How to bridge the gap? European medical plants used for treating oral mucositis: on the search for evidence

Judith Buentzel,Judith Buentzel,Christoph Bauer,Jens Buentzel

doi:10.1007/s00432-020-03124-x

Abstract

PurposeOral mucositis is a common, painful side effect of cancer treatment—be it locoregional (e.g. irradiation) or systemic (e. g. chemotherapy). Phytotherapy is often used by patients to alleviate symptoms. However, knowledge on which medical plants are recommended by literature about Traditional European Medicine (TEM), their effect(s) on symptoms and their efficacy is severely lacking. Therefore, we developed a novel approach to assess traditional knowledge of herbals used in TEM and searched the online databases for studies reporting effects of these plants.MethodsAt first, online research did not yield a satisfying number of studies (MESH terms: “mucositis” OR “stomatitis” AND “herbal” OR “herbal medicine”). Trials were labelled by the country conducting the study. In parallel, we compiled a list of 78 plants recommended for treating oral mucositis by screening 14 books on TEM. Then, a “hit list” of the plants most often mentioned was composed and used further for a second online investigation using the Latin plant designations as MESH term. Studies of both online searches were pooled for analysis.ResultsThere is a gap between traditional knowledge and trials investigating medical plants used by TEM. Overall, herbal remedies alleviate oral mucositis and especially, gingivitis well. There is good evidence for using Matricaria recutita L., Salvia officinalis L., Calendula officinalis L. and Thymus spp. L. for treating oral mucositis.ConclusionClinical trials investigating medical plants known in TEM are rare. However, following our research strategy, we could extrapolate four plants with good evidence for alleviating symptoms of oral mucositis and gingivitis.

Highlights

Oral mucositis is a common, painful side effect of cancer treatment—be it locoregional or systemic (e. g. chemotherapy, EGFR-inhibitors)
Few studies investigate medical plants recommended for treating oral mucositis by Traditional European Medicine (TEM)
Studies extracted were sorted by symptoms as followed: mucositis/stomatitis, gingivitis/periodontitis and pharyngitis

Summary

Introduction

Oral mucositis is a common, painful side effect of cancer treatment—be it locoregional (e.g. irradiation) or systemic (e. g. chemotherapy, EGFR-inhibitors). The German guideline of supportive care in oncology does only mention the first, Matricaria recutita L., citing an insufficient level of evidence due to the lack of clinical trials (or low evidence) or due to studies not really launched to German oncology practitioners (Leitlinienprogramm Onkologie|S3-Leitlinie Supportive Therapie 2017) This astonishing discrepancy between plants reported by TEM (Büntzel et al 2019) and the obvious lack of information available in the national guidelines is alarming—considering our patients’ use of herbal remedies (Molassiotis et al 2005). This argues against treating herbal remedies as the red-headed stepchild of supportive cancer care and for (re) assessing which plants are commonly recommended by TEM and for investigating whether these are backed up by clinical trials. We chose the oral mucositis as this is a common, assessed side effect of (systemic) oncological treatment

Methods

Figures and illustrations

Results

Literature research

Discussion

Compliance with ethical standards