The correlation of traditional chinese medicine deficiency syndromes, cancer related fatigue, and quality of life in breast cancer patients

Clinical Efficacy of Yiqi Yangyin Decoction Combined with Adjuvant Chemotherapy on the Postoperative Life Quality of Breast Cancer

Postoperative adjuvant chemotherapy could improve the life quality of patients with breast cancer but also bring side effects and cause adverse reactions. Yiqi Yangyin decoction has been reported to possess anti-cancer activity and has been employed in the postoperative treatment of various cancers. A total of 128 patients with breast cancer who received surgical therapy were enrolled in this study and were randomly grouped as the control and the test group to receive different therapies. Patients in the control group received single chemotherapy of fluorouracil and hydrochloride, while the therapy of the test group patients supplemented Yiqi Yangyin decoction based on the control group. Both two therapeutic strategies improved life quality and TCM syndrome scores of enrolled patients, and the supplement of Yiqi Yangyin decoction significantly improved the therapeutic effect. Adverse reactions including nausea, vomiting, thrombocytopenia, diarrhea, leukopenia, and hemoglobinia occurred in both two groups, but the application of Yiqi Yangyin decoction significantly alleviated adverse reactions. Additionally, patients in the test group showed a better 1-year disease-free survival. The combination of adjuvant chemotherapy with Yiqi Yangyin decoction could improve postoperative life quality, improve therapeutic efficacy, and reduce adverse reactions in patients with breast cancer.

Efficacy of Moxibustion for Cancer-Related Fatigue in Patients with Breast Cancer: A Systematic Review and Meta-Analysis

INTRODUCTION

Breast cancer is the most commonly diagnosed cancer worldwide, and most patients experience fatigue. However, there are no effective treatments for cancer-related fatigue (CRF). Several randomized controlled trials (RCTs) have suggested that moxibustion improves CRF. We conducted a systematic review and meta-analysis to compare the differences in fatigue scale scores, quality of life, and clinical efficacy in patients with breast cancer who developed CRF and did versus did not receive moxibustion.

METHODS

RCTs were searched in 7 databases using a standardized search method from database inception to March 2023, and RCTs that met the inclusion criteria were selected.

RESULTS

Among 1337 initially identified RCTs, 10 RCTs involving 744 participants were selected for this study. The meta-analysis involved assessment of the revised Piper Fatigue Scale scores, Cancer Fatigue Scale scores, Karnofsky Performance Scale scores, Athens Insomnia Scale scores, clinical efficacy, and Qi deficiency syndrome scale scores. Compared with the control, moxibustion was associated with significantly better Piper Fatigue Scale scores (P < 0.0001), quality of life [Karnofsky Performance Scale scores (P < 0.0001)], clinical efficacy (P = 0.0007), and Qi deficiency syndrome scale scores (P = 0.02).

CONCLUSIONS

Moxibustion improves CRF in patients with breast cancer. The efficacy of moxibustion should be further examined by high-quality studies in various countries with patients subdivided by their breast cancer treatment status.

REGISTRATION

PROSPERO ID: CRD42023451292.

Molecular Mechanisms Underlying Qi-Invigorating Effects in Traditional Medicine: Network Pharmacology-Based Study on the Unique Functions of Qi-Invigorating Herb Group

Qi-invigorating herbs (QIHs) are a group of herbs that invigorate Qi, the most vital force for maintaining the physiological functions of the human body in traditional medicine. However, the mechanism underlying the Qi-invigorating effects remains unclear. This study aimed to elucidate the unique mechanisms of QIHs based on unique compounds, using a network pharmacology approach. QIHs and their compounds were identified using existing literature and the TCMSP database, respectively. Subsequently, a method was proposed to screen for unique compounds that are common in QIHs but rare in other traditional herbs. Unique compounds’ targets were predicted using the TCMSP, BATMAN-TCM, and SwissTargetPrediction databases. Finally, enriched GO and KEGG pathways were obtained using DAVID to uncover the biomolecular functions and mechanisms. Thirteen unique compounds, mainly including amino acids and vitamins that participate in energy metabolism and improve Qi deficiency syndrome, were identified among the eight QIHs. GO and KEGG pathway analyses revealed that these compounds commonly participate in neuroactive ligand–receptor interaction and the metabolism of amino acids, and are related to the components of mitochondria and neuronal cells. Our results appropriately reflect the characteristics of traditional Qi-invigorating effects; therefore, this study facilitates the scientific interpretation of Qi functions and provides evidence regarding the treatment effectiveness of QIHs.

