EFFECTIVENESS OF TOPICAL APPLICATION OF MIXTURE OF HONEY AND COFFEE IN RADIATION INDUCED ORAL MUCOSITIS AMONG PATIENTS WITH HEAD & NECK CANCER UNDERGOING RADIOTHERAPY AT RADIOTHERAPY DEPARTMENT OF KGMU, LUCKNOW, U.P

1. M.Sc (N). Student, Department of Medical and Surgical Nursing, College of Nursing, KGMU, Lucknow, India. 2. Principal, Department of Medical and Surgical Nursing, College of Nursing, KGMU, Lucknow, India. 3. M.D, Professor of Radiotherapy Department, KGMU, Lucknow, India. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 05 August 2020 Final Accepted: 10 September 2020 Published: October 2020


ISSN: 2320-5407
Int. J. Adv. Res. 8(10), 55-62 56 developing countries, mainly in Southeast Asia. Head & neck cancers are more common in males as compared to the females. This is mainly attributed to the use of tobacco, areca nut & alcohol etc. Head & neck cancers are more common in several regions of the world where the prevalence of tobacco & alcohol consumption is very high. 5 The standard of care for head & neck cancers especially oropharyngeal cancer & inoperable oral cavity cancer, is concurrent chemo radiation. 1 Oral mucositis is the most common & irritating side effect of chemo radiation. Around 80% of the patients treated with radiotherapy suffer from Radiation Induced Oral Mucositis and may reach upto 100% in patients with altered fraction in head and neck cancer. 4 In recent years, more head & neck cancer patients have been treated with radiotherapy (RT). 1 Nowadays a number of commercial agents have been marketed to treat or prevent oral mucositis that are expensive & doubtful efficacy. Finance is the major issue, some home-made remedy can help the poor patients to deal with chemoradiation induced side effects & continue their treatment without breaks in the developing countries. 1 Mohammad A R, Neda R (2014) conducted a RCT on coffee plus honey versus topical steroid in the treatment of chemotherapy induced oral mucositis. The result showed that all the three treatment regimens (honey plus coffee, honey, and steroids) reduce the severity of lesions. The best reduction in severity was achieved in HC group. H group and S group took the second and third places. In other words, honey plus coffee regimen was the most effective modality for the treatment of oral mucositis. The conclusion of the study was that oral mucositis can be successfully treated by a combination of honey and coffee as an alternative medicine in a short time. 6 Topical application of honey to the oral cavity and pharynx results in reduction of pain to significantly low levels resulting in\ lesser use of analgesics, treatment gaps and weight loss hence overall which improves their compliance and tolerability towards radiation schedule, which helps in completing the radiation treatment protocol within given time period, leading to the maximum possible effect achieved by RT on tumor.

Demographic variables:
Age, sex, cigarette smoking/ tobacco chewing, duration of smoking/ tobacco chewing.

Target population:
People clinically diagnosed with head and neck cancer i.e. newly diagnosed patients who met inclusion criteria in the radiotherapy department.

Accessible population:
Patients with head and neck cancer undergoing radiation therapy at radiotherapy department, who met the inclusion criteria and agree to participate in the study, were recruited as subjects.

Sample size:
It consisted of total 60 patients (30 in each group).

Sampling technique:
In this study convenience sampling technique of non probability sampling method was used.

Description of the data collection tool and technique: Section 1: Demographic variables and clinical profile:
Demographic variables include age, gender and smoking habits. Clinical profile includes weight loss during treatment, number of radiation fractions, duration of oral mucositis and oral hygiene followed.
Section 2: RTOG grading system for oral mucositis: This section includes standard RTOG grading system for oral mucositis. The RTOG grading is reliant on a clinician's ability to judge the anatomical changes associated with oral mucositis (size & characteristics of ulceration) and available in public domain which includes 5 grades that starts from grade 0 to grade 4.
Steps of application of mixture of honey and coffee: 1. In the study group, the subjects received the topical application of mixture of honey & coffee in the 3:1 ratio respectively, i.e. mixture of 100 gm will contain 75gm of honey & 25 gm of instant coffee. The subjects were explained to keep the mixture for 30 seconds in the mouth and then swallow it. 2. 10 ml of the mixture of honey and coffee was applied on the oral mucosa of the subjects for 2 times in a day i.e., 15 minutes before & 15 minutes after the radiotherapy. 3. In the control group the subjects did not receive any intervention. 4. The treatment will be continued till the radiotherapy goes. 5. At every 7 th day the post test was conducted to assess the grade of oral mucositis in both groups.

Results:-
Section I: Distribution of the demographic and clinical characteristics among study and control group.
58  Section III: Comparison of RTOG Score between Study and control group. Section IV: Association between the effectiveness of mixture of honey and coffee on radiation induced oral mucositis with selected demographic variables.  Table no. 10 shows that weight loss during treatment was more in the control group than in the study group and the difference was found to be significant (p<0.001). Number of radiotherapy fractions were associated with RTOG score as increased fractions of radiotherapy increases the grading of oral mucositis significant (p<0.001). Duration of oral mucositis was found to be more in the control group than in the study group and found significant (p<0.001).
Oral hygiene followed was significantly (p<0.013) high in the study group than in the control group.

Major findings and discussions of the study:
There was significant effect in RTOG Score after the intervention in study and control group on posttest III and IV p<0.001.
Oral hygiene showed highly significant effect on RTOG score (p<0.001) among demographic variables.
The significant difference was found in period of Oral Mucositis development between control & Study group (p<0.001).In control group most of the subjects developed Oral Mucositis in I week while in study group the Oral Mucositis was developed mostly in III week.
The findings of the study showed that there is highly significant difference in the study group due to the effect of application of mixture of honey and coffee on oral mucositis in posttest I, II, III and IV with p value p<0.001. Whereas, the findings of the study were supported by the following literature: Khanal, B. et al., (2010) literature indicates that honey appears to promote wound healing, so the authors investigated whether its anti-inflammatory properties might limit the severity of radiation induced oral mucositis. A single blinded, randomized, controlled clinical trial was carried out to compare the mucositis-limiting qualities of honey with lignocaine. A visual assessment scale permitted scoring of degrees of mucositis and statistical evaluation of the result was performed using the X 2 test. Only 1 of 20 patients in the honey group developed intolerable oral mucositis as compared to lignocaine group, indicating that honey is strongly protective (RR=0.067) against the development of mucositis. The proportion of patients with intolerable oral mucositis was lower in the honey group and this was statistically significant (p=.000). Honey applied topically to the oral mucosa of the patients. 3 From the above study the investigator draws the conclusion that findings of the study in the reviews are supporting the findings of the current study as the results are similar in some aspects. There are some of the factors that might have influenced the results may be use of some other drug or ointments for the oral mucositis. The current study can be accepted and practiced in the real scenario to overcome the burden of cancer patients dealing with the complications of cancer treatment.