Effect of Topical Application of Pure Honey in Chemo-radiation-Induced Mucositis and Its Clinical Benefits in Improving Quality of Life in Patients of Oral Squamous Cell Carcinoma

Abstract

Oral cancer is a major health problem in India, and in certain parts, it represents more than 50% of all cancers. Since almost all of these patients receive chemoradiotherapy with or without surgery for treatment, a vast majority of them also develop oral mucositis, a debilitating adverse effect of chemo-radiation. There have been various reports in the literature regarding the beneficial role of honey in the management of oral mucositis. The objective of this study was to investigate whether the application of honey in mucositis confers any significant improvement in lesions of mucositis and more specifically whether application of honey brings about any improvement in the quality of life of patients suffering from chemo-radiationinduced oral mucositis. If found to be beneficial, honey could provide a simple, elegant and cost-effective solution to a troublesome health problem, thus benefiting a large number of patients.

The Effect of Honey as a Treatment for Oral Ulcerative Lesions: A Systematic Review

“…In a study by Biswal et al, 24 patients receiving radiotherapy for head and neck cancer were provided with 20 mL of honey to smear on the inside of their mouths, and instructed to swallow it slowly in order to coat both the oral and pharyngeal mucosa, with application occurring 15 min before and after they received radiotherapy and 6 h after receiving radiotherapy, for the duration of the treatment cycle. This study design was also replicated by other studies included in this review, 27,29-32 with Jayalekshmi et al 28 and Howlader et al 26 with slight modifications, namely use of 15 mL of honey 28 and consumption of additional honey to potentially contribute to serum antioxidant levels. 26 The remaining studies investigating OM utilized study designs similar to those above, topically coating the oral cavity with honey; however, the amounts of honey used and timing of application were different.…”

“…Articles were further excluded due to use of diluted honey with or without the use of additional therapies (n = 14), unsuitable oral health conditions (n = 12) and study design (n = 8), with 13 studies fitting the inclusion criteria. [22][23][24][25][26][27][28][29][30][31][32][33][34] An article investigating the use of honey to assist in the recovery of dental extraction surgery 35 was considered but it was determined that since this wound is due to surgery, and not a condition unique to the oral cavity, this article was excluded.…”

“…The characteristics of the included studies are presented in Table 1. [22][23][24][25][26][27][28][29][30][31][32][33][34] The total number of participants recruited in the included studies was 634, with sample sizes ranging from 20 to 106 participants. Of these, 11 studies investigated oral mucositis (OM) in 579 cancer patients, 22-32 1 investigated 35 participants with denture-induced ulcers, 33 and 1 investigated 20 participants with recurrent aphthous stomatitis (RAS).…”

“…34 Although the selection criteria of this review was designed to include a broad range of oral health conditions, the intervention was common across studies, with pure, undiluted honey being applied topically to affected areas in the mouths of patients in the treatment groups. The type of honey and their floral sources used in the included studies was largely unspecified 26,28,30,33,34 ; however, two studies stated that the honey was sourced from a commercial supermarket. 23,27 Five of the studies identified the local flora that was used in the production of the honey used, 22,24,29,31,32 and one study specified their use of Manuka honey.…”

“…22,23 Participants with radiotherapy-induced OM were included in six studies, 24,25,27-29,31 with 1 study having investigated chemotherapy-induced OM 22 and 4 having determined the effect of honey on concurrent chemo-radiotherapy-induced OM. 23,26,30,32 These studies utilized routine oral care, 23,24,30,32 saline rinses of different concentration ranges (0.9%, 27 0.09%, 31 and unspecified 26 ), water, 28 and a variety of anesthetic and analgesic solutions (7.5% benzocaine gel, 22 15% benzydamine hydrochloride, 27 lignocaine gel 29 ) serving as controls, while only one study utilized a placebo gel 25 and another developed their own mixture. 22…”