Efficacy of Chamomile in the Prevention of Chemotherapy-Induced Oral Mucositis: A Systematic Review

Abstract

Introduction: Chemotherapy-induced oral mucositis (CIOM) is a common and dose-limiting complication of systemic anticancer therapy characterized by epithelial injury, inflammatory ulceration, oxidative stress, and significant pain. Increasing interest has focused on phytotherapeutic agents capable of modulating inflammatory and oxidative pathways involved in mucosal damage. Matricaria chamomilla L. (chamomile), rich in flavonoids, terpenoids, and α-bisabolol derivatives, demonstrates anti-inflammatory and antioxidant properties that may offer mucosal protection.

Methods:
Randomized controlled clinical trials assessing chamomile interventions for CIOM were identified through extensive electronic database searches conducted in PubMed, ProQuest, and Google Scholar. Studies published from January 2016 to April 2022.were screened. Outcomes assessed included mucositis incidence, severity grading, pain scores, and adverse events. Risk of bias was evaluated using the Cochrane RoB 2 tool.

Results:
Four randomized controlled clinical trials comprising 165 participants fulfilled the inclusion criteria. Chamomile was administered as cryotherapy infusion, mouthwash, or topical gel. Across studies, chamomile demonstrated a statistically significant reduction in mucositis severity and pain intensity compared with control interventions. No serious treatment-related adverse effects were reported.

Conclusions:
Chamomile-based interventions demonstrated favourable symptomatic improvement in CIOM, particularly in reducing mucosal severity and pain, with an acceptable safety profile. However, differences in formulations and study designs, along with small sample sizes, limit the strength of evidence, highlighting the need for larger, well-designed randomized trials to confirm definitive clinical efficacy.