Cho, H.K., Jeong, Y.M., Lee, H.S., Lee, Y.J., & 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. 

DOI Link

Purpose

STUDY PURPOSE: To calculate a meta-analysis of the efficacy of honey for the treatment of oral mucositis in patients with head and neck cancer receiving radiotherapy and chemoradiotherapy 
 
TYPE OF STUDY: Meta-analysis

Search Strategy

DATABASES USED: MEDLINE, Scopus, and the Cochrane Library
 
KEYWORDS: Head and neck neoplasms, radiotherapy, chemoradiotherapy, honey, and mucositis
 
INCLUSION CRITERIA: Articles that investigated oral honey administration in patients with head and neck cancer receiving radiotherapy or chemotherapy
 
EXCLUSION CRITERIA: Patients who received additional mucositis management; patients who received chemotherapy, radiotherapy, and/or surgery to remove tumors or lymph nodes; patients who had a systemic disease such as diabetes mellitus; multiple reports based on same trial data; unquantifiable or unclear outcomes; unextractable data for calculation

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 31
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: A meta-analysis was performed on nine articles, which included the incidence of mucositis, the onset of mucositis, and mean score of two articles on the incidence of bacterial and fungal colonization, two articles on the incidence of pain experience requiring analgesics, and three articles on the incidence of weight loss. Two independent reviewers extracted data using standardized forms. 

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 9
  • TOTAL PATIENTS INCLUDED IN REVIEW = 476 
  • SAMPLE RANGE ACROSS STUDIES: 19–127 patients
  • KEY SAMPLE CHARACTERISTICS:
    • Comparisons: Honey (manuka honey) vs placebo,  Honey (manuka honey) vs. placebo (sugar-free placebo), Honey (Western Ghats forests) vs. placebo (lignocaine), Honey (Dabur honey) vs. placebo (Tantum), Honey (manuka and kanuka honey) vs. placebo (sterile water) or no gargle, Honey (Egypt honey) vs. placebo (Tantum), Honey (thyme and astragale) vs. placebo (saline), Honey (manuka honey) vs. no gargle, Honey (tea plant) vs. placebo (Tantum)
    • Treatments: Radiotherapy plus chemoradiotherapy, radiotherapy alone, and chemoradiotherapy alone

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment 
 
APPLICATIONS: None stated

Results

Administration of Honey Versus Control (Mucositis)
  • The incidence of moderate to severe mucositis was significantly lower in patients receiving honey versus those who received a placebo or no treatment (control group) (p < 0.0001).
  • A subanalysis of honey efficacy pertaining to type of regimen demonstrate that honey administration had significantly greater effect in preventing moderate to severe mucositis in patients receiving radiotherapy alone than those receiving chemotherapy (p < 0.0001).
  • The onset of mucositis was significantly later in the honey group versus the control group (p = 0.0036).
  • The mean mucositis grade for first three weeks of radiotherapy or chemotherapy was significantly lower in the honey group than in the control group (p = 0.0114).

Administration of Honey Versus Control (Mucositis-Related Adverse Effects)

  • No statistically significant differences between honey and control groups were found regarding incidences of bacterial or fungal colonization and pain experience (p = 0.3804, p = 0.1831, and p = 0.2903, respectively).
  • There was a statistically significant difference for the incidence of weight loss in patients in the honey group versus the placebo group (p < 0.0001).

Conclusions

This study demonstrated the potential efficacy of honey administration in the prevention of oral mucositis and weight loss during radiotherapy and chemotherapy in patients with head and neck cancer. 

Limitations

  • Only two studies that analyzed the incidence of bacterial and fungal colonization were included. 
  • Small sample sizes
  • Different types of honey and anticancer regimens were used.
  • The heterogeneity of the incidence of moderate to severe mucositis in patients receiving chemoradiotherapy could not be decreased in this analysis.

Nursing Implications

  • This study indicated potential prevention interventions for oral mucositis in patients with head and neck cancer.
  • Its findings pointed to areas for future nursing research.
  • The honey interventions used were low-cost with easy administration and accessibility, which will assist nursing interventions if future studies support their use.   

Legacy ID

5609