A Meta-Analysis on the Efficacy of Zinc in Oral Mucositis during Cancer Chemo and/or Radiotherapy—An Evidence-Based Approach

Abstract

Zinc in various therapeutic doses was used on patients suffering from oral mucositis during cancer treatment. A meta-analysis was conducted to probe the role of oral zinc as a possible treatment option for oral mucositis. A literature search was done using PubMed, EBSCO, Cochrane, MedLine, ScienceDirect, ResearchGate and Google Scholar with key words. The analysis was directed to recognize and identify the use of zinc supplementations at a confidence interval (CI) 95% with p value significance taken as ,0.05. A total number of 21,428 articles was retrieved. After thorough screening and assessment of the eligibility criteria, 10 articles were included in qualitative and quantitative analysis in the study. The 10 articles constituted a total sample size of 299 in the case group and 294 in the control group. Oral zinc doses used were 25 mg, 30 mg, 50 mg and 220 mg capsules and mouthwash of 0.2% zinc, as well as 0.5 g of granules dissolved in 5% sodium alginate solution. Two studies showed no significance, with the overall effect 1.61. Eight studies favored zinc over a placebo with an overall effect size of 20.89 at 95% CI of 21.08 and 20.70 which was statistically significant (Z59.27, p,0.00001). This analysis suggests that zinc usage has shown significant reduction in the severity of oral mucositis but not prevention. The onset of the reaction was delayed and hastened healing. Pharyngeal mucositis, pain and quality of life of the individuals received no effect from zinc therapy.

Effect of zinc on oropharyngeal mucositis in children with acute leukemia undergoing chemotherapy

“…OM is defined as erythema and edema of the mucosa with progression to ulcers. Patients who also present with neutropenia and thrombocytopenia have an increased risk of oral bleeding and infections, which can lead to septicemia ( 2 , 7 - 9 ). OM involves pain, difficulty in swallowing and speaking, malnutrition, functional status deterioration, longer hospital stay, increased economic costs and decreased quality of life ( 3 , 4 , 7 , 8 , 10 - 13 ).…”

“…Morphine or doxepin rinses have also been useful for pain ( 9 , 10 ). Anesthetic solutions with diphenhydramine, viscous lidocaine, bismuth subsalicylate, and corticosteroids are alternatives, but no significant improvement has been observed as a result of their use ( 11 , 15 ).…”

“…Anesthetic solutions with diphenhydramine, viscous lidocaine, bismuth subsalicylate, and corticosteroids are alternatives, but no significant improvement has been observed as a result of their use ( 11 , 15 ). Palifermin (keratinocyte growth factor-1) supports cell proliferation and helps in the prevention of OM; however, its efficacy and toxicity have not been demonstrated in children ( 9 - 12 , 18 , 19 ). Zinc is an antioxidant trace element essential for tissue repair, immune and anti-inflammatory functions and resistance to infections ( 9 , 17 , 18 , 21 , 22 ).…”

“…Palifermin (keratinocyte growth factor-1) supports cell proliferation and helps in the prevention of OM; however, its efficacy and toxicity have not been demonstrated in children ( 9 - 12 , 18 , 19 ). Zinc is an antioxidant trace element essential for tissue repair, immune and anti-inflammatory functions and resistance to infections ( 9 , 17 , 18 , 21 , 22 ). It is a cofactor for DNA synthesis and important in cell proliferation ( 18 , 23 ) and may increase the gastrointestinal epithelial barrier function, thus decreasing cell death and detachment ( 3 , 23 ).…”

“…The recommended doses in children and adolescents range from 10 to 15 mg/day. However, for therapeutic purposes, the dose can be increased to 22.5 mg of elemental zinc/100 mg if administered as zinc sulfate, or to 30 mg or 80 mg elemental zinc/100 mg if administered as zinc acetate or zinc oxide, respectively ( 9 ). The objective of this study was to determine the effect of zinc in OM in children with acute leukemia in the early stages of oncological treatment.…”