Traditional Chinese medicine use among Chinese immigrant cancer patients

Network meta-analysis of 8 types of traditional Chinese medicine injection combined with chemotherapy in colorectal cancer treatment

OBJECTIVE

This study conducted a network meta-analysis to comprehensively compare the efficacy and safety of 8 types of traditional Chinese medicine injection combined with chemotherapy in colorectal cancer treatment.

METHODS

We searched relevant previous studies from databases including Pubmed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Service System (SinMed), VIP, and Wanfang Database. The searched studies spanned from the inception of databases to December 2022. The included randomized controlled trials were screened; data were extracted; and bias risk was assessed. The network meta-analysis was performed using Revman 5.4 software, R software, and STATA software.

RESULTS

Fifty randomized controlled studies were included, including 8 types of traditional Chinese medicine injection. The results showed that Aidi injection [OR 1.65,95%CI (1.33,2.05)], compound Kushenshen injection [OR 2.72,95%CI (2.12,3.51)], Kangai injection [OR 2.16,95%CI (1.56,3.02)], and Shenqi Fuzheng injection [OR 1.97,95%CI (1.24,3.15)] combined with chemotherapy in colorectal cancer treatment had a significantly higher objective response rate (p < 0.05) than single chemotherapy, and compound Kushen injection + chemotherapy [OR 2.72,95%CI (2.12,3.51)] regimen ranked the highest. The disease control rate of Aidi injection, Brucea javanica oil emulsion injection [OR 4.1,95%CI (1.74,10.43)], compound Kushen injection [OR 2.43,95%CI (1.73,3.44), Kangai injection[OR 2.31,95%CI  (1.51,3.58)], Kanglaite injection[OR 3.18,95%CI (1.52,6.9)], and Shenqi Fuzheng injection[OR 2.6,95%CI  (1.22,5.92)] combined with chemotherapy in the treatment of colorectal cancer was significantly improved (p < 0.05), and Brucea javanica oil emulsion injection + chemotherapy[OR 4.1,95%CI  (1.74,10.43)] regimen ranked the highest. The incidence of leukopenia reduction in the treatment of colorectal cancer was significantly reduced by Aidi injection[OR 0.32,95%CI  (0.24,0.43)], Brucea javanica oil emulsion injection [OR 0.34,95%CI  (0.17,0.68)] compound Kushen injection [OR 0.27,95%CI  (0.17,0.40)], Kangai injection [OR 0.23,95%CI  (0.14,0.37)], and Kanglaite injection [OR 0.20,95%CI  (0.09,0.45)] combined with chemotherapy (p < 0.05), and Kanglaite injection + chemotherapy [OR 0.20,95%CI  (0.09,0.45)] regimen ranked the highest. Aidi injection [OR 0.48,95%CI  (0.3,0.74)], Brucea javanica oil emulsion injection [OR 0.09,95%CI  (0.01,0.43)], and Kangai injection [OR 0.47,95%CI  (0.22,0.96)] combined with chemotherapy in the treatment of colorectal cancer significantly reduced the incidence of thrombocytopenia reduction (p < 0.05), and Brucea javanica oil emulsion injection + chemotherapy [OR 0.09,95%CI  (0.01,0.43)] regimen ranked the highest. Aidi injection [OR 0.49,95%CI  (0.32, 0.74)], Kangai injection [OR 0.26,95%CI (0.09,0.71)] combined with chemotherapy in the treatment of colorectal cancer significantly reduced the incidence of hemoglobin reduction (p < 0.05), and Kangai injection + chemotherapy [OR  0.26,95%CI  (0.09,0.71)] regimen ranked the highest. Aidi injection [OR 0.38,95%CI  (0.28,0.52)], compound Kushen injection [OR 0.23,95%CI  (0.15,0.36)] and Kangai injection [OR 0.19,95%CI  (0.12,0.30)] combined with chemotherapy in the treatment of colorectal cancer significantly reduced the incidence of nausea and vomiting (p < 0.05), and Kangai injection + chemotherapy[OR 0.19,95%CI  (0.12,0.30)] regimen ranked the highest. Aidi injection [OR 0.51,95%CI  (0.35,0.74)], compound Kushenshen injection [OR 0.27,95%CI  (0.15,0.47)], and Kanglaite injection [OR 0.31,95%CI  (0.13,0.69)] combined with chemotherapy in the treatment of colorectal cancer significantly reduced the incidence of abdominal pain and diarrhea (p < 0.05), and compound Kushen injection + chemotherapy [OR  0.27,95%CI  (0.15,0.47)] regimen ranked the highest.

CONCLUSION

Aidi injection, Brucea javanica oil emulsion injection, compound Kushen injection, Kangai injection, Shenqi Fuzheng injection, Kanglaite injection, Shenfu injection, and Xiaoaiping injection combined with chemotherapy functioned more effectively than single chemotherapy did in colorectal cancer treatment. Nevertheless, limited by the treatment quality and methodology of different intervention measures included in the study, this conclusion is expected to be scrutinized in higher-quality and rigorously designed randomized controlled trials. PROSPERO registration No.: CRD42023392398.

Dietary Behavior and Its Association with Nutrition Literacy and Dietary Attitude Among Breast Cancer Patients Treated with Chemotherapy: A Multicenter Survey of Hospitals in China

Background

Chemotherapy often negatively impacts the nutritional status of breast cancer patients, and healthy dietary behaviors are important for patient wellbeing. With the guidance of the "Knowledge, Attitude and Practice model" (KAP model), the objective of this survey was to determine the frequency with which patients engage in healthy dietary behaviors and to explore the association between healthy dietary behaviors and nutrition literacy and dietary attitudes.