An Evidence-Based Somatic Acupressure Intervention Protocol for Managing the Breast Cancer Fatigue-Sleep Disturbance-Depression Symptom Cluster: Development and Validation following the Medical Research Council Framework

BACKGROUND

Somatic acupoint stimulation (SAS) has been frequently utilised as a promising intervention for individual cancer-related symptom management, such as fatigue, sleep disturbance and depression. However, research evidence regarding the role of SAS in mitigating the fatigue-sleep disturbance-depression symptom cluster (FSDSC) has been scant. This study was conducted to develop an evidence-based SAS intervention protocol that can be further implemented in a Phase II randomized controlled trial (RCT) to manage the FSDSC in breast cancer survivors.

METHODS

The Medical Research Council Framework for Developing and Evaluating Complex Intervention (MRC framework) was employed to guide the development procedures of the SAS intervention protocol, including the identification of an existing evidence base, the identification of theories and practice standards, and the validation of the SAS intervention protocol. A content validity study was performed through an expert panel to assess the scientific and practical appropriateness of the SAS intervention protocol. The content validity index (CVI), including item-level CVI and protocol-level CVI, were calculated to evaluate the consensus level of the expert panel.

RESULTS

Key components of the SAS protocol, including the acupoint formula, the SAS modality, technique, intensity and frequency were identified for both a true and placebo SAS intervention based on the best available research evidence retrieved from systematic reviews, clinical trials, and relevant theories, particularly regarding the inflammatory process, yin-yang theory, zang-fu organs and meridians theory, and acupressure practical standards. The true SAS intervention was determined as daily self-administered acupressure on specific acupoints for seven weeks. The placebo SAS was designed as light acupressure on non-acupoints with the same frequency and duration as the true SAS. Excellent content validity was achieved after one round of expert panel assessment, with all the key components of the true and placebo SAS protocols rated as content valid (CVI ranged from 0.86 to 1.00).

CONCLUSIONS

A research-informed, theory-driven and practically feasible SAS intervention protocol for the FSDSC management in breast cancer survivors was developed following the MRC framework. The feasibility and acceptability of the SAS intervention will be further tested in breast cancer survivors through a Phase II RCT.

A Systematic Review and Meta-Analysis of the Effects of Herbal Medicine Buyang Huanwu Tang in Patients with Poststroke Fatigue

Poststroke fatigue (PSF) is reported to occur in 30%-72% of all patients with stroke. PSF not only is a symptom of stroke but has also been reported to adversely affect the prognosis of patients with stroke. However, no treatment has had a significant effect on PSF. In East Asian countries, several herbal medicines have been used to treat stroke, with Buyang Huanwu Tang (BHT) being the most common. This review aimed to evaluate the efficacy and safety of BHT for PSF. A literature search was conducted on MEDLINE, CENTRAL, Scopus, CiNii, CNKI, OASIS, NDSL, and KTKP databases for randomized controlled trials that evaluated the effects and safety of BHT on PSF. Six studies (n = 427) were included. The overall methodological quality of these studies was relatively low. In the adjunctive BHT group, the meta-analysis indicated statistically significant improvements in the Fatigue Severity Scale score (mean difference -1.49, 95% CI [-2.25, -0.73]) and total clinical efficacy rate (risk ratio 0.11, 95% CI [0.03, 0.41]) compared to those in the nonherbal group. Adverse events were only reported in one study, and no serious adverse events occurred. BHT administration might be effective in the treatment of PSF. We were unable to draw definitive conclusions owing to the limitations of the included studies. The trial is registered with CRD42019130178 in PROSPERO.

Association between cancer-related fatigue and traditional Chinese medicine body constitution in female patients with breast cancer

BACKGROUND

Cancer-related fatigue (CRF) is a common psychosomatic problem in breast cancer patients. Traditional Chinese medicine (TCM) has been used to address symptoms in patients with CRF. Identification of the specific constitution in TCM is essential for personalized care.

