Oral mucositis is a common side effect in patients receiving chemotherapy, or radiotherapy of the head and neck being seen in about 75% of high-risk patients. Mucositis can lead to significant pain and difficulty in eating and drinking needing hospitalisation and nasogastric or intravenous nutrition. Few interventions have been shown to be beneficial but some trials using honey have suggested a potential benefit.
The aim of this review was to assess the prophylactic effects of honey use on the management of radio/chemotherapy-induced mucositis.
Searches were conducted in the PubMed, Cochrane Library, Science Direct, China National Knowledge Infrastructure (CNKI), VIP (Chinese scientific journal database), and China Biology Medicine (CBM) databases without language restriction.
Randomised controlled trials (RCTs) of honey treatment for prevention of oral mucositis in head and neck cancer patients undergoing radiotherapy and/or chemotherapy were considered.
Two reviewers independently abstracted data and assessed study quality using the Cochrane risk of bias tool with a third reviewer adjudicating disagreements. The outcome measure was the incidence of oral mucositis within 1 week after radio/chemotherapy or Oral Mucositis Assessment (OMA) scale scores of oral mucositis ≥ 3. A pooled risk ratio (RR) with the 95% confidence interval (CI) was calculated. All effect sizes and 95% CI were calculated on the basis of fixed- or random-effects models.
- 7 RCTs involving a total of 381 patients (190 in test groups, 191 as controls) were included
- 5 studies used the Radiation Therapy Oncology Group (RTOG) scale, 1 the OMA scale.
- 1 study was considered to be a low risk of bias, 2 moderate risk and 4 high risk.
- Meta-analysis of 5 studies) using a random effects model found that honey treatment could reduce the incidence of oral mucositis after radio/chemotherapy, RR = 0.35, (95%CI; 0.18-0.70, P=0.003 I2 = 58.4%).
The authors concluded:-
this meta-analysis identified that honey could reduce the severity of radio/chemotherapy-induced oral mucositis. The results of this meta-analysis are promising for clinical practice, but more multi-centre randomised controlled trials are needed in order to strengthen the current evidence.
This review is the 3rd recent review of the use of honey in the prevention or treatment of oral mucositis. The other two, Col et al 2016, and Cho et al 2015 include 8 and 9 studies respectively. All three reviews suggest that the use of honey may be beneficial. This view was shared by earlier reviewers in 2012 (Dental Elf – 12th Jan 2012) and the 2011 Cochrane review by Worthington et al.
The issues with all of these reviews is the quality of the underlying evidence, which can be characterised as low. The Cochrane review only included 3 studies published before 2011 while this current review includes 5. As all of the reviews have concluded more high quality studies are needed to clarify the benefits of this intervention. However, the recent Cochrane review of oral cryotherapy (ice chips) did demonstrated that that simple intervention can reduce oral mucositis in patients receiving some type of chemotherapy/radiotherapy (Dental Elf – 11th Jan 2016).
Xu JL, Xia R, Sun ZH, Sun L, Min X, Liu C, Zhang H, Zhu YM. Effects of honey use on the management of radio/chemotherapy-induced mucositis: a meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg. 2016 Sep 3. pii: S0901-5027(16)30185-0. doi: 10.1016/j.ijom.2016.04.023. [Epub ahead of print] Review. PubMed PMID: 27600797.
Dental Elf – 11th Jan 2016
Dental Elf – 12th Jan 2012
Co, J. L., Mejia, M. B. A., Que, J. C. and Dizon, J. M. R. (2016), Effectiveness of honey on radiation-induced oral mucositis, time to mucositis, weight loss, and treatment interruptions among patients with head and neck malignancies: A meta-analysis and systematic review of literature. Head Neck, 38: 1119–1128. doi:10.1002/hed.24431
Cho, H. K., Jeong, Y. M., Lee, H. S., Lee, Y. J. and Hwang, S. H. (2015), Effects of honey on oral mucositis in patients with head and neck Cancer: A meta-analysis. The Laryngoscope, 125: 2085–2092.
Worthington HV, Clarkson JE, Bryan G, Furness S, Glenny AM, Littlewood A, McCabe MG, Meyer S, Khalid T. Interventions for preventing oral mucositis for patients with cancer receiving treatment. Cochrane Database of Systematic Reviews 2011, Issue 4. Art. No.: CD000978. DOI: 10.1002/14651858.CD000978.pub5.