Methods

This study included a total of 284 breast cancer patients undergoing chemotherapy from three hospitals spanning three cities in China. Face-to-face interviews were conducted to collect demographic and clinical characteristics as well as the Dietary Nutritional Knowledge, Attitude and Practice Questionnaire (DNKAPQ) and the Nutrition Literacy Measurement Scale for Chinese Adult (NLMS-CA).

Results

Participants exhibited medium to high scores for nutrition literacy, dietary attitude and dietary behavior. Nutrition literacy (r = 0.505, p < 0.001) and dietary attitude (r= 0.326, p < 0.001) scores were both positively correlated with the total dietary behavior score. The total nutrition literacy score was positively correlated with the total dietary behavior score (r = 0.286, p < 0.001). In the univariate analysis, age, body mass index, living environment, education level, monthly family income, work status, menopausal status, number of comorbidities, relapse and endocrine therapy were significantly associated with dietary behavior (p < 0.05). In the multiple linear regression analysis, patients' dietary behavior was significantly associated with nutrition literacy (β = 0.449, p < 0.001) and dietary attitude (β = 0.198, p < 0.001). These two factors accounted for 28.6% of the variation in the patients' dietary behavior scores.

Conclusion

There is an important need for targeted dietary and nutritional interventions designed and implemented by health professionals to improve dietary behaviors. Intervention design and content should take the patients' nutrition literacy and dietary attitudes into consideration. In particular, women who are older, overweight, unemployed, and postmenopausal and live in rural areas, exhibit fewer comorbidities, have a lower family income and education level, have not relapsed and are currently receiving endocrine therapy are in urgent need of diet-specific intervention.

Health Problems and the Use of Medications and Traditional Therapies among Chinese Immigrants Living in Spain

In this study, we investigate the health problems and the use of medications and traditional therapies among Chinese immigrants in the Southern region of Spain. A qualitative study using semi-structured interviews and including 133 immigrants and 7 stakeholders was conducted in 2017. Transcription, literal reading, and theoretical categorization were performed, and a narrative content analysis was carried out. The most common health problems were musculoskeletal (28.6%) and allergies (25.6%) related to work activity and unhealthy lifestyles. Key informants also reported gastric problems, stress, and changes in eating habits, mostly related to their work activity. For these problems, a large number of traditional remedies (herbs, diet therapy, acupuncture, vitamins, etc.) were used, usually combined with pharmaceutical drugs used for colds, flu, general malaise (29%), pain and fever (23%), and allergy drugs (9.2%). Chinese immigrants reported health conditions associated with their working conditions and life habits in Spain, using Traditional Chinese Medicine instead of pharmacological drugs. Understanding these health problems and promoting awareness towards traditional therapies in the healthcare system may help to design public policies and Health Promotion strategies targeting this group.

A systematic review of communication about Complementary and Integrative Health (CIH) in global biomedical settings

OBJECTIVES

A systematic review to analyze communication rates of complementary and integrative health (CIH) and analyze how communication terms, such as "disclosure," are measured and operationalized.

METHODS

We searched seven databases for studies published between 2010 and 2018 with quantitative measurements of patients' communication of CIH to a biomedical clinician. We analyzed communication terms used to describe patients reporting CIH usage. We also examined the conceptual and operational definitions of CIH provided and whether those terms were explicitly operationalized. We aggregated the percentage, rate, or ratio of CIH users that communicated about CIH with their clinicians by disease type and geographical region.

RESULTS

7882 studies were screened and 89 included in the review. Studies used a wide range of conceptual and operational definitions for CIH, as well as 23 different terms to report communication related to reporting CIH usage. Usage varied by disease type and geographical region.

CONCLUSIONS

Studies of CIH and CIH communication may measure different kinds of social and communicative phenomena, which makes comparison across international studies challenging.

PRACTICE IMPLICATIONS

Future studies should employ standardized, replicable measures for defining CIH and for reporting CIH communication. Clinicians can incorporate questions about prior, current, and future CIH use during the medical visit.

Efficacy and safety of traditional Chinese medicine injections combined with FOLFOX4 regimen for gastric cancer: A protocol for systematic review and network meta-analysis

BACKGROUND

Traditional Chinese medicine injections (TCMJs) combined with FOLFOX4 regimen could achieve favorable effects in the treatment of gastric cancer. However, the efficacy and safety of different TCMJs combined with FOLFOX4 in the treatment of gastric cancer have not been fully clarified. Due to the fact that there are as many as 10 kinds of TCMJs, how to choose an appropriate TCMJ has become an urgent clinical problem. The objective of this network meta-analysis is to explore the optimal options among different TCMJs for gastric cancer.

METHODS

PubMed, Web of Science, Scopus, Cochrane Library, Embase, China Scientific Journal Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang Data were searched to identify randomized controlled trials which focused on TCMJs combined with FOLFOX4 against gastric cancer from its inception to September 2021. Subsequently, 2 researchers will be independently responsible for literature screening, data extraction, and assessment of their quality. Standard pair-wise and Bayesian network meta-analysis will be performed to compare the efficacy and safety of different TCMJs combined with FOLFOX4 regimen via Stata 14.0 and WinBUGS1.4 software.

RESULTS

The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.

