Jayachandran, S., & Balaji, N. (2012). Evaluating the effectiveness of topical application of natural honey and benzydamine hydrochloride in the management of radiation mucositis. Indian Journal of Palliative Care, 18(3), 190–195.

DOI Link

Study Purpose

To evaluate the effect of honey and 0.15% benzydamine hydrochloride on the onset and severity of radiation mucositis when compared to 0.9% normal saline

Intervention Characteristics/Basic Study Process

  • Patients in group I were instructed to rinse their mouths and swish 20 mL of honey for 5 minutes and slowly swallow. This was to be done 15 minutes before, 15 minutes during, and 6 hours following radiation therapy (RT).
  • Group II was instructed to rinse and then spit with 15 mL of 0.15% benzydamine hydrochloride for 5 minutes. This was to be done 15 minutes before, 15 minutes during, and 6 hours following RT.
  • Group III (control group) was instructed to rinse with 20 mL of 0.9% normal saline for five minutes and then spit. This was to be done 15 minutes before, 15 minutes during, and 6 hours following RT.  
  • The clinical grading of mucositis followed the World Health Organization (WHO) mucositis grading scale on day 1 of RT, daily during treatment, and weekly for two weeks following completion of RT.

Sample Characteristics

  • The study reported on 60 patients with an age range of 49–55 years.
  • The sample was 70% male and 30% female.
  • All patients had oral malignancies and were being treated with RT.

Setting

This was a single site, outpatient study conducted in Chennai, India.

Phase of Care and Clinical Applications

Patients were undergoing the active antitumor treatment phase of care.

Study Design

 This was a three-group, randomized, controlled trial.

Measurement Instruments/Methods

Patients were assess via clinical exam.

Results

The onset of mucositis and progression to grades 2, 3, and 4 were noted for each group. Group I had a later onset of grades 1, 2, 3, and 4 mucositis compared to Groups II and III. The difference was statistically significant (p < 0.001).

Conclusions

Honey can be an effective agent in managing radiation-induced oral mucositis. It is simple, inexpensive, and readily available. Further randomized studies are essential to validate the findings.

Limitations

  • The sample size was small with fewer than 100 patients.
  • A risk of bias exists because of the lack of blinding.
  • A risk of bias exists because of the variations in sample characteristics. For example, the duration of RT varied from 6000-7000 centiGray, and this variation was explained by time not the total dose. The authors did not describe if this difference between groups was statistically significant.
  • Although the authors acknowledged that the intensity of mucositis can be altered by fractionation schedules, concurrent chemoradiotherapy, and comorbid medical conditions, including bacterial colonization of the oral mucosa, the study did not address these variables.
  • The authors did not discuss how well the patients tolerated the honey.
  • Subject withdrawal was not addressed. 
  • Pain measurement was not addressed.

Nursing Implications

Mucositis during RT for oral malignancy is a continuing challenge for patients. Further testing of honey is needed. The availability and cost are benefits. The treatment is not complex or impractical.