AIM

To explore the relationship between fatigue and specific constitutions in breast cancer.

EXPERIMENTAL PROCEDURE

We conducted a cross-sectional study in all breast cancer patients at Kaohsiung Chang Gung Memorial Hospital in Taiwan. The severity of fatigue was determined using the Brief Fatigue Inventory-Taiwanese (BFI-T) form. TCM patterns were determined using the Body Constitution Questionnaire (BCQ). The relationship between constitution and fatigue was analyzed using logistic regression.

RESULTS

We recruited 110 breast cancer patients with fatigue (mean age: 55 ± 11 years). The mean duration of breast cancer was 17.4 months. The major constitution among these patients with fatigue was Yang-Qi deficiency (50%). Phlegm-Stasis syndrome was correlated with a duration of breast cancer of more than 18 months (p = 0.02). Out of all participants, 42.7% (n = 47) reported clinically significant fatigue (BFI-T score ≥4). According to logistic regression, the score of Yang-Qi deficiency [odds ratio (OR): 3.5, 95% confidence interval (CI): 1.49-8.21, p < 0.01] was also associated with clinically significant fatigue.

CONCLUSION

Yang-Qi deficiency is associated with clinically significant fatigue in breast cancer patients. However, the association of Phlegm-Stasis syndrome and fatigue as disease duration increases cannot be ignored. Further studies are needed to determine whether treating both constitutions integrating TCM treatment can alleviate patients' fatigue symptoms.

Causal Attributions and Quality of Life of Korean Breast Cancer Survivors

PURPOSE

The purpose of this study was threefold: to explore the causal attributions of breast cancer, examine underlying factors of the attributes, and determine their relationship to quality of life among Korean breast cancer survivors.

METHODS

The study used a descriptive correlational design, which included quantitative survey questionnaires and an open-ended question to complement the study. Three hundred and three breast cancer survivors were recruited from two university hospitals in South Korea, between January and April 2018. The causal attributions were explored using the Illness Perception Questionnaire Revised and an open-ended question. The survivors' quality of life was assessed using the Functional Assessment of Cancer Therapy for Breast Cancer. The quantitative analysis was performed using the SPSS 25.0 software package; the ATLAS.ti 8 software was used for thematic analysis.

RESULTS

Quantitative and qualitative data of 321 and 238 breast cancer survivors, respectively, were analyzed. "Stress and worry" and "diet or eating habits" were believed to be the two most likely causes of breast cancer. Eleven new causal attributes emerged from the analysis. Being diagnosed with breast cancer at an older age (p < .05), having received chemotherapy (p < .05), and holding nonbehavioral causal attributes (p < .001), were significantly related to lower quality of life.

CONCLUSION

There were differences between the survivors' beliefs on their causes of disease, and causal factors available from the literature. As the survivors' causal attributes were significantly related to their quality of life, healthcare providers should individually assess and incorporate these attributes into their care.

A Phase II Randomized Controlled Trial of Renshen Yangrong Tang Herbal Extract Granules for Fatigue Reduction in Cancer Survivors

CONTEXT

Based on the traditional Chinese medicine theory, Renshen Yangrong Tang (RSYRT), which is a mixture of 12 herbs, was commonly used as a pharmacological option in China for fatigue management by correcting Qi deficiency.

OBJECTIVES

This randomized controlled Phase II trial investigated the efficacy of RSYRT for reducing cancer-related fatigue.

METHODS

Cancer survivors with moderate or severe fatigue (rated ≥4 on a 0-10 scale) for more than two months were randomized to take herbal extract granules of RSYRT or a low dose of a single herb (huangqi) twice a day for six weeks. Patient-reported fatigue was measured using the MD Anderson Symptom Inventory. Efficacy of RSYRT was evaluated using mixed model to test the differences over time among groups. We also conducted responder analyses and examined time to effect of symptom reduction.

