Effectiveness of Topical Application of Honey in the Management of Chemo Radiation Therapy Induced Oral Mucositis among Cancer Survivors in a selected Oncology Hospital at Chinakakani, Guntur (DT) AP
1M.Sc Nursing II Year Student, NRI College of Nursing, Guntur AP.
2Associate Professor in Medical Surgical Nursing, NRI College of Nursing, Guntur AP.
3Associate Professor Cum HOD in Medical Surgical Nursing, NRI College of Nursing, Guntur AP.
*Corresponding Author E-mail: priyadarshini.namburi7@gmail.com
ABSTRACT:
The Aim of the Study is to assess the Effectiveness of Topical Application of Honey in the Management of Chemo Radiation Therapy Induced Oral Mucositis among Cancer Survivors. Materials and methods: True Experimental pre-test post-test with control group research design is used to achieve the objective of the study; Systematic Random Sampling technique is used to select the sample. A sample of 60 Cancer survivors with chemo-radiation induced oral mucositis. Experimental group (N=30), Control group (N=30) is selected as sample and Data were collected by using structured knowledge questionnaire using Socio Demographic data, Clinical Data and WHO oral toxicity scale. The collected data were analyzed by using Frequency and percentage distribution, inferential statistics and Chi-square test Results: The findings of the study revealed that majority of the cancer survivors were in the age group of 41-50 years i.e., 33.3% in the experimental group and % in the control group. Similarly, males constitute most in the both groups i.e., 53.3% in the experimental group and 70% in the control group. All the participants completed more than 6 radiation cycles in both groups were i.e., 100% in the experimental group and 100% in the control group. Most of them had 25-50 Millimeters mean and radiation area i.e., 93.3% in the experimental group and 53.3% in the control group. Majority of them were undergone more than 6 weeks cycles of chemotherapy i.e., 93.7% in the experimental group and 83.3% in the control group. Around 40% of them were smokers in i.e., the experimental group and 63.3% in the control group. Majority of them were diagnosed with non- hematological carcinoma. I.e., 93.7% in the experimental group and 70% in the control group. Both groups were similar in their baseline characteristics (p>0.05). during pre-test around 6.6% of the cancer survivors in the experimental group had Grade 1 Oral Mucositis and 20.6% in control group had Grade 1 Oral Mucosities, about 23.3% of them had Grade II Oral Mucositis in experimental group and 46.7% in control group, around 43.3% in the experimental group and 26.7% in the control group had Grade III Oral Mucositis, 6% of cancer survivors in the experimental group and 6.7% in the control group had Grade IV Oral Mucositis. To test the homogeneity of the outcome measure (Oral Mucosities Grades) at baseline, Chi-square test was computed and it was found that, both the groups were similar at their baseline measure (p>0.05). The comparison of level of oral mucositis between the experimental and the control groups during pretest, posttest I, II, III and IV. The results revealed that, During Pre-test and post-test I, around 6.6% of the 58 cancer survivors in the experimental group had Grade 1 Oral Mucositis and 20.6% in control group had Grade 1 Oral Micro sites, about 23.3% of them had Grade II Oral Mucositis in experimental group and 46.7% in control group, around 43.3% in the experimental group and 26.7% in the control group had Grade III Oral Mucositis, and 6% of cancer survivors in the experimental group and 6.7% in the control group had Grade IV Oral Mucositis. The chi-square results revealed that there is no significant difference in both the groups regarding level oral mucositis (Grades) during pre-test and posttest I at p>0.05. During post-test II, none of them in the experimental group had Grade 1 Oral Mucositis and only 6.7% in the control group had Grade 1 Oral Micro sites, about 20.0% of them had Grade II Oral Mucositis in the experimental group and 33.7% in control group, around 56.7% in the experimental group and 40.0% in the control group had Grade III Oral Mucositis and 23.3% of cancer survivors in the experimental group and 20.0% in the control group had Grade IV Oral Mucositis. The chi-square results revealed that there is a significant difference in both the groups regarding level oral mucositis (Grades) during posttest II at p Conclusion: The main conclusion of the present study is oral honey application was effective in reducing oral mucositis among patients with cancer which is denoted by significant level of oral mucositis. After the intervention there had been a significant reduction in level of oral mucositis. The selected subjects became familiar and found themselves comfortable and also expressed satisfaction.
KEYWORDS: Effectiveness, Topical Application, Honey, Management, Chemo- Radiation Induced Mucositis, Cancer Survivors.
INTRODUCTION:
Equilibrium is maintained in between the number of new cases and its advancements in therapies. Everybody has the affinity towards the multiple modalities like ayurvedhic, siddha and homeopathy for recovery. But the basic concept is prevention rather than curing the disease after the occurrence. Rapidly emerging technology and dramatically expanding knowledge increase the responsibilities of a health care professional to face a complex health environment1
Nowadays cancer is a unisex disease. World wide 12% of deaths occur due to cancer, which is the third leading cause of death following infection and cardiovascular diseases. Cancer affects people at all ages with the risk for most types increasing with age.
