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Dental Care Measures for Alleviating Oral Symptoms in Patients with Cancer Undergoing Oral Chemotherapy: A Scoping Review Protocol
, Adarsh Kudva3, Ananth Pai4, Naveen Salins1
The review is registered on Figshare (10.6084/m9.figshare.25815040)
*Corresponding author: Vijay Shree Dhyani, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India. vs.dhyani@manipal.edu
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Received: ,
Accepted: ,
How to cite this article: Shetty N, Dhyani V, Verma V, Ghoshal A, Kudva A, Pai A, et al. Dental Care Measures for Alleviating Oral Symptoms in Patients with Cancer Undergoing Oral Chemotherapy: A Scoping Review Protocol. Indian J Palliat Care. 2025;31:301-5. doi: 10.25259/IJPC_68_2025
Abstract
Chemotherapy-related oral side effects such as xerostomia, dysgeusia and oral pain can occur during or soon after treatment in patients with cancer. With the right guidelines, a structured approach and proper training for dental specialists, we can significantly improve the management of oral symptoms and enhance the overall oral health of patients. This scoping review aims to map and assess the dental care interventions to improve symptoms related to the oral cavity in patients with cancer receiving oral chemotherapy. The updated methodological guidance by JBI will be followed for this scoping review. This review will consider quantitative studies on the oral care interventions available to improve symptoms related to the oral cavity in patients with any type of cancer aged 18 years or older receiving oral chemotherapy. MEDLINE (PubMed), EMBASE, CINAHL (EBSCOhost), Scopus, Cochrane and Google Scholar searches will be conducted by two reviewers who will independently screen the articles in two stages and extract the data. The third reviewer will resolve the disagreements between reviewers. Studies in English published from the beginning to the present will be considered. The piloted data extraction process to gather relevant information from the selected studies will be used. The results will be presented using narrative synthesis, and the reporting will be done according to Preferred Reporting Items for Systematic Reviews and Meta-analyses – Scoping Review guidelines. Our review aims to synthesise interventions designed to improve the symptoms related to the oral cavity in patients undergoing oral chemotherapy. This will be the first review to consolidate information from several databases on this topic.
Keywords
Dental care
Palliative care
Quality of life
Scoping review
Targeted therapy
INTRODUCTION
Cancer continues to be the most common cause of mortality worldwide. In 2020, almost 19.3 million people were diagnosed with the disease, highlighting its widespread impact, according to the Global Cancer Observatory.[1] Chemotherapy, an essential component of cancer treatment, is widely used across various cancer types.[2] Among the many forms of chemotherapy, oral chemotherapy has gained considerable attention due to its convenience, improved patient adherence and potential for enhancing the quality of life.[3] Oral chemotherapeutic agents, including drugs such as chlorambucil, mercaptopurine and methotrexate, allow patients to self-administer their treatments at home, reducing the need for frequent hospital visits.[4]
With the growing use of oral chemotherapy, more patients are facing its challenging side effects, especially those that affect the mouth. Dryness, painful sores, changes in taste and infections can make even simple activities such as eating and speaking uncomfortable. Beyond the physical discomfort, these issues can take a toll on emotional well-being, making meals less enjoyable and adding to the stress of an already difficult journey. When left unaddressed, they can impact nutrition, diminish quality of life and make coping with treatment even harder.[5] Oral complications can be even more intense for patients on oral chemotherapy since the medication comes into direct contact with the delicate oral mucosa.[6,7]
Managing oral complications becomes even more critical in palliative and supportive care, where the goal is comfort and improved quality of life.[8] Preventive care, therapeutic treatments and palliative oral care strategies all play a crucial role in easing pain and discomfort. However, there is still a lack of clear, consolidated information on which approaches work best for patients undergoing oral chemotherapy for cancer in the palliative setting.[9,10]
Taking the aforementioned into account, it becomes imperative to find the dental care measures available to alleviate oral symptoms in patients with cancer. More importantly, it will examine how well oral care measures meet the needs of those in palliative and supportive care. By shedding light on effective strategies, this review will contribute towards better, more compassionate oral care, ensuring that patients can experience greater comfort and an improved quality of life.