CONCLUSIONS

The conclusion of this systematic review will provide evidence for selecting an optimal TCMJ combined with FOLFOX4 for patients with gastric cancer.

Prevalence of the Use of Herbal Medicines among Patients with Cancer: A Systematic Review and Meta-Analysis

Background

Although herbal medicines are used by patients with cancer in multiple oncology care settings, the magnitude of herbal medicine use in this context remains unclear. The purpose of this review was to establish the prevalence of herbal medicine use among patients with cancer, across various geographical settings and patient characteristics (age and gender categories).

Methods

Electronic databases that were searched for data published, from January 2000 to January 2020, were Medline (PubMed), Google Scholar, Embase, and African Index Medicus. Eligible studies reporting prevalence estimates of herbal medicine use amongst cancer patients were pooled using random-effects meta-analyses. Studies were grouped by World Bank region and income groups. Subgroup and meta-regression analyses were performed to explore source of heterogeneity.

Results

In total, 155 studies with data for 809,065 participants (53.95% female) met the inclusion criteria. Overall, the pooled prevalence of the use of herbal medicine among patients with cancer was 22% (95% confidence interval (CI): 18%–25%), with the highest prevalence estimates for Africa (40%, 95% CI: 23%–58%) and Asia (28%, 95% CI: 21%–35%). The pooled prevalence estimate was higher across low- and middle-income countries (32%, 95% CI: 23%–42%) and lower across high-income countries (17%, 95% CI: 14%–21%). Higher pooled prevalence estimates were found for adult patients with cancer (22%, 95% CI: 19%–26%) compared with children with cancer (18%, 95% CI: 11%–27%) and for female patients (27%, 95% CI: 19%–35%) compared with males (17%, 95% CI: 1%–47%).

Conclusion

Herbal medicine is used by a large percentage of patients with cancer use. The findings of this review highlight the need for herbal medicine to be integrated in cancer care.

Immunomodulatory and Anticancer Activities of Hyacinthus orientalis L.: An In Vitro and In Vivo Study

Hyacinthus orientalis L. (family Hyacinthaceae) is traditionally used to treat different diseases including cancer. In this study, the anticancer and immunomodulatory effects of this plant were evaluated. Hydroalcoholic extract was prepared, and different solvent fractions were obtained using solvent-solvent extraction. In the anticancer part, MTT assay and caspase-3 ELISA kits were used to measure the antiproliferative and apoptosis induction ability for each extract, respectively. In the immunomodulatory part, lymphocyte proliferation assay and cytokines detection kit were used to measure the effect of extracts of acquired immunity. Phagocytosis and pinocytosis induction were used to evaluate the effect of extracts on the innate immunity. GC-MS, LC-MS, and Foline-Ciocalteu assays were used to identify the chemical composition of the plant. Balb/C mice were inoculated with breast cancer and treated with hydroalcoholic extract of H. orientalis L. Results showed that hydroalcoholic extract and n-hexane fraction were highly effective in apoptosis induction. Both extract and fraction were also effective in stimulating lymphocytes proliferation and phagocytosis. Significant reduction in tumor size was achieved after treating tumor-bearing mice with hydroalcoholic extract. Additionally, high cure percentages (50%) were obtained in treated mice. Results of this study showed that H. orientalis L. has promising anticancer and immunomodulatory activities. However, further studies are needed to explore more details of apoptosis induction ability and other mechanisms of action and to measure different signaling pathways responsible for the anticancer and immunomodulatory response.

Use of Traditional Chinese Herbal Medicine Concurrently with Conventional Cancer Treatment Among Chinese Cancer Patients

In the U.S. and Canada, Traditional Chinese Medicine (TCM) use has become increasingly common; Chinese immigrants have particularly high rates of TCM use. In this study, we used a cross sectional survey study design to assess the specific types of Traditional Chinese Herbal Medicine (TCHM) used, the concurrent use of TCHM and conventional cancer treatment, and communication with providers about TCHM use, among Chinese immigrant cancer patients in New York City (NYC). We surveyed 114 patients from several community and clinical settings in NYC. The mean age was 63, 59% were female, and 83% originated from mainland China. Breast (18%) and lung (21%) cancer were the most common cancer diagnoses, and 60% were receiving conventional cancer treatment at the time of the survey. 75% reported ever using TCHM since their most recent primary cancer diagnosis. 68% of those who used herbs reported concurrent use of TCHM with conventional cancer treatment. Only 13% of those who used herbs reported sharing TCHM use with a provider, and only 19% reported that a provider had ever discussed TCHM use with them. Our findings demonstrated an alarmingly high rate of concurrent use of TCHM and conventional cancer treatment and low rate of communication with providers about TCHM use. A wide variety of herbs were used, including those with potentially negative interactions with conventional treatment. This study highlights the urgent need for the development of interventions to assist providers and patients in improving communication around this important topic.

The Asian Immigrant Cancer Survivor Experience in the United States: A Scoping Review of the Literature

BACKGROUND

Cancer is the leading cause of death for Asian Americans, a growing population in the United States. While cancer survivors often experience complex issues after diagnosis, being an immigrant and having cancer pose additional challenges.

OBJECTIVE

This scoping review analyzed research about immigrant cancer survivors of Asian ethnicity in the United States and provided a structured method to understand an area of research and evidence. Aims focused on immigrants' experiences and how findings could tailor evidence-based interventions, programs, and resources.

METHODS

The PubMed, CINAHL, and Scopus databases were searched to identify studies in English (2009-2018) targeting Asian immigrant cancer survivors in the United States. While 385 records were initially identified, 32 studies met the inclusion criteria.

