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A randomized placebo-controlled trial of manuka honey for radiation-induced oral mucositis



Few treatments have the potential to reduce the severity of radiation-induced mucositis in head and neck cancer patients. Some small studies have suggested that organic honey may be a useful preventive treatment.


This investigator-initiated double-blind randomized placebo-controlled trial investigated whether honey reduced the severity of radiation-induced oral mucositis (ROM). One hundred six head and neck cancer patients from the Vancouver and Sudbury Cancer Centers in Canada were randomized to swish, hold, and swallow either 5 ml of irradiated organic manuka honey or a placebo gel, four times a day throughout radiation treatment, plus seven more days. Severity of oral mucositis according to the Radiation Therapy Oncology Group (RTOG), World Health Organization (WHO), and Oral Mucositis Assessment Scale scales, weight, and subjects' symptom severity and quality of life were assessed weekly. Sialometry was performed at baseline and at the last study visit.


One hundred six patients were recruited. Twenty-four did not attend any mucositis assessments. One was removed from the study because of off-study consumption of store-bought manuka honey. The remaining 81 patients had at least one mucositis assessment and were included in the analysis. Sixty-two percent of subjects received concurrent chemotherapy; 81 % were male. The groups were well-matched, and blinding was excellent. Dropouts were mostly due to nausea and were similar in both arms, with 78 % being able to tolerate the study products for more than 1 week. The dropout rate was 57 % in those who received honey and 52 % in those who received placebo gel. The dropout rate in those who had concurrent chemotherapy was 59 % and in those who only received radiation was 47 %. There was no statistically significant difference between the honey and placebo arms in any of the outcome indicators. Those who completed the study in both treatment arms had low rates of RTOG greater than or equal to grade 3 mucositis; 35 % in the honey group and 43 % in the placebo group.


Despite promising earlier reports, manuka honey was not tolerated well by our patients and, even when used as directed, did not have a significant impact on the severity of ROM.

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The authors thank Dr. John Hay and John French from the Vancouver Cancer Centre for their assistance in planning this study. The authors would also like to acknowledge the assistance and inspiration of Dr. Barry Sheehan who died before this study was completed. Special thanks to Ms. Carole Chenier RDH for her instrumental encouragement to patients of the Sudbury arm while on study. All costs for this investigator-initiated study were paid from donated funds through the Vancouver Cancer Centre Palliative Care Fund of the BC Cancer Foundation. The authors thank MacDonald's Realty and the friends, colleagues, and family of Joy Langan. Funding to run the multicenter study arm in Sudbury was provided by the Northern Cancer Research Fund (NCRF) which covered salary for the research assistant (Carole Chenier, RDH) and the cost of product. The irradiated honey was provided at cost by Wedderspoon Organics, and the placebo gel was provided by Macdonalds Prescriptions of Vancouver. Dr. Hawley is the 2010 recipient of the Gordon Dunn Pioneer Award from the Prostate Cancer Foundation of BC, a salary support grant which facilitated the completion and analysis of the study.

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The authors have no conflicts of interest.

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Correspondence to Philippa Hawley.

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Hawley, P., Hovan, A., McGahan, C.E. et al. A randomized placebo-controlled trial of manuka honey for radiation-induced oral mucositis. Support Care Cancer 22, 751–761 (2014).

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  • Radiotherapy
  • Mucositis
  • Honey
  • Quality of life
  • Randomized
  • Placebo-controlled