1
|
Li L, Wang R, Zhang A, Wang L, Ge Q, Liu Y, Chen T, Wang CC, Leung PC, Sun Q, Fan X. Evidence on Efficacy and Safety of Chinese Medicines Combined Western Medicines Treatment for Breast Cancer With Endocrine Therapy. Front Oncol 2021; 11:661925. [PMID: 34235077 PMCID: PMC8255804 DOI: 10.3389/fonc.2021.661925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/07/2021] [Indexed: 12/31/2022] Open
Abstract
Background Breast cancer, a malignant disorder, occurs in epithelial tissue of the breast glands and ducts. Endocrine therapy is commonly applied as an important adjuvant treatment for breast cancer, but it usually induces a variety of side effects. Chinese Medicines (CM) has therapeutic effect on reducing adverse effects of the endocrine therapy in many clinical studies. But strong evidence is still limited on the efficacy and safety of CM combined western medicines (CM-WM) for breast cancer. Objective To study the efficacy and safety of CM-WM as an adjuvant treatment for reducing side effects induced by endocrine therapy in breast cancer patients. Method We searched relevant clinical studies in PubMed and the Chinese National Knowledge Infrastructure (CNKI) databases up to February 28, 2021 and only Randomized Controlled Trials (RCTs) were included. There were no limitations on the languages. We extracted data from the included RCTs, assessed study quality, conducted meta-analyses by RevMan 5.4 and compared the pooled Risk Ratios (RR) or Mean Difference (MD) with 95% CIs. Results In total 28 trials involving 1,926 participants were included. Six RCTs compared CM-WM with CM placebo-WM, while 22 RCTs compared CM-WM with WM alone. No study compared CM-WM with no treatment. Meta-analysis showed that CM-WM treatment significantly improved quality of life (MD = 0.73, 95% CI = 0.11–1.35, P = 0.02) when compared with CM placebo-WM treatment. When compared with WM treatment alone, CM-WM treatment significantly improved bone mineral density (MD = 0.24, 95% CI = 0.13–0.35, P <0.0001), TCM syndrome score (MD = −5.39, 95% CI = −8.81 to −1.97, P = 0.0002), Kupperman Scale (MD = 0.24, 95% CI = −2.76 to −1.94, P <0.0001), Karnofsky Performance Scale (MD = 3.76, 95% CI = 1.64–5.88, P = 0.0005), quality of life (MD = 3.01, 95% CI = 1.00–5.02, P = 0.003), and pain relief (MD = 2.10, 95% CI = 0.72–3.48, P <0.0001). Compared with WM, CM-WM significantly decreased incidence of TCM symptoms (nausea, vomiting, fatigue, etc.) (RR = 1.60, 95% CI = 1.40–1.84, P <0.0001). For safety, serum calcium, estradiol, ALP, and blood CD3, CD4 and CD8 counts were not significantly difference between two treatments (P >0.05). Serious side effects or reactions were not reported in all included studies. Conclusion The adjunctive use of CM reduced the endocrine therapy associated adverse events, including bone mineral density loss, perimenopausal symptoms, poor quality of life, pain and impaired immune function. But large-scale and high quality RCTs are needed to support the application of CM-WM therapy.
Collapse
Affiliation(s)
- Lu Li
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China.,Innovation Center in Zhejiang University, State Key Laboratory of Component-Based Chinese Medicine, Hangzhou, China.,Department of Obstetrics & Gyneacology, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Institute of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Rongyun Wang
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Aolin Zhang
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China.,Innovation Center in Zhejiang University, State Key Laboratory of Component-Based Chinese Medicine, Hangzhou, China
| | - Ling Wang
- The First College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Qianwen Ge
- The First College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuan Liu
- The First College of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Tianhui Chen
- Department of Cancer Prevention/Experimental Research Center, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Chi Chiu Wang
- Department of Obstetrics & Gyneacology, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ping Chung Leung
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Qiuhua Sun
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaohui Fan
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China.,Innovation Center in Zhejiang University, State Key Laboratory of Component-Based Chinese Medicine, Hangzhou, China
| |
Collapse
|
2
|
Oh B, Eade T, Kneebone A, Hruby G, Lamoury G, Pavlakis N, Clarke S, Zaslawski C, Marr I, Costa D, Back M. Acupuncture in Oncology: The Effectiveness of Acupuncture May Not Depend on Needle Retention Duration. Integr Cancer Ther 2017; 17:458-466. [PMID: 29094616 PMCID: PMC6041915 DOI: 10.1177/1534735417734912] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background. Guidelines surrounding optimum needle retention duration in acupuncture have not been established, despite a growing evidence base for acupuncture over recent decades. This retrospective study explored the effect of varying acupuncture needle retention durations in cancer patients. Method. Patients received either 2 (n = 35), 10 (n = 53), or 20 minutes (n = 54) of acupuncture once a week for 6 weeks. Outcomes of anxiety and depression, stress, fatigue, and quality of life (QOL), with the Hospital Anxiety and Depression Scale, Perceived Stress Scale, Functional Assessment of Cancer Therapy–Fatigue, and European Organization for Research and Treatment of Cancer Quality of Life, were measured at baseline and at 6 weeks following the intervention. Results. The mean age of participants was 58 years (n = 152). The majority were female, diagnosed with breast cancer. Depression, stress, fatigue, and QOL were significantly improved in all 3 groups at 6 weeks postintervention. No significant differences in all outcomes were found between the 3 groups (≤2 vs 10 minutes vs 20 minutes). There were no differences with the satisfaction of the acupuncture services and perceived efficacy of acupuncture among the 3 groups. More than 95% of participants indicated that they would recommend acupuncture to other cancer patients, friends, and their family members. Conclusion. The efficacy of acupuncture may not only depend on needle retention duration, but may also be associated with multiple factors. Considering the limitations of this study design, robust randomized controlled studies are warranted to confirm the findings.
