Effects of Integrated Chinese Traditional Medicine and Conventional Western Medicine on the Quality of Life of Breast Cancer Patients: A Systematic Review and Meta-Analysis

Effect of Huaier granule on prognosis of breast cancer: A single-center propensity score matching retrospective study

BACKGROUND

Huaier granule is an important medicinal fungus extract widely used in cancer treatment. Previous retrospective studies have reported its effectiveness in breast cancer patients, but the imbalanced baseline characteristics of participants could have biased the results. Therefore, this retrospective study aimed to examine the efficacy of Huaier granule on the prognosis of breast cancer patients.

METHODS

In this single-center cohort study, breast cancer patients diagnosed and treated at the Guangdong Provincial Hospital of Chinese Medicine between 2009 and 2017 were selected. The data were retrospectively analyzed and divided into two groups according to whether the patients received Huaier granules. The propensity score matching (PSM) method was used to eliminate selection bias. The disease-free survival (DFS) and overall survival (OS) for these groups were compared using the Kaplan-Meier method and the Cox regression.

RESULTS

This study included 214 early invasive breast cancer patients, 107 in the Huaier group and 107 in the control group. In the Kaplan-Meier analysis, the 2-year and 5-year DFS rates were significantly different in the Huaier group and control group (hazard ratio [HR], 0.495; 95% confidence interval [CI], 0.257-0.953; P = 0.023). The 2-year and 5-year OS rates were also significantly different (HR, 0.308; 95% CI, 0.148-0.644; P = 0.001). On multivariable Cox regression, Huaier granule was associated with improved DFS (HR, 0.440; 95% CI, 0.223-0.868; P = 0.018) and OS (HR, 0.236; 95% CI, 0.103-0.540; P = 0.001).

CONCLUSION

In this retrospective study, Huaier granules improved the DFS and OS of early invasive breast cancer patients, providing real-world evidence for further prospective studies on treating breast cancer with Huaier granules.

Quality of life and survival analyses of breast cancer cases treated with integrated traditional Chinese and Western medicine

BACKGROUND

Breast cancer (BC) is the second leading cause of tumor-related mortality after lung cancer. Chemotherapy resistance remains a major challenge to progress in BC treatment, warranting further exploration of feasible and effective alternative therapies.

AIM

To analyzed the quality of life (QoL) and survival of patients with BC treated with integrated traditional Chinese and Western medicine (TCM-WM).

METHODS

This study included 226 patients with BC admitted to the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine between February 2018 and February 2023, including 100 who received conventional Western medicine treatment (control group) and 126 who received TCM-WM treatment (research group). The total effective rate, side effects (alopecia, nausea and vomiting, hepatorenal toxicity, and myelosuppression), QoL assessed using the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30), 1-year overall survival (OS), recurrence and metastasis rates, and serum inflammatory factors [interleukin (IL)-6, IL-10, and tumor necrosis factor alpha] were comparatively analyzed.

RESULTS

The research group showed statistically better overall efficacy, EORTC QoL-C30 scores, and 1-year OS than the control group, with markedly lower side effects and 1-year recurrence and metastasis rates. Moreover, the posttreatment levels of serum inflammatory in the research group were significantly lower than the baseline and those in the control group.

CONCLUSION

Overall, TCM-WM demonstrated significantly improved therapeutic efficacy while ensuring drug safety in BC, which not only improved patients' QoL and prolonged survival, but also significantly inhibited the inflammatory response.

Effect of Low-Frequency Pulsed Electrotherapy Combined with Acupoint Nursing on Postpartum Urinary Retention in Patients with Vaginal Delivery

INTRODUCTION AND HYPOTHESIS

This study was carried out to investigate the effect of low-frequency pulsed electrotherapy combined with acupoint massage on postpartum urinary retention (PUR).

METHODS

The patients were divided into control group, intervention group 1, and intervention group 2 according to the nursing method. The control group received conventional postpartum care, intervention group 1 received conventional postpartum care and low frequency pulsed electrotherapy, and intervention group 2 received conventional postpartum care, low-frequency pulsed electrotherapy, and Shuidao point massage. The bladder function, comfort score, and quality of life score before and after intervention were compared among the three groups.

