Effects of honey and Taiwanese green propolis on oral mucositis and quality of life in head and neck cancer patients undergoing radiotherapy: a randomized controlled trial

Background: Head and neck cancer (HNC) significantly impacts patients' quality of life (QoL), particularly due to complications like oral mucositis (OM). This study evaluated the effectiveness of honey and Taiwanese green propolis (TGP) in managing OM severity in HNC patients undergoing radiotherapy. Methods: From April 2019 to January 2022, 75 HNC patients were randomly assigned to honey, TGP, or usual-care groups. The primary outcome was OM severity, measured using the World Health Organization (WHO) mucositis scale (0-4). Secondary outcomes, including patient-reported OM symptoms, xerostomia, and QoL, were also assessed. Data were collected weekly for 12 weeks post-radiotherapy and analyzed using the generalized estimating equation (GEE) method. All patients were free of OM symptoms at the baseline. Results: Compared to the usual-care group, the honey group showed significantly higher QoL scores (β = 10.05, SE = 3.59, 95% CI = 3.02 to 17.08, P = 0.01) and reduced OM severity (β = -0.45, SE = 0.15, P < 0.01). The TGP group also significantly reduced OM severity (β = -0.37, SE = 0.13, P < 0.01) but did not significantly affect QoL (β = 2.42, SE = 3.63, P = 0.51). OM severity peaked at week 7 in the usual-care group (mean 2.75 ± 1.07), with significantly lower scores in both honey (1.73 ± 1.39) and TGP (2.00 ± 1.38) groups (P < 0.05). Post-hoc comparisons at week 7 showed that honey was more effective than TGP (P = 0.046). The cumulative incidence of severe OM (WHO grade ≥3) was significantly lower in the honey group (36%) compared to the usual-care group (68%; P = 0.012). Additionally, weight maintenance was better in the honey group (average weight loss: 0.84 kg) compared to the TGP (3.30 kg) and usual-care (4.55 kg) groups, which may be associated with improved oral function. Conclusion: Honey is an effective therapy for managing OM severity in HNC patients undergoing radiotherapy. While TGP reduces OM severity, it is less effective than honey. Further studies are needed to establish standardized clinical guidelines for the use of honey and propolis products in HNC supportive care. The clinical trial registry number is NCT04382079 (https://clinicaltrials.gov).