RESULTS

Thematic analysis of charted study elements revealed 4 themes with subthemes: (1) survival patterns, (2) barriers, (3) culturally informed care, and (4) quality of life (QOL). While qualitative studies provided insight about the cancer experience from immigrants' perspectives, quantitative designs posed descriptions and associations among QOL concepts.

CONCLUSIONS

Study results illustrate the need for survival research that explores outcomes by Asian ethnic subgroups and tracks the influence of acculturation. Future research should test culturally informed interventions that minimize barriers and foster QOL across the cancer continuum. Culturally tailored instruments can expedite larger-scaled studies that allow generalization.

IMPLICATIONS FOR PRACTICE

Asian immigrants comprise an underserved, vulnerable, and growing group with various cancers. Nurses who care for immigrants and their families should be cognizant of cultural beliefs, values, practices, and issues related to communication, care access, and socioeconomics.

Risk evaluation of the use of complementary and alternative medicines in cancer

INTRODUCTION

Cancer patients use complementary and alternative medicines (CAM) to improve their well-being. Little is known about real risks.

OBJECTIVE

To highlight 3 different types of axes: 1/cancer patients' perceptions concerning CAM; 2/misinformation/miscommunication about CAM; 3/CAM toxicity (direct toxicity, CAM-anticancer drugs, CAM-cancer interactions).

METHOD

A questionnaire was proposed to cancer patients for 2 months. The CAM toxicity was analyzed if patients documented their drugs and CAM.

RESULTS

Eighty-five patients responded: 72/85 were taking≥1CAM. In total, 95% patients were satisfied. There was an increasing CAM intake after cancer diagnosis. One hundred and seventeen different CAM were identified (63 herbs, 24 essential oils, 28 food supplements, 2 homeopathic specialities). Only 30/85 were aware CAM could interact with anticancer drugs. No other type of risk was perceived.

INFORMATION SOURCES

43/85 Internet, 38/85 general practitioner, 38/85 community pharmacist, 32/85 entourage, 25/85 other patients, 22/85 oncologist. In total, 81.3% questioned healthcare professionals (HCP) about CAM. Twelve patients noticed HCP lacked knowledge regarding CAM. The toxicity analysis was carried out for 24 patients who consumed 1 to 24CAM. In total, 133CAM were reported, including 87 different CAM. For only 43CAM/87, studies were found. All patients presented≥1risk: 14 at risk of CAM-cancer interactions, 15 of CAM-anticancer drug interactions, 21 of CAM direct toxicities.

CONCLUSION

Many CAM are used by patients. The diagnosis of cancer favors their use. The risks are manifold: low perception of risk that can be induced by CAM, diverse and insecure sources of information and many potential toxicities that are not scientifically documented.

Usage of Chinese Herbs in Cancer Patients in Southern China: A Survey

OBJECTIVE

To study the use of Chinese medicine (CM) in cancer patients in southern China.

METHODS

A total of 1,950 cancer patients finished questionnaires in four provinces in southern China. The survey included socio-demographic and clinical characteristics of participants, dosage forms, efficacy, and side effects.

RESULTS

The study results showed that cancer patients with higher education (>12 years) were more likely to accept the treatment of Chinese herbs. There were 54.61% (1,065 cases) of patients chose Chinese herbs for the initial treatment and 14.46% (282 cases) chose Chinese herbs as monotherapy. Most patients (54.51%, 1,063 cases) continuously used CM for more than 6 months, and a few of them (212 cases) used CM for up to 3 years. All kinds of dosage forms of CM had been used, including CM decoction, CM patent prescription and CM injection. Concerning the efficacy in the view of patients, 40.31% (786 cases) believed that it would be effective to take Chinese herbs before they starting the anti-cancer treatment, and the percentage increased to 81.08% after 1-month CM treatment. The effect of Chinese herbs was mainly demonstrated by symptom relief and improvement of quality of life, and 8.31% (162 cases) of patients experienced control of tumor growth and decreased tumor markers. Furthermore, only 14.31% (279 cases) participants reported that they experienced side effects during CM treatment.

CONCLUSION

This large scale investigation reflects the current situation of domestic CM usage objectively and comprehensively, which might provide new ways for cancer treatment.

No improvement in disclosure of natural health product use to primary care medical doctors in the last 15 years: A survey of naturopathic patients

BACKGROUND

The use of natural health products (NHPs) is common in North America. In 2003, we found that 42% of NHP users had not disclosed this information to their primary care medical doctors (MDs). We repeated our survey in 2018/2019 to explore if the rate of NHP use disclosure had improved.

METHODS

From November 2018-February 2019, a 21-item survey about NHP use and disclosure was administered to adult patients who visited the Robert Schad Naturopathic Clinic in Toronto, Canada.

RESULTS

Almost all patients surveyed were using NHPs (99%), and 46% were using NHPs and prescription medication concurrently. Consistent with our 2003 findings, 42% of respondents who used NHPs did not disclose this information to their MD.

CONCLUSION

Disclosure of NHP use to MDs by naturopathic patients is limited and remained unchanged over the past 15 years. Future research should explore primary care MDs' hesitancy to inquire about patient NHP use.

Traditional Chinese Medicine Prolongs Progression-Free Survival and Enhances Therapeutic Effects in Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor (EGFR-TKI)Treated Non-Small-Cell Lung Cancer (NSCLC) Patients Harboring EGFR Mutations

Background

Lung cancer is the most common cause of cancer-associated deaths worldwide. This study aimed to investigate the efficacy and safety of Traditional Chinese Medicine combining EGFR-TKIs in treatment of NSCLC patients harboring EGFR mutations.

