A Spoonful of Honey? New Findings Shed Light on Its Role in Relieving Esophagitis Pain

Lawrence Berk, MD

New patient-reported data presented at the 2014 ASTRO 56th Annual Meeting has shown that Manuka honey is not more effective than standard medical care for the treatment of esophagitis pain during radiation therapy (RT).

“The results from our study were somewhat unexpected since three previous trials had indicated that honey worked, and reducing esophagitis is important so that patients can continue eating their normal diet,” lead study author Lawrence Berk, MD, chief of radiation oncology, Morsani School of Medicine at the University of South Florida, Tampa said in a statement.

In the past, small studies have been conducted to evaluate if honey can prevent the loss of the normal surface of the mouth or throat caused by RT. The reduction of esophagitis pain is important so that patients’ do not forgo eating; maintaining patients’ positive nutritional status is vital during cancer treatment.

“A larger trial was just completed in Canada for a similar problem—mouth and throat pain during head and neck RT—and that trial also found no benefit with the honey,” Berk said. “Both the Canadian study and our trial used Manuka honey, whereas previous trials all used a local honey. This is often a problem in using natural products—each batch or type of product may be different, so it is hard to reproduce the effects seen by others.”

In this study, researchers assessed the use of Manuka honey, a standardized, medical grade honey from New Zealand, to treat esophagitis, a common and temporary side effect experienced by the majority of patients with lung cancer undergoing RT.

The randomized, phase II trial enrolled 163 patients with lung cancer at 13 cancer centers who were undergoing concurrent chemotherapy and RT. Of the study group, ≥30% of the patients had received 60 Gy of RT to the espophagus (V60).

The patients were assigned to three groups: 56 patients in arm 1 received standard supportive care; 53 patients in arm 2 received 10 mL of Manuka honey orally, 4 times per day; and 54 patients in arm 3 received one lozenge, consisting of 10 mL of dehydrated Manuka honey, 4 times per day. The honey was administered on the first day of treatment and continued throughout RT.

After 4 weeks of RT with and without the Manuka honey, patients assessed their pain during swallowing using the Numerical Pain Rating Scale (NPRS) scale, with a 0 indicating “no pain,” a 5 indicating “moderate pain,” and a 10 indicating “worst possible pain.”

The study concluded that there was no significant difference in levels of pain reported by patients within the three groups (mean change scores of 2.7, 2.1, and 2.1, respectively (P = .73 for arm 1 vs arm 2; P = .68 arm 1 vs arm 3).

Also, researchers evaluated secondary endpoints, such as the trend of the patients’ pain over time, opiod use, adverse events, weight loss, quality of life, dysphagia, and nutritional status. There were no differences in any of the secondary endpoints.

“Currently, honey cannot be recommended for every patient to use for esophagitis pain relief,” Berk said. “However, it is safe and inexpensive, so if patients want to try it, there is probably little harm. Patients with diabetes should be cautious with honey because it does have a high sugar load.”

Berk LB, Deshmukh S, Fogh SE, et al. Randomized Phase II Trial of Best Supportive Care, Manuka Honey Liquid and Manuka Honey Lozenges for Prevention of Radiation Esophagitis During Chemotherapy and Radiotherapy for Lung Cancer. Presented at: 2014 ASTRO Annual Meeting; September 14-17, 2014; San Francisco, CA. Presentation Number: 2065.