Collapse
Affiliation(s)
- Byeongsang Oh
- 1 Sydney Medical School, NSW, Australia.,2 University of Technology, Sydney, NSW, Australia
| | | | | | | | | | | | | | | | | | - Daniel Costa
- 3 University of Sydney Royal North Shore Hospital, NSW, Australia
| | | |
Collapse
|
3
|
Porter D, Cochrane S, Zhu X. Current Usage of Traditional Chinese Medicine for Breast Cancer-A Narrative Approach to the Experiences of Women with Breast Cancer in Australia-A Pilot Study. MEDICINES 2017; 4:medicines4020020. [PMID: 28930235 PMCID: PMC5590056 DOI: 10.3390/medicines4020020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 04/10/2017] [Accepted: 04/10/2017] [Indexed: 01/06/2023]
Abstract
Background: The use of Traditional Chinese Medicine (TCM) by breast cancer patients is growing. Few studies have examined the complexity of breast cancer survivors' attitudes, lived experiences, barriers, and perceptions in using TCM as part of their treatment journey. This article examines breast cancer survivors' experiences, perceptions of, and benefits (or not) in using TCM. Methods: Qualitative research, using semi-structured interviews, was the chosen methodology. Results: Participants used TCM as a form of self-help and as a complement, not an alternative, to standard care. Overall, 100% of the participants used acupuncture, 62% used Chinese herbal medicine, 23% used Qigong, and 23% used Chinese dietary therapy. Participants reported perceived outcomes and health benefits from TCM usage ranging from increased coping mechanisms, relieving stress and side-effects of standard treatment, the desire to be pro-active in the treatment journey, and to have a locus of control. Some cited the need to have "time-out" and the therapeutic relationship with the practitioner as being important. Conclusion: There is a clear need to understand breast cancer survivors' needs for physical and psychological support as they aim to regain control over their life through their experience of illness. More studies are needed to measure and evaluate these outcomes and to help identify breast cancer survivors' healthcare seeking behaviours, during and after the acute treatment stage that addresses their physical, emotional, and spiritual needs. These results aim to inform future research design and evaluate and develop support services that are patient-centred and focus on whole health outcomes, shared decision-making, and quality of life.
Collapse
Affiliation(s)
- Dianna Porter
- National Institute of Complementary Medicine, Western Sydney University, Penrith 2751, Australia.
| | - Suzanne Cochrane
- National Institute of Complementary Medicine, Western Sydney University, Penrith 2751, Australia.
| | - Xiaoshu Zhu
- School of Science and Health, Western Sydney University, Penrith 2751, Australia.
| |
Collapse
|
4
|
Oh B, Eade T, Kneebone A, Pavlakis N, Clarke S, Eslick G, River J, Back M. Factors Affecting Whether Or Not Cancer Patients Consider Using Acupuncture. Acupunct Med 2017; 35:107-113. [DOI: 10.1136/acupmed-2016-011115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2016] [Indexed: 11/04/2022]
Abstract
Objective To explore the factors associated with utilisation of an acupuncture service in a tertiary oncology setting in an Australian public hospital. Method Cancer patients attending oncology clinics at a university teaching hospital were invited to participate in the evaluation of acupuncture services from June 2014 to May 2015. Patients had a prior diagnosis of cancer (albeit at different stages) and were planning to receive, or were already receiving, systemic and/or radiation cancer treatment. Results The majority (81%) of participants indicated that they would consider the use of acupuncture during their cancer treatment. The most common reasons given for not considering acupuncture included adequate control of symptoms already with medical treatment, inconvenient clinic timing, and needle phobia. The main reasons given for considering acupuncture use included its perceived capability of reducing fatigue, boosting energy levels, improving immune function, and reducing pain and anxiety. Patients considering acupuncture use also demonstrated significantly higher levels of stress (p<0.001), anxiety and depression (p<0.001), fatigue (p<0.001), and lower global quality of life (p<0.01) compared to those who were not considering acupuncture. Conclusions The findings show that demand for acupuncture by cancer patients is high. A substantial proportion of cancer patients intend to use acupuncture to manage cancer and/or cancer treatment-related symptoms. Discussion with patients about acupuncture and other complementary therapies during the consultation may improve cancer care.