RESULTS

None of the 83 evaluable patients (control group 42; intervention group 41) had discomfort or Grade 3 or 4 toxicity. We observed a significantly greater MD Anderson Symptom Inventory-fatigue score reduction in the intervention group than that in the control group (time-by-group interaction: estimate = -0.61 [0.10]; P < 0.0001). More patients in the intervention group had a two-point reduction on fatigue than that of the control group (90.2% vs. 52.4%). By Week 4, between-group differences of fatigue reduction on mean severity reached large effect size (intervention group vs. control group: -2.66 vs. -1.36; Cohen's d = 1.0; P < 0.0001).

CONCLUSION

Compared with control therapy, RSYRT therapy elicits a statistical and clinical improvement of fatigue severity and functioning. The effectiveness of RSYRT in managing cancer-related fatigue warrants further study in the real world.

Protective effects of aqueous extract from Gei Herba on blood-deficiency mice: insights gained by a metabolomic approach

With increasing tumor incidence, anemia (categorized as a blood deficiency in traditional Chinese medicine) caused by chemotherapy has become a major side effect worldwide. Gei Herba, a traditional Miao nation herb, has a prominent effect on the treatment of blood deficiency (BD). However, its application is limited owing to little fundamental research. Therefore, a GC-MS metabolomic approach was used to study the protective effect of aqueous extract from Gei Herba (AEG) on BD mice and its putative mechanism. In this study, 32 male mice were divided into four groups: a control group, a BD model group, and two groups subjected to AEG treatment at a daily dose of 0.15 or 0.30 g kg⁻¹ for 8 d. After AEG treatment, the HGB and HCT levels in the blood of BD mice were significantly increased, the activity of superoxide dismutase was increased, and the histomorphology of the liver was improved. Furthermore, compared with those in the model group, the levels of eight significant metabolites [phosphoric acid, glycine, l-proline, ribitol, (Z,Z)-9,12-octadecadienoic acid, oleic acid, uridine and 4B2H-carbamic acid] in the liver were significantly changed by AEG. The findings of this study provide sound evidence regarding the protective effects of AEG in BD mice from both classical and metabolomic perspectives. The mechanisms of action of AEG could be related to regulation of linoleic acid metabolism and that of glycine, serine, and threonine metabolism.

The protective effect and mechanism of Gei Herba in BD mice were revealed by classical and metabolomic perspectives.

Buyang Huanwu Tang (Boyang Hwano Tang) for the treatment of post-stroke fatigue: Protocol for a systematic review of randomized controlled trials

BACKGROUND

Buyang Huanwu Tang (BHT) is a well-known herbal complex used for stroke treatment and has been used mainly during post-stroke rehabilitation in East Asia. In this review, we aim to evaluate the efficacy and safety of BHT as a treatment for post-stroke fatigue (PSF).

METHODS

Eight databases will be searched for relevant studies from inception to the present date. We will include randomized controlled trials (RCTs), which assess the effect and safety of BHT for the treatment of PSF. The methodological qualities, including the risk of bias (RoB), will be evaluated using the Cochrane RoB assessment tool. After screening the studies, a meta-analysis of the RCTs will be done.

RESULTS

This study will provide high-quality synthesis of current evidence of BHT for PSF.

CONCLUSION

The conclusion of our systematic review will provide evidence to judge whether BHT is an effective intervention for patients with PSF.

ETHICS AND DISSEMINATION

Ethical approval is not required, as this study is based on the review of published research. This review will be published in a peer-reviewed journal and disseminated both electronically and in print.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42019130178.

Effect of Baduanjin Qigong Exercise on Cancer-Related Fatigue in Patients with Colorectal Cancer Undergoing Chemotherapy: A Randomized Controlled Trial

BACKGROUND

Cancer-related fatigue (CRF) is one of the most troubling symptoms of cancer patients during chemotherapy, and no gold standard for the treatment of CRF has been established.

OBJECTIVE

This study aimed to examine the effects of the Baduanjin qigong on patients with colorectal cancer and CRF, and to explore its intervention effects.

METHODS

This was an open-label, randomized controlled clinical trial. Ninety patients with chemotherapy-treated colorectal cancer and CRF were randomized to a Baduanjin exercise group or a routine care group. The primary outcome was the Brief Fatigue Inventory (BFI) score at 24 weeks. The secondary outcomes were the Karnofsky Performance Status (KPS) and Pittsburgh Sleep Quality Index (PSQI) scores at 24 weeks.

