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Systematic review of natural and miscellaneous agents, for the management of oral mucositis in cancer patients and clinical practice guidelines — part 2: honey, herbal compounds, saliva stimulants, probiotics, and miscellaneous agents

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Abstract

Objective

To update the clinical practice guidelines for the management of oral mucositis (OM) that were developed by the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). This part focuses on honey, herbal compounds, saliva stimulants, probiotics, and miscellaneous agents.

Methods

A systematic review was conducted by the Mucositis Study Group of MASCC/ISOO. The body of evidence for each intervention, in each clinical setting, was assigned an evidence level. The findings were added to the database used to develop the 2014 MASCC/ISOO clinical practice guidelines. Based on the evidence level, one of the following guidelines were determined: Recommendation, Suggestion, No Guideline Possible.

Results

A total of 78 papers were identified within the scope of this section, of which 49 were included in this review and merged with nine publications that were reported in the previous guidelines update. A new Suggestion was made for honey (combined topical and systemic delivery) for the prevention of OM in head and neck cancer patients receiving radiotherapy with or without chemotherapy. A new Suggestion clarified that chewing gum is not effective for the prevention of OM in pediatric patients with hematological or solid cancer treated with chemotherapy. No guideline was possible for other interventions.

Conclusions

Numerous natural products and herbal remedies were studied for the management of OM. Of the agents reviewed in this systematic review, a guideline in favor was made for honey (combined topical and systemic), while a guideline against was made for chewing gum. Additional research is warranted to clarify the potential of other interventions.

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References

  1. Elad S, Zadik Y, Yarom N (2017) Oral complications of nonsurgical cancer therapies. Atlas Oral Maxillofac Surg Clin North Am 25:133–147

    Article  PubMed  Google Scholar 

  2. Keefe DM, Schubert MM, Elting LS, Sonis ST, Epstein JB, Raber-Durlacher JE, Migliorati CA, McGuire D, Hutchins RD, Peterson DE, Mucositis Study Section of the Multinational Association of Supportive Care in Cancer and the International Society for Oral Oncology (2007) Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer 109:820–831

    Article  CAS  PubMed  Google Scholar 

  3. Rubenstein EB, Peterson DE, Schubert M, Keefe D, McGuire D, Epstein J, Elting LS, Fox PC, Cooksley C, Sonis ST, Mucositis Study Section of the Multinational Association for Supportive Care in Cancer, International Society for Oral Oncology (2004) Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis. Cancer 100:2026–2046

    Article  PubMed  Google Scholar 

  4. Lalla RV, Bowen J, Barasch A, Elting L, Epstein J, Keefe DM, McGuire D, Migliorati C, Nicolatou-Galitis O, Peterson DE, Raber-Durlacher JE, Sonis ST, Elad S, Mucositis Guidelines Leadership Group of the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) (2014) MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer 120:1453–1461

    Article  PubMed  Google Scholar 

  5. Jensen SB, Jarvis V, Zadik Y et al (2013) Systematic review of miscellaneous agents for the management of oral mucositis in cancer patients. Support Care Cancer 21:3223–3232

    Article  PubMed  Google Scholar 

  6. Yarom N, Ariyawardana A, Hovan A, Barasch A, Jarvis V, Jensen SB, Zadik Y, Elad S, Bowen J, Lalla RV, Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) (2013) Systematic review of natural agents for the management of oral mucositis in cancer patients. Support Care Cancer 21:3209–3221

    Article  PubMed  Google Scholar 

  7. Yarom N, Hovan A, P. B, et al: Systematic review of natural and miscellaneous agents for the management of oral mucositis in cancer patients and Clinical Practice Guidelines – Part 1: vitamins, minerals and nutritional supplements. Support Care Cancer, 2019

  8. Ranna V, Cheng KKF, Castillo DA et al (2019) Development of the MASCC/ISOO clinical practice guidelines for mucositis: an overview of the methods. Support Care Cancer

  9. Somerfield MPJ, Pfister D, Bennett C, Recht A, Smith T, Weeks J, Winn R, Duraant J (2000) ASCO clinical practice guidelines: process, progress, pitfalls, and prospects. Classic Papers and Current Comments 4:881–886

    Google Scholar 

  10. Hadorn DC, Baker D, Hodges JS, Hicks N (1996) Rating the quality of evidence for clinical practice guidelines. J Clin Epidemiol 49:749–754

