蜂蜜预防放化疗导致的口腔黏膜炎及相关疼痛的系统评价
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摘要
目的 :评价蜂蜜在预防放化疗导致的口腔黏膜炎及相关疼痛中的作用。方法 :计算机检索The Cochrane Library、PubMed、Web of Science、中国生物医学文献数据库(CBM)、维普信息资源系统(VIP)、中国知网(CNKI)和万方数据库(WanfangData),检索时限均截止于2018年9月,纳入关于蜂蜜用于放化疗后口腔黏膜炎及相关疼痛的随机对照试验。由2位研究者独立按照纳入与排除标准筛选文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.3软件进行Meta分析。结果 :最终纳入15篇文献,共856例患者。Meta分析结果显示,蜂蜜可降低重度口腔黏膜炎[RR=0.48,95%CI(0.35,0.66),P<0.001]、黏膜炎相关疼痛(P<0.05)、口腔真菌定植[RR=0.21,95%CI(0.09,0.49),P<0.001]、治疗中断[RR=0.10,95%CI(0.01,0.75),P=0.02]、体质量减轻[MD=-3.72,95%CI(-6.86,-0.57),P=0.02]的发生风险,并延缓重度口腔黏膜炎的发生。结论 :当前证据表明,蜂蜜是一种合理的辅助治疗放化疗口腔黏膜炎及缓解相关疼痛的方法,需要开展更多的随机对照试验证实其效果。
Objective: To evaluate the prophylactic effects of honey use on radio or chemotherapy-induced oral mucositis and associated pain. Methods: Such databases as The Cochrane Library, PubMed, Web of Science, CBM, VIP,CNKI and Wanfang Data were searched up to September 2018 for randomized controlled trials(RCTs) about honey use on radio or chemotherapy-induced oral mucositis and associated pain. According to the inclusion and exclusion criteria, two reviewers independently screened each database, extracted data, and assessed the methodological quality of included studies.Then meta-analysis was performed using RevMan 5.3 software. Results: Fifteen RCTs involving 856 patients were included.The meta-analysis showed that honey was significantly better in lowering the risk of mucositis [RR=0.48, 95% CI(0.35,0.66), P<0.001], pain associated with mucositis(P<0.05), mouth fungal colonization [RR=0.21, 95% CI(0.09, 0.49), P<0.001],treatment interruptions [RR=0.10, 95% CI(0.01, 0.75), P=0.02] and weight loss [MD=-3.72, 95% CI(-6.86,-0.57), P=0.02].And honey use could also delay the onset of severe mucositis. Conclusion: Current evidence shows that honey is a reasonable treatment for radio or chemotherapy-induced oral mucositis and associated pain, but more RCTs are still needed.
Objective: To evaluate the prophylactic effects of honey use on radio or chemotherapy-induced oral mucositis and associated pain. Methods: Such databases as The Cochrane Library, PubMed, Web of Science, CBM, VIP,CNKI and Wanfang Data were searched up to September 2018 for randomized controlled trials(RCTs) about honey use on radio or chemotherapy-induced oral mucositis and associated pain. According to the inclusion and exclusion criteria, two reviewers independently screened each database, extracted data, and assessed the methodological quality of included studies.Then meta-analysis was performed using RevMan 5.3 software. Results: Fifteen RCTs involving 856 patients were included.The meta-analysis showed that honey was significantly better in lowering the risk of mucositis [RR=0.48, 95% CI(0.35,0.66), P<0.001], pain associated with mucositis(P<0.05), mouth fungal colonization [RR=0.21, 95% CI(0.09, 0.49), P<0.001],treatment interruptions [RR=0.10, 95% CI(0.01, 0.75), P=0.02] and weight loss [MD=-3.72, 95% CI(-6.86,-0.57), P=0.02].And honey use could also delay the onset of severe mucositis. Conclusion: Current evidence shows that honey is a reasonable treatment for radio or chemotherapy-induced oral mucositis and associated pain, but more RCTs are still needed.
引文
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[8] Biswal BM, Zakaria A, Ahmad NM.Topical application of honey in the management ofradiationmucositis.apreliminarystudy.Supportive Care in Cancer, 2003,11(4):242-248.
