Effectiveness of Black Mulberry Molasses in Prevention of Radiotherapy-Induced Oral Mucositis: A Randomized Controlled Study in Head and Neck Cancer Patients
Publication: The Journal of Alternative and Complementary Medicine
Volume 23, Issue Number 12
Abstract
Objectives: Radiation-induced oral mucositis is one of the problems experienced by 70%–80% of patients receiving radiation therapy (RT). This randomized controlled trial assessed the effectiveness of black mulberry molasses in the prevention of oral mucositis in head and neck cancer patients receiving RT.
Interventions and Outcome measures: Eighty head and neck cancer patients scheduled to undergo RT to the oropharyngeal mucosa were randomly assigned to receive RT (42) or RT plus mulberry molasses (38). The research data were collected with a Patient Description Form, Common Terminology Criteria for Adverse Events, version 4.0, an Oral Assessment Guide, and the University of Washington Quality of Life Assessment Questionnaire.
Results: The incidence and severity of oral mucositis were lower in the black mulberry molasses group. However, black mulberry molasses usage was an only independent and significant factor in prevention of mucositis [HR 0.63 (%95 GI 0.40–0.98)]. There were no differences between the quality of life scores of experimental and control groups.
Conclusions: This randomized controlled study showed that black mulberry molasses usage is an effective intervention in the prevention of the radiation-induced mucositis of head and neck cancer patients. However, to confirm these results, further studies are needed.
Get full access to this article
View all available purchase options and get full access to this article.
References
1.
Ang K. Advances in the Treatment of Head and Neck Cancer. Radiation Oncology: Rationale, Technique, Results. Philadelphia: Mosby, 2010.
2.
Shah J, Patel S, Singh P. Jatin Shah's Head and Neck Surgery and Oncology. Fourth Edition. Philadelphia, PA: Elsevier Mosby, 2012:1–11.
3.
Ray-Chaudhuri A, Shah K, Porter RJ. The oral management of patients who have received radiotherapy to the head and neck region. Br Dent J 2013;214:387–393.
4.
Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2008. CA Cancer J Clin 2008;58:71–96.
5.
The Ministry of Health of Turkey Health Statistics Yearbook 2010. [homepage on the Internet]. Online document at: http://sbu.saglik.gov.tr/Ekutuphane/kitaplar/saglikistatistikleriyilligi2010.pdf Accessed February 27, 2012.
6.
Fu KK, Pajak TF, Trotti A, et al. A Radiation Therapy Oncology Group (RTOG) phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: First report of RTOG 9003. Int J Radiat Oncol Biol Phys 2000;48:7–16.
7.
Elting LS, Cooksley CD, Chambers MS, Garden AS. Risk, outcomes, and costs of radiation-induced oral mucositis among patients with head-and-neck malignancies. Int J Radiat Oncol Biol Phys 2007;68:110–120.
8.
Rosenthal D, Trotti A. Strategies for managing radiation-induced mucositis in head and neck cancer. Semin Radiat Oncol 2009;19:29–34.
9.
Yen S, Wang L, Lın Y, et al. Phenylbutyrate mouthwash mitigates oral mucositis during radiotherapy or chemoradiotherapy in patients with head and neck cancer. Int J Radiat Oncol Biol Phys 2011;82:1463–1470.
10.
Worthington HV, Clarkson JE, Bryan G, et al. Interventions for preventing oral mucositis for patients with cancer receiving treatment. Cochrane Database Syst Rev 2011;4:CD000978.
11.
Worthington HV, Clarkson JE, Eden OB. Interventions for preventing oral mucositis for patients with cancer receiving treatment. Cochrane Database Syst Rev 2006;2:CD000978.
12.
Yarom N, Ariyawardana A, Hovan A, et al. Systematic review of natural agents for the management of oral mucositis in cancer patients. Support Care Cancer 2013;21:3209–3221.
13.
Lalla R, Bowen J, Barasch A, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer 2014;1453–1461.
14.
Yiğit N, Yiğit D, Özgen U, Aktaş A. Karadut (Morus nigra L.)'un antikandidal aktivitesi (anticandidal activity of black mulberry). Türk Mikrobiyol Cem Derg 2007;37:169–173.
15.
Sohn HY, Son KH, Kwon CS, Kong SS. Antimicrobial and cytotoxic activity of 18 prenylated flavonoids isolated from medicinal plants: Morus alba L., Morus mongolica Schneider, Broussnetia papyrifera (L) Vent, Saphora flavescens Ait and Echinosophora koreensis Nakai. Phytomedicine 2004;11:666–672.
16.
Ercisli S, Orhan E. Chemical composition of white (Morus alba), red (Morus rubra) and black (Morus nigra) mulberry fruits. Food Chem 2007;103:1380–1384.