PROTOCOL
Objectives
This scoping review aims to explore how dental care can ease oral symptoms and improve the well-being of patients with cancer undergoing oral chemotherapy, especially those in palliative and supportive care.
Objective 1: Identify the different dental care approaches used to manage oral discomfort in patients with cancer.
Objective 2: Assess how oral care measures impact patients’ experiences, focusing on symptom relief and overall quality of life.
By bringing the insights together, this review hopes to guide better, more patient-centred oral care strategies.
Methods
A scoping review is carried out when the existing research on a topic is varied and the area has not been studied much. It helps to map out the range of available studies on the subject. This approach also highlights where there are gaps in knowledge and points out the different kinds of evidence and sources that can guide practical applications, policymaking and further research.[10] This scoping review will adhere to updated JBI guidance on scoping reviews[11] and Arksey and O’Malley’s framework[12] which consists of six main stages: (1) Identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; (5) collating, summarising and reporting the results and (6) consulting with stakeholders to validate findings and enhance the comprehensiveness of the review.[13] This protocol has been registered in Figshare (10.6084/m9.figshare.25815040). For reporting, we will use Preferred Reporting Items for Systematic Reviews and Meta-Analyses – Protocols (PRISMA-P) – Statements for for this protocol and Preferred Reporting Items for Systematic Reviews and Meta-Analyses – Extension for Scoping Reviews for the review itself. PRISMA-P checklist is provided in Supplementary File 1.[14]
Research question
The first step in the review is creating a clear research question that focuses on the specific challenges faced by patients with cancer who are undergoing oral chemotherapy, especially regarding oral symptoms and the importance of dental care in palliative and supportive care settings. A multidisciplinary team, which included palliative care experts, dentists and oncologists, started the scoping review by informally screening literature from MEDLINE through PubMed and various other literature sources. The keywords were identified by an information specialist in scoping reviews to identify the research question.[15-19]
Research question:
What are the different oral care measures to alleviate oral symptoms in patients with cancer receiving oral chemotherapy?
Identifying relevant studies
In this phase, the authors will conduct a literature search in five databases, such as MEDLINE (PubMed), EMBASE, CINAHL (EBSCOhost), Scopus Cochrane and Google Scholar to find the studies related to dental care and oral health management in patients with cancer receiving oral chemotherapy. These searches will be developed by an information specialist. The search strategy will include keywords and phrases related to ‘oral symptoms’, ‘oral chemotherapy’, ‘dental care’ and ‘cancer’. The search will be tailored to each database, employing Boolean operators such as AND and OR to combine relevant terms. The reference articles of included studies will also be used to screen the additional relevant articles (inclusion of various study designs, such as clinical trials, observational studies, and qualitative research, will be made to capture a broad spectrum of data [Supplementary File 2 shows search strategy in PUBMED]).[20] The search will cover all available literature in the English language without any date restriction from the database inception to June 30, 2025. The authors will aim to ensure that their review encompasses a diverse array of studies reflecting various geographic, demographic and clinical contexts, thereby enhancing the comprehensiveness of the review.
Eligibility criteria
Participants
The articles involve adults aged 18 years and older who are diagnosed with any type of cancer and receiving only oral chemotherapy. Patients must report at least one oral symptom, such as mucositis, xerostomia or dysgeusia and studies involving patients at any stage of cancer, from early diagnosis to those receiving curative or palliative chemotherapy, will be considered in this review. Participants receiving intravenous chemotherapy and radiotherapy are excluded.
Concept
The concept under review is the range of oral care measures designed to manage or alleviate oral complications in patients with cancer receiving oral chemotherapy. This includes preventive dental care, therapeutic measures and palliative and/or supportive oral care measures. The review will focus on measures that report measurable outcomes, such as reduction in symptom severity or improvement in patient-reported quality of life.
