Incidence and Risk Factors for Radiotherapy-Induced Oral Mucositis Among Patients With Nasopharyngeal Carcinoma: A Meta-Analysis

Purpose: To evaluate the incidence and identify the risk factors for radiotherapy-induced oral mucositis among patients with nasopharyngeal carcinoma. Methods: A meta-analysis was conducted. Eight electronic databases (Medline, Embase, Cochrane Li-brary, CINAHL Plus with Full Text, Web of Science, China National Knowledge Infrastructure, Wanfang Database, and Chinese Scientific Journals Database) were systematically searched from inception to 4 March 2023 for relevant studies. Study selection and data extraction were conducted by two indepen-dent authors. The Newcastle-Ottawa scale was used for quality assessment among the included studies. Data synthesis and analyses were performed in R software package version 4.1.3 and Review Manager Software 5.4. The pooled incidence was calculated using proportions with 95% confidence intervals (CIs), and the risk factors were evaluated using the odds ratio (OR) with 95% CIs. Sensitivity analysis and predesigned subgroup analyses were also conducted. Results: A total of 22 studies published from 2005 to 2023 were included. The results of the meta-analysis showed that the incidence of radiotherapy-induced oral mucositis was 99.0% among nasopha-ryngeal carcinoma patients, and the incidence of severe radiotherapy-induced oral mucositis was 52.0%. Poor oral hygiene, overweight before radiotherapy, oral pH < 7.0, the use of oral mucosal protective agents, smoking, drinking, combined chemotherapy, and the use of antibiotics at early treatment stage are risk factors for severe radiotherapy-induced oral mucositis. Sensitivity analysis and subgroup ana-lyses also revealed that our results are stable and reliable. Conclusions: Almost all patients with nasopharyngeal carcinoma have suffered from radiotherapy-induced oral mucositis, and more than half of patients have experienced severe oral mucositis. Facili-tating oral health might be the key focus of reducing the incidence and severity of radiotherapy-induced oral mucositis among nasopharyngeal carcinoma patients. Registration number: CRD42022322035. (c) 2023 Korean Society of Nursing Science. Published by Elsevier BV. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).