Chinese medicinal herbs to treat the side-effects of chemotherapy in breast cancer patients

 

Abstract

Background

Short term side-effects of chemotherapy include fatigue, nausea, vomiting, mucositis and myelosuppression or neutropenia. These occur during the course of treatment and generally resolve within months of completion of chemotherapy. A variety of Chinese medicinal herbs have been used for managing these side effects.

Objectives

To assess the effectiveness and safety of Chinese medicinal herbs in alleviating chemotherapy-induced short term side effects in breast cancer patients.

Search methods

We searched The Cochrane Breast Cancer Specialised Register (15/02/2007), The Cochrane Central Register of Controlled Trials (CENTRAL); (The Cochrane Library 2006, Issue 4); MEDLINE (1966 to December 2006); EMBASE (1990 to December 2006); and Chinese Biomedical Literature (2006, Issue 4). A number of journals were hand searched.

Selection criteria

Randomised controlled trials comparing chemotherapy with or without Chinese herbs in women with breast cancer.

Data collection and analysis

Two authors independently extracted the data, which were analysed using RevMan 4.2. For dichotomous data, we estimated the relative risk. For continuous data, we calculated the weighted mean difference.

Main results

We identified seven randomised controlled trials involving 542 breast cancer patients undergoing or having recently undergone chemotherapy. All studies were conducted and published in China. We did not pool the results because few studies were identified and no more than two used the same intervention. All were of low quality and used CMH plus chemotherapy compared with chemotherapy alone.

CMH combined with chemotherapy showed no statistically significant difference for the outcomes of phlebitis and alopecia. Only one study showed an improvement in nausea and vomiting, and in fatigue. Three indicated an improvement in white blood cells in the group receiving CMH. Two showed an increase in percentage changes in T-lymphocyte subsets CD4 and CD8. One study showed a statistically significant difference for CMH in percentage changes in T-lymphocyte subsets CD3, CD4 and CD8. Two herbal compounds may have improved quality of life. One study reported that CMH may have some effect on reducing toxicity in liver and kidney, but differences were not statistically significant.

Authors' conclusions

This review provides limited evidence about the effectiveness and safety of Chinese medicinal herbs in alleviating chemotherapy induced short term side effects. Chinese medicinal herbs, when used together with chemotherapy, may offer some benefit to breast cancer patients in terms of bone marrow improvement and quality of life, but the evidence is too limited to make any confident conclusions. Well designed clinical trials are required before any conclusions can be drawn about the effectiveness and safety of CHM in the management of breast cancer patients.

 

Plain language summary

Chinese medicinal herbs for the treatment of side-effects from chemotherapy in breast cancer patients

Chinese medicinal herbs (CMH) include any mixture of herbal compounds and decoction (the process by which herbs are boiled and remaining liquid used for health purposes), including the development of herbal formulae and injections, and capsules. Although CMH are used to counteract the side effects of chemotherapy (cancer treatment with chemical agents that are selectively destructive to malignant cells and tissues) in patients being treated for cancer, the evidence for their use for women with breast cancer has not been ascertained. The purpose of this systematic review was to evaluate the effectiveness and safety of CMH in alleviating chemotherapy-induced short term side effects for women either undergoing chemotherapy or having recently undergone chemotherapy. Short term side effects are those that occur during the course of the treatment and generally resolve within months of the completion of the therapy and affect up to 60% of patients.They include nausea and vomiting, mucositis (inflammation of the mucous membranes lining the digestive tract from the mouth down to the anus caused by chemotherapy); neutropenia (a decrease in white blood cells caused by chemotherapy); myelosuppression (a condition in which bone marrow activity is decreased, resulting in fewer red blood cells, white blood cells, and platelets), and fatigue (loss of energy and tirdness). This review found seven randomised studies involving 542 breast cancer patients addressing this question. These studies used six different herbal remedies to treat the side effects of chemotherapy, all used CMH plus chemotherapy as the intervention compared with chemotherapy alone. The results suggest that using Chinese herbs in conjunction with chemotherapy or CHM alone may be beneficial in terms of improvement in marrow suppression and Immune sytstem, and may improve overall state of quality of life. However, further trials are needed before the effects of TCM for people with breast cancer can be evaluated with any real confidence.There was no evidence of any harms of CMH.