Context
The review will include studies from any geographic location, focusing on measures applicable in hospital, home, hospice or palliative care settings. There will be no geographic restrictions.[11]
Types of sources
The review includes experimental designs such as randomised controlled trials and non-randomised controlled trials (quantitative studies), published in English. Articles such as opinion pieces, reviews, letters to the editor, grey literature, conference abstracts and commentaries will not be considered.[20,21]
Study selection
Once the search is complete, all identified studies obtained from multiple databases will be organised and uploaded into Rayyan. Two independent reviewers will then determine eligibility based on the inclusion criteria by carefully screening the titles and abstracts. If a study appears relevant or if its abstract lacks clarity, the full text will be retrieved for further evaluation. Selected full-text articles will be thoroughly reviewed to confirm their inclusion or exclusion. Studies will be excluded if they do not meet the inclusion criteria, and the reasons for excluding the study will be documented in an appendix of the final report.[10] The reviewers will hold periodic discussions to address any challenges and ensure consistency in the selection process. In cases where disagreements arise and cannot be resolved through discussion, senior investigators will step in to make the final decision.[22]
Charting the data
Data extraction
Data from the included article will be extracted using a piloted data extraction form that is aligned with the objectives of the review. The charting process likely included the following components:[23]
Key themes: Identification of major themes related to oral symptoms (such as mucositis, xerostomia and oral infections) and dental care measures (such as preventive care, patient education and specific interventions).
Intervention types: Documentation of the types of dental care measures implemented, including pharmacological treatments (e.g., saliva substitutes, mouthwashes), nonpharmacological approaches (e.g., oral hygiene education) and interdisciplinary care strategies.
Outcomes: Collection of data on patient outcomes related to oral health, such as improvements in symptom severity, patient-reported quality of life and any reported complications or side effects associated with the interventions.
A sample layout of this form can be found in Supplementary File 3. To ensure its validity for academic literature, our reviewers will first independently extract data from 10 selected sources. After this initial phase, once we confirm consistency between reviewers, the forms will be shared with the entire team for use. To maintain accuracy, a second reviewer will verify data extraction for 20% of the included academic sources. Since data charting is an evolving process, we anticipate making adjustments to the forms as needed to better capture the findings of the included studies. Once the forms are finalised and consistency is established, one team member will extract data from each full-text article.[24]
Data analysis and synthesis
The data will be analysed using a combination of descriptive and narrative synthesis methods:
Objective 1: The types of dental care measures will be categorised by measure type, frequency and mode of delivery. A descriptive summary of measure types and their frequencies will be provided, highlighting the most common approaches.
Analysis: This objective will be addressed through an exhaustive search of the literature to identify the range of dental care measures available for managing oral symptoms such as xerostomia, oral mucositis, dysgeusia and oral infections. The measures will be categorised based on the type of care provided (e.g., preventive, therapeutic or palliative). In addition, the delivery methods of oral care measures (e.g., in-clinic dental treatment, home-based care or hospice-based measures) will be analysed. A narrative synthesis will be used to describe the diversity and frequency of oral care measures, providing a comprehensive map of the current state of knowledge.
Objective 2: Outcome measures related to oral symptom relief will be summarised using descriptive statistics. The impact of the measures on patient-reported outcomes will be synthesised narratively, emphasising symptom reduction and improvements in quality of life, particularly in palliative care settings.
Analysis: To evaluate the impact of oral care measures, data on patient-reported outcomes (e.g., pain reduction, mucositis severity, relief of xerostomia) will be extracted and analysed. Descriptive statistics will summarise the frequency and effectiveness of different measures. For each measure, a narrative synthesis will describe the extent to which it improved oral symptoms and enhanced the patient’s quality of life. This analysis will pay special attention to symptom control in patients with cancer receiving oral chemotherapy, focusing on whether oral care measures are adaptable for palliative care patients who may have more complex symptom profiles.[25]
Objective 3: Focus on the oral care measures that are feasible within palliative care, their long-term benefits and their ease of implementation. A thematic analysis will be created on the same.