Material/Methods

This study involved 153 advanced-stage NSCLC patients harboring EGFR mutations. Patients were divided into a Control group (administered EGFR-TKI, n=61) and an Experimental group (administered Traditional Chinese Medicine combining EGFR and TKI, n=92). Progression-free survival (PFS) was evaluated for exon 19 deletion and/or 21 deletion patients. Disease control rate (DCR) was assessed to observe therapeutic effects. Adverse effects, including rashes, diarrhea, ALT/AST increase, dental ulcers, and onychia lateralis, were also evaluated.

Results

TCM combining EGFR-TKI (90.11%) demonstrated no DCR improvement compared to single EGFR-TKI (83.33%) (p>0.05). Median PFS (mPFS) of TCM combining EGFR-TKI (13 months) was significantly longer compared to that in the single EGFR-TKI group (8.8 months) (p=0.001). For 19DEL mutant NSCLC, the mPFS (11 months) in TCM combining EGFR-TKI was significantly longer compared to single EGFR-TKI (8.5 months) (p=0.007). The mPFS of L858 mutant NSCLC patients in EGFR-TKI combining CTM (14 months) was significantly longer compared to single EGFR-TKI (9.5 months) (p=0.015). TCM combining EGFR-TKI was more inclined to prolong mPFS of NSCLC with exon 21 deletion. TCM combining EGFR-TKI illustrated no additional adverse effects in NSCLC patients (p=0.956).

Conclusions

Application of Traditional Chinese Medicine prolonged progression-free survival and enhanced therapeutic effect in NSCLC patients harboring EGFR mutations receiving EGFR-TKI treatment. Meanwhile, adjunctive Chinese medicine combining EGFR-TKI in NSCLC with EGFR mutations caused no adverse effects.

Association of Traditional Chinese Medicine Use With Adherence to Prescribed Western Rheumatic Medications Among Chinese American Patients: A Cross-Sectional Survey

OBJECTIVE

Chinese Americans are a fast-growing immigrant group with worse rheumatic disease outcomes compared to white populations and frequently use traditional Chinese medicine (TCM). Whether TCM use is associated with lower adherence to Western rheumatic medications is unknown. The present study was undertaken to examine adherence to Western medications for systemic rheumatic diseases in the Chinese American immigrant population and its association with TCM use.

METHODS

Chinese Americans actively treated for a systemic rheumatic disease were recruited from 2 Chinatown clinics. Sociodemographic, TCM use, and clinical data were gathered. Self-reported health status was assessed using Patient-Reported Outcome Measurement Information System short forms. Adherence was stratified using the 8-item Morisky Medication Adherence Scale. Factors independently associated with high adherence were identified using multivariable logistic regression.

RESULTS

Of 230 subjects, the median age was 55 years (range 20-97 years), 65% were female, 71% had a high school education or less, 70% were enrolled in Medicaid, and 22% reported fluency in English. The most common rheumatic diagnoses were rheumatoid arthritis (41%), systemic lupus erythematosus (17%), and seronegative spondyloarthropathies (15%). One-half reported TCM use in the past year, and 28% reported high adherence to Western rheumatic medications. In multivariable analysis, high adherence was associated with TCM use (odds ratio [OR] 3.96, P < 0.001), being married (OR 3.69, P = 0.004), medication regimen complexity (OR 1.13, P = 0.004), and older age (OR 1.06, P < 0.001), and was negatively associated with anxiety (OR 0.94, P = 0.001).

CONCLUSION

While adherence to Western rheumatic medications was low in this cohort, interestingly, it was higher among TCM users compared to nonusers. TCM use appears to represent a complementary rather than an alternate approach to disease management for these patients. Future studies should evaluate whether TCM use is associated with better disease outcomes.

Is Traditional Chinese Medicine Use Associated with Worse Patient-reported Outcomes among Chinese American Rheumatology Patients?

OBJECTIVE

Chinese Americans are a fast-growing immigrant group with more severe rheumatic disease manifestations than whites and often a strong cultural preference for traditional Chinese medicine (TCM). We aimed to examine TCM use patterns and association with patient-reported outcomes (PRO) among Chinese American rheumatology patients.

METHODS

Chinese Americans actively treated for systemic rheumatic diseases were recruited from urban Chinatown rheumatology clinics. Data on sociodemographics, acculturation, clinical factors, and TCM use (11 modalities) were gathered. Self-reported health status was assessed using Patient Reported Outcomes Measurement Information System (PROMIS) short forms. TCM users and nonusers were compared. Factors independently associated with TCM use were identified using multivariable logistic regression.

RESULTS

Among 230 participants, median age was 57 years (range 20-97), 65% were women, 71% had ≤ high school education, 70% were on Medicaid insurance, 47% lived in the United States for ≥ 20 years, and 22% spoke English fluently. Half used TCM in the past year; these participants had worse self-reported anxiety, depression, fatigue, and ability to participate in social roles and activities compared with nonusers. In multivariable analysis, TCM use was associated with belief in TCM, female sex, ≥ 20 years of US residency, reporting Western medicine as ineffective, and shorter rheumatic disease duration.

CONCLUSION

Among these Chinese American rheumatology patients, TCM users had worse PRO in many physical and mental health domains. TCM use may be a proxy for unmet therapeutic needs. Asking about TCM use could help providers identify patients with suboptimal health-related quality of life who may benefit from targeted interventions.

