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Chinese Herbal Relief of Chemotherapy Side Effects Ambiguous at Best


CHENGDU, China -- The jury is still out on whether traditional Chinese herbal medicine can counter the adverse effects of adjuvant chemotherapy for breast cancer.

CHENGDU, China, April 19 -- The jury is still out on whether traditional Chinese herbal medicine can counter the adverse effects of chemotherapy for breast cancer.

On the other hand, while the benefits remain questionable, the herbal concoctions don't appear do harm, according to Jing Li, M.D., of West China Hospital and Sichuan University here.

A systematic examination of seven randomized trials - all conducted in China - found herbal medicine "may offer some benefit to breast cancer patients in terms of bone marrow improvement and quality of life," Dr. Li and colleagues said in a Cochrane Collaboration review.

However, they added, "the evidence is too limited to make any confident conclusions."

The researchers called for well-designed clinical trials to look at questions of safety and efficacy of the large number of possible traditional remedies for such chemotherapy side effects. These adverse effects include fatigue, nausea, vomiting, mucositis, and myelosuppression or neutropenia.

For this review, Dr. Li and colleagues found seven randomized controlled trials involving 542 breast cancer patients undergoing or having recently undergone chemotherapy.

All compared some form of Chinese traditional herbal medicine plus chemotherapy with chemotherapy alone.

The results were not pooled, the researchers said, because few studies were identified and no more than two used the same intervention. In fact, Dr. Li and colleagues said, the seven studies used 27 different herbal medicines.

The review found:

  • Three studies looked at control of nausea and vomiting and two found no statistically significant difference between the herbal medicine arm and chemotherapy alone. A third study reported a trend toward better control using a mixture of seven herbs called Aifukang.
  • Only one study reported on alopecia, finding found no statistical difference between the arms.
  • One study (testing the Aifukang mixture of seven herbs) reported on fatigue, finding a statistically significant difference, with a weighted mean difference of 0.80, and a 95% confidence interval from 0.37 to 1.23.
  • Two studies reported on phlebitis, and found no statistically significant differences.
  • Three studies looked at reductions in white blood cells, defined as a white blood cell count of less than 3.0 x 109 per liter. Two found no statistical difference in white blood cell reduction between the groups. A third showed a lower rate of white blood cell reduction in the herbal group than in the control group, which was significant (the relative risk was 0.25, with a 95% confidence interval from 0.12 to 0.52).
  • Three studies showed a statistically significant improvement in white blood cell counts for the herbal medicine arms. The weighted mean differences were 2.20, 0.60, and 0.91, respectively.
  • Three studies looked at the effect of herbal medicines on T-lymphocytes, with mixed results. One showed no differences for any T-cell subset, while another showed significant benefits in terms of CD3-positive, CD4-positive, and CD8-positive cells. The third showed a benefit for CD4-positive, and CD8-positive cells but none for CD3-positive cells.
  • Only one study looked at thrombocytopenia; it showed no benefit for herbal medicine.
  • Three studies, using different measures, examined quality of life. Two showed a significant improvement, but the third showed no benefit.

The authors noted several limitations of the studies. All included studies were small; the patients included in individual studies had different stages of breast cancer and were subject to different diagnostic criteria; there were variations in formulae, dosages, modes of administration, duration of treatment and control interventions; and, the outcome measures were also different.

They wrote that "it was regrettable that the quality of the included trials was poor."

"How these findings may be incorporated into everyday practice is unclear," the researchers said.

On one hand, clinicians using Chinese herbs should share the data from the review with patients and support more definitive studies, they said. On the other hand, Western physicians "should not dismiss these approaches as being without theory or clinical basis" and should also support further studies.

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