    Article  CAS  PubMed  Google Scholar 

  11. Molan PC (2006) The evidence supporting the use of honey as a wound dressing. Int J Low Extrem Wounds 5:40–54

    Article  CAS  PubMed  Google Scholar 

  12. Bang LM, Buntting C, Molan P (2003) The effect of dilution on the rate of hydrogen peroxide production in honey and its implications for wound healing. J Altern Complement Med 9:267–273

    Article  PubMed  Google Scholar 

  13. Willix DJ, Molan PC, Harfoot CG (1992) A comparison of the sensitivity of wound-infecting species of bacteria to the antibacterial activity of manuka honey and other honey. J Appl Bacteriol 73:388–394

    Article  CAS  PubMed  Google Scholar 

  14. Bardy J, Molassiotis A, Ryder WD, Mais K, Sykes A, Yap B, Lee L, Kaczmarski E, Slevin N (2012) A double-blind, placebo-controlled, randomised trial of active manuka honey and standard oral care for radiation-induced oral mucositis. Br J Oral Maxillofac Surg 50:221–226

    Article  PubMed  Google Scholar 

  15. Hawley P, Hovan A, McGahan CE, Saunders D (2014) A randomized placebo-controlled trial of manuka honey for radiation-induced oral mucositis. Support Care Cancer 22:751–761

    Article  PubMed  Google Scholar 

  16. Jayalekshmi JL, Lakshmi R, Mukerji A (2016) Honey on oral mucositis: a randomized controlled trial. Gulf J Oncolog 1:30–37

    CAS  PubMed  Google Scholar 

  17. Yamauchi K, Kogashiwa Y, Moro Y et al (2014) The effect of topical application of royal jelly on chemoradiotherapy-induced mucositis in head and neck cancer: a preliminary study. Int J Otolaryngol 2014:974967

    Article  PubMed  PubMed Central  Google Scholar 

  18. Biswal BM, Zakaria A, Ahmad NM (2003) Topical application of honey in the management of radiation mucositis: a preliminary study. Support Care Cancer 11:242–248

    Article  PubMed  Google Scholar 

  19. Jayachandran S, Balaji N (2012) Evaluating the effectiveness of topical application of natural honey and benzydamine hydrochloride in the management of radiation mucositis. Indian J Palliat Care 18:190–195

    Article  PubMed  PubMed Central  Google Scholar 

  20. Maiti PK, Ray A, Mitra TN, Jana U, Bhattacharya J, Ganguly S (2012) The effect of honey on mucositis induced by chemoradiation in head and neck cancer. J Indian Med Assoc 110:453–456

    PubMed  Google Scholar 

  21. Motallebnejad M, Akram S, Moghadamnia A et al (2008) The effect of topical application of pure honey on radiation-induced mucositis: a randomized clinical trial. J Contemp Dent Pract 9:40–47

    Article  CAS  PubMed  Google Scholar 

  22. Rashad UM, Al-Gezawy SM, El-Gezawy E et al (2009) Honey as topical prophylaxis against radiochemotherapy-induced mucositis in head and neck cancer. J Laryngol Otol 123:223–228

    Article  CAS  PubMed  Google Scholar 

  23. Samdariya S, Lewis S, Kauser H, Ahmed I, Kumar D (2015) A randomized controlled trial evaluating the role of honey in reducing pain due to radiation induced mucositis in head and neck Cancer patients. Indian J Palliat Care 21:268–273

    Article  PubMed  PubMed Central  Google Scholar 

  24. Erdem O, Gungormus Z (2014) The effect of royal jelly on oral mucositis in patients undergoing radiotherapy and chemotherapy. Holist Nurs Pract 28:242–246

    Article  PubMed  Google Scholar 

  25. Khanal B, Baliga M, Uppal N (2010) Effect of topical honey on limitation of radiation-induced oral mucositis: an intervention study. Int J Oral Maxillofac Surg 39:1181–1185

    Article  CAS  PubMed  Google Scholar 

  26. Raeessi MA, Raeessi N, Panahi Y et al (2014) “Coffee plus honey” versus “topical steroid” in the treatment of chemotherapy-induced oral mucositis: a randomised controlled trial. BMC Complement Altern Med 14:293

    Article  PubMed  PubMed Central  Google Scholar 

  27. Abdulrhman M, Elbarbary NS, Ahmed Amin D, Saeid Ebrahim R (2012) Honey and a mixture of honey, beeswax, and olive oil-propolis extract in treatment of chemotherapy-induced oral mucositis: a randomized controlled pilot study. Pediatr Hematol Oncol 29:285–292