 

摘要

背景

以中國醫藥草藥治療乳癌病人接受化療之副作用

化療的短期副作用包括:疲累,反胃, 嘔吐,發炎,骨髓抑制或嗜中性白血球減少症. 這些症狀可能會發生在治療期間並可能在化療完成的幾個月間結束。很多的中藥已被用來治療這些副作用

目標

為了衡量中藥減輕乳癌病人化療的短期副作用的有效性及安全性

搜尋策略

我們搜尋了The Cochrane Breast Cancer Specialised Register (15/02/2007), The Cochrane Central Register of Controlled Trials (CENTRAL); (The Cochrane Library 2006, Issue 4); MEDLINE (1966 to December 2006); EMBASE (1990 to December 2006); and Chinese Biomedical Literature (2006, Issue 4).許多學術論文期刊均被搜尋

選擇標準

隨機對照試驗比較乳癌婦女化療中接受中藥與沒有接受中藥治療

資料收集與分析

兩位作者分別以RevMan 4.2分析數據， 以相對危險性分析二分變項，以加權平均差異分析連續變項

主要結論

我們發現七組隨機控制試驗，包含542個近期接受或正在接受化療的乳癌病患，這些研究均在中國大陸收集及發表。我們沒有共用結果因為只有很少的研究被發現且只有低於兩組的試驗使用相同的介入方式。所有的結果都是低表現，使用CMH伴隨化療與單獨接受化療作比較，CMH結合化療在靜脈炎和脫髮症的結果中都沒有達到統計上的顯著差異。只有一個研究顯示反胃,噁心,疲累有改善。 有三個研究顯是白血球細胞在全體中接收CMH有改善,有兩個研究顯示T淋巴細胞 CD4細胞和CD8細胞百分比的改變有增加。一個研究顯示CMH在T淋巴細胞, CD3細胞, CD4細胞和CD8細胞百分比的改變在統計上達到顯著差異。兩種草藥的複合物可能可以提升生活品質。一個研究顯示CMH可能有同樣減低肝和腎臟毒性的效果,但是並沒有達到統計上的顯著差異

作者結論

這個文獻回顧在中藥降低化療的短期副作用之有效性和安全性方面提供有限的證據。中藥與化療同時使用時可能可以提供乳癌患者好處在骨髓改善和生活質量,但是這樣的證據太有限了以致無法做出明確的結論。一個經過完善設計的臨床試驗是在得出CMH治療乳癌病患的有效性與安全性之前就先設計好的

翻譯人

本摘要由國泰綜合醫院林茵翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

中藥治療接受化療乳癌病人的副作用。中藥包括任何草藥複合物的混合物以及煎熬(為了健康的目的而將草藥煮沸而仍呈現液態的過程，包括發展中草藥配方，注射和製作膠囊。雖然中草藥結合化療的副作用(用來治療癌症的化學藥劑會選擇性破壞惡性細胞和組織) 治療癌症病人,但是用來治療乳癌婦女的證據目前尚未被確認。這個系統性回顧的目的只在衡量中藥降低化療的有效性及安全性用來減低不論是正在受化療或近期以結束化療女性病人的短期副作用. 這些症狀通常發生在治療的療程中，通常在化療的幾個月內會結束，且影響到多達60％的病人.這些症狀包括噁心，嘔吐，口腔粘膜炎(從嘴巴到肛門等消化器官因為化療所引起的黏液發炎); 嗜中性白血球減少症(因化療造成白血球減少);骨髓抑制(骨髓活動減低的情況,導致產生少量的紅血球,白血球和血小板)。這個文獻回顧的研究發現七組隨機抽樣的研究包含542位乳癌病人回答了這個問題。本研究使用了六種不同的草藥來治療化療的副作用,均使用中藥及化療作為介入方式來與單純接受化療作比較。本研究的結論認為以中藥伴隨化療或是單獨使用中藥均能提升骨髓抑制和免疫系統,提昇整體生活品質的狀態。 然而，未來的研究TCM對乳癌病人的效果可以被確認出有明確證據是需要的。目前則無研究顯示中藥會對人體造成危害