RESULTS

The bladder function, comfort level, and quality of life of intervention group 1 and intervention group 2 after nursing were significantly better than those of the control group. In addition, intervention group 2 had better bladder function than intervention group 1, with lower residual urine volume and higher bladder compliance. In the Kolcaba score, the mental dimension of intervention group 2 was significantly higher than that of intervention group 1. In terms of QOL scores, the social function, physical function, and state of material life scores of intervention group 2 were significantly higher than those of intervention group 1.

CONCLUSIONS

Low-frequency pulsed electrotherapy combined with acupoint massage can significantly improve the bladder function, comfort, and quality of life of patients with PUR.

Modulatory Effects of XIAOPI Formula on CXCL1 and Selected Outcomes in Triple-Negative Breast Cancer: A Randomized Controlled Clinical Trial

Background

Triple-negative breast cancer (TNBC) is the most aggressive malignancy. Psychological distress and elevated CXCL1 level have been reported to be closely associated with the poor prognosis and quality of life of patients with TNBC. In preclinical studies using xenograft mouse models, XIAOPI formula, a nationally approved drug prescribed to patients at high risk for breast cancer, inhibited CXCL1 expression and improved survival. Traditional Chinese medicine has unique advantages in improving patients' emotional disorders and quality of life. However, the impact of XIAOPI formula on the serum level of CXCL1, psychological distress, and quality of life among patients with TNBC is currently unknown.

Methods

In this study, we designed a randomized, double-blind, placebo-controlled trial. Patients with TNBC were randomly assigned to receive either the XIAOPI formula or a placebo for three months. The primary outcomes include serum CXCL1 expression, Self-Rating Anxiety Scale (SAS), and the Self-Rating Depression Scale (SDS). Secondary outcomes included the Pittsburgh Sleep Quality Index (PSQI) and the Functional Assessment of Cancer Therapy-Breast (FACT-B).

Results

A total of 60 patients with TNBC were enrolled in the investigation. The results showed that the XIAOPI formula significantly decreased CXCL1 expression compared with the control group. Moreover, in comparison to the placebo, the XIAOPI formula increased FACT-B scores while decreasing SDS, SAS, and PSQI scores.

Conclusion

In patients with TNBC, XIAOPI formula may be effective in reducing CXCL1 levels, enhancing psychological well-being, and quality of life. While our research offers a natural alternative therapy that may enhance the prognosis of TNBC, future validation of its therapeutic effects will require large-scale, long-term clinical trials.

Clinical Registration Number

Registration website: www.chictr.org.cn, Registration date: 2018-1-19, Registration number: ChiCTR1800014535.

Immunoregulatory and Anti-cancer Activities of Combination Treatment of Novel Four-Herb Formula and Doxorubicin in 4T1-Breast Cancer Bearing Mice

OBJECTIVE

To investigate the in vivo immunomodulatory and anti-tumor mechanisms of the combined treatment of novel Four-Herb formula (4HF) and doxorubicin in triple-negative breast cancer (TNBC).

METHODS

Murine-derived triple-negative mammary carcinoma cell line, 4T1 cells, was cultured and inoculated into mouse mammary glands. Sixty-six mice were randomly assigned into 6 groups (n=11 in ench): naïve, control, LD 4HF (low dose 4HF), HD 4HF (high dose 4HF), LD 4HF + D (low dose and doxorubicin), and D (doxorubicin). Apart from the naïve group, each mouse received subcutaneous inoculation with 5 × 105 4T1 cells resuspended in 100 µL of normal saline in the mammary fat pads. Starting from the day of tumor cell inoculation, tumors were grown for 6 days. The LD and HD groups received daily oral gavage of 658 and 2,630 mg/kg 4HF, respectively. The LD 4HF+D group received daily oral gavage of 658 mg/kg 4HF and weekly intraperitoneal injection of doxorubicin (5 mg/kg). The D group received weekly intraperitoneal injections of doxorubicin (5 mg/kg). The treatment naïve mice received daily oral gavage of 0.2 mL double distilled water and 0.1 mL normal saline via intraperitoneal injection once a week. The control group received daily oral gavage of 0.2 mL double-distilled water. The treatment period was 30 days. At the end of treatment, mice organs were harvested to analyze immunological activities via immunophenotyping, gene and multiplex analysis, histological staining, and gut microbiota analysis.

