• Internal Code :
  • Subject Code : NURS3046
  • University : Univeristy of South Australia
  • Subject Name : Nursing

Introduction to Oral Mucositis

Oral mucositis (OM) is a relatively common side effect among patients receiving chemotherapy and/or radiation therapy, with a prevalence ranging from 20% to 49% in new cancer patients (Sonis 2009). The actual risk of developing OM depends on patient factors such as advanced age (Cakmak & Nural 2019); and treatment factors such as the carcinoma site and the dose of therapy (Brown et al. 2009; Sonis 2009; Vera-Llonch et al. 2006). The pathophysiology of OM involves a complex interaction of biological processes, triggered by the breakdown of deoxyribonucleic acid (DNA) strands following radiation and/or chemotherapy (Sonis 2009). The severity of OM ranges from erythema to ulceration (Sonis et al. 1999), often companied by physical symptoms including dry mouth, reduced appetite, and altered taste (Cakmak & Nural 2019). Patients living with severe episodes of OM have also reported a higher level of anxiety, depression, and fatigue (Brown et al. 2009), and are known to experience a longer hospital stay (Elting et al. 2003).

As an ancient remedy, honey was used as a method of healing (Mandal & Mandal 2011). In modern medicine, the treatment of partial-thickness burns and post-operative wounds with honey is documented (Jull et al. 2015). The healing properties of honey can be attributed to its antimicrobial potential, which impedes the growth of bacterial; and its high concentration of water, which maintains the moist level in the wound bed (Mandal & Mandal 2011). These properties together help create an optimal environment for cell and tissue growth. Previous studies have examined the effects of honey in promoting healing of OM among cancer patients, yet the results have been inconsistent.

Research Question:

Is honey effective in promoting healing of oral mucositis among patients receiving chemotherapy and/or radiation therapy?

Significance of the Question

The research question is highly significant because providing care based on the best available evidence is an integral part of nursing practice (Nursing and Midwifery Board of Australia 2016). The results of this review might inform and complement current nursing practice in the management of oral mucositis among cancer patients. If shown to be effective, honey has the potential to become a readily available remedy in treating OM, subsequently improving the patient's nutrition status and quality of life.

Paper 1

Hawley, P., Hovan, A., McGahan, C.E., and Saunders, D. 2014. A randomized placebo-controlled trial of manuka honey for radiation-induced oral mucositis. Supportive Care in Cancer, 22(3), pp.751-761.

An investigation on the-initiated double-blind randomized placebo-controlled trial that has further helped to analyze if the honey reduced can lead to the radiation-induced oral mucositis (ROM). The trial included the hundred six head and neck cancer patients that has been conducted by the Vancouver and Sudbury Cancer Centers that can belong to Canada and further holds the randomized method to swish, hold, and swallow and would include the method of the 5 ml of irradiated organic manuka honey along with the placebo gel, that has accounted to the four times a day that can represent the radiation treatment along with the plus seven more days. The result concluded how the one hundred including the six patients that have been extensively been recruited. Among the twenty-four that have not attended and would have not been part of the mucositis assessments. Extensively include the one among the off-study that have included the manuka, honey. From the remaining 81 patients includes the least one mucositis assessment part of the analysis. In this, the sixty-two percent of subjects have included the concurrent chemotherapy from which 81 % were male and the groups have been well-matched with the blinding was excellent. The result showed that there was dropout mostly on account of nausea and with the 78% indicating to be tolerated from more than 1week. Indicates the drop out rate to be 57 % showed the honey and further with the 52 % including the placebo gel. The dropout rate indicates the concurrent chemotherapy to be 59 % has been part of the radiation to be 47 %.

Paper 2

Raeessi, M.A., Raeessi, N., Panahi, Y., Gharaie, H., Davoudi, S.M., Saadat, A., Zarchi, A.A.K., Raeessi, F., Ahmadi, S.M. and Jalalian, H. 2014. “Coffee plus Honey” versus “topical steroid” in the treatment of Chemotherapy-induced Oral Mucositis: a randomized controlled trial. BMC complementary and alternative medicine, 14(1), p.293.

The study was the double-blinded extensively been a randomized clinical trial with the inclusion of 75 eligible adult participants that accounted for three treatment groups. Among the three participants includes the syrup-like solution to be prepared. Includes the 600 grams further with the product including the “20 eight-mg Betamethasone solution ampoules” such as the Steroid (S) group and further to be part of “300 grams that can include the honey plus 20 grams including the instant coffee” with the further Honey plus Coffee (HC) group and to note the “300 grams that can honey” concluding the Honey (H) group. The related sip 10 ml includes the prescribed product that can be inhaled every three hours within the given one week. It would help to achieve the severity of lesions that can further be included before the treatment part of 1 week of the intervention. The part of the study indicates how there can be principles of the Declaration that can identify the Helsinki and further be included with the Good Clinical Practice. The result shows how their can that it includes the three treatment regimens that can further help to reduce and make it part of the severity of lesions. In order to reduce the reduction during the severity can be concluded through the HC group. The relation of the H group along with the S group which can be achieved from second and third places and include the honey plus coffee regimen and make it part of the effective modality through the quick treatment done with the oral mucositis.

