SAN FRANCISCO ― A medical grade honey from New Zealand (Manuka), which is known to be effective in wound healing, does not reduce pain from radiation esophagitis more effectively than standard supportive care, phase 2 research shows.
“Reducing esophagitis is important so that patients can continue eating their normal diet,” Lawrence Berk, MD, chief of radiation oncology, Morsani School of Medicine, University of South Florida, Tampa, told Medscape Medicine News.
“And since there is no proven treatment for the prevention of esophagitis during concurrent chemotherapy and radiation therapy, we decided to try honey, because of the reported success in head and neck mucositis in several small studies.
“And neither liquid honey nor honey lozenges worked better than standard supportive care in reducing pain from esophagitis, so I would not encourage patients to take Manuka honey, because it didn’t work and it’s expensive.”
The study was presented at the annual meeting of the American Society of Radiation Oncology, held in San Francisco, California.
Investigators included 163 lung cancer patients who were undergoing concurrent chemotherapy and radiation therapy. Approximately 30% of patients had received 60 Gy of radiation to the esophagus.
Patients were randomly assigned to 1 of 3 treatment arms: 56 patients received standard supportive care; 53 patients received 10 mL of Manuka honey orally, 4 times a day; and 54 patients received 1 lozenge consisting of 10 mL of dehydrated Manuka honey, 4 times per day.
The honey was taken on the first day of treatment and continued to be taken throughout the course of radiation therapy.
After 4 weeks of treatment, patients were asked to assess pain during swallowing using the Numerical Pain Rating Scale (NPRS) scale. Zero on the NPRS scale indicates no pain, 5 indicates moderate pain, and 10 indicates worst possible pain.
No patients in the standard supportive care arm developed grade 3 or higher adverse events (AEs) related to the treatment protocol, whereas 11 patients in the liquid honey arm did, as did 2 patients in the honey lozenges group.
At the end of 4 weeks of radiation therapy, the mean change in the NPRS score was 2.7 in the standard supportive care group vs 2.1 for both groups who took either the liquid or lozenge form of Manuka honey, a difference that was not statistically significant.
There was also no difference between the 3 groups in secondary endpoints, including trend of pain over time, opioid use, AEs, weight loss, or quality-of-life measurements.
Previous Studies With Local Honey
The previous studies showing that honey decreased head and neck mucositis were small, randomized trials carried out in Malaysia, Egypt, Nepal, and Iran, and they all used locally produced honey, Dr Berk noted.
However, another study (Support Care Cancer. 2014;22:751-61) conducted in Canada, which used Manuka honey, found no significant impact on the severity of radiation-induced mucositis in head and neck cancer patients. Furthermore, patients did not tolerate the honey well.
A British study (Br J Oral Maxillofac Surg. 2012;50:221-6) again found that Manuka honey did not improve mucositis in head and neck cancer patients, although the reserachers noted that it did seem to be associated with a reduction in bacterial infections.
“Studies with natural products are difficult to do because compounds vary from batch to batch, and the honey will depend on what flowers the bees pollinated,” Dr. Berk said.
“The reason we chose Manuka honey is that it is widely available and it’s a well-studied, well-quantified honey, and it’s pretty much the only honey there that is well defined.
“But it’s pretty clear from 3 studies now that Manuka honey has no effect, and currently, there are no proven methods of preventing radiation esophagitis except minimizing the dose of radiation, which we frequently have to do,” he said.
*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.