    Article  PubMed  Google Scholar 

  28. Mohamed SA, Shebl A, Weheida SM (2012) The effect of topical application of honey on management of chemotherapy induced oral stomatitis. Life Science Journal 9:5128–5134

    Google Scholar 

  29. Oryan A, Alemzadeh E, Moshiri A (2018) Potential role of propolis in wound healing: biological properties and therapeutic activities. Biomed Pharmacother 98:469–483

    Article  CAS  PubMed  Google Scholar 

  30. Kuropatnicki AK, Szliszka E, Krol W (2013) Historical aspects of propolis research in modern times. Evid Based Complement Alternat Med 2013:964149

    PubMed  PubMed Central  Google Scholar 

  31. AkhavanKarbassi MH, Yazdi MF, Ahadian H, SadrAbad M (2016) Randomized double blind placebo controlled trial of propolis for oral mucositis in patients receiving chemotherapy for head and neck cancer. Asian Pac J Cancer Prev 17:3611–3614

    PubMed  Google Scholar 

  32. Javadzadeh Bolouri A, Pakfetrat A, Tonkaboni A et al (2015) Preventing and therapeutic effect of propolis in radiotherapy induced mucositis of head and neck cancers: a triple-blind, randomized, placebo-controlled trial. Iran J Cancer Prev 8:e4019

    Article  PubMed  PubMed Central  Google Scholar 

  33. Tomazevic T, Jazbec J (2013) A double blind randomised placebo controlled study of propolis (bee glue) effectiveness in the treatment of severe oral mucositis in chemotherapy treated children. Complement Ther Med 21:306–312

    Article  CAS  PubMed  Google Scholar 

  34. Noronha VR, Araujo GS, Gomes RT, Iwanaga SH, Barbosa MC, Abdo EN, Ferreira e Ferreira E, Viana Campos AC, Souza AA, Abreu SR, Santos VR (2014) Mucoadhesive propolis gel for prevention of radiation-induced oral mucositis. Curr Clin Pharmacol 9:359–364

    Article  CAS  PubMed  Google Scholar 

  35. Sencer SF, Zhou T, Freedman LS et al (2012) Traumeel S in preventing and treating mucositis in young patients undergoing SCT: a report of the Children’s oncology group. Bone Marrow Transplant 47:1409–1414

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Oberbaum M, Yaniv I, Ben-Gal Y et al (2001) A randomized, controlled clinical trial of the homeopathic medication TRAUMEEL S in the treatment of chemotherapy-induced stomatitis in children undergoing stem cell transplantation. Cancer 92:684–690

    Article  CAS  PubMed  Google Scholar 

  37. Steinmann D, Eilers V, Beynenson D, Buhck H, Fink M (2012) Effect of Traumeel S on pain and discomfort in radiation-induced oral mucositis: a preliminary observational study. Altern Ther Health Med 18:12–18

    PubMed  Google Scholar 

  38. Pedersen AML, Sorensen CE, Proctor GB et al (2018) Salivary secretion in health and disease. J Oral Rehabil 45:730–746

    Article  CAS  PubMed  Google Scholar 

  39. Bodner L, Dayan D (1995) Epithelium and connective tissue regeneration during palatal wound healing in desalivated rats--a comparative study. Comp Biochem Physiol A Physiol 111:415–419

    Article  CAS  PubMed  Google Scholar 

  40. Edgar WM (1998) Sugar substitutes, chewing gum and dental caries--a review. Br Dent J 184:29–32

    Article  CAS  PubMed  Google Scholar 

  41. Eghbali A, Taherkhanchi B, Bagheri B, Sadeghi Sedeh B (2016) Effect of chewing gum on oral mucositis in children undergoing chemotherapy: a randomized controlled study. Iran J Ped Hematol Oncol 6:9–14

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Gandemer V, Le Deley MC, Dollfus C et al (2007) Multicenter randomized trial of chewing gum for preventing oral mucositis in children receiving chemotherapy. J Pediatr Hematol Oncol 29:86–94

    Article  PubMed  Google Scholar 

  43. Pimenta Amaral TM, Campos CC, Moreira dos Santos TP et al (2012) effect of salivary stimulation therapies on salivary flow and chemotherapy-induced mucositis: a preliminary study. Oral Surg Oral Med Oral Pathol Oral Radiol 113:628–637

