Adjuvant honey for chemoradiotherapy and oral mucositis and relieve pain

Objective: To evaluate the role of honey in preventing oral mucositis and related pain caused by radiotherapy and chemotherapy.

Methods: The computer retrieved TheCochrane Library, PubMed, Web of Science, Chinese Biomedical Literature Database (CBM), VIP Information Resource System (VIP), China Knowledge Network (CNKI), and Wanfang Data. In September 2018, a randomized controlled trial on honey for oral mucositis and related pain after radiochemotherapy was included. After 2 researchers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and evaluated the methodological quality of the included studies, the RevMan 5.3 software was used for meta-analysis. RESULTS: A total of 15 articles were included in a total of 856 patients.

Meta analysis results show that honey can reduce severe oral mucositis [RR = 0.48, 95% CI (0.35, 0.66), P <0 -0.57="" -3.72="" .001="" 0.10="" 0.21="" 0.49="" 0.75="" 95="" and="" ci="" colonization="" delay="" fungal="" interruption="" loss="" mucositis-related="" mucositis.="" of="" onset="" oral="" p="0.02]," pain="" severe="" span="" the="" treatment="" weight="">

Conclusion: Current evidence indicates that honey is a reasonable adjuvant treatment for chemoradiotherapy and oral mucositis and alleviates related pain, and more randomized controlled trials are needed to confirm its effect.

Honey can reduce the incidence of severe oral mucositis and oral fungal colonization after chemoradiotherapy, and delay the occurrence of severe oral mucositis

Studies have shown that honey can reduce the incidence of severe oral mucositis after chemotherapy. However, the Meta results of Co and others showed that the effect of honey on reducing the incidence of severe oral mucositis after radiotherapy was not different from that of the control group, which may be related to the small sample size and excessive heterogeneity between studies. This study included newly published related studies and performed a sensitivity analysis to find sources of heterogeneity. In addition, from the analysis of the occurrence of severe oral mucositis in different intervention cycles, honey has a certain effect in delaying the occurrence of severe oral mucositis, which is consistent with the findings of Co et al. [29].

Studies have shown that honey has been used to treat burns, surgical wounds, and oral infections because of its antibacterial, analgesic, and epithelialization-promoting effects. The effectiveness of honey on oral mucositis may be due to the high permeability, viscosity, and acidic pH of honey, which can prevent bacteria from growing on the mucosa, and honey contains glucose oxidase, which interacts with glucose to produce hydrogen peroxide with antibacterial effects. In addition, honey also activates the immune system by energizing white blood cells, which is well tolerated by patients.

It is worth noting that although honey has a certain theoretical basis in reducing the incidence of oral fungal colonization, the results are based on 2 small sample studies, intervention and control of 40 samples each, which may affect the reliability of the results and need further Large sample studies confirm it.

Honey can reduce the incidence of patients with mucositis-related pain and treatment interruptions due to oral mucositis

Sonis et al. Described that honey's analgesic and anti-inflammatory activity is due to the inhibition of signal amplification of pro-inflammatory cytokines such as the secretion of tumor necrosis factor alpha, IL-1 and IL-6. The results of this study cannot be combined because of the different evaluation criteria of the two studies [22,27], and both are described, but the results of both studies confirm the efficacy of honey on mucositis-related pain. Severe oral mucositis and related pain can make patients abandon cancer treatment, and when mucositis and related pain are controlled, the incidence of treatment interruptions they may cause may also decrease. However, other factors that may lead to differences in treatment interruptions must be considered, such as patients' subjective perception of mucositis and doctors tolerating treatment interruptions.

Effect of honey on oral mucositis on patients' body weight

The influence of honey treatment on the change of patient's body weight varies from study to study, and due to different expressions, it cannot be combined to obtain more accurate results. However, from the current results, the effect of the honey treatment group on the weight loss of the patients was small, and even the body weight increased more. This may be due to the late onset of mucositis and less severe mucositis in the honey treatment group, which allows patients to eat orally, resulting in less weight loss or even more increase. However, changes in body weight are related to the patient's physique and treatment status, so the overall condition of the patient should be paid attention to.

Conclusion and outlook

The results of this study show that honey can reduce the risk of severe mucositis and related pain in patients after radiotherapy and chemotherapy, delay the occurrence of severe mucositis in patients, reduce the incidence of oral fungal colonization and treatment interruption, and have less impact on patients' body weight. Based on the results of this study, honey may be a reasonable adjunct to the treatment of oral mucositis and related pain. However, considering that some outcome indicators cannot be combined, it is recommended to carry out high-quality, large-sample, multi-center randomized controlled studies in order to provide a basis for clinically standardized honey treatment.

(Source: "Chinese Nursing Management" 2019, No. 5 Author: Zhou Linlin Sushao Chen Zhai Tian Jin Qi Mei Li Yumin Tiansu Yan Huo Shaojuan Mason)