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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

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A systematic review of honey uses and its potential value within oncology care

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Review published: .

CRD summary

This review assessed the therapeutic efficacy of honey. The authors concluded that honey was a suitable alternative for wound healing, burns and skin conditions, and potentially in cancer care. These conclusions were based on largely poor quality or unrandomised evidence. Several of the higher quality studies favoured the comparator treatment. The reliability of the conclusions is unclear.

Authors' objectives

To assess the evidence for the role of honey in health care and to determine whether this evidence is specifically applicable to cancer care.

Searching

MEDLINE/PubMed, EMBASE, CINAHL, British Nursing Index and the Cochrane Library were searched (1951 to 2007). References of included studies and other key articles were checked. Only studies reported in English were eligible for inclusion.

Study selection

Randomised controlled trials (RCTs), controlled clinical trials (CCTs), comparative studies, case studies and systematic reviews of the therapeutic use of honey in patients of any age were eligible for inclusion. No criteria were stated for outcomes.

Included studies used honey for a range of indications including wounds, burns, cancer, and skin complaints, and reported outcomes that included wound healing, wound infections, use of antibiotics, scarring, pain and other condition-specific outcomes. Patients' ages ranged from infants to adults.

Two reviewers independently assessed the papers for inclusion in the review.

Assessment of study quality

Two reviewers independently assessed the studies for quality using the Jadad scale, which assigns up to 5 points for criteria based on blinding, randomisation and treatment of withdrawals and dropouts. Disagreements were resolved through discussion.

Data extraction

The authors did not state how the data were extracted for the review or state how many reviewers performed the extraction.

Methods of synthesis

The studies were combined in a narrative synthesis grouped by the indication for use. Differences in study design and quality were highlighted.

Results of the review

Forty-three studies (n = 2,316) were included in the review, of which 20 were described as RCTs. The mean Jadad score was 0.86. The median was 0 as a result of applying the Jadad scale to non-RCTs. Only four studies scored 3 or more points.

Wound healing (19 studies). Two RCTs compared honey dressings with paraffin gauze (1 RCT) or iodine (1 RCT) dressings. In both studies the comparator was found to be significantly more effective than honey. Seventeen low-quality studies were considered to collectively show benefits for honey in situations including post-operative wound infections, leg ulcers and Fournier's gangrene across a range of outcomes including infection rates, need for antibiotics, extent of scarring and reduction in pain.

Burns (11 studies). Eight low-quality studies found that honey produced better results in terms of wound healing time and infection rates compared with other topical treatments. Three RCTs produced mixed results. One found honey to be more effective than paraffin gauze. Of the two that compared honey with silver sulphadiazine, one found honey to be more effective and one found no difference between the groups.

Skin conditions (three studies). All three non-comparative studies found honey to be useful in managing conditions including seborrheic dermatitis, dandruff, psoriasis and fungal conditions.

Cancer patients (five studies). One small good-quality RCT showed that honey reduced the severity and duration of radiation-induced mucositis and prevented weight loss. The remaining studies showed results suggesting that honey was associated with less tooth decay in head and neck cancer patients with xerostomia (two studies) and that honey promoted wound healing in cancer patients (one paediatric population, one post-vulvectomy).

Miscellaneous uses (five studies). One small high quality RCT found no difference between honey and placebo in the treatment of rhinoconjunctivitis. Other studies assessed patients undergoing haemodialysis, treatment of central vein catheter exit sites, bleeding gums and gastroenteritis.

Authors' conclusions

Honey was found to be a suitable alternative for wound healing, burns and various skin conditions, and to potentially have a role within cancer care.

CRD commentary

The review question was clear, although very broad. Inclusion criteria were not explicitly stated for population or outcomes, which may have increased the risk of bias and error at the selection stage of the review. A number of relevant databases were searched. However, the authors did not report searching for unpublished studies and this, together with the decision to limit the review to studies reported in English, may have led to the exclusion of relevant studies and the introduction of publication and language bias. The authors report using rigorous methodology in some aspects of the review process; it is not clear if this was also the case for the extraction of data. A validity assessment was carried out and used to inform the synthesis, but the use of the Jadad scale as an assessment tool for study designs other than RCTs was inappropriate and produced results that were uninformative. The decision to employ a narrative synthesis was clearly appropriate given the clinical and methodological heterogeneity between the studies. The authors' conclusions are generally reflective of the evidence included in the review. However, much of the evidence was unrandomised, low quality, or both; some of the higher-quality evidence was inconclusive or negative. In view of this the conclusions should be regarded with some caution.

Implications of the review for practice and research

Practice: The authors stated a number of indications in which honey might be utilised in cancer care, including: the treatment of fungating wounds and surgical wounds following tumour removal, especially in facial surgery for scar reduction; the healing of dry and moist desquamation wounds in radiotherapy-induced skin reactions; and in the treatment of palmar-plantar erythrodysesthia.

Research: The authors stated that a large RCT should be undertaken to examine the use of honey for radiation-induced mucositis. They listed a number of indications that might benefit from further investigation, including ingestion for immunosuppressed cancer patients and topically for radiotherapy-induced skin reactions.

Funding

Not stated.

Bibliographic details

Bardy J, Slevin N J, Mais K L, Molassiotis A. A systematic review of honey uses and its potential value within oncology care. Journal of Clinical Nursing 2008; 17: 2604-2623. [PubMed: 18808626]

Indexing Status

Subject indexing assigned by NLM

MeSH

Antineoplastic Agents /adverse effects; Honey; Humans; Neoplasms /drug therapy /radiotherapy /therapy; Radiotherapy /adverse effects; Wound Healing

AccessionNumber

12009101148

Database entry date

03/02/2009

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

Copyright © 2014 University of York.
Bookshelf ID: NBK75654

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