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

Background 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. Methods 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). Results 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. Conclusion Multimodal NPIs, herbal medicine, and acupuncture are promising for improving xerostomia among patients with HNC.