Impact of honey on radiotherapy-induced oral mucositis in patients with head and neck cancer: a systematic review and meta-analysis

Abstract

Background: Oral mucositis is one of the most frequent, irreversible and distressing complications faced by head and neck cancer (HNC) patients undergoing radiotherapy. Several studies have investigated the role of honey in the prevention and alleviation of radiation-induced oral mucositis in HNC patients, however, a definitive conclusion has not yet been generated. We performed this updated systematic review and metaanalysis to determine whether honey can prevent and alleviate radiation-induced oral mucositis in HNC patients.Methods: We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and China National Knowledge Infrastructure (CNKI) through October 2019. We searched and selected literature, extracted data and assessed risk of bias accordingly, and then conducted statistical analyses with RevMan software version 5.3.Results: Seven trials involving 412 patients were included in the final analysis. Meta-analyses showed that honey did not decrease the incidence of radiation-induced oral mucositis [(relative risk (RR), 0.69; 95% confidence interval (CI), 0.40-1.18; P=0.18]; however, relieved the severity of oral mucositis (RR, 0.22; 95% CI, 0.13-0.38; P<0.001), maintained or increased weight (RR, 1.92; 95% CI, 1.33-2.77; P<0.001) and reduced the treatment interruption related to oral mucositis (RR, 0.13; 95% CI, 0.02-0.97; P=0.05).Qualitative analysis also revealed a decreased incidence of oral mucositis in the honey group.Conclusions: Based on limited evidence, honey may have a clinical benefit against radiation-induced oral mucositis in HNC patients. However, future trials with large-scale and rigorous methods are warranted to further establish the role of honey in the management of radiation-induced oral mucositis.

A Narrative Review about Nutritional Management and Prevention of Oral Mucositis in Haematology and Oncology Cancer Patients Undergoing Antineoplastic Treatments

“…Münstedt and Männle (2019) [73] in their review evaluating the use of honey as an OM treatment showed a decrease in the severity of the ulcers, which harmonized with the scientific articles found in the present paper and in the systematic review and meta-analysis conducted by Tian et al (2020) [74].…”

“…Other aspects mentioned by Tian et al (2020) [74] include the indication of a potential decrease in the incidence of OM during the treatment with honey; however, from the present study, only one study proved significant prevention.…”

Intra-socket application of medical-grade honey after tooth extraction attenuates inflammation and promotes healing in cats

“… 42 MGH could reduce pain when used in other oral conditions in humans such as mucositis and tonsillectomy wounds, as reported in two meta-analyses. 43 , 44 …”

“…42 MGH could reduce pain when used in other oral conditions in humans such as mucositis and tonsillectomy wounds, as reported in two meta-analyses. 43,44 To investigate the underlying mechanism of how MGH improves intra-oral wound healing in more detail, future research may include additional possible objective outcome measures, such as inflammatory markers (systemically in the blood or locally in potential exudate), alveolar bone formation and microbiological colonisation. As these parameters are harder to evaluate, requiring extra blood sampling, CT and/or sedation, and these procedures result in increased discomfort, such investigations would require prior ethical approval.…”

Noninvasive Systemic Modalities for Prevention of Head and Neck Radiation-Associated Soft Tissue Injury: A Narrative Review

“…Much of the existing literature has focused on treatments after radiation injury has occurred, ranging from topical agents, such as honey, to more invasive measures, such as fat grafting. 8 9 10 Preventative modalities are poorly represented; the best studied measures are typically nonspecific interventions that are largely out of the surgeon's control, such as modulation of radiation doses and maintenance of good oral hygiene. 11 12 Few specific interventions are described, and even fewer are supported by a wide body of clinical evidence.…”