International Journal of Oncological Nursing and Practices Review Article

The Effectiveness of Honey Application for Oral Mucositis in Cancer Patients: A Review of Randomized Controlled Trials

  1. Mathew Varghese V Department of Nursing, All India Institute of Medical Sciences
  2. Sneha Sara Sam Department of Nursing, All India Institute of Medical Sciences

Abstract

Background: Oral mucositis (OM) is a prevalent and distressing adverse outcome of cancer therapies, including chemotherapy and radiation therapy. It is an inflammatory ailment that impacts the mucous membrane inside the mouth, tongue, gums, and throat. OM can cause pain, discomfort, difficulty swallowing, and in severe cases, it can lead to infection and delayed cancer treatment. Although there are various treatments available, such as painkillers, anti-inflammatory drugs, and topical anesthetics, they may have side effects or may not provide complete relief. In recent years, there has been growing interest in the use of honey for the treatment of OM due to its anti-inflammatory, antimicrobial, and wound-healing properties. Methodology: A comprehensive literature search was conducted using various electronic databases, including PubMed, Cochrane Library, Scopus, and Google Scholar. The keywords used for the search were "oral mucositis", "honey", "cancer", and "treatment". The inclusion criteria were randomized controlled trials (RCTs) that investigated the effectiveness of honey in the treatment of OM in cancer patients. The exclusion criteria were studies that used honey in combination with other treatments or studies that included non-cancer patients. Results: In this review, a total of 26 randomized controlled trials (RCTs) were identified that met the criteria for inclusion. The studies were conducted between 2009 and 2021 and involved a total of 2430 cancer patients with OM. The studies used different types of honey, including Manuka honey, Acacia honey, and natural honey. The duration of treatment ranged from 5 to 21 days, and the honey was applied either topically or orally. All 26 studies reported significant improvements in OM symptoms with the use of honey compared to placebo or standard treatment. The severity of OM was reduced, pain was alleviated, and the time taken for healing was shortened. Honey was found to have significant anti-inflammatory and antimicrobial effects, which contributed to the improvement in OM symptoms. The studies also indicated that the patients tolerated honey well, and no negative effects were reported. Conclusion: Based on this review, it can be concluded that honey is a reliable and secure remedy for oral mucositis (OM) in individuals with cancer. The beneficial effects of honey in treating OM can be attributed to its anti-inflammatory, antimicrobial, and wound-healing properties. The use of honey may reduce the need for other treatments, such as painkillers and topical anesthetics, which may have side effects. Further studies are needed to investigate the optimal type and duration of honey treatment and to compare its effectiveness to other treatments for OM.

Keywords

References (29)