17.
Çubukçu N, Çınar S. Kemoterapi alan kanserli hastalarda oral mukozitler önlenebilir mi? (It is possible to manage oral mucositis in chemotherapy patients?). Marmara Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 2012;2:155–163.
18.
Rashad UM, Al-Gezawy SM, El-Gezawy E, Azzaz AN. Honey as topical prophylaxis against radiochemotherapy induced mucositis in head and neck cancer. J Laryngol Otol 2009;123:223–228.
19.
Biswal BM, Zakaria A, Ahmad NM. Topical application of honey in the management of radiation mucositis: A preliminary study. Support Care Cancer 2003;11:242–248.
20.
Khanal B, Baliga M, Uppal N. Effect of topical honey on limitation of radiation induced oral mucositis: An intervention study. Int J Oral Maxillofac Surg 2010;39:1181–1185.
21.
Motallebnejad M, Akram S, Moghadamnia A, et al. The effect of topical application of pure honey on radiation-induced mucositis: A randomized clinical trial. J Contemp Dent Pract 2008;9:40–47.
22.
Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. [homepage on the Internet]. Online document at: http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010–06 14_QuickReference_8.5x11.pdf Accessed September 6, 2014.
23.
Eilers J, Berger AM, Petersen MC. Development, testing, and application of the oral assessment guide. Oncol Nurs Forum 1988;15:325–330.
24.
Şenkal HA, Hayran M, Karakaya E, et al. The validity and reliability of the Turkish version of the University of Washington Quality of Life Questionnaire for patients with head and neck cancer. Am J Otolaryngol 2012;33:417–426.
25.
Fua TF, Corry J, Milner AD, et al. Intensity-modulated radiotherapy for nasopharyngeal carcinoma: Clinical correlation of dose to the pharyngo-esophageal axis and dysphagia. Int J Radiat Oncol Biol Phys 2007;67:976–981.
26.
Mohammed F, Poon I, Zhang L, Elliott L. Acute-phase response reactants as objective biomarkers of radiation-induced mucositis in head and neck cancer. Head Neck 2012;34:985–993.
27.
Trotti A, Bellm LA, Epstein JB, et al. Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: A systematic literature review. Radiother Oncol 2003;66:253–262.
28.
Vera-Llonch M, Oster G, Hagiwara M, et al. Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma. Cancer 2006;106:329–336.
29.
Zahn K, Wong G, Bedrick E, et al. Relationship of protein and calorie intake to the severity of oral mucositis in patients with head and neck cancer receiving radiation therapy. Head Neck 2012;34:655–662.
30.
Sonis S, Elting LS, Peterson DE, et al. Perspectives on cancer therapy-induced mucosal injury. Cancer Suppl 2004;100:1995–2025.
31.
Gautam A, Fernandes D, Vidyasagar M, et al. Low level laser therapy for concurrent chemoradiotherapy induced oral mucositis in head and neck cancer patients—a triple blinded randomized controlled trial. Radiother Oncol 2012;104:349–354.
32.
Cheng KK, Leung SF, Liang RH, et al. Severe oral mucositis associated with cancer therapy: Impact on oral functional status and quality of life. Support Care Cancer 2010;18:1477–1485.
33.
Murphy B, Beaumont J, Isitt J, et al. Mucositis-related morbidity and resource utilization in head and neck cancer patients receiving radiation therapy with or without chemotherapy. J Pain Symptom Manage 2009;38:522–532.
34.
Scrimger R, Kanji A, Parliament M, et al. Correlation between saliva production and quality of life measurements in head and neck cancer patients treated with intensity- modulated radiotherapy. Am J Clin Oncol 2007;30:271–277.
35.
Tschiesner U, Linseisen E, Baumann S, Siedek V. Assessment of functioning in patients with head and neck cancer according to the International Classification of Functioning, Disability, and Health (ICF): A multicenter study. Laryngoscope 2009;119:915–923.
Information & Authors
Information
Published In
The Journal of Alternative and Complementary Medicine
Volume 23 • Issue Number 12 • December 2017
Pages: 971 - 979
PubMed: 28677999
Copyright
Copyright 2017, Mary Ann Liebert, Inc.
History
Published in print: December 2017
Published online: 1 December 2017
Published ahead of print: 5 July 2017
Topics
Authors
Author Disclosure Statement
No competing financial interests exist.
Metrics & Citations
Metrics
Citations
Export Citation
Export citation
Select the format you want to export the citations of this publication.
View Options
Get Access
Access content
To read the fulltext, please use one of the options below to sign in or purchase access.⚠ Society Access
If you are a member of a society that has access to this content please log in via your society website and then return to this publication.