RESULTS

Mice treated with the combination of 4HF and doxorubicin resulted in significantly reduced tumor and spleen burdens (P<0.05), altered the hypoxia and overall immune lymphocyte landscape, and manipulated gut microbiota to favor the anti-tumor immunological activities. Moreover, immunosuppressive genes, cytokines, and chemokines such as C-C motif chemokine 2 and interleukin-10 of tumors were significantly downregulated (P<0.05). 4HF-doxorubicin combination treatment demonstrated synergetic activities and was most effective in activating the anti-tumor immune response (P<0.05).

CONCLUSION

The above results provide evidence for evaluating the immune regulating mechanisms of 4HF in breast cancer and support its clinical significance in its potential as an adjunctive therapeutic agent or immune supplement.

Integrating artificial intelligence into the modernization of traditional Chinese medicine industry: a review

Traditional Chinese medicine (TCM) is the practical experience and summary of the Chinese nation for thousands of years. It shows great potential in treating various chronic diseases, complex diseases and major infectious diseases, and has gradually attracted the attention of people all over the world. However, due to the complexity of prescription and action mechanism of TCM, the development of TCM industry is still in a relatively conservative stage. With the rise of artificial intelligence technology in various fields, many scholars began to apply artificial intelligence technology to traditional Chinese medicine industry and made remarkable progress. This paper comprehensively summarizes the important role of artificial intelligence in the development of traditional Chinese medicine industry from various aspects, including new drug discovery, data mining, quality standardization and industry technology of traditional Chinese medicine. The limitations of artificial intelligence in these applications are also emphasized, including the lack of pharmacological research, database quality problems and the challenges brought by human-computer interaction. Nevertheless, the development of artificial intelligence has brought new opportunities and innovations to the modernization of traditional Chinese medicine. Integrating artificial intelligence technology into the comprehensive application of Chinese medicine industry is expected to overcome the major problems faced by traditional Chinese medicine industry and further promote the modernization of the whole traditional Chinese medicine industry.

The Potential Mechanism of Liujunzi Decoction in the Treatment of Breast Cancer based on Network Pharmacology and Molecular Docking Technology

BACKGROUND

Liujunzi Decoction (LJZD) is a potential clinical treatment for Breast Cancer (BC), but the active ingredients and mechanisms underlying its effectiveness remain unclear.

OBJECTIVE

The study aimed to investigate the target gene of LJZD compatibility and the possible mechanism of action in the treatment of breast cancer by using network pharmacology and molecular docking.

METHODS

Based on TCMSP, ETCM, and BATMAN database searching and screening to obtain the ingredients of LJZD, the related targets were obtained. Breast cancer-related targets were collected through GEO, Geencards, OMIM, and other databases, and drug-disease Venn diagrams were drawn by R. The PPI network map was constructed by using Cytoscape. The intersecting targets were imported into the STRING database, and the core targets were analyzed and screened. The intersected targets were analyzed by the DAVID database for GO and KEGG enrichment. AutoDock Vina and Gromacs were used for molecular docking and simulation of the core targets and active ingredients.

RESULTS

126 active ingredients of LJZD were obtained; 241 targets related to breast cancer were sought after screening, and 180 intersection targets were identified through Venn diagram analysis. The core targets were FOS and ESR1. KEGG enrichment analysis mainly involved PI3K/Akt, MAPK, and other signaling pathways.

