Chung, V.C., Wu, X., Lu, P., Hui, E.P., Zhang, Y., Zhang, A.L., . . . Wu, J.C. (2016). Chinese herbal medicine for symptom management in cancer palliative care: Systematic review and meta-analysis. Medicine, 95, e2793. 

DOI Link

Purpose

STUDY PURPOSE: To summarize the results from randomized, controlled trials (RCTs) of the effectiveness of Chinese herbal medicines (CHMs) for managing fatigue, paresthesias, chronic pain, anorexia, edema, and constipation

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: AMED, CENTRAL, MEDLINE, EMBASE, CINAHL, Chinese Biomedical Databases, Wan Feng Digital Journals, Taiwan Periodical Literature Database
 
INCLUSION CRITERIA: RCTs comparing the effect of CHM in combination with other treatments or alone in managing cancer or treatment-related symptoms. RCTs must report the effectiveness of CHM on at least one symptom using validated scales. RCTs must include at least one CHM in the 2010 China Pharmacopeia Chinese herbal medicine index. The control groups included conventional treatment, chemotherapy, radiotherapy, placebo, or no treatment. RCTs reported information on regimens in both treatment and control groups, and the follow-up duration was clearly reported.
 
EXCLUSION CRITERIA: Not identified

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 4,767
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Two reviewers extracted data on RCT characteristics (author, year, country, eligibility criteria, diagnostic criteria); patient characteristics (CHM, control interventions, outcomes, effect size for each outcome, adverse effects). The data analysis used risk of bias (Cochrane risk of bias tool), relative risk, weighted mean difference, 95% confidence interval, I2 statistic for level of heterogeneity, and funnel plot for publication bias.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 14 
  • TOTAL PATIENTS INCLUDED IN REVIEW = 878
  • SAMPLE RANGE ACROSS STUDIES: 35–124 patients
  • KEY SAMPLE CHARACTERISTICS: Various cancer sites

Phase of Care and Clinical Applications

PHASE OF CARE: Multiple phases of care
 
APPLICATIONS: Elder care, palliative care

Results

  • Fatigue—four RCTs. In three RCTs, no difference existed between CHM and chemotherapy versus chemotherapy alone. In the other RCT, Fu Zheng decoction plus chemotherapy (ellence [epirubicin]/paclitaxel [taxol]) improved fatigue score compared to chemotherapy alone in breast cancer (MD: –18.62, 95% CI [–24.18, –13.16]).
  • Pain—three RCTs. CHM plus conventional treatment decreased the pain score compared to conventional treatment alone (WMD: –0.9, 95% CI [–1.69, –0.11]).
  • Constipation—seven RCTs. In six RCTs, CHM compared to conventional treatment had a similar effect. In the other RCT, Tong-Tai decoction plus chemotherapy compared to chemotherapy alone showed no difference.
  • Anorexia—two RCTs. No difference existed with CHM plus conventional treatment.

Conclusions

Combining CHM with chemotherapy may improve fatigue in patients with breast cancer. Adding CHM to conventional treatment may improve pain control. CHM alone may improve constipation.

Limitations

  • Mostly low quality/high risk of bias studies
  • High heterogeneity
  • Trials conducted and published in China

Nursing Implications

Further research needs to be performed on CHM treating cancer- and cancer treatment-related symptoms.

Legacy ID

6209