Aqueous extract of clove inhibits tumor growth by inducing autophagy through AMPK/ULK pathway

Cloves (Syzygium aromaticum), a traditional Chinese medicinal herb, displays broad biological activity. In the present study, the aqueous extract of clove (AEC) was prepared, and its anticancer affects were studied. 3-(4,5-Dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetra-zolium (MTS) analysis revealed that AEC was able to inhibit cancer cell growth in vitro on several cancer cell lines; the IC₅₀ is around 150 μg/ml for human pancreatic ASPC-1 and human colon HT-29 cancer cells. Treatment of the cancer cells with AEC also diminished the colony formation significantly in both human pancreatic ASPC-1 cancer cells and human colon HT-29 cancer cells. In vivo study revealed that AEC inhibited the tumor growth significantly in HT-29 xenograft mice model. Transmission electron microscope, flow cytometry assay, and fluorescence microscope analysis confirmed that AEC is capable of inducing cell autophagy. Further study showed that AMPK/ULK pathway plays an important role in AEC-induced autophagy in cancer cells. Analysis of AEC components was performed by liquid chromatograph mass spectrometer approach, and more than nine constitutes were identified in AEC fraction. The study provides evidence that AEC has potential to be developed as a novel anticancer agent or as an adjuvant in cancer chemotherapy.

Culture Care Beliefs and Practices of Ethiopian Immigrants

INTRODUCTION

The purposes of this mini study were to identify and describe the culture care beliefs and practices of Ethiopian immigrants in the mid-Atlantic region of the United States and to advance the science of transcultural nursing.

METHODOLOGY

Leininger's theory of culture care diversity and universality guided the research and was the framework for the design of this qualitative ethnonursing mini study. Data were collected from 15 participants through in-depth interviews.

RESULTS

Five themes and 14 care patterns merged from the data, including preserving cultural heritage, supporting family and friends, importance of religion and prayer, valuing freedom, cultural caring, and therapeutic communication.

DISCUSSION

Participants valued health care and medical technology in the United States. They wanted nurses to inquire about their culture, language preference, food and dietary practices, and family dynamics. Perceived lack of caring by nurses and unavailability of interpreters in health care settings negatively affected access to care.

Effect of a traditional Chinese medicine course for undergraduate nursing students: A pre-/post-test study

BACKGROUND

Traditional Chinese medicine is widely used for treating aging-related chronic conditions. Therefore, designing a TCM theoretical course for undergraduate nursing students will be a preparation for further clinical practice in TCM in the future.

OBJECTIVES

To identify the effect of a TCM course designed for undergraduate nursing students on understanding four key parts of TCM theories.

DESIGN

A quasi-experimental pre- and post-test study.

SETTING

A university in China during the 2016 fall semester.

PARTICIPANTS

A convenience sample of 47 senior undergraduate nursing students.

METHODS

Each pair of pre- and post-tests were conducted before and after one lecture. Four pairs pre-/post-tests were conducted during lectures of fundamental theories, TCM diagnostic principles, herb properties, and treatment principles. Four questionnaires including ten multiple-choice questions were used for pre-/post-tests. Stata 14.0 was used for descriptive analysis and paired t-tests.

RESULTS

Mean scores of post-tests were significantly higher than those of pre-tests (p < 0.001). Among pre-tests, the lowest correctness rates of key contents in the four lectures were the pathological relation of five elements (31.25%), the differentiation of symptoms for a case analysis (16.67%), the compatibility relation (12.77%), and the role of Monarch herbs (also called as "Principal herbs") and the characteristics of herbal pills (29.79%), separately; the highest were the nature of Yin-Yang (87.50%), identifying symptoms for a specific syndrome (85.42%), the herb usage (95.74%), and the principle of prescription composition (85.11%), separately. TCM knowledge in relation of nature of Yin-Yang and Five Elements and basic principles of TCM knowledge gained more increased correctness rates than that related to pathological-based and differentiation of symptoms.

CONCLUSION

The TCM course has a positive effect to enhance TCM knowledge of undergraduate nursing students. The students were easier to gain TCM fundamental knowledge and principles than pathological based knowledge and differentiation of symptoms.

Which are the best Chinese herbal injections combined with XELOX regimen for gastric cancer?: A PRISMA-compliant network meta-analysis

BACKGROUND

The optimal Chinese herbal injections (CHIs) combined with XELOX regimen for patients with gastric cancer remains elusive. The aim of our network meta-analysis (NMA) is to explore the best options among different CHIs for gastric cancer.

METHODS

PubMed, Embase, the Cochrane Library, the China National Knowledge Infrastructure Database (CNKI), Wan-fang Database, Cqvip Database (VIP), China Biology Medicine disc (CBMdisc) were searched to identify RCTs which focused on CHIs against gastric cancer. The quality assessment of included randomized controlled trials (RCTs) was conducted by the Cochrane risk of bias tool. Standard pair-wise and Bayesian NMAs were performed to compare the efficacy and safety of different CHIs combined with the XELOX regimen via Stata 13.0 and WinBUGS1.4 software.