CONCLUSION

This study has explored the possible targets and signaling pathways of LJZD in treating breast cancer through network pharmacology and bioinformatics analysis. Molecular docking and simulation have further validated the potential mechanism of action of LJZD in breast cancer treatment, providing essential experimental data for future studies.

The Effects of Complementary Therapies on Patient-Reported Outcomes: An Overview of Recent Systematic Reviews in Oncology

Many patients with cancer make use of complementary medicine alongside conventional medicine, but clinicians in oncology often lack the knowledge to adequately advise patients on the evidence base for complementary therapies. This study aims to provide an overview of recently published systematic reviews that assess the effects of complementary therapies on patient-reported health outcomes in patients with cancer. Systematic reviews, including a meta-analysis of at least two randomized controlled trials, were identified from the PubMed, Embase, Cochrane Library, CINAHL and PsycINFO databases. The methodological quality was assessed with AMSTAR 2. One hundred systematic reviews were included. The results suggest that several complementary therapies can improve health outcomes reported by patients with cancer, such as acupuncture to relieve pain, music interventions to reduce anxiety and yoga to improve cancer-related fatigue. The side effects related to complementary therapy use are generally mild. The results remain inconclusive for some intervention-outcome combinations. Many of the included systematic reviews insufficiently assessed the causes and impact of bias in their interpretation of the results. This overview of systematic reviews can support clinicians in counselling their patients on this topic and provide directions for future research and clinical practice guidelines in the field of complementary medicine.

The intention of utilization and experience toward traditional Chinese medicine among breast cancer patients in the early and late stages: a qualitative study

BACKGROUND

In Taiwan, breast cancer patients usually take conventional medicine and traditional Chinese medicine simultaneously. The utilization of traditional Chinese medicine among breast cancer patients at various stages has not been examined. This study aims to compare the intention of utilization and experience toward traditional Chinese medicine among early- and late-stage breast cancer patients.

METHOD

This qualitative research collected data from breast cancer patients through focus groups interview by convenience sampling. Conducted in 2 branches of Taipei City Hospital, a public hospital managed by the Taipei City government. Breast cancer patients > 20 years old and had used TCM for breast cancer therapy for at least 3 months were included in the interview. A semi-structured interview guide was adopted in each focus group interview. In the following data analysis, stages I and II were considered early-stage, and stages III and IV were late-stage. For analyzing the data and reporting the results, we used qualitative content analysis as the approach for data analysis, assisted by NVivo 12. Categories and subcategories were identified through content analysis.

RESULTS

Twelve and seven early- and late-stage breast cancer patients were included in this study, respectively. The side effects were the main intention of utilizing traditional Chinese medicine. Improving side effects and constitution was the main benefit for patients in both stages. Additionally, early-stage breast cancer patients used traditional Chinese medicine to prevent recurrence or metastasis. Late-stage breast cancer patients responded more frequently to the use of traditional Chinese medicine due to the side effects of western medicine. However, some of their symptoms were not fully relieved.

CONCLUSIONS

Breast cancer staging may influence the intention and utilization of traditional Chinese medicine. Health policymakers should consider the results of this research and the evidence-based illustrations to establish guidelines for integrating traditional Chinese medicine among various stages of breast cancer to improve the outcome and quality of care for cancer patients.

Integrating Acupuncture into a Dialysis Center

A growing interest in integrating traditional Chinese medicine (TCM) and conventional medicine (CM) to create a more comprehensive approach to healthcare has been verified. Scientific evidence supports acupuncture as an integrative treatment for specific health conditions. The aim of this study was to assess the acceptance and feasibility by patients and healthcare professionals of integrating acupuncture in a dialysis center. Individuals undergoing hemodialysis (HD) who participated in a patient-assessor-blinded randomized controlled trial that evaluated the effect of acupuncture on functional capacity and quality of life were included. Acceptance was measured by adherence (percentage of patients who completed treatments and dropouts) and patients' and healthcare professionals' opinions toward acupuncture (pre- and pro-intervention questionnaires). Feasibility was measured by safety (number of reported adverse events) and effectiveness (changes in functional capacity, peripheral muscle strength, and health-related quality of life scores after treatment). Forty-eight patients were included, and forty-five (93.8%) were analyzed. No adverse events were reported. All patients completed the treatment, and only three patients (6.2%) were lost to the 12-week post-treatment follow-up. The attitudes of patients and health professionals were favorable to acupuncture, namely in relation to its use, degree of discomfort, recommendation to others, and interference with routine care and clinical setting. Integrating acupuncture into a dialysis center seems viable and well-accepted by patients with kidney failure on maintenance HD, doctors and nurses.