    Article  PubMed  Google Scholar 

  44. Macann A, Fua T, Milross CG et al (2014) Phase 3 trial of domiciliary humidification to mitigate acute mucosal toxicity during radiation therapy for head-and-neck cancer: first report of Trans Tasman Radiation Oncology Group (TROG) 07.03 RadioHUM study. Int J Radiat Oncol Biol Phys 88:572–579

    Article  PubMed  Google Scholar 

  45. Moslehi A, Taghizadeh-Ghehi M, Gholami K, Hadjibabaie M, Jahangard-Rafsanjani Z, Sarayani A, Javadi M, Esfandbod M, Ghavamzadeh A (2014) N-acetyl cysteine for prevention of oral mucositis in hematopoietic SCT: a double-blind, randomized, placebo-controlled trial. Bone Marrow Transplant 49:818–823

    Article  CAS  PubMed  Google Scholar 

  46. Mohanty C, Sahoo SK (2017) Curcumin and its topical formulations for wound healing applications. Drug Discov Today 22:1582–1592

    Article  CAS  PubMed  Google Scholar 

  47. Bachmeier BE, Killian PH, Melchart D (2018) The role of Curcumin in prevention and management of metastatic disease. Int J Mol Sci 19

    Article  PubMed Central  CAS  Google Scholar 

  48. Mansourian A, Amanlou M, Shirazian S et al (2015) The effect of “Curcuma Longa” topical gel on radiation-induced oral mucositis in patients with head and neck cancer. International Journal of Radiation Research 13:269–274

    Google Scholar 

  49. Francis M, Williams S (2014) Effectiveness of Indian turmeric powder with honey as complementary therapy on oral mucositis : a nursing perspective among cancer patients in Mysore. Nurs J India 105:258–260

    PubMed  Google Scholar 

  50. Rao S, Dinkar C, Vaishnav LK, Rao P, Rai MP, Fayad R, Baliga MS (2014) The Indian spice turmeric delays and mitigates radiation-induced oral mucositis in patients undergoing treatment for head and neck cancer: an investigational study. Integr Cancer Ther 13:201–210

    Article  PubMed  Google Scholar 

  51. Patil K, Guledgud MV, Kulkarni PK et al (2015) Use of curcumin mouthrinse in radio-chemotherapy induced oral mucositis patients: a pilot study. J Clin Diagn Res 9:Zc59–Zc62

    CAS  PubMed  PubMed Central  Google Scholar 

  52. Matsuda C, Munemoto Y, Mishima H, Nagata N, Oshiro M, Kataoka M, Sakamoto J, Aoyama T, Morita S, Kono T (2015) Double-blind, placebo-controlled, randomized phase II study of TJ-14 (Hangeshashinto) for infusional fluorinated-pyrimidine-based colorectal cancer chemotherapy-induced oral mucositis. Cancer Chemother Pharmacol 76:97–103

    Article  PubMed  PubMed Central  Google Scholar 

  53. Kono T, Kaneko A, Matsumoto C et al (2012) Amelioration of 5-fluorouracil-induced oral mucositis in hamsters by TJ-14 (Hangeshashinto), inhibitor of inducible prostaglandin E2 and proinflammatory cytokines. Gastroenterology 142:S673

    Article  Google Scholar 

  54. Aoyama T, Nishikawa K, Takiguchi N, Tanabe K, Imano M, Fukushima R, Sakamoto J, Oba MS, Morita S, Kono T, Tsuburaya A (2014) Double-blind, placebo-controlled, randomized phase II study of TJ-14 (hangeshashinto) for gastric cancer chemotherapy-induced oral mucositis. Cancer Chemother Pharmacol 73:1047–1054

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Yamashita T, Araki K, Tomifuji M, Kamide D, Tanaka Y, Shiotani A (2015) A traditional Japanese medicine--Hangeshashinto (TJ-14)--alleviates chemoradiation-induced mucositis and improves rates of treatment completion. Support Care Cancer 23:29–35

    Article  PubMed  Google Scholar 

  56. Srivastava JK, Pandey M, Gupta S (2009) Chamomile, a novel and selective COX-2 inhibitor with anti-inflammatory activity. Life Sci 85:663–669

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Srivastava JK, Shankar E, Gupta S (2010) Chamomile: a herbal medicine of the past with bright future. Mol Med Rep 3:895–901