RESULTS

A total of 2316 records were searched, the network of evidence included 26 eligible RCTs involving 13 types of CHIs and 2154 patients. The results suggested that Shenqifuzheng+ XELOX, Huachansu+ XELOX, Kangai+ XELOX, Javanica oil emulsion+ XELOX, Aidi injection+ XELOX might be the optimal treatment for gastric cancer in improving the performance status than using XELOX regimen single, with odds ratios (OR) and 95% confidence intervals (CIs) of 2.74 (1.24, 6.17), 8.27 (1.74, 42.43), 4.28 (1.80, 10.48), 5.14 (1.87, 16.28), 0.20 (0.090, 0.44). At the aspects of ADRs (adverse reactions), Compound Kushen+ XELOX, Lentinan+ XELOX, Xiaoaiping injection+ XELOX could obviously relieve leukopenia than only receiving XELOX regimen, and their ORs and 95% CIs were 5.62 (1.41, 36.24), 8.16 (2.25, 29.43), 5.69 (1.85, 15.77). Furthermore, Disodium cantharidinate and vitamin B6+ XELOX, Shenqifuzheng+ XELOX, Kangai+ XELOX, Lentinan+ XELOX could obviously relieve the nausea and vomiting than receiving the XELOX regimen alone, with ORs and 95% CIs of 5.29 (1.30, 23.96), 2.50 (1.16, 5.26), 2.42 (1.06, 5.63), 9.04 (3.24, 26.73). Nevertheless, CHIs combined with XELOX regimen did not confer higher better clinical effectiveness rate over receiving XELOX regimen alone, with nonstatistically significant between-group differences.

CONCLUSIONS

As the available evidence suggested that CHIs combined with XELOX regimen could provide treatment benefits for patients with gastric cancer. Among 13 types of CHIs, Javanica oil emulsion and Compound Kushen injection is the optimal treatment in improving the clinical effectiveness rate and performance status, and Lentinan injection was superior in relieving ADRs.

The Association Between Immigration Status and Office-based Medical Provider Visits for Cancer Patients in the United States

OBJECTIVES

We examined differences in cancer-related office-based provider visits associated with immigration status in the United States.

METHODS

Data from the 2007-2012 Medical Expenditure Panel Survey and National Health Interview Survey included adult patients diagnosed with cancer. Univariate analyses described distributions of cancer-related office-based provider visits received, expenditures, visit characteristics, as well as demographic, socioeconomic, and health covariates, across immigration groups. We measured the relationships of immigrant status to number of visits and associated expenditure within the past 12 months, adjusting for age, sex, educational attainment, race/ethnicity, self-reported health status, time since cancer diagnosis, cancer remission status, marital status, poverty status, insurance status, and usual source of care. We finally performed sensitivity analyses for regression results by using the propensity score matching method to adjust for potential selection bias.

RESULTS

Noncitizens had about 2 fewer visits in a 12-month period in comparison to US-born citizens (4.0 vs. 5.9). Total expenditure per patient was higher for US-born citizens than immigrants (not statistically significant). Noncitizens (88.3%) were more likely than US-born citizens (76.6%) to be seen by a medical doctor during a visit. Multivariate regression results showed that noncitizens had 42% lower number of visiting medical providers at office-based settings for cancer care than US-born citizens, after adjusting for all the other covariates. There were no significant differences in expenditures across immigration groups. The propensity score matching results were largely consistent with those in multivariate-adjusted regressions.

CONCLUSIONS

Results suggest targeted interventions are needed to reduce disparities in utilization between immigrants and US-born citizen cancer patients.

"A Word can become a Seed": A Lesson Learned about Cultural Humility

Culturally competent cancer care approaches are necessary to effectively engage ethnic and racial minorities. This reflection shares personal insights on this subject gained throughout my journey from a young immigrant to a medical and public health student in the USA. The death of a friend prompted me to explore what I had deemed as my family's taboo subjects: discussing illness, cancer, and death in the family. However, I eventually realized that it was I who perceived it as taboo subjects. When I inquired earnestly about their health beliefs and values and asked questions in a way that respected those beliefs and values, my family was quite willing to talk about these uncomfortable topics. Subsequent encounters with minority patients and the process of synthesizing this reflection helped me recognize that the way I successfully addressed what I had erroneously assumed to be taboo subjects embodied the idea of cultural humility and can also be applied to issues with other minority patients and families. This recognition will not only make me a better physician but also allow me to become a strong advocate of cultural humility, especially in cancer care and education.

Inhibitory effect of α-solanine on esophageal carcinoma in vitro

α-solanine, a bioactive component and one of the major steroidal glycoalkaloids in potatoes, has been observed to inhibit growth and induce apoptosis in cancer cells. However, the antitumor efficacy of α-solanine on esophageal carcinoma has yet to be fully elucidated. In the present study, the antitumor efficacy of α-solanine against human esophageal carcinoma cells was investigated. It was determined that α-solanine inhibited the growth and proliferation of human esophageal EC9706 and Eca109 cancer cells in a dose-dependent manner, as well as the cell migration and invasion. In addition, the apoptotic rate was increased in the cancer cells treated with α-solanine in a dose-dependent manner, compared with that of the control group (P<0.05). The expression levels of tumor metastasis-related proteins, including matrix metalloproteinase (MMP)-2 and MMP-9, were reduced in the cells treated with α-solanine, as compared with the control group. Conversely, significantly higher expression levels of E-cadherin were detected in the α-solanine-treated groups, as compared with the control group (P<0.05). Therefore, the current results provide a novel insight into the anti-tumor mechanism of α-solanine, and suggest that α-solanine is a potential agent for the prevention and treatment of esophageal carcinoma.

