Aims
Chemo- and radiotherapy-induced oral mucositis can potentially cause reduced quality of life, treatment interruptions, decreased nutritional status, and severe pain in cancer patients. Honey, propolis and royal jelly are proposed treatments for oral mucositis primarily due to their antioxidant, antibacterial and anti-inflammatory effects. The aim of this systematic review was to assess the effectiveness of honey and bee products in the prevention and treatment of oral mucositis in cancer patients.
Methods
Five electronic databases were searched (Cochrane, PubMed, Science Direct, Scopus, Web of Science) following the PRISMA (2015) guidelines, for randomised controlled trials assessing the effect of honey and bee products in the prevention and treatment of oral mucositis in cancer patients.
Results
In total, 9307 records were identified, with 11 studies included after the application of exclusion criteria. Only studies that used honey as a treatment met the inclusion criteria. These studies included head and neck cancer patients receiving radiotherapy (n=7) or concurrent chemo-radiotherapy (n=3), and leukaemia patients receiving chemotherapy (n=1). Regardless of cancer type or treatment utilised, topically applied undiluted honey was effective in delaying onset and reducing severity of oral mucositis compared with control groups (n=10; p<0.05). Honey application also improved patient’s quality of life, and fewer treatment interruptions were reported. The exception was where Manuka honey was utilised (n=1), where considerable withdrawals were attributed to honey composition and no difference in peak mucositis score between groups (p=0.77).
Conclusions
Based on the observed findings, it appears that honey application is a potentially effective method in the prevention and treatment of oral mucositis induced by chemo- and radiotherapy in cancer patients. Nevertheless, larger trials should be conducted in future with focus on timing of the treatment and application duration. In addition, study design should take the bioactive composition of the utilised honey into consideration.