    CAS  PubMed  Google Scholar 

  58. Fidler P, Loprinzi CL, O’Fallon JR, Leitch JM, Lee JK, Hayes DL, Novotny P, Clemens-Schutjer D, Bartel J, Michalak JC (1996) Prospective evaluation of a chamomile mouthwash for prevention of 5-FU-induced oral mucositis. Cancer 77:522–525

    Article  CAS  PubMed  Google Scholar 

  59. Dos Reis PE, Ciol MA, de Melo NS, Figueiredo PT, Leite AF, Manzi Nde M (2016) Chamomile infusion cryotherapy to prevent oral mucositis induced by chemotherapy: a pilot study. Support Care Cancer 24:4393–4398

    Article  PubMed  Google Scholar 

  60. Braga FT, Santos AC, Bueno PC, Silveira RC, Santos CB, Bastos JK, Carvalho EC (2015) Use of Chamomilla recutita in the prevention and treatment of oral mucositis in patients undergoing hematopoietic stem cell transplantation: a randomized, controlled. Phase II Clinical Trial Cancer Nurs 38:322–329

    PubMed  Google Scholar 

  61. Khurana H, Pandey RK, Saksena AK, Kumar A (2013) An evaluation of vitamin E and pycnogenol in children suffering from oral mucositis during cancer chemotherapy. Oral Dis 19:456–464

    Article  CAS  PubMed  Google Scholar 

  62. Ahmed KM (2013) The effect of olive leaf extract in decreasing the expression of two pro-inflammatory cytokines in patients receiving chemotherapy for cancer. A randomized clinical trial. Saudi Dent J 25:141–147

    Article  PubMed  PubMed Central  Google Scholar 

  63. Luo Y, Feng M, Fan Z et al (2016) Effect of Kangfuxin solution on chemo/radiotherapy-induced mucositis in nasopharyngeal carcinoma patients: a multicenter, prospective randomized phase III clinical study. Evid Based Complement Alternat Med 2016:8692343

    PubMed  PubMed Central  Google Scholar 

  64. Carulli G, Rocco M, Panichi A et al (2013) Treatment of oral mucositis in hematologic patients undergoing autologous or allogeneic transplantation of peripheral blood stem cells: a prospective, randomized study with a mouthwash containing camelia sinensis leaf extract. Hematol Rep 5:21–25

    Article  PubMed  PubMed Central  Google Scholar 

  65. Kong M, Hwang DS, Yoon SW et al (2016) The effect of clove-based herbal mouthwash on radiation-induced oral mucositis in patients with head and neck cancer: a single-blind randomized preliminary study. Onco Targets Ther 9:4533–4538

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Das D, Agarwal SK, Chandola HM (2011) Protective effect of Yashtimadhu (Glycyrrhiza glabra) against side effects of radiation/chemotherapy in head and neck malignancies. Ayu 32:196–199

    Article  PubMed  PubMed Central  Google Scholar 

  67. Babaee N, Moslemi D, Khalilpour M et al (2013) Antioxidant capacity of calendula officinalis flowers extract and prevention of radiation induced oropharyngeal mucositis in patients with head and neck cancers: a randomized controlled clinical study. Daru 21:18

    Article  PubMed  PubMed Central  Google Scholar 

  68. Miranzadeh S, Adib-Hajbaghery M, Soleymanpoor L et al (2014) A new mouthwash for chemotherapy induced stomatitis. Nurs Midwifery Stud 3:e20249

    Article  PubMed  PubMed Central  Google Scholar 

  69. Elkerm Y, Tawashi R (2014) Date palm pollen as a preventative intervention in radiation- and chemotherapy-induced oral mucositis: a pilot study. Integr Cancer Ther 13:468–472

    Article  PubMed  Google Scholar 

  70. Giacomelli I, Scartoni D, Fiammetta M, Baki M, Zei G, Muntoni C, Cappelli S, Greto D, Scoccianti S, Livi L (2015) Oral Lapacho-based medication: an easy, safe, and feasible support to prevent and/or reduce oral mucositis during radiotherapy for head and neck cancer. Nutr Cancer 67:1247–1253

    Article  PubMed  CAS  Google Scholar 

  71. Bertoglio JC, Calderon S, Lesina B et al (2013) Effect of SAMITAL(R) in the treatment of chemotherapy-induced mucositis in adult oncohematological patients. Future Oncol 9:1727–1732

