Trans-cutaneous electrical nerve stimulation to treat dry mouth (xerostomia) following radiotherapy for head and neck cancer. A systematic review. (March 2021)

• Record Type: Journal Article
• Authors: Salimi, Fatemeh; Saavedra, Francisco; Andrews, Brain; FitzGerald, James; Winter, Stuart C.
• Is Part Of: Annals of medicine and surgery. Volume 63(2021)
• Publication Date: 2021-03
• Subjects: Xerostomia -- Head and neck cancer -- Dry mouth in patients with head and neck cancer -- Post radiotherapy complications in patients with head and neck cancer -- Transcutaneous Electrical Nerve stimulation of the salivary glands -- TENS machine in production of sa; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2021.01.094
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Background: A dry mouth or xerostomia is one of the most common long-term complications following radiotherapy for head and neck cancer and has a negative impact on quality of life in cancer survivors. Transcutaneous electrical nerve stimulation (TENS) is a novel approach to improving saliva flow in these patients. Objective: To perform a systematic review of studies evaluating TENS in the treatment of radiotherapy induced xerostomia in head and neck cancer patients. Data collection and analysis: A comprehensive electronic search was performed in PubMed/MEDLINE, the Cochrane Library, and Google Scholar databases for appropriate published studies. The last search was conducted in January 2020. Two review authors assessed all studies identified by the search strategy and carried out data extraction. Results: Five studies were included in the systematic review which analysed a total of 280 patients with head and neck cancer. Methodological quality and outcomes were evaluated in every study included. The outcome measure was either subjectively assessed or objectively measured. Three studies used conventional TENS therapy to stimulate parotid glands which produced a significant increase in saliva production following therapy. Two studies used acupunctured TENS type to electrically stimulate acupuncture points scattered in the body and they reported improvement in saliva production at the same level as medical treatment. No reported adverse effect of TENS was identified. Conclusions: This systematic review confirms the safety and feasibility of TENS in the treatment of xerostomia. It is established that commencing daily TENS therapy simultaneously with radiotherapy has the most efficacy. Given the nonspecific parameters used in the included studies, further evidence is needed in order to establish optimal settings and parameters of TENS for treatment of xerostomia. Highlights: Transcutaneous electrical nerve stimulation technique shows promise in treating xerostomia in patients with head and neck cancer. Concurrent radiotherapy treatment with TENS techniques in stimulating the salivary glands has a better outcome slowing the progress of developing severe dry mouth. Daily TENS technique treatment is required for optimal outcome in treating dry mouth. We recommend using a finite element mathematical modelling to design an optimal TENS parameters and effective electrodes geometries to enhance more selective stimulation of the nerve innervating the parotid glands.