  1. Sonis ST, Elting LS, Keefe D, Peterson DE, Schubert M, Hauer-Jensen M, et al. Perspectives on cancer therapy-induced mucosal injury. Cancer. 2004;100(S9):1995-2025. doi:10.1002/cncr.20162
  2. Molan PC. Potential of Honey in the Treatment of Wounds and Burns. American Journal of Clinical Dermatology. 2001;2(1):13-19. doi:10.2165/00128071-200102010-00003
  3. Majtan J, Kumar P, Majtan T, Walls AF, Klaudiny J. Effect of honey and its major royal jelly protein 1 on cytokine and MMP‐9 mRNA transcripts in human keratinocytes. Exp Dermatol. 2010 Aug; 19(8): e73–
  4. Rashad UM, Al-Gezawy SM, El-Gezawy E, Azzaz AN. Honey as topical prophylaxis against radiochemotherapy-induced mucositis in head and neck cancer. The Journal of Laryngology & Otology. 2008;123(2):223-228. doi:10.1017/s0022215108002478
  5. Elad S, et al. Topical preparations for the management of oral ulcers in cancer patients: a systematic review and meta-analysis. Support Care Cancer. 2010; 18(9): 1139–
  6. Gouvêa de Lima A, Villar RC, de Castro G, Antequera R, Gil E, Rosalmeida MC, et al. Oral Mucositis Prevention By Low-Level Laser Therapy in Head-and-Neck Cancer Patients Undergoing Concurrent Chemoradiotherapy: A Phase III Randomized Study. International Journal of Radiation Oncology*Biology*Physics. 2012;82(1):270-275. doi:10.1016/j.ijrobp.2010.10.012
  7. Haddad R, Wirth L, Costello R, Weeks L, Posner M. Phase II randomized study of concomitant chemoradiation using weekly carboplatin/paclitaxel with or without daily subcutaneous amifostine in patients with newly diagnosed locally advanced squamous cell carcinoma of the head and neck. Seminars in Oncology. 2003;30:84-88. doi:10.1053/j.seminoncol.2003.11.011
  8. Kwon SM, Lee JH, Lee SH, Jung SY, Kim DY, Kang SH, et al. Cross Talk with Hematopoietic Cells Regulates the Endothelial Progenitor Cell Differentiation of CD34 Positive Cells. PLoS ONE. 2014;9(8):e106310. doi:10.1371/journal.pone.0106310
  9. El–Housseiny A, Saleh S, El–Masry A, Allam A. The Effectiveness of Vitamin "E" in the Treatment of Oral Mucositis in Children Receiving Chemotherapy. Journal of Clinical Pediatric Dentistry. 2007;31(3):167-170. doi:10.17796/jcpd.31.3.r8371x45m42l10j7
  10. Cho HK, Jeong YM, Lee HS, Lee YJ, Hwang SH. Effects of honey on oral mucositis in patients with head and neck Cancer: A meta‐analysis. The Laryngoscope. 2015;125(9):2085-2092. doi:10.1002/lary.25233
  11. Najafi A, Sequeira V, Kuster DWD, van der Velden J. β‐adrenergic receptor signalling and its functional consequences in the diseased heart. European Journal of Clinical Investigation. 2016;46(4):362-374. doi:10.1111/eci.12598
  12. Co JL, Mejia MBA, Que JC, Dizon JMR. 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 & Neck. 2016;38(7):1119-1128. doi:10.1002/hed.24431
  13. Amouzegar Hashemi FA, Barzegartahamtan M, Mohammadpour RA, Sebzari A, Kalaghchi B, Haddad P. Comparison of conventional and hypofractionated radiotherapy in breast cancer patients in terms of 5-year survival, locoregional recurrence, late skin complications and cosmetic results. Asian Pac J Cancer Prev. 2016;17(11):4819-23. doi:10.22034/APJCP.2016.17.11.4819.
  14. Hupp EJR, Epstein JB, Schubert MM. Oral mucositis in myelosuppressive cancer therapy. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 1999;88(3):273-276. doi:10.1016/s1079-2104(99)70026-0
  15. Mohamed ASR, Rosenthal DI, Awan MJ, Garden AS, Kocak-Uzel E, Belal AM, et al. Methodology for analysis and reporting patterns of failure in the Era of IMRT: head and neck cancer applications. Radiation Oncology. 2016;11(1). doi:10.1186/s13014-016-0678-7
  16. Salih AM, Kakamad FH, A. H. D, J. Habibullah I, M. Rauf G, Najar KA. Parasitic leiomyoma: A case report with literature review. International Journal of Surgery Case Reports. 2017;41:33-35. doi:10.1016/j.ijscr.2017.10.003