Paper 3

Bulut, H.K., and Tüfekci, F.G. 2016. Honey prevents oral mocositis in children undergoing chemotherapy: A quasi-experimental study with a control group. Complementary therapies in medicine, 29, pp.132-140.

The experiment includes the quasi-experimental study that can be indicated with the children that are going with the chemotherapy. To research, the study group indicates the 83 children that have been part of clinics along with the polyclinics done for the chemotherapy. The study included the children who have been part of the extensive study period. The study included a total of 76 children that have been part except for the seven patients that have been excluded. This study's objective was to access and check the effectiveness of oral care with honey for the children that have been part of chemotherapy anticipated for the prevention and healing aimed for oral mucositis. The mode of the data was taken from World Health Organization Mucositis Assessment Index and used brief percentage distributions that have been part of the means, a chi-square test along with the t-test with the variance analysis and having the Friedman test.

Further, the inclusion of the severity that can include the oral mucositis that has been part of the children that are part of the experimental group that is less than the control group. It includes the mucositis recovery period within the experimental group to be consistent with the control group. Through the regular oral care with honey done for the children have to be part of the chemotherapy for hematological cancers that can resort to mucositis and further help to accelerate the mucositis onset. Through the treatment of oral mucositis, the inclusion of the methods and products would have not been part of the consensus to offer the best results.

Paper 4

Charalambous, M., Raftopoulos, V., Paikousis, L., Katodritis, N., Lambrinou, E., Vomvas, D., Georgiou, M., and Charalambous, A., 2018. The effect of the use of thyme honey in minimizing radiation-induced oral mucositis in head and neck cancer patients: A randomized controlled trial. European Journal of Oncology Nursing, 34, pp.89-97.

The method includes the randomized controlled trial (RCT) that would include the 72 head along with the neck cancer patients that have been divided through the intervention group (thyme honey rinses) and further to control group (saline rinses). The inclusion of oral mucositis has been done with the help of Radiation Therapy Oncology Group (RTOC criteria) and it would include the assessment that has been done over the consistent weekly starting from the 4th week done over the radiotherapy consistent for the seven weeks and with the repeated over the 6 months later. Further, the assessment is done from the Oral Mucositis Weekly Questionnaire(OMWQ) that has been done through the 4th week of radiotherapy and with the1month part of the completion done with the help of radiotherapy along with the 6 months later.

The paper also has the consistent findings that can include the hyme honey's effectiveness placed over the oral mucositis. the results indicate how through estimating equations, it can help to identify the patients that can be part of the intervention group that would be related graded lower done with the objective assessment part of the oral mucositis (p < 0,001) that would be accessed with the maintained relation to body weight (p < 0,001) and it includes the improvement with the fair global health (p=0.001) that can relate with the control group. Further, it includes the quality of life part of the patients in the same group that has been statistically higher including the patients part of the control group (p < 0,001).

Results and Discussion of Honey's Effectiveness in Promoting Healing of Oral Mucositis

Compare and Contrast

In the article” A randomized placebo-controlled trial of manuka honey for radiation-induced oral mucositis” , the result identifies how the analysis can be subjective to recruit and further include the study from 106 patients. It would be significant to the concerns included the recruitment rate and include the subjects dropping that have caused nausea. The result shows nausea that can include the radiation±chemotherapy and not with the main aim through the honey and placebo that can include the gagging along with the worsening of nausea can be due to the thick consistency (Hawley, 2014). To include the prior studies' part of the positive results that can be decreasing numbers included the patients to include the risk of assigned placebo and to include the manuka honey part of the health food stores.

The strength the 62 %, more than twice the related to the number of patients which can be included with the expected received CRT having the slightly (that have been part of the statistically significantly) that can include the patients such as the chemotherapy due to the placebo arm done with the honey arm.

The limitation is the time on the study that has been identified the time from first treatment which can include the last mucositis assessment, and the relation the patient which would be due to the study product

In the article, “Coffee plus Honey” versus “topical steroid” in the treatment of Chemotherapy-induced Oral Mucositis: a randomized controlled trial”, the result includes how with the honey it would not the kill cancer cells, can conclude the hair follicles, and further include the bone marrow cells along with the basal epithelial cells that can lead to the digestive tract that has been associated. The relation to the patients that can conclude the chemotherapy drugs which can conclude the mucositis that can be part of the oral cavity, including the oropharynx and digestive system (Raeessi et al. 2014). The assessment helps to evaluate the oral mucositis reflects the irritating complications done with the cancer treatment.