Comparison of Quality of Life Between Breast Cancer Patients Treated With and Without Adjunctive Traditional Chinese Medicine in Taiwan

In Taiwan, breast cancer has the highest incidence among all cancers. Although adjunctive traditional Chinese medicine treatment (TCM) have been used to ameliorate the side effects or discomfort caused by cancer treatments, no study has focused on the assessment of the quality of life of patients undergoing adjunctive TCM treatments. This study compared the quality of life between breast cancer patients treated with and without adjunctive TCM. Questionnaires were collected from 7 hospitals with a Chinese medicine clinic in 2018 to 2019. Breast cancer patients who had cancer stages I, II, or III and also underwent resection surgery were included in the study. They were divided into 2 groups: patients receiving cancer treatments with adjunctive traditional Chinese medicine (TCM group) and those receiving cancer treatments without adjunctive traditional Chinese medicine (non-TCM group). A 1:1 matching was used to obtain the study participants. The EQ-5D questionnaire was used to assess the quality of life. Statistical analysis was performed using the t-test and ANOVA to compare the differences between variables. The conditional multiple regression model was applied to explore the factors associated with quality of life in breast cancer patients. A total of 543 participants were surveyed, and 450 participants were included in the study. The EQ-5D score of the TCM group (81.60 ± 11.67) was significantly higher than that of the non-TCM group (78.80 ± 13.10; P < .05). The results of a conditional multiple regression model showed that the TCM group had a higher (3.45 points) quality of life than non-TCM group (P = .002) after adjusting for other related factors. After stratifying by cancer stage, patients with cancer stages II and III scored 5.58 and 4.35 points higher in the TCM group than did those in the non-TCM group (P < .05). Breast cancer patients undergoing cancer treatment with adjunctive traditional Chinese medicine have a higher quality of life than those treated without adjunctive traditional Chinese medicine.

The Effectiveness of Personalized Nursing on Quality of Life in Cardiovascular Disease Patients: A Systematic Review and Meta-analysis

Aims

This study aimed to examine the potential effectiveness of personalized nursing interventions on improving the heart-related quality of life of patients with CVDs versus an usual care.

Design

A systematic review and meta-analysis. Data Sources. The study researched the article between January 2011 and December 2021 from four electronic databases: PubMed, Embase, Cochrane library, and Web of Science. Review Methods. Randomized controlled trials (RCTs) related to personalized nursing in CVDs population were included. The main variables were analyzed by standardized mean differences with 95% confidence intervals and heterogeneity was used by the I ² test and P value.

Results

Of 734 studies, fourteen articles were eligible for this study. Personalized nursing significantly improved the quality of life [SMD = 0.39, 95% CI (0.29, 0.49)] with obvious heterogeneity (P = 0.000, I ² = 66.1%) which needs to be further subgroup analyzed. The nurse-led intervention was considered the main-related effect to influence the heterogeneity with value of 0.39 (I2 = 66.1%, P = 0.000; Group 1: I2 = 48.4%, P = 0.071, and Group 2: I2 = 0.0%,. In addition, related results of athletic ability and mental health and follow-up and education in the intervention had higher level of quality of life compared to the control group [SMD = 0.27, 95% CI (0.10, 0.44); SMD = 0.21, 95% CI (0.04, 0.37); SMD = 0.39, 95% CI (0.29, 0.49) and SMD = 0.28, 95% CI (0.11, 0.44)].