Cancer causes 13% of all human deaths in 2007 ( 7.5 million). In 2008 about 11 million peoples were diagnosed as cancer and 6.2 million peoples die every year (Feeley, 2008)2. Cancer commonly occurs as a result of multi factorial causation like alcohol consumption, smoking, physical inactivity, obesity, use of exogenous hormones, exposure to ionizing radiation and occupational chemical exposures. Head and neck cancer refers to a group of biologically similar cancers originating from the upper aero digestive tract including lip, oral cavity (mouth), nasal cavity, paranasal sinuses, pharynx and larynx, salivary glands and the thyroid gland3.
Honey is one of the oldest medicines. The honey is one of the natures most amazing and enduring medicinal product. Recent studies shows honey a natural byproduct of flower nectar from upper aerodigestive tract of the honey bee is effective in managing radiation induced mucositis (Liza, 1999)4.
The bacteriostatic and bactericidal effects of honey has been well documented. Honey possesses an effective antimycobacterial effect. It was demonstrated that the growth of mycobacteria was inhibited by adding 10% of honey to the media. Based on this results Avicenna, is a recommended honey in the treatment of Tuberculosis5. Radiation therapy plays an important role in the management of head and neck cancer. The majority of new cases with invasive head and neck cancer will require radiation therapy as a primary treatment, as an adjunct to surgery. The most common acute complication of radiation therapy in the head and neck region is oral mucositis. It is estimated that 30-60% of patients receiving radiation therapy for head and neck cancer develops radiation induced mucositis (Petersen, 2005)6.
Normally cell of the mouth undergo rapid renewal over a 7-14 days cycle. Radiation treatment interferes with cellular regeneration and reduce the ability of the oral mucosa to regenerate. Direct somato toxicity is usually seen 5-7 days after administration of radiation therapy. The early radiation reaction causes discomforts in drinking, swallowing which results in nutritional problems (National Institute of health conference, 1980)7.
The consensus development panel of the National Institutes of health has stated that no drugs can prevent mucositis. Routine oral care programs, removal of mucosal irritation factors, cleansing of mucosa with chlorhexidine gluconate, saline rinses, sodium bicarbonate rinses, local antibiotics, lozenges, is not found to be effective in the management of radiation induced mucositis8. The radiation induced mucositis alters the patients quality of life creating pain and discomfort. This enforces the Western Consortium Cancer Nursing research foundation to form Oral mucositis assessment scale for the systematic ongoing assessment of the oral mucosa for the patients undergoing radiation therapy. (Scully, 1996)9.
Honey is an ancient remedy for the treatment of infected wound which has recently being rediscovered by the medical profession particularly where the conventional modern therapies are failing. There is also wide evidence suggests that honey actively promote healing. In laboratory studies honey has been shown to have an antimicrobial action against a broad spectrum of bacteria and fungi (Molan, 1992)10.
According to clinical study oral honey stimulates antibody production during primary and secondary immune responses against thymus-dependent and thymus- independent antigens. It has been reported that honey stimulates T- lymphocytes in cell culture to multiply, and activates neutrophils. In an study with humans receiving a diet supplemented with a daily honey 6 consumption of 1.2g/kg body weight has the following effects: Increase of serum iron by 20% and decrease of plasma ferritin by 11%, an 50 % increase of monocytes and slight increases of lymphocyte and eosinophil percentages, reduction in serum of immunoglobulin E (34%) aspartate transaminase (22%) and alanine transaminase (18%), lactic acid dehydrogenase (41%), fasting sugar (5%) and creatine kinase and finally an increase in blood of copper (33%) and slight elevations of zinc and magnesium, hemoglobin and packed cell volume (Waili, 2003)11.
Considering the above facts the researcher implements the topical application of honey on oral mucosa as a non pharmacological measure to reduce the complication of radiation therapy induced mucositis.
· To assess the effectiveness of topical application of the honey in the management of Chemo- Radiation Therapy induced oral mucositis among cancer survivors in experimental group and without intervention in the control group.
· To determine the association between post interventional score with their selected variables among experimental group.
H1: A significant difference will be their between pre and post interventional scores of cancer survivors after topical application of honey in experimental group and without interventional in control group.
H2: A significant association will be there between post interventional scores of cancer survivors with their selected variables.
Research Approach and Design:
Qualitative Research Approach. True Experimental pre-test post-test with control group was choosen for this study.
American Oncology Institute of NRIGH, chinakakani, mangalagiri, Guntur district.
Sample and Sampling Technique:
Cancer survivors with chemo radiation induced oral mucosities admitted American Oncology Institute and Systematic Random Sampling Technique was used.
