Salivary Gland Hypofunction and/or Xerostomia Induced by Nonsurgical Cancer Therapies

Publication Date: July 16, 2021
Last Updated: September 2, 2022

Prevention

Intensity-modulated radiation therapy (IMRT) should be used to spare major and minor salivary glands from a higher dose of radiation to reduce the risk of salivary gland hypofunction and xerostomia in patients with head and neck cancer. ( EB , H , S )
6539
Other radiation modalities that limit cumulative dose to and irradiated volume of major and minor salivary glands as or more effectively than IMRT may be offered in order to reduce salivary gland hypofunction and xerostomia. ( IC , L , S )
6539
Acupuncture may be offered during radiation therapy for head and neck cancer to reduce the risk of developing xerostomia. ( EB , I , M )
6539
Systemic administration of the sialagogue bethanechol may be offered during radiation therapy for head and neck cancer to reduce the risk of salivary gland hypofunction and xerostomia. ( EB , L , W )
6539
Vitamin E or other antioxidants should not be used to reduce the risk of radiation-induced salivary gland hypofunction and xerostomia due to the potential adverse impact on cancer-related outcomes and the lack of evidence of benefit. ( IC , L , W )
6539
Evidence remains insufficient for a recommendation for or against the use of submandibular gland transfer administered before head and neck cancer treatment to reduce the risk of salivary gland hypofunction and xerostomia due to insufficient evidence with contemporary radiation modalities. (, Ins , )
6539
Evidence remains insufficient for a recommendation for or against the use of the following interventions during radiation therapy for head and neck cancer: Oral pilocarpine, amifostine (with contemporary radiation modalities), or low-level laser therapy. (, Ins , )
6539
Evidence remains insufficient for a recommendation for or against the use of the following interventions to reduce the risk of salivary gland hypofunction or xerostomia in patients with head and neck cancer: n-acetylcysteine oral rinse, traditional Chinese medicine-based herbal mouthwash, local clonidine, concurrent chemotherapy with nedaplatin, boost radiation therapy, hyperfractionated or hypofractionated radiation therapy, intraarterial chemoradiation, minocycline, melatonin, nimotuzumab, zinc sulfate, propolis, viscosity-reducing mouth spray, transcutaneous electrical nerve stimulation (TENS), parotid gland massage, thyme honey, and human epidermal growth factor. (, Ins , )
6539

Management

Topical mucosal lubricants/saliva substitutes (agents directed at ameliorating xerostomia and other salivary gland hypofunction-related symptoms) may be offered to improve xerostomia induced by non-surgical cancer therapies. ( EB , I , S )
6539
Other radiation modalities that limit cumulative dose to and irradiated volume of major and minor salivary glands as or more effectively than IMRT may be offered in order to reduce salivary gland hypofunction and xerostomia. (Gustatory and masticatory salivary reflex stimulation by sugar-free lozenges, acidic (non-erosive and sugar-free special preparation if dentate patients) candies, or sugar-free, non-acidic chewing gum may be offered to produce transitory increased saliva flow rate and transitory relief from xerostomia by stimulating residual capacity of salivary gland tissue. ( EB , I , M )
6539
Oral pilocarpine, and cevimeline where available, may be offered post-radiation therapy in patients with head and neck cancer for transitory improvement of xerostomia and salivary gland hypofunction by stimulating residual capacity of salivary gland tissue. However, improvement of salivary gland hypofunction may be limited. ( EB , H , S )
6539
Acupuncture may be offered post-radiation therapy in head and neck cancer patients for improvement of xerostomia. ( EB , L , W )
6539
Transcutaneous electrostimulation or acupuncture-like transcutaneous electrostimulation of the salivary glands may be offered post-radiation therapy in head and neck cancer patients for improvement of salivary gland hypofunction and xerostomia. ( EB , L , W )
6539
Evidence remains insufficient for a recommendation for or against the use of the following interventions for improvement of salivary gland hypofunction and xerostomia: Extract of ginger and mesenchymal stem cell therapy. (, Ins , )
6539

Recommendation Grading

Overview

Title

Salivary Gland Hypofunction and/or Xerostomia Induced by Nonsurgical Cancer Therapies

Authoring Organizations

American Society of Clinical Oncology

Multinational Association of Supportive Care in Cancer

Publication Month/Year

July 16, 2021

Last Updated Month/Year

October 1, 2024

Document Type

Guideline

Country of Publication

US

Document Objectives

To provide evidence-based recommendations for prevention and management of salivary gland hypofunction and xerostomia induced by nonsurgical cancer therapies.

Target Patient Population

Adult patients with cancer who are scheduled to receive or who have received nonsurgical cancer therapy.

Target Provider Population

Oncologists and other physicians, dentists, dental specialists, dental hygienists, oncology nurses, clinical researchers, advanced practitioners, and patients with cancer

PICO Questions

  1. What is the efficacy of available pharmacologic and nonpharmacologic interventions (including the effects of radiation dose, type, and regimen) for the prevention of salivary gland hypofunction and/or xerostomia induced by nonsurgical cancer therapies?

  2. What is the efficacy of available pharmacologic and nonpharmacologic interventions for the management of salivary gland hypofunction and/or xerostomia induced by nonsurgical cancer therapies?

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory, Outpatient, Radiology services

Intended Users

Dentist, nurse, nurse practitioner, physician, physician assistant

Scope

Management, Prevention

Diseases/Conditions (MeSH)

D014987 - Xerostomia, D018987 - Salivary Ducts, D012469 - Salivary Glands

Keywords

head and neck cancer, Head and Neck Carcinomas, salivary gland malignancy, xerostomia, salivary gland

Source Citation

Mercadante V, Jensen SB, Smith DK, Bohlke K, Bauman J, Brennan MT, Coppes RP, Jessen N, Malhotra NK, Murphy B, Rosenthal DI, Vissink A, Wu J, Saunders DP, Peterson DE. Salivary Gland Hypofunction and/or Xerostomia Induced by Nonsurgical Cancer Therapies: ISOO/MASCC/ASCO Guideline. J Clin Oncol. 2021 Sep 1;39(25):2825-2843. doi: 10.1200/JCO.21.01208. Epub 2021 Jul 20. PMID: 34283635.

Supplemental Methodology Resources

Data Supplement, Evidence Tables

Methodology

Number of Source Documents
158
Literature Search Start Date
December 31, 2008
Literature Search End Date
June 11, 2020