Analysis: The sub-analysis to determine how well the identified measures meet the specific needs of palliative care patients. A thematic synthesis will be conducted on types of measures with minimal patient effort. Special attention will be given to patient comfort, the feasibility of measure implementation and the long-term benefits of the measures for managing symptoms in a palliative context.
Collation, summarisation and reporting the results
The first step in summarising our research findings is charting the data.[26] We will identify the key information for each study, such as the article information, methodology and study objectives, followed by categorising and organising based on the themes. Key findings will be recognised by reading and rereading the data. Finally, the thematic framework will be developed such as:
Summary of findings: A detailed presentation of the oral symptoms identified in the studies and the effectiveness of various dental care measures in alleviating oral symptoms.
Implications for palliative care: Discussion on how the findings relate to palliative care practices, emphasising the need for integrating dental care into comprehensive cancer care to improve overall quality of life.
Identification of gaps: This review will also highlight gaps in existing research, identifying areas where more evidence is needed. Recognising the gaps is essential for dental interventions or limited research on specific patient groups.[27]
DISCUSSION
This scoping review will create a clear and complete guide to dental care strategies for patients with cancer receiving oral chemotherapy, with a special focus on those in palliative care. By bringing together existing evidence, this review will help bridge a critical gap in understanding the best way to manage the unique oral health challenges faced by patients. More than just research, these findings have real-world implications in helping clinicians develop targeted, practical strategies to manage oral complications. Ultimately, this work aims to enhance oral health care, relieve discomfort and improve the quality of life for patients navigating both cancer and palliative care.[28]
This review will offer a detailed, practical guide to the various dental care measures available for managing oral symptoms in patients undergoing oral chemotherapy. It will not only highlight the range of interventions but also assess how effective they are in relieving symptoms and improving patient well-being. Special emphasis will be placed on patient-reported outcomes, ensuring that the findings reflect what truly matters to those experiencing these challenges firsthand.[2] This review will also explore how oral care measures can be adapted for palliative care, ensuring that patients receive the most practical and compassionate support. By identifying gaps in current research, it will highlight areas where more work is needed to improve care. More importantly, by pinpointing the most effective and feasible interventions, this review will serve as a valuable guide for healthcare providers. It will help them implement strategies that truly meet the needs of patients with cancer, especially those in the advanced stages of their illness, ensuring that oral care remains a source of comfort rather than an additional burden.[29]
This review is limited by the inclusion of only English-language literature. Valuable research published in other languages was excluded due to the limited capacity to accurately translate and interpret non-English studies, which may introduce language bias and reduce the overall comprehensiveness of the review . In addition, differences in study designs and methodologies may make it difficult to compare results, leading to some inconsistencies in conclusions. Another concern is potential biases within the existing research, such as small sample sizes or studies lacking control groups. These factors could affect the reliability of reported outcomes. Despite the challenges, this review aims to provide the best possible insights, highlighting areas where more research is needed to improve care for patients with cancer, especially those in palliative settings.[30] Since many studies are cross-sectional, they provide only a snapshot in time, making it harder to understand the long-term impact of dental care measures on oral health. Finally, potential conflicts of interest in some included studies could introduce bias, which is always a consideration when interpreting research findings. Despite the limitations, this review aims to provide meaningful guidance, identifying the best available strategies to improve oral care and comfort for patients with cancer receiving oral chemotherapy.
CONCLUSION
This review will bring together what is currently known about dental care measures that ease oral symptoms in patients receiving oral chemotherapy. By highlighting what works best, it aims to support approaches that make patients more comfortable and improve their quality of life, especially in palliative and supportive care. It will also point out where more research is needed so that future care can be even more patient-centered and effective, while laying the groundwork for designing evidence-based oral care interventions tailored to the needs of cancer patients.
Acknowledgements:
The authors would like to acknowledge the institutional and infrastructural support provided by Manipal Academy of Higher Education.
Ethical approval:
Institutional Review Board approval is not required.
Declaration of patient consent:
Patient’s consent is not required as there are no patients in this study.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript, and no images were manipulated using AI.
Financial support and sponsorship: Nil.
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