RESULTS

There were no significant differences between the two groups in CRF level at baseline and 12 weeks. At 24 weeks, the proportion of patients with moderate-to-severe CRF was significantly smaller in the exercise group than in the control group (23.2 vs. 59.1%, p < 0.01). The KPS and PSQI scores were similar in the two groups at baseline and 12 weeks, but they were significantly higher and lower, respectively, at 24 weeks in the exercise group compared with the control group (KPS score: 89.3 ± 8.3 vs. 75.2 ± 11.5, p < 0.01; PSQI score: 4.1 ± 1.1 vs. 6.9 ± 2.0, p < 0.01). Significant time-group interactions were observed for all three scores (all p < 0.01).

CONCLUSIONS

Baduanjin qigong exercise can relieve CRF in patients with colorectal cancer undergoing chemotherapy and can improve their physical activity level and their quality of sleep.

In vitro assays suggest Shenqi Fuzheng Injection has the potential to alter melanoma immune microenvironment

ETHNOPHARMACOLOGICAL RELEVANCE

A modern agent Shenqi Fuzheng Injection (SFI), prepared from Codonopsis Radix and Astragali Radix, has been commonly used as a supplementary therapy for cancers including melanoma. This agent was derived from a formula documented in the "National Collection of Chinese Medicine Prescriptions". The formula has long been used as a remedy for Qi deficiency that is closely associated with cancer-related fatigue and poor quality of life. However, the antimelanoma mechanisms of SFI remain unclear. Here we tested if SFI exerted antimelanoma effects by reprograming the tumour immune microenvironment using in vitro assays.

MATERIALS AND METHODS

The cytotoxic activities of Jurkat T cells when co-cultured with A375 cells were determined in the presence or absence of SFI. The migratory activities of Jurkat T cells were examined in the transwell assay system. The mRNA expression and production of cytokines (IL-10, TGF β and VEGF) in A375 cells in the presence or absence of SFI were determined by real-time PCR and ELISA, respectively.

RESULTS

When A375 cells were co-cultured with Jurkat T cells in the presence of SFI (220µg/mL), a potent cytotoxicity effect against A375 cells was observed. Supernatants from A375 cells that were treated with SFI (110 and 220µg/mL) significantly increased the migratory capacity of Jurkat T cells in transwell assays. SFI also markedly reduced the mRNA expression levels and the release of immunosuppressive cytokines IL-10, TGF-β and VEGF in A375 cells in a concentration-dependent manner.

CONCLUSIONS

SFI enhanced the cytotoxic and migratory activities of Jurkat T cells towards A375 melanoma cells. The effects were associated with SFI's suppression on immunosuppressive cytokines for their release from and gene expressions in A375 melanoma cells. These in vitro findings suggested that SFI might reprogramme the immunosuppressive melanoma microenvironment in vivo to enhance the cytotoxicity of tumour-infiltrating immune cells. This study provides a pharmacological basis for the adjunctive use of SFI in melanoma treatment.

Research advances in traditional Chinese medicine syndromes in cancer patients

Traditional Chinese medicine (TCM) syndrome, also known as TCM ZHENG or TCM pattern, is an integral and essential part of TCM theory that helps to guide the design of individualized treatments. A TCM syndrome, in essence, is a characteristic profile of all clinical manifestations in one patient that can be readily identified by a TCM practitioner. In this article, the authors reviewed the presentations of TCM syndromes in seven common malignancies (liver, lung, gastric, breast, colorectal, pancreatic and esophageal cancers), the objectivity and the standardization of TCM syndrome differentiation, the evaluation of TCM syndrome modeling in cancer research, and syndrome differentiation-guided TCM treatment of cancers. A better understanding of TCM syndrome theory, as well as its potential biological basis, may contribute greatly to the clinical TCM diagnosis and the treatment of cancer.