Complementary and alternative medicine use among cancer patients in Palestine with special reference to safety-related concerns

ETHNOPHARMACOLOGICAL RELEVANCE

The use of CAM including herbal medicine as the most preferred CAM modality, among cancer patients who are taking prescription medications has shown to be highly prevalent worldwide as well as in several Middle Eastern countries, with a high percentage of the patients do not disclose their CAM use to treating physician.

AIM OF THE STUDY

The current study aimed to evaluate the patterns of CAM use among two cohorts of cancer patients in Palestine over a three-year period, and to identify socio-demographic factors that are associated with CAM use.

MATERIALS AND METHODS

Across-sectional survey of patients attending outpatient cancer clinics. The method was based on a semi-structured questionnaire. In order to identify safety-related concerns associated with the products listed, a literature search was conducted using different databases (PubMed, Micromedex, AltMedDex, and the Natural Medicine Comprehensive Database).

RESULTS

In 472 cancer patients including 372 of the 2011 cohort; and 100 of the 2014 cohort, the overall prevalence of CAM use was 69.5%. CAM users were more likely to be ≤65 years old, village resident, being in the midst of chemotherapy, to have high interest spiritual quest, and to have no other chronic diseases. A significant number of CAM users reported using herbal preparations (98.3%, and 89.6% in the two study cohorts, respectively). In the current study, a total of 40 plant taxa belonging to 23 botanical families were reported by ≥3 cancer patients in the two cohort groups. The top most commonly used plant in the 2011 cohort group was Arum palaestinum (43.5%), while Ephedra foeminea emerged as the top most commonly utilized plant (from 0.0% in 2011 to 55.2% in the 2014 cohort), mainly due to a recent publicizing and portraying of the plant in the local media as an effective cancer herbal remedy. Safety-related concerns were associated with 33 (82.5%) herbs, including herb-drug interactions with altered pharmacokinetics (8, 20% herbs), direct toxic effects (16, 40% herbs), and increased in vitro response of cancer cells to chemotherapy (30, 75% herbs).

CONCLUSIONS

CAM use, especially herbal medicine in cancer is highly prevalent in Palestine. This study has demonstrated the role of the media on the emergence of new CAM herbal therapies among cancer patients in Palestine, and discussed its potential implications on patients and for oncologists who are treating them. Some of the most widely used herbal medicines by cancer patients in the present work are known to interact with conventional anticancer drugs. Hence, the disclosure of the use of herbal remedies by patients to health professionals with sufficient training in CAM use is important for the later in order to assess whether there are any possible herbal drug interactions and/or harmful drug reactions.

Factors contributing to delayed diagnosis of cancer among Aboriginal people in Australia: a qualitative study

BACKGROUND/OBJECTIVES

Delayed presentation of symptomatic cancer is associated with poorer survival. Aboriginal patients with cancer have higher rates of distant metastases at diagnosis compared with non-Aboriginal Australians. This paper examined factors contributing to delayed diagnosis of cancer among Aboriginal Australians from patient and service providers' perspectives.

METHODS

In-depth, open-ended interviews were conducted in two stages (2006-2007 and 2011). Inductive thematic analysis was assisted by use of NVivo looking around delays in presentation, diagnosis and referral for cancer.

PARTICIPANTS

Aboriginal patients with cancer/family members (n=30) and health service providers (n=62) were recruited from metropolitan Perth and six rural/remote regions of Western Australia.

RESULTS

Three broad themes of factors were identified: (1) Contextual factors such as intergenerational impact of colonisation and racism and socioeconomic deprivation have negatively impacted on Aboriginal Australians' trust of the healthcare professionals; (2) health service-related factors included low accessibility to health services, long waiting periods, inadequate numbers of Aboriginal professionals and high staff turnover; (3) patient appraisal of symptoms and decision-making, fear of cancer and denial of symptoms were key reasons patients procrastinated in seeking help. Elements of shame, embarrassment, shyness of seeing the doctor, psychological 'fear of the whole health system', attachment to the land and 'fear of leaving home' for cancer treatment in metropolitan cities were other deterrents for Aboriginal people. Manifestation of masculinity and the belief that 'health is women's domain' emerged as a reason why Aboriginal men were reluctant to receive health checks.

CONCLUSIONS

Solutions to improved Aboriginal cancer outcomes include focusing on the primary care sector encouraging general practitioners to be proactive to suspicion of symptoms with appropriate investigations to facilitate earlier diagnosis and the need to improve Aboriginal health literacy regarding cancer. Access to health services remains a critical problem affecting timely diagnosis.

Annual Review of Asian American Psychology, 2014

This 2014 review of Asian American psychology is the sixth review in the series. It includes 316 articles that met the inclusion criteria established by the past five annual reviews. Featured articles were derived from three sources: 137 were generated via the search term "Asian American" in PyscINFO, 111 were generated via a search for specific Asian American ethnic groups, and 32 were generated via author searches of articles that met the inclusion criteria. The top primary topic was health and health-related behaviors, the most frequently employed study design was cross-sectional, and the most studied Asian American ethnic group was Chinese. This year's review includes information on the target population of the primary topic, the age range and developmental period of participants, and whether the study design was cross-sectional or longitudinal. It also identifies top authors and journals contributing to the 2014 annual review. These new features reveal that the most common target population of the primary topic was youths; studies most commonly included emerging adults ages 18-25; cross-sectional study design was employed more often than longitudinal design; the top contributor to the 2014 review was Stephen Chen, who authored the highest number of papers included; and the Asian American Journal of Psychology generated the highest number of publications for this review.