Conclusion

Effectiveness studies of personalized care focus on more relevant outcomes have higher health outcomes, whereas evidence of the effectiveness of personalized nursing approach is still limited. Therefore, more and more high-quality RCT are needed.

Chinese Medicine Enhancing Response Rates to Immunosuppressant PD-L1 Inhibitor and Improving the Quality of Life of Hepatocellular Carcinoma-Bearing Mice

Background

Malignant tumors are a significant disease endangering human health. Chinese Medicine (CM) plays an important role in comprehensive and holistic tumor treatment.

Objectives

We aimed to investigate whether CM combined with the immunosuppressant PD-1/PD-L1 inhibitor has a good synergistic effect and can significantly improve response rates for the immunosuppressant.

Methods

We combined CM with immunosuppressant in treating six-week-old hepatocellular carcinoma-bearing mice and compared the outcomes of groups undergoing different interventions: blank group, control group, CM group, PD-L1 inhibitor group, and CM + PD-L1 inhibitor group, with ten mice in each group. The quality of life was evaluated along with the tumor inhibition effects and growth rates.

Results

CM significantly reduced tumor load and improved the quality of life of cancer-bearing mice. The survival rate was 81.8% in the control group, 100% in the CM group, 90.9% in the PD-L1 inhibitor group, and 100% in the combined group in the first week. The survival rate was 45.5% in the control group, 54.5% in the CM group, 81.8% in the PD-L1 inhibitor group, and 81.8% in the combined group in the second week. 38% mice in the CM+PD-L1 inhibitor group with smaller tumor size than the average of the control group, which was much higher than other treatment groups. CM also reduced the expression of JAK2 mRNA and STAT3 mRNA, although not significantly (P > 0.05), and reduced PD-L1 mRNA in tumor tissue compared to the control group (P < 0.05).

Conclusions

CM had a synergistic effect on PD-L1 inhibitors and increased response rates to PD-L1 inhibitor treatment.

Ethnobotany of traditional medicinal plants and associated indigenous knowledge in Dawuro Zone of Southwestern Ethiopia

BACKGROUND

The study aimed at documenting the indigenous and local knowledge and use of traditional medicinal plants for treating human and livestock ailments in Dawuro Zone of Ethiopia.

METHODS

A survey was conducted among traditional healers and native administrators through discussion, interviews, and field observations. The snowball sampling technique was used to select 384 traditional healers in purposefully selected 50 villages spanning seven districts for face-to-face individual interviews. The chi-square test was applied to establish associations between traditional healers' demographics, the distance between the village site and the nearest natural forest and a health center, and SPSS V.20 software was used for the analysis.

RESULTS

The traditional healers of the study area reported the use of 274 traditional medicinal plant species belonging to 217 genera and 82 families. Asteraceae (11.68%), Fabaceae (9.49%), and Lamiaceae (9.12%) were the foremost frequently used families. Herb species (54.8%) and leaves (65%) were predominantly sourced from the wild environment. The quantity of medicinal plants used (x² = 278.368, df = 20, P = 0.000) and years of (experience in) traditional healing using herbs (x² = 76.358, df = 10, P = 0.000) varied with distance from the natural forests. The service charge for healing had strong positive association (x² = 24.349, df = 5, P = 0.000) with healer's age (x² = 309.119, df = 184, P = 0.000) and educational level (x² = 851.230, df = 598, P = 0.000) with distance of traditional healer's residence from the medical institution. The agricultural activities, urbanization, low or no charge for the healing service, the secrecy and oral transfer of the knowledge, and the demand for medicinal and other multiple purposes species were some of the factors threatening the resource and the associated knowledge as well as the service in the study area.

CONCLUSION

There are diversified traditional medicinal plants applied for healthcare of the community and domestic animals of the study area. The source of remedies mostly depends on herbs of natural forests, and the leaf was the most frequently used plant part. Developing conservation intervention and sustainable systems of utilization is needed for multipurpose medicinal plants. Finally, integrating with modern system and formalizing, legalizing, and capacitating the traditional medicine practitioners are needed for access of primary healthcare systems to rural communities.