Collapse
Affiliation(s)
- Byeongsang Oh
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas Eade
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew Kneebone
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Nick Pavlakis
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Clarke
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Guy Eslick
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Jo River
- Sydney Nursing School, University of Sydney, Camperdown, New South Wales, Australia
| | - Michael Back
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
5
|
McPherson L, Cochrane S, Zhu X. Current Usage of Traditional Chinese Medicine in the Management of Breast Cancer: A Practitioner's Perspective. Integr Cancer Ther 2015; 15:335-42. [PMID: 26420777 PMCID: PMC5739178 DOI: 10.1177/1534735415607656] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction. This qualitative study seeks to explore the role within the context of Australian breast cancer oncology treatments that traditional Chinese medicine (TCM) practitioners play in the treatment of breast cancer. Methods. Semistructured interviews were used on 2 groups: the first group was TCM practitioners who were recognized experts in breast cancer, and the second group consisted of TCM practitioners who treated breast cancer as part of their practice but were not recognized experts. Data analysis was achieved through grounded theory with open coding. Results. The main themes reported on here are the following: the role of TCM in the biomedical management of breast cancer, TCM strategies for the management of breast cancer, and the perceived holistic approach of the TCM practitioner and the importance of a TCM diagnosis in the role of breast cancer care. Discussion. The role of TCM in biomedical breast cancer management is a supportive one; however, this role is difficult as there is a lack of understanding of TCM by biomedical practitioners. The viewpoints of practitioners differed on key strategies of TCM: diagnosis, and treatment protocols. Patients sought the holistic approach of TCM practitioners as they felt it addressed all aspects of their health and not just the symptoms relating to breast cancer. Conclusion. The lack of an integrated medicine approach in relation to TCM makes it difficult to demonstrate the value of the contribution TCM can make to biomedicine in the field of breast care oncology. Effectiveness studies are needed that can accurately represent TCM in this field.
Collapse
Affiliation(s)
- Luke McPherson
- University of Western Sydney, Macarthur, New South Wales, Australia
| | - Suzanne Cochrane
- University of Western Sydney, Macarthur, New South Wales, Australia
| | - Xiaoshu Zhu
- University of Western Sydney, Macarthur, New South Wales, Australia
| |
Collapse
|
6
|
Oh B, Kimble B, Costa DSJ, Davis E, McLean A, Orme K, Beith J. Acupuncture for treatment of arthralgia secondary to aromatase inhibitor therapy in women with early breast cancer: pilot study. Acupunct Med 2013; 31:264-71. [PMID: 23722951 DOI: 10.1136/acupmed-2012-010309] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Aromatase inhibitors (AIs) are recommended as adjuvant hormone treatment for postmenopausal women with early breast cancer. A substantial proportion of women taking AIs experience joint pain and stiffness. Studies have suggested that acupuncture may be effective in treating joint pain. OBJECTIVE A pilot study was conducted to evaluate the feasibility, safety and efficacy of using acupuncture to treat AI-induced arthralgia. METHODS A total of 32 patients were randomised to receive either sham or real electroacupuncture (EA) twice weekly for 6 weeks. Outcomes of joint pain, stiffness and physical function were measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), overall pain severity and interference with the BPI-SF and quality of life (QOL) with the Functional Assessment of Cancer Therapy-General (FACT-G) instrument. Hand strength was assessed by a grip test, and a serum marker of inflammation (C reactive protein (CRP)) was also measured. All assessments were performed at baseline, 6 weeks and 12 weeks, except for blood samples at baseline and 6 weeks only. RESULTS No serious adverse events were reported during or after acupuncture treatments. There were no significant differences in outcome measures. However, positive trends were observed in stiffness and physical function at week 12 in favour of real EA. CONCLUSIONS Findings suggest that acupuncture is feasible and safe in patients with breast cancer with joint pain caused by AI. A larger study with adequately powered to confirm these results and detect clinically relevant effects is needed.
Collapse
Affiliation(s)
- B Oh
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | | | | | | | | | | | | |
Collapse
|