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[14] Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group(RTOG)and the European Organization for Research and Treatment of Cancer(EORTC). Int J Radiat Oncol Biol Phys, 2015,31(5):1341-1346.
[15] Sonis ST, Eilers JP, Epstein JB, et al.Validation of a new scoring system for the assessmentofclinicaltrialresearchoforal mucositis induced by radiation or chemotherapy.Cancer, 2015,85(10):2103-2113.
[16] Trotti A, Colevas AD, Setser A, et al. CTCAE v3.0:development of a comprehensive grading system for the adverse effects of cancer treatment.Seminars in Radiation Oncology, 2003,13(3):176-181.
[17] Epstein JB, Beaumont JL, Gwede CK, et al.Longitudinal evaluation of the oral mucositis weekly questionnaire-head and neck cancer, a patient-reported outcomes questionnaire. Cancer,2007,109(9):1914-1922.
[18] Higgins JPT, Green S. Cochrance handbook for systematic reviews of interventions 4.2.6.2006. The Cochrane Collaboration, 2006.
[19] Jaouni ALSK, Almuhayawi MS, Hussein A, et al. Effects of honey on oral mucositis among pediatric cancer patients undergoing chemo/radiotherapytreatmentatKingAbdulaziz University Hospital in Jeddah, Kingdom of Saudi Arabia. Evidence-Based Complementray and Alternative Medicine, 2017(3):1-7.
[20]AmanatA,AhmedA,KazmiA,etal.The effect of honey on radiation-induced oral mucositis in head and neck cancer patients. Indian Journal of Palliative Care, 2017,23(3):317-320.
[21] Jayachandran S, Balaji N. Evaluating the effectiveness of topical application of natural honey and benzydamine hydrochloride in the management of radiation mucositis. Indian J Palliat Care, 2012,18(3):190-195.
[22] Charalambous M, Raftopoulos V, Paikousis L, et al. The effect of the use of thyme honey in minimizing radiation-induced oral mucositis in head and neck cancer patients:a randomized controlled trial. Eur J Oncol Nurs, 2018(34):89-97.
[23] Jayalekshmi JL, Lakshmi R, Mukerji A.Honey on oral mucositis:a randomized controlled trial. Gulf Journal of Oncology, 2016,1(20):30-37.
[24] Pour-Fard-Pachekenari AK, Rahmani A,Ghahramanian A, et al. The effect of an oral care protocol and honey mouthwash on mucositis in acute myeloid leukemia patients undergoing chemotherapy:asingle-blindclinicaltrial.Clinical Oral Investigations, 2019,23(4):1811-1821.
[25] Motallebnejad M, Akram S, Moghadamnia A,etal.Theeffectoftopicalapplicationof pure honey on radiation-induced mucositis:a randomised clinical trial. J Contemp Dent Pract,2008,9(3):40-47.
[26] Rao S, Hegde SK, Rao P, et al. Honey mitigates radiation-induced oral mucositis in head and neck cancer patients without affecting the tumor response. Foods, 2017,6(9):77-84.
[27] Samdariya S, Lewis S, Kauser H, et al. A randomized controlled trial evaluating the role of honey in reducing pain due to radiation induced mucositis in head and neck cancer patients. Indian Journal of Palliative Care, 2015,21(3):268-273.
[28]赖敏栋,熊淑萍,刘蓉,等.洋槐蜂蜜防治鼻咽癌患者放射性口腔粘膜炎的临床观察.实用癌症杂志,2016,31(12):2096-2098.Lai MD, Xiong SP, Liu R, et al. Clinical observation of locust honey for radiation-induced oral mucositis in nasopharyngeal carcinom. Pract J Cancer, 2016,31(12):2096-2098.
[29] Co JL, Mejia MBA, Que JC, et al.Effectiveness of honey on radiation-induced oral mucositis, time to mucositis, weight loss,and treatment interruptions among patients with head and neck malignancies:a Meta-analysis and systematic review of literature. Head&Neck,2016,38(7):1119-1128.
