Xu, J.L., Xia, R., Sun, Z.H., Sun, L., Min, X., Liu, C., ... & Zhu, Y.M. (2016). Effects of honey use on the management of radio/chemotherapy-induced mucositis: A meta-analysis of randomized controlled trials. International Journal of Oral and Maxillofacial Surgery, 45, 1618–1625.

DOI Link

Purpose

STUDY PURPOSE: To determine the prophylactic effects of honey on radiation- and chemotherapy-induced mucositis

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: PubMed, Cochrane, Science Direct, China National Knowledge Infrastructure (CNKI), VIP (Chinese scientific journal database), China Biology Medicine (CBM)
 
INCLUSION CRITERIA: Randomized, controlled trials and/or blinding methods, head and neck cancer undergoing chemotherapy and/or radiation therapy, test group received honey treatment and control group (no treatment) or another single intervention (lidocaine or golden syrup), outcome measure incidence of oral mucositis within one week after radiation therapy and/or chemotherapy
 
EXCLUSION CRITERIA: Review articles/letters to editor, animal/laboratory studies, case reports, technical reports

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 113
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Data were extracted independently by two reviewers using predefined abstraction forms. Disagreements were resolved by consensus with a third reviewer. Publication bias was assessed by using Egger’s linear regression test and Begg’s funnel plot.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 7
  • TOTAL PATIENTS INCLUDED IN REVIEW = 190 test groups, 191 control groups
  • SAMPLE RANGE ACROSS STUDIES: 13–127
  • KEY SAMPLE CHARACTERISTICS: In five studies, patient received radiation therapy (260 patients, two studies radiation therapy and chemotherapy [121]). Only three studies mentioned age range (13–89 years).

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results

Each study was assessed for risk of bias, and only one study was considered to be at low risk. Only one study gave information on the difference in incidence of mucositis for honey versus lidocaine and honey versus golden syrup. Five studies reported the prophylactic effect of honey. One study revealed that honey prevented mucositis better than lidocaine (p < 0.01). Another study showed no differences between honey and golden syrup (p = 0.64). The combined result yielded a relative ratio of 0.35 (95% confidence interval [0.18, 0.7], p = 0.003). The development of mucositis was 0.35 times in honey use compared to the likelihood of mucositis in no prophylaxis treatment (1).

Conclusions

Honey treatment reduced the incidence of oral mucositis in the honey group by 65% compared to the control group. The type of radiation therapy (source, dose) may have influenced the results.

Limitations

Mostly low quality/high risk of bias studies

Nursing Implications

Honey prevents the incidence of mucositis compared to no intervention. However, more randomized, controlled trials are needed to determine the prophylactic effects of honey on patients receiving radiation or radiation and chemotherapy.

Legacy ID

6482