Research Working Group - Updates from 2017
March 2017: Unleashing the power of nature in advanced symptom management: the case of thyme honey in xerostomia
By Andreas Charalambous, Assistant Professor of Oncology Nursing and Palliative Care, Nursing Faculty, Cyprus University of Technology and Docent at University of Turku, Finland.
Cancer treatments including immunotherapy have all been associated with numerous adverse effects of varying levels of severity, including oral toxicities and cutaneous toxicities, to name a few. One of the most prominent and persistent side effects for patients with malignancy undergoing chemotherapy and/or radiotherapy is xerostomia. These adverse effects, when severe, can cause dose limitation, interruption of treatment, difficulties in performing the activities of daily living and subsequently increasing the negative impact on the patient’s overall Health-Related Quality of Life (Charalambous, 2014).
Xerostomia is the abnormal dryness in the mouth characterized by a marked decrease and/or thickening of saliva, resulting from the reduction or absence of sufficient quantity of salivary production. For example, radiation therapy as monotherapy (worse effects observed when radiotherapy is combined with chemotherapy such as increased duration of xerostomia) can reduce the salivary flow rate by up to 80% by the 7th week (Li et al., 2007). As a result the patient has to deal with difficulties in eating and swallowing that in turn lead to limited intake of food and liquids, causing severe malnutrition and secondary infections.
The pharmacological options available for the comprehensive management of xerostomia remain ineffective and with many presenting with low adherence among patients (i.e. pilocarpine, artificial saliva). The value of complementary and alternative (CAM) interventions such as thyme honey in the management of xerostomia has not been fully captured in the literature. The fact that an increased number of people will have to live with this side-effect during the treatment and soon after its completion, has created a more positive trend towards the value and effectiveness of CAM interventions both among patients and healthcare professionals.
Honey is one of products in nature’s arsenal that have been studied to an extent for the management of H&N cancer treatment adverse-effects, but not for xerostomia. Honey has many properties that can prospectively be of high value in managing xerostomia. For example, honey presence in the oral cavity can have a sialagogue effect by stimulating the salivary glands (i.e. minor salivary glands) to produce more saliva (Ganjre et al., 2015). Honey also has excellent antibacterial action due to the presence of phytochemicals (Anderson, 2006) and its acidic environment with a pH ranging from 3.2 to 4.5 (Bardy et al., 2008:1). The antibacterial properties of honey can be further fortified by those of thyme, which also has strong anti-inflammatory and pain-relief actions when used locally.
We have recently published the first study that was designed to explore the effectiveness of thyme honey in xerostomia (Charalambous et al 2017). This was a parallel randomised controlled trial with two equal arms, the experimental arm (thyme honey) and the control arm (saline). Seventy-two head and neck cancer patients receiving radiotherapy or/and chemotherapy or/and surgery were recruited for this trial. Patients in both arms followed the same administration protocol with thyme honey and saline respectively. Identical assessments at baseline, 1 month and 6 months following completion of the intervention were performed in both arms including the National Cancer Institute (NCI) xerostomia scale and the Xerostomia Questionnaire (XQ) additionally to weekly oral clinical assessments. The ClinicalTrials.gov Identifier for this study is NCT01465308. The study’s results demonstrated the safety and efficacy of Thyme honey in head and neck cancer patients for the management of treatment induced xerostomia. Thyme honey was found effective in reducing or stabilizing the severity of xerostomia grade and improving overall health related quality of life. Its positive effects on xerostomia grade increased over time. However, this being the first study exploring the safety and effectiveness of thyme honey in xerostomia, there is a need for further larger, multi-site and high quality studies to validate these findings.
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Bardy, J.N. Slevin, L.K. Mais, et al. A systematic review of honey uses and its potential value within oncology care J. Clin. Nurs., 17 (2008), pp. 2604-2623
Charalambous, A. Charalambous M. Hermeneutic phenomenological interpretations of patients with head and neck neoplasm experiences living with radiation-induced xerostomia: the price to pay? Eur. J. Oncol. Nurs., 18 (2014), pp. 512-520.
Charalambous A, Lambrinou A, Katodritis N, Vomvas D, Raftopoulos V, Georgiou M, Paikousis L, Charalambous M. The effectiveness of thyme honey for the management of treatment-induced xerostomia in head and neck cancer patients: A feasibility randomized control trial, European Journal of Oncology Nursing, 27(2017), pp 1-8
Ganjre, A, K. Rahul, V. Pawar, N. Bagul, et al. Anti-carcinogenic and anti-bacterial properties of selected spices Implic. Oral Health Clin Nutr Res., 4 (2015), pp. 209-215.
Y. Li, J.M. Taylor, R.K. Ten, Haken. The impact of dose on parotid salivary recovery in head and neck cancer patients treated with radiation therapy. Int. J. Radiat. Oncol. Biol. Phys., 67 (3, 1) (2007), pp. 660-669.
February 2017: Personalised medicine
Personalised medicine aims to tailor treatment to the patient’s individual biology. Recent advances in genetic science are revolutionising cancer treatment. For the February Research News Update, Professor Theresa Wiseman shares an article from the journal Oncology.
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