients) | - Intervention group: 310 patients | Almost two-thirds of patients with severe mucosal dryness significantly benefited from complementary medicine. Side-effects of hormone therapy were significantly reduced after 4 weeks |
| Heydarirad et al. [145] | 2017 | Iran | RCT | Alcea digitata and Malva sylvestris | Head and neck cancer patients (60 patients) |
- Intervention group: 30 patients - Control group: 30 patients |
In the intervention group, a significant improvement in quality of life, pain, and ease of swallowing, speaking, and eating was observed |
| Quimbt et al. [146] | 2020 | Canada | Uncontrolled pilot study | Coconut oil | Post-radiation head and neck cancer patients (30 patients) | - Intervention group: 30 patients | No significant difference was observed before and after the intervention |
| Charalambou et al. [147] | 2018 | Cyprus | RCT | Thyme honey rinses | Head and neck cancer patients (72 patients) |
- Intervention group: 36 - Control group (saline rinses): 36 |
The intervention group had significantly lower grades of xerostomia. Patients’ quality of life was also significantly higher in the intervention group |
| Chamani et al. [148] | 2017 | Iran | RCT | Ginger capsule | Patients with post-radiotherapy xerostomia (61 patients) |
- Intervention group: 30 patients - Control group (Placebo): 31 patients |
Although the intervention group had a marginally improved status, no significant difference was observed between groups |
| Chung et al. [149] | 2016 | South Korea | RCT | Antioxidant supplements (vitamin E + vitamin C) | Head and neck cancer patients with radiotherapy-induced xerostomia (45 patients) |
- Intervention group: 25 patients - Control group (Placebo): 20 patients |
The intervention group showed significant long-term improvement compared to the control group |
| Heiser et al. [150] | 2016 | Germany | Clinical trial | Liposomal nose and mouth spray (LipoNasal, LipoSaliva) | Head and neck cancer patients (98 patients) | - Intervention groups (three subgroups per cancer treatment): 98 patients | A positive subjective outcome was observed, which could suggest liposomal sprays as a first-line treatment due to their safety |
| Steinmann et al. [151] | 2012 | Germany | Non-randomized trial | Homeopathy (Mouth rinses with either Traumeel S solution or Salvia officinalis) | Patients under radiation therapy for head and neck cancer (20 patients) |
- Intervention group (Traumeel S): 10 patients - Control group (sage tea or Salvia officinalis): 10 patients |
No significant difference was observed among the study groups |
| Dalbem Paim et al. [152] | 2019 | Brazil | RCT | Transcutaneous electrical nerve stimulation (TENS) | Post-radiation head and neck cancer patients (68 patients) |
- Intervention group (TENS): 37 patients - Control group: 31 patients |
The intervention group showed a progressive increase in salivary flow in long-term follow-up |
| Wong et al. [153] | 2015 | USA | Clinical trial | Acupuncture-like transcutaneous electrical nerve stimulation (ALTENS) | Patients with post-radiation xerostomia (146 patients) |
- Intervention group 1 (ALTENS): 75 patients - Intervention group 2 (Oral Pilocarpine): 73 patients |
No significant difference was observed between the groups. However, less toxicity was seen in patients receiving ALTENS. Radiation-induced xerostomia improved over time for all patients |
ALTENS Acupuncture-like transcutaneous electrical nerve stimulation, DMFT index decayed, missing, and filled teeth index, OMJ Oral moisturizing jelly, RCT randomized controlled trial, SG Saliva gel, TENS Transcutaneous electrical nerve stimulation