· Male and female with age above 21 years.
· Non-diabetic cancer survivors
· Willing to participate in study
· Conscious cancer survivors
· Available at the time of data collection
· Who can speak and understand Telugu and English
Based on the study objectives the tool was divided into two sections.
It consists of a structured interview schedule to collect the socio- demographic variables. It had 2 items such as : 1. Age 2. Gender
It consists of questions related to the clinical data which is gathered from clinical records and reports. It had five items such as:
1. Numberof Radiation cycles
2. Mean and Radiation Area 41
3. Cycle of Chemo Therapy
4. Smoking 5.Diagnosis
Section – II
It consists of the standardized “WHO” oral Toxicity Scale” to evaluate the Intensity loss grade of oral mucosities grade.
Scores from 1-5. It has 5 components. There are:
1. Life Threatening
2. Severe
3. Moderate
4. Mild
5. None.
The prepared tool along with the objectives were submitted to 2 Doctors and 5 Nursing faculty. The modifications and suggestions of expert were incorporated in the final preparations of the tool.
Reliability of the tool was checked by split half technique by using spearman’s brow prophecy formula. It is found that “r” value of knowledge items is 0.9 which indicates that, the tool is highly reliable.
Ethical clearance was taken from the institutional ethical committee.
Data was collected by using Section I (A): Socio Demographic data Section I (B): Clinical DataSection – II: WHO oral toxicity scale
The data obtained were analysed in terms of the objectives and hypothesis of the study by using descriptive and inferential statistics. Frequency and percentage, mean, standard deviation and chi-square test were used to analyse the data.
The study findings are presented in sections as follows:
Frequency and Percentage Distribution of baseline Characteristics of cancer survivors: The majority of the cancer survivors were in the age group of 41-50 years i.e. 33.3% in the experimental group and % in the control group. Similarly males constitute most in the both groups i.e. 53.3% in the experimental group and 70% in the control group. All the participants completed more than 6 radiation cycles in both groups were i.e. 100% in the experimental group and 100% in the control group. Most of them had 25-50 Millimers mean and radiation area i.e. 93.3% in the experimental group and 53.3% in the control group. Majority of them were undergone more than 6 weeks cycles of chemotherapy i.e. 93.7% in the experimental group and 83.3% in the control group. Around 40% of them were smokers in i.e. the experimental group and 63.3% in the control group. Majority of them were diagnosed with non-haematological carcinoma. i.e. 93.7% in the experimental group and 70% in the control group. Both groups were similar in their baseline characteristics (p>0.05)
During pre-test around 6.6% of the cancer survivors in the experimental group had Grade 1 Oral Mucositis and 20.6% in control group had Grade 1 Oral Microsites, about 23.3% of them had Grade II Oral Mucositis in experimental group and 46.7% in control group, around 43.3% in the experimental group and 26.7% in the control group had Grade III Oral Mucositis, 6% of cancer survivors in the experimental group and 6.7% in the control group had Grade IV Oral Mucositis. To test the homogeneity of the outcome measure (Oral Mucosities Grades) at baseline, Chi- square test was computed and it was found that, both the groups were similar at their baseline measure (p>0.05).
The comparison of level of oral mucositis between the experimental and the control groups during pretest, posttest I, II, III and IV. The results revealed that, During Pre-test and post-test I, around 6.6% of the 58 cancer survivors in the experimental group had Grade 1 Oral Mucositis and 20.6% in control group had Grade 1 Oral Microsites, about 23.3% of them had Grade II Oral Mucositis in experimental group and 46.7% in control group, around 43.3% in the experimental group and 26.7% in the control group had Grade III Oral Mucositis, and 6% of cancer survivors in the experimental group and 6.7% in the control group had Grade IV Oral Mucositis. The chi-square results revealed that there is no significant difference in both the groups regarding level oral mucositis (Grades) during pre-test and posttest I at p>0.05. During post-test II, none of them in the experimental group had Grade 1 Oral Mucositis and only 6.7% in the control group had Grade 1 Oral Microsites, about 20.0% of them had Grade II Oral Mucositis in the experimental group and 33.7% in control group, around 56.7% in the experimental group and 40.0% in the control group had Grade III Oral Mucositis and 23.3% of cancer survivors in the experimental group and 20.0% in the control group had Grade IV Oral Mucositis. The chi- square results revealed that there is a significant difference in both the groups regarding level oral mucositis (Grades) during posttest II at p<0.05.
Association between levels of Oral Mucositis with demographic variables among cancer survivors in experimental and control group: There is no significant association found between levels of oral mucositis with demographic variables of cancer survivors during post-test IV in experimental group.
