Zhang, M., Liu, X., Li, J., He, L., Tripathy, D. (2007) Chinese medicinal herbs to treat the side-effects of chemotherapy in breast cancer patients. Cochrane Database of Systematic Reviews, CD004921. 

To review the evidence regarding the effects of Chinese herbal medicine on side effects of chemotherapy in women with breast cancer.

Databases searched were Cochrane Library, EMBASE, LILACS, SIGLE, and Chinese Biomedical Disk. Handsearching of key medical journals and references lists of retrieved articles was also performed.

Search keywords were Chinese medicine, plants, drugs, botanical, herbal medicine, and additional search terms related to herbal medicine as well as breast cancer treatments. A full listing of search terms was provided.

Studies were included if they included

• Women with breast cancer receiving chemotherapy as adjuvant or palliative treatment. 
• Single and compound herbal treatments. 
• Randomized clinical trials with chemotherapy-induced side effects.

Patients were excluded if they had other cancers as well as breast cancer (except for skin cancer).

In total, 88 references were retrieved. The authors allocated trials to quality categories described in the Cochrane Reviewers' Handbook and assessed quality according to criteria from Schultz (1995); studies were categorized as having a low, moderate, or high risk of bias.

• The final number of studies included was seven.  
• The sample range across studies was 48 to 120 patients (N = 541).
• All patients had breast cancer and were receiving chemotherapy. 
• All studies were performed on Chinese patients in a mix of settings.

Patients were undergoing multiple phases of care.

Trial duration ranged from 14 to 84 days. Treatments were varied with different herbal concoctions; most included radix ginseng along with other substances. The authors did not provide the findings for all outcomes of interest. A few studies measured quality of life, and several attempted to evaluate the effect on thrombocytopenia and white blood cell volumes and types. Some studies used inappropriate statistical methods. The quality of the included trials was poor.

The nature of the evidence in use of Chinese herbal medicine was not sufficient to draw any conclusions.

The study included a small number of studies with relatively small samples and poor quality.

The evidence reviewed did not provide clear implications for the incorporation of findings into practice. Further well-designed research is needed.