An herb is a plant or part of a plant that people take for health benefits as dietary supplements or medication. Herbal medicine may also be referred to as phytotherapy or use of botanicals. Herbal medicine interventions include a variety of substances and combinations of substances. Herbal medicine is contraindicated with some chemotherapy agents.
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
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.
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.
Mok, T.S., Yeo, W., Johnson, P.J., Hui, P., Ho, W.M., Lam, K.C., … Zee, B. (2007). A double-blind placebo-controlled randomized study of Chinese herbal medicine as complementary therapy for reduction of chemotherapy-induced toxicity. Annals of Oncology, 18, 768-774.
To evaluate the use of Chinese herbal medicine as a complementary therapy for the reducing chemotherapy-induced toxicity
Patients were randomly assigned to one of three Chinese herbalists who evaluated and prescribed combination, single-item, packaged, herbal extract granules. Herbalists completed university training and were licensed to practice Chinese herbal medicine (CHM) in Hong Kong and China. Patients were randomly assigned to each group and received either CHM or placebo packages with corresponding serial numbers in a 14-day supply at each clinic visit. The placebo package contained nontherapeutic herbs with an artificial smell and taste similar to typical herb tea. Each patient completed the log for each day’s consumption. On days 1 and 14, patients met with the herbalist in the clinic setting for evaluation and the herbalist documented the visit in case report form. A quality-of-life questionnaire was completed at baseline, day 1 of each cycle, and after four months.
The sample consisted of 120 patients with early-stage breast and colon cancer receiving adjuvant treatment in a university-based cancer center in Hong Kong.
Patients were included in the study if they
Patients were excluded from the study if they
The study was conducted at a university-based cancer center in Hong Kong.
This was a double-blind, placebo-controlled, randomized study.
The National Cancer Institute Common Toxicity Criteria (NCI-CTC) version 2.0 and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire 30 were used.
Patients recorded their daily intake of the herbal package contents on patient logs. Herbalists documented patient visits in case report form
Nazari, M., Taghizadeh, A., Bazzaz, M. M., Rakhshandeh, H., & Shokri, S. (2017). Effect of Persian medicine remedy on chemotherapy induced nausea and vomiting in breast cancer: A double blind, randomized, crossover clinical trial. Electronic Physician, 9, 3535–3543.
To assess the effects of Persumac, a Persian herbal preparation, on refractory CINV.
Patients were randomized to two study sequence groups. One group received Persumac first and then placebo in crossover. The other group received the opposite sequence. Patients were entered in the second course of chemotherapy. Crossover was done in the third course of chemotherapy. Persumac and placebo were taken three times daily before meals. A washout period of six days was done prior to the third chemotherapy course. Patients were studied for 33 days. Patients recorded information about the severity and number of nausea and vomiting episodes on a visual analog scale and answered questions related to frequency of forgetting to take the study drug or other antiemetics. All patients received standard triple antiemetic regimens. Persuma included sumac and Bunium persicum.
PHASE OF CARE: Active anti-tumor treatment
Double blind, randomized, crossover clinical trial
VAS for nausea and vomiting (1-10 scale)
Average nausea severity was significantly lower during the period when using the persumac (p < 0.001), with reduction in at least two points on the VAS in the delayed phase compared to baseline results. There was no significant effect for acute phase CINV. The number of vomiting episodes was reduced. There were very few patients who had complete response for CINV (range = 0%-23%)
Persumac appeared to have some benefit in reduction of the severity of delayed CINV in this study.
Findings suggest that the Persian herbal medicine, Persumac, may have some benefit in reducing delayed CINV in women receiving moderate to severe emetic chemotherapy. Further evidence is needed to determine potential benefit.