[30] Alam F, Islam MA, Gan SH, et al. Honey:a potential therapeutic agent for managing diabetic wounds. Evid Based Complement Alternat Med,2004,2014:169130.
[31] Belcher J. Dressings and healing with honey.Br J Nurs, 2014,23(6):S22.
[32] Bardy J, Slevin NJ, Mais KL, et al. A systematic review of honey uses and its potential value within oncology care. Journal of Clinical Nursing, 2010,17(19):2604-2623.
[33] Sonis ST, Elting LS, Keefe D, et al.Perspectives on cancer therapy-induced mucosal injury:pathogenesis, measurement, epidemiology,and consequences for patients. Cancer, 2004,100(9Suppl):S1995–S2025.
[2] Rosenthal DI. Consequences of mucositisinduced treatment breaks and dose reductions on head and neck cancer treatment outcomes. Journal of Supportive Oncology, 2007,5 Suppl 4:S23-31.
[3] Oberoi S, Zamperlininetto G, Beyene J, et al.Effect of prophylactic low level laser therapy on oral mucositis:a systematic review and Metaanalysis. Plos One, 2014,9(9):e107418.
[4] Mercadante S, Aielli F, Adile C, et al.Prevalence of oral mucositis, dry mouth, and dysphagia in advanced cancer patients. Supportive Care in Cancer, 2015,23(11):3249-3255.
[5]吴莹嘉,郭素萍,陈建珠,等.放射性口腔黏膜炎患者应用芬太尼透皮贴剂止痛的效果观察.中华护理杂志,2013,48(5):467-468.Wu YJ, Guo SP, Chen JZ, et al. Effect of fentanyl transdermal paste on patients with radioactive oral mucositis. Chin J Nurs, 2013,48(5):467-468.
[6] Epstein JB, Thariat J, Bensadoun RJ, et al.Oral complications of cancer and cancer therapy:from cancer treatment to survivorship. CA Cancer J Clin, 2012,62(6):400-422.
[7] Oryan A, Alemzadeh E, Moshiri A. Biological properties and therapeutic activities of honey in wound healing:a narrative review and Metaanalysis. Journal of Tissue Viability, 2016,25(2):98-118.
[8] Biswal BM, Zakaria A, Ahmad NM.Topical application of honey in the management ofradiationmucositis.apreliminarystudy.Supportive Care in Cancer, 2003,11(4):242-248.
[9] Rashad UM, Algezawy SM, Elgezawy E, et al. Honey as topical prophylaxis against radiochemotherapy-induced mucositis in head and neck cancer. Journal of Laryngology&Otology,2009,123(2):223-228.
[10] Khanal B, Baliga M, Uppal N. Effect of topical honey on limitation of radiation-induced oral mucositis:an intervention study. International Journal of Oral&Maxillofacial Surgery, 2010,39(12):1181-1185.
[11] Bardy J, Molassiotis A, Ryder WD, et al. A double-blind, placebo-controlled, randomised trial of active manuka honey and standard oral care for radiation-induced oral mucositis. British Journal of Oral&Maxillofacial Surgery, 2012,50(3):221-226.
[12] Hawley P, Hovan A, Mcgahan CE, et al. A randomized placebo-controlled trial of manuka honeyforradiation-inducedoralmucositis.Supportive Care in Cancer, 2014,22(3):751-761.
[13] Palmer MK. WHO handbook for reporting results of cancer treatment. British Journal of Cancer, 1982,45(3):484-485.
[14] Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group(RTOG)and the European Organization for Research and Treatment of Cancer(EORTC). Int J Radiat Oncol Biol Phys, 2015,31(5):1341-1346.
[15] Sonis ST, Eilers JP, Epstein JB, et al.Validation of a new scoring system for the assessmentofclinicaltrialresearchoforal mucositis induced by radiation or chemotherapy.Cancer, 2015,85(10):2103-2113.
[16] Trotti A, Colevas AD, Setser A, et al. CTCAE v3.0:development of a comprehensive grading system for the adverse effects of cancer treatment.Seminars in Radiation Oncology, 2003,13(3):176-181.
