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Cheng CW, Mok HF, Yau CWS, Chan JTM, Kang YC, Lam PY, Zhong LLD, Zhao C, Ng BFL, Kwok AOL, Tse DMW, Bian ZX. A pilot randomized placebo-controlled study on modified MaZiRenWan: a formulated Chinese medicine to relieve constipation for palliative cancer patients. Chin Med 2022; 17:31. [PMID: 35236375 PMCID: PMC8889635 DOI: 10.1186/s13020-022-00580-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Constipation is a common problem among advanced cancer patients; however, many of them find limited effective from current therapies. Thus, we aimed to test the effect of a traditional Chinese herbal formula, modified MaZiRenWan (MZRW), by comparing with placebo among palliative cancer patients with constipation. METHODS This is a randomized, double-blind, placebo-controlled trial. Participants aged over 18 were recruited and randomized to MZRW or placebo group in addition to current prescriptions (including ongoing laxatives treatment) for two weeks. Exclusion criteria included cognitive impairment, presence of a colostomy or gastrointestinal obstruction and estimated life expectancy of less than one month. Individualized modification of MZRW was allowed according to the traditional Chinese medicine (TCM) pattern of patient. The primary outcome was the global assessment of improvement, which reflected whether the constipation had improved, remained the same or worsened. RESULTS Sixty patients, with mean age 75.2 years (range 47-95 years), were randomized to MZRW or placebo group. Among the MZRW group, 59.3% (16/27) had improvement in the global assessment score, as compared with 28.6% (8/28) of the placebo group (p-value = 0.022). Besides, the MZRW group had significant increase in stool frequency, and reduction in constipation severity and straining of defecation (p-value < 0.05). No serious adverse event was reported due to the research medication. CONCLUSION This pilot trial suggests modified MZRW is well-tolerated and effective for relief of constipation in patients with advance cancer. It could be considered as a potential treatment option for constipation in palliative care. TRIAL REGISTRATION The trial had been registered in ClinicalTrials.gov with identifier number NCT02795390 [ https://clinicaltrials.gov/ct2/show/NCT02795390 ] on June 10, 2016.
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Affiliation(s)
- Chung-Wah Cheng
- Hong Kong Chinese Medicine Clinical Study Centre, School of Chinese Medicine, Hong Kong Baptist University, 3/F, Jockey Club School of Chinese Medicine Building, 7 Baptist University Road, Hong Kong, SAR, People's Republic of China
| | - Hoi-Fung Mok
- Yan Chai Hospital - Hong Kong Baptist University Clinical Centre for Training and Research in Chinese Medicine (West Kowloon), Yan Chai Hospital, Hong Kong, SAR, People's Republic of China
| | - Cora W S Yau
- Integrated Palliative Care Unit, Department of Medicine, Hong Kong Buddhist Hospital, Hong Kong, SAR, People's Republic of China
| | - Jasmine T M Chan
- Palliative Care Unit, Department of Medicine and Geriatrics, Our Lady of Maryknoll Hospital, Hong Kong, SAR, People's Republic of China
| | - Yu-Chen Kang
- Hong Kong Buddhist Association-University of Hong Kong Clinical Centre for Teaching and Research in Chinese Medicine, Hong Kong, SAR, People's Republic of China
| | - Pui-Yan Lam
- Hong Kong Chinese Medicine Clinical Study Centre, School of Chinese Medicine, Hong Kong Baptist University, 3/F, Jockey Club School of Chinese Medicine Building, 7 Baptist University Road, Hong Kong, SAR, People's Republic of China
| | - Linda L D Zhong
- Hong Kong Chinese Medicine Clinical Study Centre, School of Chinese Medicine, Hong Kong Baptist University, 3/F, Jockey Club School of Chinese Medicine Building, 7 Baptist University Road, Hong Kong, SAR, People's Republic of China
| | - Chen Zhao
- Hong Kong Chinese Medicine Clinical Study Centre, School of Chinese Medicine, Hong Kong Baptist University, 3/F, Jockey Club School of Chinese Medicine Building, 7 Baptist University Road, Hong Kong, SAR, People's Republic of China.,Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Bacon F L Ng
- Chinese Medicine Department, Hospital Authority, Hong Kong, SAR, People's Republic of China
| | - Annie O L Kwok
- Palliative Care Unit, Department of Medicine and Geriatrics, Caritas Medical Centre, 111 Wing Hong Street, Shamshuipo, Hong Kong, SAR, People's Republic of China.
| | - Doris M W Tse
- Palliative Care Unit, Department of Medicine and Geriatrics, Caritas Medical Centre, 111 Wing Hong Street, Shamshuipo, Hong Kong, SAR, People's Republic of China.
| | - Zhao-Xiang Bian
- Hong Kong Chinese Medicine Clinical Study Centre, School of Chinese Medicine, Hong Kong Baptist University, 3/F, Jockey Club School of Chinese Medicine Building, 7 Baptist University Road, Hong Kong, SAR, People's Republic of China.
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Goel AR, Elhassan H, Patterson M, Reid MC. Characteristics of Provider-Focused Research on Complementary and Integrative Medicine in Palliative Care: A Scoping Review. Am J Hosp Palliat Care 2022; 39:370-387. [PMID: 33887994 PMCID: PMC9109423 DOI: 10.1177/10499091211011708] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The use of complementary and integrative medicine (CIM) continues to grow in palliative care. While research supports the use of many CIM therapies for symptom relief, the scope of provider-focused research on CIM remains poorly characterized. OBJECTIVES We conducted a scoping review to characterize provider-focused research on CIM in palliative care in order to map existing evidence and identify knowledge gaps. METHODS We developed a protocol outlining the study population, concept, and context; then used a validated approach per the JBI manual and searched MEDLINE, EMBASE, CINAHL, and AMED. RESULTS We identified 34 studies that were conducted primarily in the US (n = 9) and UK (n = 6), focused mostly on nurse (n = 29) and physician (n = 22) providers, and employed questionnaires (n = 16) or qualitative (n = 15) methods. Studies investigated 58 CIM modalities, including massage (n = 13), music therapy (n = 12), and aromatherapy (n = 10), to address common symptoms including pain (n = 17), fatigue (n = 6), and nausea/vomiting (n = 6). Study outcomes included perceived benefits of CIM (n = 17) and types of CIM modalities that providers offer (n = 15). Uncommonly studied phenomena included referral patterns (n = 4), facilitators of provider recommendation of CIM (n = 3), and rates of CIM use (n = 3). CONCLUSION Provider-focused research on CIM in palliative care can expand its scope by addressing perspectives of interdisciplinary providers, examining CIM modalities that patients report using, addressing symptoms commonly encountered in palliative care, and researching provider-use-focused outcomes. We identify these possibilities for future studies in addition to opportunities for systematic investigations to enhance the safe and efficacious delivery of CIM in the palliative care setting.
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Affiliation(s)
| | - Hana Elhassan
- MD Program, Weill Cornell Medicine, New York, NY, USA
| | - Melissa Patterson
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine/New York-Presbyterian, NY, USA
| | - M. Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine/New York-Presbyterian, NY, USA
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