Systematic review of natural and miscellaneous agents for the management of oral mucositis in cancer patients and clinical practice guidelines-part 1: vitamins, minerals, and nutritional supplements

Support Care Cancer. 2019 Oct;27(10):3997-4010. doi: 10.1007/s00520-019-04887-x. Epub 2019 Jul 8.


Purpose: To update the clinical practice guidelines for the use of natural and miscellaneous agents for the prevention and/or treatment of oral mucositis (OM).

Methods: A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer / International Society of Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. The findings were added to the database used to develop the 2014 MASCC/ISOO clinical practice guidelines. Based on the evidence level, the following guidelines were determined: Recommendation, Suggestion, and No Guideline Possible.

Results: A total of 78 papers were identified within the scope of this section, out of which 29 were included in this part, and were analyzed with 27 previously reviewed studies. A new Suggestion was made for oral glutamine for the prevention of OM in head and neck (H&N) cancer patients receiving radiotherapy with concomitant chemotherapy. The previous Recommendation against the use of parenteral glutamine for the prevention of OM in hematopoietic stem cell transplantation (HSCT) patients was re-established. A previous Suggestion for zinc to prevent OM in H&N cancer patients treated with radiotherapy or chemo-radiotherapy was reversed to No Guideline Possible. No guideline was possible for other interventions.

Conclusions: Of the vitamins, minerals, and nutritional supplements studied for the management of OM, the evidence supports a Recommendation against parenteral glutamine in HSCT patients and a Suggestion in favor of oral glutamine in H&N cancer patients for the management of OM.

Keywords: Glutamine; Guidelines; Herbal medicine; Natural; Oral mucositis; Supersaturated calcium phosphate rinse; Zinc.

Publication types

  • Systematic Review

MeSH terms

  • Dietary Supplements
  • Glutamine / administration & dosage
  • Glutamine / therapeutic use*
  • Head and Neck Neoplasms / therapy
  • Humans
  • Minerals / therapeutic use*
  • Mucositis / drug therapy*
  • Mucositis / prevention & control*
  • Neoplasms / drug therapy
  • Stomatitis / drug therapy*
  • Stomatitis / prevention & control*
  • Vitamins / therapeutic use*


  • Minerals
  • Vitamins
  • Glutamine