  17. Eslami E, Barkhordar H, Abramovitch K, Kim J, Masoud MI. Cone-beam computed tomography vs conventional radiography in visualization of maxillary impacted-canine localization: A systematic review of comparative studies. American Journal of Orthodontics and Dentofacial Orthopedics. 2017;151(2):248-258. doi:10.1016/j.ajodo.2016.07.018
  18. Abdollahi E, Momtazi AA, Johnston TP, Sahebkar A. Therapeutic effects of curcumin in inflammatory and immune‐mediated diseases: A nature‐made jack‐of‐all‐trades? Journal of Cellular Physiology. 2017;233(2):830-848. doi:10.1002/jcp.25778
  19. Samdariya S, Lewis S, Kauser H, Ahmed I, Kumar D. A randomized controlled trial evaluating the role of honey in reducing pain due to radiation induced mucositis in head and neck cancer patients. Indian Journal of Palliative Care. 2015;21(3):268. doi:10.4103/0973-1075.164892
  20. Sharifi‐Rad M, Varoni EM, Iriti M, Martorell M, Setzer WN, del Mar Contreras M, et al. Carvacrol and human health: A comprehensive review. Phytotherapy Research. 2018;32(9):1675-1687. doi:10.1002/ptr.6103
  21. Zandi H, Kristoffersen AK, Ørstavik D, Rôças IN, Siqueira JF, Enersen M. Microbial Analysis of Endodontic Infections in Root-filled Teeth with Apical Periodontitis before and after Irrigation Using Pyrosequencing. Journal of Endodontics. 2018;44(3):372-378. doi:10.1016/j.joen.2017.11.019
  22. Al-Kamel A, Baraniya D, Al-Hajj WA, Halboub E, Abdulrab S, Chen T, et al. Subgingival microbiome of experimental gingivitis: shifts associated with the use of chlorhexidine andN-acetyl cysteine mouthwashes. Journal of Oral Microbiology. 2019;11(1):1608141. doi:10.1080/20002297.2019.1608141
  23. Li J, Choi PS, Chaffer CL, Labella K, Hwang JH, Giacomelli AO, et al. An alternative splicing switch in FLNB promotes the mesenchymal cell state in human breast cancer. eLife. 2018;7. doi:10.7554/elife.37184
  24. Zarezadeh Mehrizi M, Momeni MR, Beygi R, Eisaabadi B. G, Kim BH, Kim SK. Reaction pathway of NiAl/WC nanocomposite synthesized from mechanical activated Ni Al W C powder system. Ceramics International. 2019;45(9):11833-11837. doi:10.1016/j.ceramint.2019.03.062
  25. Al Jaouni SK, Al Muhayawi MS, Hussein A, Elfiki I, Al-Raddadi R, Al Muhayawi SM, et al. Effects of Honey on Oral Mucositis among Pediatric Cancer Patients Undergoing Chemo/Radiotherapy Treatment at King Abdulaziz University Hospital in Jeddah, Kingdom of Saudi Arabia. Evidence-Based Complementary and Alternative Medicine. 2017;2017(1). doi:10.1155/2017/5861024
  26. Khan A, Aldebasy YH, Alsuhaibani SA, Khan MA. Thymoquinone Augments Cyclophosphamide-Mediated Inhibition of Cell Proliferation in Breast Cancer Cells. Asian Pacific Journal of Cancer Prevention. 2019;20(4):1153-1160. doi:10.31557/apjcp.2019.20.4.1153
  27. Gkantaifi A, Alongi F, Vardas E, Cuccia F, Hajiioannou J, Kyrodimos E, et al. Honey Against Radiation-induced Oral Mucositis in Head and Neck Cancer Patients. An Umbrella Review of Systematic Reviews and Meta- Analyses of the Literature. Reviews on Recent Clinical Trials. 2021;15(4):360-369. doi:10.2174/1574887115666200709140405
  28. Tian X, Xu L, Liu X, Wang CC, Xie W, Jiménez-Herrera MAF, et al. Impact of honey on radiotherapy-induced oral mucositis in patients with head and neck cancer: a systematic review and meta-analysis. Annals of Palliative Medicine. 2020;9(4):1431-1441. doi:10.21037/apm-20-44
  29. Ameri A, Poshtmahi S, Heydarirad G, Cramer H, Choopani R, Hajimehdipoor H, et al. Effect of Honey–Lemon Spray Versus Benzydamine Hydrochloride Spray on Radiation-Induced Acute Oral Mucositis in Head and Neck Cancer Patients: A Pilot, Randomized, Double-Blind, Active-Controlled Clinical Trial. The Journal of Alternative and Complementary Medicine. 2021;27(3):255-262. doi:10.1089/acm.2020.0468