Influence of traditional Chinese medicine syndrome groups on quality of life in women with metabolic syndrome

Traditional Chinese medicine (TCM; 中醫 zhōng yī) syndrome groups are based on the symptoms of human diseases and guide the use of Chinese herbs. The aim of this study was to examine the effects of TCM syndrome groups on biochemical characteristics and quality of life (QOL) in women with metabolic syndrome (MS). Among the 1080 registered female patients screened at our outpatient clinic, a total of 322 women aged between 18 and 65 years and meeting the requirements of MS were enrolled. All the patients were asked to fill out a questionnaire on metabolic TCM syndrome groups and a questionnaire on the QOL, the Medical Outcomes Study (MOS) Short Form-12 (SF-12). Data of biochemical characteristics were collected at the same time. The present study showed MS women in TCM syndrome groups had significantly lower physical and mental component scores in SF-12 compared with those not in TCM syndrome groups. We also found MS patients in TCM syndrome groups, except Kidney Deficiency syndrome, showed higher body mass indexes, waist circumference, and hip circumference. However, there was almost no difference in most biochemical characteristics between TCM syndrome groups. The MS patients diagnosed as belonging to TCM syndrome groups had poor QOL.

Ren Shen Yangrong Tang for Fatigue in Cancer Survivors: A Phase I/II Open-Label Study

OBJECTIVES

This open-label, prospective, phase I/II trial was performed to establish the safety and efficacy of Traditional Chinese Medicine (TCM) herbal products for treating non-anemia-related fatigue in patients with cancer. Although this practice is widespread in China, it has not been confirmed in a prospective clinical study.

DESIGN

Thirty-three patients who had completed cancer treatment, had stable disease and no anemia, and reported moderate to severe fatigue (rated ≥4 on a 0-10 scale) were enrolled in a TCM outpatient clinic. Patients took Ren Shen Yangrong Tang (RSYRT) decoction, a soup containing 12 TCM herbs, twice a day for 6 weeks. RSYRT aims to correct qi deficiency. Fatigue was assessed before and after RSYRT therapy, which all patients completed.

RESULTS

No discomfort or toxicity was observed. Before the study, all patients had had fatigue for at least 4 months. Fatigue severity decreased significantly from before therapy to 6 weeks after therapy: from 7.06 to 3.30 on a 0-10 scale (p<0.001). Fatigue category (mild, moderate, severe) shifted significantly (p=0.024): Of 22 patients with severe fatigue (rated ≥7) before therapy, 11 had mild fatigue and 11 had moderate fatigue after TCM treatment. The time-to-fatigue-alleviation was 2-3 weeks.

CONCLUSION

RSYRT therapy was safe and was associated with fatigue improvement in nonanemic cancer survivors, consistent with historical TCM clinical practice experience. Because of a possible placebo effect in this open-label study, decoction RSYRT warrants further study in randomized clinical trials to confirm its effectiveness for managing moderate to severe fatigue.

The correlation of lab data, hormone peptides, quality of life, and different traditional chinese medicine syndrome groups in type 2 diabetes patients

The aim of this study is to explore the correlation of laboratory data, hormone peptides, and quality of life with different traditional Chinese medicine (TCM) syndrome groups in type 2 diabetes patients. Of 513 registered patients, 179 subjects aged between 20 and 65 years and having type 2 diabetes mellitus (T2DM) for more than 1 year were enrolled in the study. All the participants were asked to fill out a questionnaire on diabetic TCM syndrome groups, which was designed by professional TCM doctors, and two questionnaires on the quality of life (QOL), WHOQOL-BREF Taiwan version and Medical Outcomes Study (MOS) Short Form-12 (SF-12). The biochemical characteristics and hormone peptide levels were collected at the same time. The patients in any one of the six TCM syndrome groups had the trend to have worse QOL. Especially, patients with qi deficiency had worse life quality on every aspect compared to those without qi deficiency and were fatter than others. We also found that the subjects who had qi deficiency, qi stagnation, and yin deficiency at the same time had worsened condition. We consider that patients with qi deficiency may also be at a higher risk of developing other complications. They need more advanced health care than others. This self-reported questionnaire will be a reference for health care workers screening those T2DM patients who have a higher possibility of developing other complications. Especially in remote areas, where there is a lack of medical resources, an easy-to-use tool such as the one in the present study for detecting and evaluating disease conditions is needed.