The Effects of Comvita Manuka Honey on Oral Mucositis in Patients treated with Radiation Therapy to the Head and Neck

Mucositis is a common side effect of radiation therapy to the head and neck region and one that causes considerable discomfort for patients. Mucositis compromises patients ability to eat, drink and talk thus affecting patient health and quality of life. Currently there is no worldwide standard for the prevention or treatment of oral mucositis; care is limited to symptom control. Honey has anti-bacterial and potential anti-inflammatory properties and three trials overseas investigated its effect on radiation-induced oral mucositis. The three trials conducted in Malaysia, Iran and Egypt found that honey did reduce the incidence of severe mucositis in head and neck patients. This New Zealand mucositis trial aimed to verify the results from the three overseas trials by comparing the effects of manuka honey with current best practice on oral mucositis in head and neck patients. This report analyses a sub-set of the patients recruited to the trial; those from the Wellington and Dunedin departments. A total of 14 patients were recruited to the trial from these departments, nine recruited to the honey arm and five to the control arm. Four honey patients withdrew from the trial due to issues with the honey application and one patient withdrew from the control arm. Honey arm patients were given manuka honey and instructed to swirl 20mL (amended to 10mL) around their oral cavity and then swallow three times a day, these patients also had access to the standard of care. The control arm patients were treated with the standard of care alone. Patient assessment involved three times weekly mucositis scoring using the TROG multi-site mucositis scoring system, weekly weight and fortnightly quality of life assessment using a 65 question form adapted from the European organisation for Research and Treatment of Cancer questionnaires (EORTC QLQ-C30 and EORTC QLQ HN35). Patients were also asked to fill in food and drug diaries to assess changes in food intake and pain medication. Results showed that manuka honey was not well tolerated by our patient cohort. Patients complained of extreme nausea and stinging sensations in the oral cavity. The honey had to be diluted to be better tolerated (1:3 with another liquid). Contradictory to previous studies, preliminary analysis showed that manuka honey did not affect the extent of oral mucositis in the small cohort of New Zealand head and neck patients when taken in addition to current best practice