The main aim of the study was to compare the effects of oral honey application in healing of oral mucosities is among cancer survivors on chemo and radiation therapy. The study was conducted by using quasi experimental design with time. Series pre and post test with Experimental group and Control Group. The present study was conducted in Nri American Oncology Institute, Chinakakani, Guntur(DT). The sampling technique is systematic random Sampling technique was used for this study. The total sample size was 60, among them 30 were in the Experimental group and 30 were in the Experimental group and Control Group . WHO Oral Toxicity Scale was used for data collection. After data collection, data was organized, tabulated, summarized and analyzed.
An experimental study was conduct to evaluate the effect of honey on clinically scoring grades of oral mucositis. The study was carried out in radiation oncology department of Mayo hospital, Lahore. In this study 82 patients of both genders of head and neck cancer were taken and divided into two groups by random sampling numbers. Patient in both groups were treated with a total dose of 60-78 grays in 4-6 weeks. In treatment group patient were instructed to take 20ml of honey. In control group they were advised to rinse with 0.9% of saline. Patients were evaluated every week to assess the grades of oral mucositis upto 6 weeks. The assessment tool was radiation therapy oncology group grading system. The statistical analysis was done by chi-square test. In the regroup, patients were given 20ml of ziziphus honey, 15min before and after the radiotherapy. They were instructed to swallow slowly also advised to take before 69 sleeping in the night. By protocol was followed from day 1 of radiation till the end of 6th week. In the cell group patients were given 20ml of 0.9% of saline 15min before and after radio therapy and they were advised to rinse 20ml of saline in the same manner before sleeping.
The assessment scale used in the study was radiation therapy oncology group (RTOG) grading system. The honey was analysed by the Pakistan council of scientific and industrial research. The moisture content of this honey was 17.34% specific gravity was 1.420 pH was 6.05. The results were in the group, twenty lesions of grade 0 mucositis in week 1 were observed. This no faced by the end of 6th week. In 4th group, 32 lesions of grade 0 mucositis were observed in week 1st. this no used till week 3, but used from week 3 till 6. In week 1, the number of Grade I oral mucositis was 7 and it’s frequency iced till the end of 6th week in 4 group. Grade 3 oral mucositis was observed at the end of 3rd week of radiotherapy when compared to control group where I was observed at the end of 2nd week the total number of grade 3 oral mucositis in the group at the end of 6 th week was 17 less than control group grade 3 lesions. Grade 4 mucositis was observed in the group but in treatment Group. The number was 2. In the group the number used in week and week 5, 6 weeks, 19 grade 4 oral mucositis were present in control group and 3 in treatment group. Results were during the course of radiation in week 4 and 5, there was a significant reduction of oral mucositis in the group as compared to control group (the P value of grade 3 mucositis : 0.016 and P value of Grade 4 mucositis : 0.032). This study showed that oral intake of honey during radiotherapy is valuable in the reduction of severity of oral mucositis.
The main conclusion of the present study is oral honey application was effective in reducing oral mucositis among patients with cancer which is denoted by significant level of oral mucositis. After the intervention there had been a significant reduction in level of oral mucositis. The selected subjects became familiar and found themselves comfortable and also expressed satisfaction.
1. Abuharfeil, N., Oran, L., Shehada, M. The effects of bee honey on the proliferative activity of human B and T lymphocytes and activity of phagocytes. Food and Agricultural Immunology 2008: 169- 177.
2. Feeley. The Changing Face of Cancer. Asian Hospital and Health Care Management. 2008; 15: 27-29.
3. Cancer statistics. (2009). WHO? Retrieved from http// www.asian htm.com on 15th June 2010
4. Scully, C., Epstein, J.B. Oral health care for the cancer patient. Oral Oncology European Journal on Cancer. 1996; 281-292.
5. Hanyu, N. Utilization of complementary and alternative medicine by United States Adults: Interview Survey. Medical Care. 2002; 40(4): 253-358.
6. Feeley. The Changing Face of Cancer. Asian Hospital and Health Care Management. 2008; 15: 27-29.
7. Cancer Statistics. (2009). WHO? Retrieved from http// www.asian htm.com on 15th June 2010.
8. Liza, G., Ovington, L.G. Honey: Ancient cure or modern alternative? Wound Care Newsletter. 1999: 1-3.
9. Scully, C., Epstein, J.B. Oral health care for the cancer patient. Oral Oncology European Journal on Cancer. 1996; 281-292.
10. Molan, P C. The antibacterial activity of honey. Bee World. 1992; 5- 28.
11. Waili, N.S., Boni, N. S. Natural honey lowers plasma prostaglandin concentrations in normal individuals. Journal of Medicinal Food. 2003; 129-133.
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Received on 07.11.2024 Revised on 09.12.2024 Accepted on 01.01.2025 Published on 18.02.2025 Available online from March 10, 2025 Int. J. of Advances in Nursing Management. 2025;13(1):41-45. DOI: 10.52711/2454-2652.2025.00009 ©A and V Publications All right reserved
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