Impact of honey on radiotherapy-induced oral mucositis

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.