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Meta-Analysis
. 2024 May-Jun;38(3):1397-1404.
doi: 10.21873/invivo.13581.

Honey in Alleviating Severe Oral Mucositis Among Head and Neck Cancer Patients Undergoing Radiation Therapy

Chen-Pi Li  1   2 , Shuo-Yan Gau  3 , Chin-Chang Chen  4   5 , Chieh-Hsin Kao  3 , Ru-Yin Tsai  6   5 , Hao-Jan Yang  7   8
Affiliations
Meta-Analysis

Honey in Alleviating Severe Oral Mucositis Among Head and Neck Cancer Patients Undergoing Radiation Therapy

Chen-Pi Li et al. In Vivo. 2024 May-Jun.

Abstract

Background/aim: Aiming to resolve debates on honey's efficacy for radiotherapy-induced severe oral mucositis in head and neck cancer, we conducted a meta-analysis focused on randomized trials, primarily assessing severe mucositis incidence. Secondary outcomes included weight loss, pain management, and honey types.

Materials and methods: A comprehensive literature search was conducted in PubMed, Embase, WOS, and the Cochrane Library up to December 2023. The analysis concentrated on randomized controlled trials that assessed the efficacy of honey, targeting the incidence of mucositis as the main outcome. Additional outcomes explored were weight loss, intolerable pain, and the specific types of honey used in interventions. Data analysis was performed using CMA software, and a funnel plot was employed to identify publication bias.

Results: The analysis of 176 records resulted in the inclusion of 10 studies with 599 patients receiving radiotherapy. The research showed that honey significantly reduced the occurrence of grade 3-4 mucositis (severe mucositis), provided significant pain relief, and had a positive effect on reducing weight loss. Regarding the type of honey used, no significant differences were found in their effectiveness in alleviating severe mucositis.

Conclusion: Honey serves as an effective intervention for individuals with oral mucositis. It can be considered as an adjuvant in the management of clinical radiotherapy-associated oral mucositis, particularly for patients requiring prolonged use of anti-analgesic or antifungal medications.

Keywords: Head and neck cancer; anti-analgesic; antifungal; chronic pain; ulcer.

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Conflict of interest statement

The Authors declare no conflicts of interest in relation to this study.

Figures

Figure 1
Figure 1. Diagram of the study selection process for the systematic review and meta-analysis.
Figure 2
Figure 2. Assessment of methodological quality of the included trials. (A) Risk of bias for each included study. (B) The overall summary of bias of the ten studies.
Figure 3
Figure 3. The effect of honey on radiation-induced oral mucositis by WHO and RTOG scales was compared with placebo from the 2nd week (A), 4th week (B) to the 6th week (C) of treatment. (D) Funnel plot for figure C studies reporting.
Figure 4
Figure 4. Subgroup analysis of the effects of honey on body weight loss (A) and pain relief (B) after radiotherapy. (C) Subgroup analysis of the effect of different honey types on radiation-induced oral mucositis by WHO and RTOG scales was compared with placebo at treatment completion. (D) Funnel plot for figure C studies reporting.
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