Co, J.L., Mejia, M.B., Que, J.C., & Dizon, J.M. (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 and Neck, 38, 1119–1128. 

DOI Link

Purpose

STUDY PURPOSE: To synthesize the available literature to determine the role of honey in reducing oral mucositis, time to onset of mucositis, weight loss, and treatment interruptions among patients with head and neck cancers undergoing radiation with or without concomitant chemotherapy

TYPE OF STUDY: Meta analysis and systematic review

Search Strategy

DATABASES USED: MEDLINE Complete, CINAHL Plus, ProQuest Health and Medical Complete, Academic Search Complete, Biomedical Reference Collection Basic, PubMed, and Google Scholar
 
INCLUSION CRITERIA: Patients with head and neck cancer receiving chemotherapy with or without chemotherapy; use of wither raw, pure, or processed honey; administration of honey had to be oral, including concentrated or diluted
 
EXCLUSION CRITERIA: Nonrandomized controlled trails

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 83 abstracts; however, after refining the review of abstract, only eight articles were closely reviewed and five were included in the quantitative pooling according to the author. 
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The authors stated that eight articles were closely reviewed for systematic review, but only two articles from meta-analysis. The authors did not say why only five articles were included in the summary table, and the selection rational was unclear.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 5 for meta-analysis and 8 for systematic review 
  • TOTAL PATIENTS INCLUDED IN REVIEW = 244 (according to the authors)
  • SAMPLE RANGE ACROSS STUDIES: Author did not report each sample size, but some numbers were found in the report and a figure. According to the figure, each study had 20–33 participants per group, and it was assumed that each study had approximately 40–60 participants. However, one study used in systematic review seemed to have 131 patients in the study. Sample sizes were not reported well in this study. 
  • KEY SAMPLE CHARACTERISTICS: The authors included only randomized controlled trials with a honey intervention for patients with head and neck cancer who were receiving radiation therapy. The authors took appropriate screening procedures to select articles that met the criteria. This shrunk the sample size but resulted in more reliable results for meta-analysis.

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results

Treatment Interruption: Treatment interruption was reported in three studies with a total sample of 140 patients. Statistical pooling yielded that the risk ratio of having a treatment interruption was significantly lower with the use of honey versus the control 0.11 (95% CI [0.02, 0.58], z = 2.6, p = 0.009).
 
Weight Loss (not meta-analysis result): Only two studies reported related to weight loss. They did not use the same reporting, and statistical pooling was not able to be conducted. Both studies showed statistical significance to show the effectiveness. In one study, the mean weight loss was 1 kg (SD = 0.35 kg) (range = 0–7 kg) for honey and 6.3 kg (SD = 0.53 kg) (range = 2–11 kg), and this was significant. Another study showed 55% static or positive weight gain in honey compared to the control (p < 0.05).
 
Peak mucositis score (not meta-analysis result): Some studies showed the benefit, but not all. 
 
Time to mucositis (not meta-analysis result): Two studies showed statistical significance, and one did not. No negative results exist to support honey use.

Conclusions

Honey was significantly better in lowering the risk for treatment interruptions and probably less weight loss but did not decrease the rate of the peak mucositis score. The results for prolonged onset of mucositis is favorable with the honey intervention in two studies, but one study did not show a significant difference.

Limitations

  • Limited number of studies included
  • No quality evaluation
  • High heterogeneity
  • Low sample sizes

Nursing Implications

The results showed that the honey intervention is effective in reducing treatment interruption. Other measures (weight loss, peak mucositis score, time to mucositis) need further meta-analysis to establish. Further well-designed research is needed to confirm the usefulness of honey preparations.

Legacy ID

5952