Non-Pharmacological Interventions for Improving Xerostomia Among Patients With Head and Neck Cancer: A Systematic Review and Network Meta-Analysis.

Abstract

Xerostomia is highly prevalent among patients with head and neck cancer (HNC). This review aimed to compare the effectiveness of non-pharmacological interventions (NPIs) for xerostomia among patients with HNC. We systematically searched nine databases (inception-October 2024) for RCTs assessing the effects of NPIs on xerostomia (self-reported xerostomia, incidence, stimulated/unstimulated salivary flow). Forty-six trials (3802 patients) identified 10 arms: multimodal NPIs, herbal medicine, acupuncture, exercise, oral care, devices, health education, supplements, and active/passive controls. At post-intervention, multimodal NPIs (the majority being herbal medicine combined with other therapies) ranked first for self-reported xerostomia, incidence, and unstimulated flow versus other interventions. Herbal medicine ranked second for self-reported and incidence of xerostomia and first for stimulated flow. Though lower-ranked, acupuncture significantly improved all outcomes versus passive controls. Sensitivity analyses showed enhanced acupuncture efficacy with high-dose radiotherapy. Multimodal NPIs, herbal medicine, and acupuncture are promising for improving xerostomia among patients with HNC.