    Article  CAS  PubMed  Google Scholar 

  72. Limaye SA, Haddad RI, Cilli F, Sonis ST, Colevas AD, Brennan MT, Hu KS, Murphy BA (2013) Phase 1b, multicenter, single blinded, placebo-controlled, sequential dose escalation study to assess the safety and tolerability of topically applied AG013 in subjects with locally advanced head and neck cancer receiving induction chemotherapy. Cancer 119:4268–4276

    Article  CAS  PubMed  Google Scholar 

  73. Sharma A, Rath GK, Chaudhary SP et al (2012) Lactobacillus brevis CD2 lozenges reduce radiation- and chemotherapy-induced mucositis in patients with head and neck cancer: a randomized double-blind placebo-controlled study. Eur J Cancer 48:875–881

    Article  CAS  PubMed  Google Scholar 

  74. Yen SH, Wang LW, Lin YH et al (2012) Phenylbutyrate mouthwash mitigates oral mucositis during radiotherapy or chemoradiotherapy in patients with head-and-neck cancer. Int J Radiat Oncol Biol Phys 82:1463–1470

    Article  CAS  PubMed  Google Scholar 

  75. Baharvand M, Hamian M, Moosavizadeh MA, Mortazavi A, Ameri A (2015) Phenytoin mouthwash to treat cancer therapy-induced oral mucositis: a pilot studyPrimary neuroendocrine carcinoma of breast: a rare tumor. Indian J Cancer 52:81–85

    Article  CAS  PubMed  Google Scholar 

  76. Karaca H, Bozkurt O, Ozaslan E, Baldane S, Berk V, Inanc M, Duran AO, Dikilitas M, Er O, Ozkan M (2014) Positive effects of oral beta-glucan on mucositis and leukopenia in colorectal cancer patients receiving adjuvant FOLFOX-4 combination chemotherapy. Asian Pac J Cancer Prev 15:3641–3644

    Article  PubMed  Google Scholar 

  77. Bonfili P, Gravina GL, Marampon F, Rughetti A, di Staso M, Dell’Orso L, Vittorini F, Moro R, la Verghetta ME, Parente S, Reale M, Ruggieri V, Franzese P, Tombolini V, Masciocchi C, di Cesare E (2017) Oral platelet gel supernatant plus supportive medical treatment versus supportive medical treatment in the management of radiation-induced oral mucositis: a matched explorative active control trial by propensity analysis. Am J Clin Oncol 40:336–341

    Article  PubMed  Google Scholar 

  78. Atay MH, Aslan NA, Aktimur S et al (2015) Safety and efficacy of Ankaferd hemostat (ABS) in the chemotherapy-induced Oral Mucositis. Int J Hematol Oncol 3:166–171

    Article  CAS  Google Scholar 

  79. Li L, Yao H, Wang J et al (2019) The role of Chinese Medicine in Health Maintenance and Disease Prevention: Application of Constitution Theory. Am J Chin Med:1–12

  80. Bowen WH, Lawrence RA (2005) Comparison of the cariogenicity of cola, honey, cow milk, human milk, and sucrose. Pediatrics 116:921–926

    Article  PubMed  Google Scholar 

  81. Fidler Mis N, Braegger C, Bronsky J et al (2017) Sugar in infants, children and adolescents: A Position Paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr 65:681–696

    Article  CAS  PubMed  Google Scholar 

  82. Santos-Silva AR, Rosa GB, Eduardo CP et al (2011) Increased risk for radiation-related caries in cancer patients using topical honey for the prevention of oral mucositis. Int J Oral Maxillofac Surg 40:1335–1336; author reply 1235

    Article  PubMed  Google Scholar 

  83. Verrone JR, Alves FA, Prado JD, Marcicano Ad, de Assis Pellizzon AC, Damascena AS, Jaguar GC (2014) Benefits of an intraoral stent in decreasing the irradiation dose to oral healthy tissue: dosimetric and clinical features. Oral Surg Oral Med Oral Pathol Oral Radiol 118:573–578

    Article  PubMed  Google Scholar 

  84. Yangchen K, Siddharth R, Singh SV et al (2016) A pilot study to evaluate the efficacy of cerrobend shielding stents in preventing adverse radiotherapeutic effects in buccal carcinoma patients. J Cancer Res Ther 12:314–317

