Network meta-analysis of interventions for oral mucositis in breast cancer patients

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Breast cancer research and treatment Published May 9, 2026 Medically reviewed May 12, 2026 Study authors: Liu Qianxi, Wang Ruhuai, Jiang Siyu, Yuan Jiang, He Guang, Wang Qian, Cheng Shuai, Chen Lulu, Zhao L… PubMed ↗ DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Consider zinc for overall oral mucositis and propolis for grade ≥2 oral mucositis in breast cancer patients, based on network meta-analysis.

This is a network meta-analysis of randomized controlled trials evaluating interventions for preventing and alleviating oral mucositis in breast cancer patients. The analysis included 869 patients and compared zinc, propolis dry extract, bifico, MuGard, and professional oral health care. The authors synthesized that zinc most effectively reduced overall oral mucositis (RR = 0.53, 95%CrI: 0.27 to 0.95), while propolis dry extract was optimal for grade ≥2 oral mucositis (RR = 0.15, 95%CrI: 0.01 to 0.99). Bifico significantly decreased overall oral mucositis (RR = 0.58, 95%CrI: 0.44 to 0.73) and ranked second for grade ≥2 oral mucositis. In chemotherapy patients, professional oral health care and zinc were superior for overall oral mucositis. In targeted therapy patients, MuGard and professional oral health care performed best for overall oral mucositis, and professional oral health care was most effective for grade ≥2 oral mucositis (SUCRA = 96.17%). The authors acknowledge that further large-scale RCTs are needed to validate these findings. Practice relevance suggests zinc and propolis are optimal strategies, with bifico showing promise and professional oral health care effective across subgroups.

Study Details

Study typeMeta analysis

Sample sizen = 869

EvidenceLevel 1

PublishedMay 2026

PMID42101732

View Original Abstract ↓

BACKGROUND: This study aimed to evaluate the efficacy of various interventions for preventing and alleviating oral mucositis (OM), a dose-limiting toxicity induced by cancer treatment. METHODS: PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched from their inception to March 19, 2026. The quality of included studies was assessed using version 2 of the Cochrane risk-of-bias tool (ROB 2). A Bayesian network meta-analysis (NMA) was conducted utilizing R 4.5.1 and the JAGS package (version 4.3.1). The interventions were compared using league tables, surface under the cumulative ranking curve (SUCRA), and heterogeneity testing. RESULTS: A total of 7,790 articles were retrieved. Ultimately, 10 randomized controlled trials (RCTs) involving 869 patients were included. According to the NMA, zinc most effectively reduced overall OM (RR = 0.53, 95%CrI: 0.27 to 0.95), while propolis dry extract was optimal for grade ≥ 2 OM (RR = 0.15, 95%CrI: 0.01 to 0.99). bifico significantly decreased overall OM (RR = 0.58, 95%CrI: 0.44 to 0.73) and ranked second for grade ≥ 2 OM. Subgroup analyses showed that professional oral health care and zinc were superior in chemotherapy patients, while MuGard and professional oral health care performed best in targeted therapy patients. Professional oral health care was most effective against grade ≥ 2 OM in the targeted therapy subgroup (SUCRA = 96.17%). CONCLUSION: Zinc and propolis dry extract are the most optimal strategies for overall and grade ≥ 2 OM in BC patients, respectively. bifico shows promising clinical potential. Professional oral health care is effective in both chemotherapy and targeted therapy subgroups. Further large-scale RCTs are needed to validate these findings. CLINICAL TRIAL NUMBER: Not applicable.