Chen, M.H., May, B.H., Zhou, I.W., Zhang, A.L., & Xue, C.C. (2016). Integrative medicine for relief of nausea and vomiting in the treatment of colorectal cancer using oxaliplatin-based chemotherapy: A systematic review and meta-analysis. Phytotherapy Research, 30, 741–753. 

STUDY PURPOSE: To assess whether integrative management of colorectal cancer, in which traditional medicines are added to oxaliplatin regimens, reduced the incidence of chemotherapy-induced nausea and vomiting (CINV) and to determine if specific particular traditional medicines provided enough evidence to pursue further research for CINV

TYPE OF STUDY: Meta-analysis and systematic review

• FINAL NUMBER STUDIES INCLUDED = 27 
• TOTAL PATIENTS INCLUDED IN REVIEW = 1,843
• SAMPLE RANGE ACROSS STUDIES: 16–74 patients
• KEY SAMPLE CHARACTERISTICS: Adult patients from China and Australia with a colorectal diagnosis

PHASE OF CARE: Active antitumor treatment

Across all 27 studies, the test groups showed significantly reduced CINV (RR = 0.65) with an absolute risk reduction of 24% compared to controls. They further divided test groups into an injection group and an oral administration group. Four different injection products were tested in six studies, with an overall RR of 0.73 in the traditional medicine plus oxaliplatin group. In the oral administration, 21 studies were analyzed, which contained 98 different plant-based ingredients with an average of 12 ingredients per traditional medicine intervention. The oral agents demonstrated an overall reduction in CINV with a RR of 0.62. The absolute risk reduction was 25% for the test groups compared to controls. In addition, each plant was analyzed individually as well as in all combinations (2, 3, 4, 5, 6, and 7 plants). The results demonstrated that six plants influenced the relative risk for CINV, including atractylodes, poria, coix, glycyrrhiza, astragalus, and panax ginseng.

This meta-analysis of 27 studies suggested the potential benefit of adding traditional medicines in the reduction of CINV associated with oxaliplatin-based chemotherapy in adults with colorectal cancer. The lack of blinding in most studies may have led to an overestimation of the effects on CINV. Sensitivity analysis identified six plants that were associated with significant reductions in CINV, which may warrant further clinical research.

• No quality evaluation
• Low sample sizes
• Most studies were not blinded and did not have a placebo for the control groups, which is likely to influence participant-reported CINV. The use of antiemetics also may have affected study results. No dosing information on treatment regimens were used other than the inclusion of oxaliplatin. Most studies were small single institutions studies, and the methodological reporting of the quality of studies and randomization was weak.

In this meta-analysis of traditional medicine interventions in adult patients with colorectal cancer receiving oxaliplatin-based therapies, six plants demonstrated reductions in CINV. Although the studies had limitations related to methodology, no serious adverse events or increase in CINV occurred. These plants warrant further research and consideration in patients whose CINV is not well-controlled by conventional therapies.