[17] Epstein JB, Beaumont JL, Gwede CK, et al.Longitudinal evaluation of the oral mucositis weekly questionnaire-head and neck cancer, a patient-reported outcomes questionnaire. Cancer,2007,109(9):1914-1922.
[18] Higgins JPT, Green S. Cochrance handbook for systematic reviews of interventions 4.2.6.2006. The Cochrane Collaboration, 2006.
[19] Jaouni ALSK, Almuhayawi MS, Hussein A, et al. Effects of honey on oral mucositis among pediatric cancer patients undergoing chemo/radiotherapytreatmentatKingAbdulaziz University Hospital in Jeddah, Kingdom of Saudi Arabia. Evidence-Based Complementray and Alternative Medicine, 2017(3):1-7.
[20]AmanatA,AhmedA,KazmiA,etal.The effect of honey on radiation-induced oral mucositis in head and neck cancer patients. Indian Journal of Palliative Care, 2017,23(3):317-320.
[21] Jayachandran S, Balaji N. Evaluating the effectiveness of topical application of natural honey and benzydamine hydrochloride in the management of radiation mucositis. Indian J Palliat Care, 2012,18(3):190-195.
[22] Charalambous M, Raftopoulos V, Paikousis L, et al. The effect of the use of thyme honey in minimizing radiation-induced oral mucositis in head and neck cancer patients:a randomized controlled trial. Eur J Oncol Nurs, 2018(34):89-97.
[23] Jayalekshmi JL, Lakshmi R, Mukerji A.Honey on oral mucositis:a randomized controlled trial. Gulf Journal of Oncology, 2016,1(20):30-37.
[24] Pour-Fard-Pachekenari AK, Rahmani A,Ghahramanian A, et al. The effect of an oral care protocol and honey mouthwash on mucositis in acute myeloid leukemia patients undergoing chemotherapy:asingle-blindclinicaltrial.Clinical Oral Investigations, 2019,23(4):1811-1821.
[25] Motallebnejad M, Akram S, Moghadamnia A,etal.Theeffectoftopicalapplicationof pure honey on radiation-induced mucositis:a randomised clinical trial. J Contemp Dent Pract,2008,9(3):40-47.
[26] Rao S, Hegde SK, Rao P, et al. Honey mitigates radiation-induced oral mucositis in head and neck cancer patients without affecting the tumor response. Foods, 2017,6(9):77-84.
[27] Samdariya S, Lewis S, Kauser H, et al. A randomized controlled trial evaluating the role of honey in reducing pain due to radiation induced mucositis in head and neck cancer patients. Indian Journal of Palliative Care, 2015,21(3):268-273.
[28]赖敏栋,熊淑萍,刘蓉,等.洋槐蜂蜜防治鼻咽癌患者放射性口腔粘膜炎的临床观察.实用癌症杂志,2016,31(12):2096-2098.Lai MD, Xiong SP, Liu R, et al. Clinical observation of locust honey for radiation-induced oral mucositis in nasopharyngeal carcinom. Pract J Cancer, 2016,31(12):2096-2098.
[29] Co JL, Mejia MBA, Que JC, et al.Effectiveness of honey on radiation-induced oral mucositis, time to mucositis, weight loss,and treatment interruptions among patients with head and neck malignancies:a Meta-analysis and systematic review of literature. Head&Neck,2016,38(7):1119-1128.
[30] Alam F, Islam MA, Gan SH, et al. Honey:a potential therapeutic agent for managing diabetic wounds. Evid Based Complement Alternat Med,2004,2014:169130.
[31] Belcher J. Dressings and healing with honey.Br J Nurs, 2014,23(6):S22.
[32] Bardy J, Slevin NJ, Mais KL, et al. A systematic review of honey uses and its potential value within oncology care. Journal of Clinical Nursing, 2010,17(19):2604-2623.
[33] Sonis ST, Elting LS, Keefe D, et al.Perspectives on cancer therapy-induced mucosal injury:pathogenesis, measurement, epidemiology,and consequences for patients. Cancer, 2004,100(9Suppl):S1995–S2025.