    Article  CAS  PubMed  Google Scholar 

  85. Al-Mamgani A, van Rooij P, Verduijn GM et al (2013) The impact of treatment modality and radiation technique on outcomes and toxicity of patients with locally advanced oropharyngeal cancer. Laryngoscope 123:386–393

    Article  PubMed  Google Scholar 

  86. Fleming S, Harrison SJ, Blombery P et al (2014) The choice of multiple myeloma induction therapy affects the frequency and severity of oral mucositis after melphalan-based autologous stem cell transplantation. Clin Lymphoma Myeloma Leuk 14:291–296

    Article  PubMed  Google Scholar 

  87. Wang ZH, Zhang SZ, Zhang ZY, Zhang CP, Hu HS, Tu WY, Kirwan J, Mendenhall WM (2012) Protecting the oral mucosa in patients with oral tongue squamous cell carcinoma treated postoperatively with intensity-modulated radiotherapy: a randomized study. Laryngoscope 122:291–298

    Article  PubMed  Google Scholar 

  88. Piredda M, Facchinetti G, Biagioli V et al (2017) Propolis in the prevention of oral mucositis in breast cancer patients receiving adjuvant chemotherapy: a pilot randomised controlled trial. Eur J Cancer Care (Engl) 26

  89. Marucci L, Farneti A, Di Ridolfi P et al (2017) Double-blind randomized phase III study comparing a mixture of natural agents versus placebo in the prevention of acute mucositis during chemoradiotherapy for head and neck cancer. Head Neck 39:1761–1769

    Article  PubMed  Google Scholar 

  90. Khanjani Pour-Fard-Pachekenari A, Rahmani A, Ghahramanian A, Asghari Jafarabadi M, Onyeka TC, Davoodi A (2019) The effect of an oral care protocol and honey mouthwash on mucositis in acute myeloid leukemia patients undergoing chemotherapy: a single-blind clinical trial. Clin Oral Investig 23:1811–1821

    Article  PubMed  Google Scholar 

  91. Najafi S, Koujan SE, Manifar S, Kharazifard MJ, Kidi S, Hajheidary S (2017) Preventive effect of Glycyrrhiza Glabra extract on Oral Mucositis in patients under head and neck radiotherapy: a randomized clinical trial. J Dent (Tehran) 14:267–274

    Google Scholar 

  92. Ghalayani P, Emami H, Pakravan F et al (2017) Comparison of triamcinolone acetonide mucoadhesive film with licorice mucoadhesive film on radiotherapy-induced oral mucositis: a randomized double-blinded clinical trial. Asia Pac J Clin Oncol 13:e48–e56

    Article  PubMed  Google Scholar 

  93. Bahramnezhad F, Dehghan Nayeri N, Bassampour SS et al (2015) Honey and radiation-induced stomatitis in patients with head and neck cancer. Iran Red Crescent Med J 17:e19256

    PubMed  PubMed Central  Google Scholar 

  94. Elad S, Meidan I, Sellam G, Simaan S, Zeevi I, Waldman E, Weintraub M, Revel-Vilk S (2013) Topical curcumin for the prevention of oral mucositis in pediatric patients: case series. Altern Ther Health Med 19:21–24

    PubMed  Google Scholar 

  95. Carl W, Emrich LS (1991) Management of oral mucositis during local radiation and systemic chemotherapy: a study of 98 patients. J Prosthet Dent 66:361–369

    Article  CAS  PubMed  Google Scholar 

  96. Sahebjamee M, Mansourian A, Hajimirzamohammad M, Zadeh MT, Bekhradi R, Kazemian A, Manifar S, Ashnagar S, Doroudgar K (2015) Comparative efficacy of Aloe vera and benzydamine mouthwashes on radiation-induced oral mucositis: a triple-blind, randomised. Controlled Clinical Trial Oral Health Prev Dent 13:309–315

    PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Oral Medicine Unit, Sheba Medical Center, Tel Hashomer, Israel

    Noam Yarom

  2. School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel

    Noam Yarom

  3. British Columbia Cancer-Vancouver Centre, Vancouver, Canada

    Allan Hovan

  4. Department of Medical and Surgical Specialties, Radiological Sciences and Public Health - Medical Oncology, University of Brescia, Spedali Civili, Brescia, Italy

