A double-blind, placebo-controlled, randomised trial of active manuka honey and standard oral care for radiation-induced oral mucositis


      Our aim was to investigate the effect of active manuka honey on radiation-induced mucositis. A total of 131 patients diagnosed with head and neck cancer who were having radiotherapy to the oral cavity or oropharyngeal area were recruited into the study, and were randomly allocated to take either manuka honey or placebo (golden syrup) 20 ml 4 times daily for 6 weeks. Mucositis was assessed according to the Radiation Therapy Oncology Group (RTOG) scale at baseline, weekly during radiotherapy, and twice weekly thereafter until the mucositis resolved. The patient's weight was recorded at the same time as the mucositis was assessed. Throat swabs to identify bacterial or fungal infections were taken at baseline, and during and after radiotherapy. There was no significant difference between honey and golden syrup in their effects on mucositis. Active manuka honey did not improve mucositis, but both the honey and the syrup seemed to be associated with a reduction in bacterial infections. Compliance was a problem after the onset of mucositis, which may have affected the findings.


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        • Scully C.
        • Epstein E.
        • Sonis S.
        Oral mucositis: a challenging complication of radiotherapy, chemotherapy, and radiochemotherapy. Part 1, pathogenesis and prophylaxis of mucositis.
        Head Neck. 2003; 25: 1057-1070
        • Rubenstein E.B.
        • Peterson D.E.
        • Schubert M.
        • Keefe D.
        • McGuire D.
        • Epstein J.
        Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis.
        Cancer. 2004; 100: 2026-2046
        • Stokman M.A.
        • Spijkervet F.K.
        • Burlage F.R.
        • Dijkstra P.U.
        • Manson W.L.
        • de Vries E.
        Oral mucositis and selective elimination of oral flora in head and neck cancer patients receiving radiotherapy: a double-blind randomised clinical trial.
        Br J Cancer. 2003; 88: 1012-1016
        • Nicolatou-Galitis O.
        • Dardoufas K.
        • Markoulatos P.
        • Sotiropoulou-Lontou A.
        • Kyprianou K.
        • Kolitsi G.
        Oral pseudomembranous candidiasis, herpes simplex virus-1 infection, and oral mucositis in head and neck cancer patients receiving radiotherapy and granulocyte-macrophage colony-stimulating factor (GM-CSF) mouthwash.
        J Oral Pathol Med. 2001; 30: 471-480
        • Biswal B.M.
        • Zakaria A.
        • Ahmad N.M.
        Topical application of honey in the management of radiation mucositis: a preliminary study.
        Support Care Cancer. 2003; 11: 242-248
        • Epstein J.B.
        • Schubert M.M.
        Managing pain in mucositis.
        Semin Oncol Nurs. 2004; 20: 30-37
        • Kostler W.J.
        • Hejna M.
        • Wenzel C.
        • Zielinski C.C.
        Oral mucositis complicating chemotherapy and/or radiotherapy: options for prevention and treatment.
        CA Cancer J Clin. 2001; 51: 290-315
        • Dodd M.
        The pathogenesis and characterization of oral mucositis associated with cancer therapy.
        Oncol Nurs Forum. 2004; 31: 5-11
        • Ngeow W.C.
        • Chai W.L.
        • Zain R.B.
        Management of radiation therapy-induced mucositis in head and neck cancer patients. Part II. Supportive treatment.
        Oncol Rev. 2008; 2: 164-182
        • El-Sayed S.
        • Nabid A.
        • Shelley W.
        • Hay J.
        • Balogh J.
        • Gelinas M.
        Prophylaxis of radiation associated mucositis in conventionally treated patients with head and neck cancer: a double-blind phase III randomized controlled trial evaluating the clinical efficacy of an antimicrobial lozenge using a validated mucositis scoring system.
        J Clin Oncol. 2002; 20: 3956-3963
        • Bardy J.
        • Slevin N.J.
        • Mais K.L.
        • Molassiotis A.
        A systematic review of honey uses and its potential value within oncology care.
        J Clin Nurs. 2008; 17: 2604-2623
        • Keefe D.M.
        • Schubert M.M.
        • Elting L.S.
        • Sonis S.T.
        • Epstein J.B.
        • Raber-Durlacher J.E.
        Updated clinical practice guidelines for the prevention and treatment of mucositis.
        Cancer. 2007; 109: 820-831
        • Clarkson J.E.
        • Worthington H.V.
        • Eden O.B.
        Interventions for treating oral mucositis for patients with cancer receiving treatment.
        Cochrane Database Syst Rev. 2007; : CD001973
        • Worthington H.V.
        • Clarkson J.E.
        • Eden O.B.
        Interventions for preventing oral mucositis for patients with cancer receiving treatment.
        Cochrane Database Syst Rev. 2006; : CD000978
        • Symonds R.P.
        Treatment-induced mucositis: an old problem with new remedies.
        Br J Cancer. 1998; 77: 1689-1695
        • Makkonen T.A.
        • Bostrom P.
        • Vilja P.
        • Joensuu H.
        Sucralfate mouthwashes in the prevention of radiation induced mucositis: a placebo controlled double blind randomized study.
        Int J Radiat Oncol Biol Phys. 1994; 30: 177-182
        • Wasserman T.
        • Mackowiak J.I.
        • Brizel D.M.
        • Oster W.
        • Zhang J.
        • Peeples P.J.
        • et al.
        Effect of amifostine on patient assessed clinical benefit in irradiated head and neck cancer.
        Int J Radiat Oncol Biol Phys. 2000; 48: 1035-1039
        • McInerney R.J.
        Honey—a remedy rediscovered.
        J R Soc Med. 1990; 83: 127
      1. Molan PC. Honey as a topical antibacterial agent for the treatment of infected wounds. World Wide Wounds 2001, [accessed 6th February 2010].

        • Atrott J.
        • Henle T.
        Methylglyoxal in Manuka honey—correlation with antibacterial properties.
        Czech J Food Sci. 2009; 27: S163-S165
        • Rashad U.M.
        • Al-Gezawy S.M.
        • El-Gezawy E.
        • Azzaz A.N.
        Honey as topical prophylaxis against radiochemotherapy-induced mucositis in head and neck cancer.
        J Laryngol Otol. 2009; 123: 223-228
        • Motallebnejad M.
        • Akram S.
        • Moghadamnia A.
        • Moulana Z.
        • Omidi S.
        The effect of topical application of pure honey on radiation-induced mucositis: a randomized clinical trial.
        J Contemp Dent Pract. 2008; 9: 40-47
        • Maddocks-Jennings W.
        • Wilkinson J.M.
        • Cavanagh H.M.
        • Shillington D.
        Evaluating the effects of the essential oils Leptospermum scoparium (manuka) and Kunzea ericoides (kanuka) on radiotherapy induced mucositis: a randomized, placebo controlled feasibility study.
        Eur J Oncol Nurs. 2009; 13: 87-93
        • Epstein J.B.
        • Silverman Jr., S.
        • Paggiarino D.A.
        • Crockett S.
        • Schubert M.M.
        • Senzer N.N.
        Benzydamine HCl for prophylaxis of radiation-induced oral mucositis: results from a multicenter, randomized, double-blind, placebo-controlled clinical trial.
        Cancer. 2001; 92: 875-885
        • Khanal B.
        • Baliga M.
        • Uppal N.
        Effect of topical honey on limitation of radiation-induced oral mucositis: an intervention study.
        Intl J Oral Maxillofac Surg. 2010; 39: 1181-1185