Royal Jelly

To determine the efficacy of royal jelly on oral mucositis in patients receiving chemotherapy and radiation

Patients were divided into two groups. All patients received benzydamine hydrochloride and nystatin rinses. In the experimental group, royal jelly was swished orally for 30 seconds and then swallowed twice per day for a total of 1 g per day. Patients could not eat or drink within 30 minutes of using the royal jelly. Both groups used the mouthwash protocol or mouthwash protocol plus royal jelly until mucositis was resolved. All participants and assessors were blinded to group. Oral mucosa was divided into five sites—labial mucosa, buccal mucosa, gingivae, tongue, and soft and hard palates—and the mucositis score was determined daily by a trained researcher for each site until no further evidence of mucositis existed.

• N = 103  
• AGE = 52.25 years
• MALES: 47%, FEMALES: 53%
• KEY DISEASE CHARACTERISTICS: Multiple types of cancer
• OTHER KEY SAMPLE CHARACTERISTICS: Multiple stages of cancer, chemotherapy types, and chemotherapy cycles

• SITE: Single site    
• SETTING TYPE: Outpatient    
• LOCATION: Turkey

• PHASE OF CARE: Active antitumor treatment

• Prospective, randomized clinical trial

• World Health Organization criteria for mucositis

No statistical difference was seen in mucositis severity at the beginning of the study between the two groups. For grade 1 mucositis, the mean number of days to healing in the royal jelly group was 1.1 days, and in the control group it was 2.7 days (U = 64; p = 0.0001). For grade 2 mucositis, the mean number of days to healing in the control group was 5.8 days, and in the experimental group it was 3 days (U = 77; p = 0.0001). For grade 3 mucositis, those in the experimental group had a faster healing time than those in the control group (U = 59; p = 0.005).

The addition of royal jelly to a mouthwash protocol with benzydamine and nystatin rinses significantly decreased the healing time for grade 1, 2, and 3 oral mucositis.

• Risk of bias (no random assignment)
• Other limitations/explanation: Random assignment was not described in the study

Royal jelly should be considered as an additional intervention to promote the healing of oral mucositis caused by chemotherapy and radiation. Royal jelly, in addition to a mouthwash protocol consisting of a benzydamine and nystatin rinse, effectively reduced the number of days to complete healing of oral mucositis. The sample in this study included a wide variety of cancer types as well as a wide range of types of chemotherapy and number of chemotherapy cycles.

To test the effectiveness of royal jelly on the prevention of mucositis in patients with head and neck cancer receiving chemotherapy and radiation

The royal jelly (RJ) was collected from the species Apis mellifera with a primary diet of nectar and pollen from flowers in China. Patients in the intervention group applied 1 g of royal jelly three times per day for the duration of radiation treatment (RT), and patients in the control group did not apply royal jelly. Data were collected during radiation twice per week and one month after radiation was complete.

• N = 13  
• AGE RANGE = 51–84 years
• MALES: 92.3%, FEMALES: 7.6%
• KEY DISEASE CHARACTERISTICS: Hypopharyngeal, oropharyngeal, laryngeal, oral cavity squamous cell carcinoma
• OTHER KEY SAMPLE CHARACTERISTICS: Three different chemotherapy regimens; radiation therapy dose 33–35 fractions (60–70 Gy)

• SITE: Single-site    
• SETTING TYPE: Not specified    
• LOCATION: Kyorin University School of Medicine, Tokyo, Japan

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Elder care  

Randomized, single-blinded (physician-blinded) trial

• Inspection 
• Fiberscope 
• National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 3 used to grade mucositis

In the control group, 100% (six) patients experienced grade 3 oral mucositis at the end of radiation compared to the 71.4% (five) who experienced grade 3 in the RJ group and the 28.6% (two) who experienced grade 2 mucositis in the RJ group. RJ delayed the progression to grade 2 mucositis (19 ± 4.1 days in the RJ group, 25.9 ± 9.6 days in the control group, p < .001). RJ also significantly delayed the progression to grade 3 mucositis (37.4 ± 11.8 days in the RJ group, 31 ± 5.8 days in the control group, p < .001).

The results of this study suggest that the topical application of RJ is effective in preventing accelerated mucositis induced by chemoradiotherapy.

• Small sample (< 30)
• Unintended interventions or applicable interventions not described that would influence results
• Other limitations/explanation: Different chemotherapy regimens; no description of regimens; RT dose may have differed based on the disease site

Chemoradiotherapy for head and neck cancer continues to cause significant mucositis, which is debilitating and can impact nutritional status, comfort, and often patients' ability to complete therapy without treatment breaks. The topical administration of RJ offers one intervention that could improve this side effect; however, further studies are needed to support these findings.