Strength and Limitation

The strength of the article shows how the least 30-40% further patients that can relate with the chemotherapy drugs, an experience that can be far fetched with the oral problem to begin the five to ten days that can relate to the treatment regimen.

The limitation was the oral mucositis and it would be related to characterize by inflammation and would conclude the erythema and ulcerations done with the mucous membrane done with the oral cavity. Through the mucositis cusses, the pain can conclude through the honey is limited to the period.

In the article, “Honey prevents oral mocositis in children undergoing chemotherapy: A quasi-experimental study with a control group”, the result shows how it was found to be the severity of oral mucositis done to the children in the experimental group and how it can further lead to how one can lead a control group (Bulut, 2016). Through the mucositis recovery period the inclusion of the experimental group that can be shorter with the control group.

The strengths include the mucositis recovery period within the experimental group to be consistent with the control group. Through the regular oral care with honey done for the children have to be part of the chemotherapy for hematological cancers that can resort to mucositis and further help to accelerate the mucositis onset. The limitation is found in the treatment of oral mucositis, the inclusion of the methods and products would have not been part of the consensus to offer the best results.

In the article of “The effect of the use of thyme honey in minimizing radiation-induced oral mucositis in head and neck cancer patients: A randomized controlled trial”, the result, shows how there has been consistent finding to the study that can indicate the effectiveness of thyme honey that can be helpful for the effective management of OM in H&N cancer patients done with the help of the radiotherapy (Charalambous, et al, 2018). With the help of the effective part of the study, the relation can be in fact can conclude the patients, and it includes the significant number of lesions done within the 2–4weeks after stopping the RT.

The strength is the importance of how to lead to how there can be an intervention group and would include the impairment of swallowing along with the drinking, which can be consistent with the better form of the control group. Through relation to difference can conclude the period which can be part of the groups, and can be related to the statistically significant. It is important to relate to the gradual improvement and can relate to the completion concerning the treatment.

The limitation is the result that can conclude the present study that can help the significant improvement and make it part of the patients that can conclude the intervention group with the help of the oral activities parameters such as the swallowing, drinking, eating and can be done with the help of oral presentation and further pharyngeal pain.

Conclusion to Honey's Effectiveness in Promoting Healing of Oral Mucositis

It can be concluded, how there can be the inclusion of RCT that can further be concluded through the evidence done with the thyme honey's positive effects and can further be concluded with the management with the help of radiation-induced OM. To relate with the swallowing, dysphagia and conclude the oral and throat pain can further lead to the head and neck cancer patients and how there can be weight loss. To check how there can be RCT evaluation to the shows how there can be managed to the overall quality of life for the patients.

References 

Brown, CG, McGuire, DB, Peterson, DE, Beck, SL, Dudley, WN & Mooney, KH 2009, ‘The experience of a sore mouth and associated symptoms in patients with cancer receiving outpatient chemotherapy’. Cancer Nursing, vol. 32, no. 4, pp. 259–270. 

Cakmak, S & Nural, N 2019, ‘Incidence of and risk factors for development of oral mucositis in outpatients undergoing cancer chemotherapy’. International Journal of Nursing Practice, vol. 25, no. 1, pp. e12710. 

Elting, LS, Cooksley, C, Chambers, M, Cantor, SB, Manzullo, E & Rubenstein, EB 2003, ‘The burdens of cancer therapy. Clinical and economic outcomes of chemotherapy-induced mucositis. Cancer, vol. 98, no. 7, pp. 1531–1539. 

Jull, AB, Cullum, N, Dumville, JC, Westby, MJ, Deshpande, S & Walker, N 2015, ’Honey as a topical treatment for wounds’. Cochrane Database of Systematic Reviews (3), Cd005083. doi:10.1002/14651858.CD005083.pub4.

Mandal, MD & Mandal, S 2011, ‘Honey: its medicinal property and antibacterial activity. Asian Pacific Journal of Tropical Biomedicine, vol. 1, no. 2, pp. 154–160. 

Nursing and Midwifery Board of Australia 2016, Registered nurses standards for practice. Nursing and Midwifery Board of Australia, Melbourne. 

Sonis, ST 2009, ‘Mucositis: The impact, biology and therapeutic opportunities of oral mucositis’. Oral Oncology, vol. 45, no. 12, pp. 1015–1020. 

Sonis, ST, Eilers, JP, Epstein, JB., LeVeque, FG, Liggett, WH Jr., Mulagha, MT, . . . Wittes, JP 1999, ‘Validation of a new scoring system for the assessment of clinical trial research of oral mucositis induced by radiation or chemotherapy. Mucositis Study Group’. Cancer, vol. 85, no. 10, pp. 2103–2113. 

Vera-Llonch, M, Oster, G, Hagiwara, M & Sonis, S 2006, ‘Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma’. Cancer, vol. 106, no. 2, pp. 329–336.

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