    Paolo Bossi

  5. College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia

    Anura Ariyawardana

  6. Metro South Oral Health, Queensland Health, Brisbane, Australia

    Anura Ariyawardana

  7. Department of Dentistry and Oral Health, Faculty of Health, Aarhus University, Aarhus, Denmark

    Siri Beier Jensen

  8. Division of Oral Medicine and Pathology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy

    Margherita Gobbo & Giulia Ottaviani

  9. Al-Maha Cancer Foundation, Bethlehem, Palestine

    Hanan Saca-Hazboun

  10. Swami Rama Himayalan University Cancer research institute, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India

    Abhishek Kandwal

  11. Dental School University of Brescia Radiological, Department of Medical and Surgical Specialties, Science and Public Health, Brescia, Italy

    Alessandra Majorana

  12. Department of Oncology, Oral Medicine and Oral Oncology Unit, University of Turin, Turin, Italy

    Monica Pentenero

  13. Special Needs Dentistry, Dental Services, Ministry of Health, Muscat, Oman

    Narmin Mohammed Nasr

  14. Dental Oncology Program, Health Sciences North, North East Cancer Center, Sudbury, ON, Canada

    Tanya Rouleau

  15. Medical Oncology Service, Department of Medicine, NYU Langone Perlmutter Cancer Center, New York, NY, USA

    Anna Skripnik Lucas

  16. Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, Boston, MA, USA

    Nathaniel Simon Treister

  17. Harvard School of Dental Medicine Department of Oral Medicine, Infection and Immunity, Boston, MA, USA

    Nathaniel Simon Treister

  18. Compounding Solutions, Tel-Mond, Israel

    Eyal Zur

  19. The Mount Sinai Hospital Department of Oral and Maxillofacial Surgery New York 10029, NY, USA

    Vinisha Ranna

  20. University of Rochester Medical Center Oral Medicine, Eastman Institute for Oral Health Rochester, New York, USA

    Anusha Vaddi & Sharon Elad

  21. Division of Oral and Maxillofacial Diagnostic Sciences, UConn School of Dental Medicine, UConn Health, Farmington, CT, USA

    Anusha Vaddi & Rajesh V Lalla

  22. Dental Clinics, Cambridge Health Alliance, Cambridge, MA, USA

    Andrei Barasch

  23. National University of Singapore Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine , Singapore, Singapore

    Karis Kin Fong Cheng

Authors
  1. Noam Yarom
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  2. Allan Hovan
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  3. Paolo Bossi
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  4. Anura Ariyawardana
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  5. Siri Beier Jensen
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  6. Margherita Gobbo
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  7. Hanan Saca-Hazboun
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  8. Abhishek Kandwal
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  9. Alessandra Majorana
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  10. Giulia Ottaviani
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  11. Monica Pentenero
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  12. Narmin Mohammed Nasr
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  13. Tanya Rouleau
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  14. Anna Skripnik Lucas
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  15. Nathaniel Simon Treister
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  16. Eyal Zur
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  17. Vinisha Ranna
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  18. Anusha Vaddi
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  19. Andrei Barasch
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  20. Rajesh V Lalla
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  21. Karis Kin Fong Cheng
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  22. Sharon Elad
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Consortia

On behalf of the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer / International Society of Oral Oncology (MASCC/ISOO)

Corresponding author

Correspondence to Noam Yarom.

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Conflict of interest

Per MASCC Guidelines Policy, employees of commercial entities were not eligible to serve on this MASCC Guidelines Panel.

The authors disclose no conflict of interest (NY, AH, AA, SBJ, MG, HIH, AK, AM, JO, MP, NMN, TR, ASL, NST, EZ, VR, AV, KF, AB). PB has served an advisory role for AstraZeneca, Helsinn, and Kyowa Kyrin and received grants from Merck, Kyowa Kyrin, and Roche. RVL has served as a consultant for Colgate Oral Pharmaceuticals, Galera Therapeutics, Ingalfarma SA, Monopar Therapeutics, Mundipharma, and Sucampo Pharma; has received research support to his institution from Galera Therapeutics, Novartis, Oragenics, and Sucampo Pharma; and has received stock in Logic Biosciences. SE discloses no conflict of interest in regards to the subject matter, and served as a consultant for Falk Pharma outside the submitted work.

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Yarom, N., Hovan, A., Bossi, P. et al. Systematic review of natural and miscellaneous agents, for the management of oral mucositis in cancer patients and clinical practice guidelines — part 2: honey, herbal compounds, saliva stimulants, probiotics, and miscellaneous agents. Support Care Cancer 28, 2457–2472 (2020). https://doi.org/10.1007/s00520-019-05256-4

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