Evidence summary on managing radiotherapy-induced oral mucositis in patients with head and neck cancer

Objective: To summarize the best evidence for managing radiotherapy-induced oral mucositis in patients with head and neck cancer, and improve the quality of care. Methods: According to the "6S" evidence pyramid model, we searched local and other part of world published clinical guidelines, expert consensus, evidence summary, and systematic review. The literature quality assessment followed the Appraisal of Guidelines for Research and Evaluation (AGREE II). for guidelines, AMSTAR-2 for systematic reviews, and Joanna Briggs Institute (JBI) Evidence-Based Health Care Center's quality evaluation tool for expert opinions and expert consensus articles. The quality of other literature was evaluated according to the type of original literature. If there were any conflicts about the conclusions drawn from different sources of evidence, this study followed the principle of high-quality evidence priority and the latest published authoritative literature priority. The "JBI Evidence Pre-grading and Evidence Recommendation Level System 2014" was adopted for the evidence lacking a grading system. Quality evaluation, evidence extraction, and summary were performed by 2 or more researchers, combined with the advice of the head and neck cancer radiotherapy professionals. Results: Finally, a total of ten pieces of literature were included. Twenty-two best evidence items for radiotherapyinduced oral mucositis management were summarized from six aspects, including multidisciplinary management, oral assessment, basic oral care, pain management, nutritional support, and application of honey or propolis. Conclusions: This study provides clinical caregivers with the evidence-based measures on managing radiotherapyinduced oral mucositis. Clinical backgrounds, patients' condition, willingness, economy, and cost-effectiveness should be fully considered when promoting evidence transformation. Applying evidence-based approaches with high feasibility, strong appropriateness, clinical significance and high effectiveness could reduce the incidence of severe radiotherapy-induced oral mucositis in patients with head and neck cancer. Systematic review registration: This study has been registered on the Fudan University Centre for Evidence-based Nursing. Registration No. is ES20232732.