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JKM > Volume 38(1); 2017 > Article
Lee, Bae, and Yoo: The Effect of Traditional Oriental Herbal Medicine for Anorexia in Cancer Patients: A Systematic Review

Abstract

Objectives

Traditional oriental herbal medicine is used in cancer care to alleviate symptoms. Anorexia is a symptom which is frequently observed in patients with cancer and impairs their quality of life. The objective of this systematic review is to summarize current available evidence to evaluate the effect of traditional oriental herbal medicine on anorexia in cancer patients.

Methods

The review evaluated randomized controlled trials (RCTs) measuring the effect of any types of herbal medicine on anorexia in cancer patients within 4 electronic databases and manual search up to December 2015. The Cochrane risk of bias tool (ROB) was used to assess the quality of RCTs.

Results

In total, 11 RCTs met the inclusion criteria. All of the studies reported the rate or severity of anorexia improved after treatment in herbal-conventional medicine combined group compared to conventional medicine group. 7 of 11 studies showed between-group statistical differences. The methodological quality of RCTs was insufficient with unclear and high ROB.

Conclusions

Traditional oriental herbal medicine may have a potential to improve anorexia in patients with cancer. To confirm the clinical recommendation, further researches with rigorous study design are required to support the effects of herbal medicine.

Fig. 1
Flow chart of the study selection process for the systematic review.
Four electronic databases were searched for the randomized controlled trials evaluating the effects of herbal medicine on anorexia in patients with cancer. At first, 204 citations were retrieved from the databases and additional 2 citations were found from manual search. After excluding duplicates, screening titles and abstracts, the full-texts of 20 articles were examined to identify whether or not to meet inclusion criteria. At last, 11 randomized controlled trials were included in the systematic review.
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Table 1
The characteristics of the randomized controlled trials included in the systematic review.
First author and year of publication Study design Patients Sample size (T; C) Dropout rate Duration of treatment Route of administration Treatment group Control group Observation indexes Results
Herbal medicine Conventional medicine
Chen, 201319) 2-arm RCT Malignant tumor :15 liver cancer, 17 lung cancer, 12 gastric cancer, 12 nasopharyngeal cancer, 15 colorectal cancer, 15 breast cancer, 9 esophageal cancer Total N=94 (47; 47)
N/R
42 days(2 cycles of chemotherapy) I.V Shenqi Fuzheng injection(蔘芪扶正注射液)250ml Chemotherapy liver cancer: CAF lung cancer: MFP or CAO gastric cancer: FAM nasopharyngeal cancer: CDF or BPF colorectal cancer: 5Fu-CF or CAF breast cancer: CMF or BPF esophageal cancer: PF Chemotherapy liver cancer: CAF lung cancer: MFP or CAO gastric cancer: FAM nasopharyngeal cancer: CDF or BPF colorectal cancer: 5Fu-CF or CAF breast cancer: CMF or BPF esophageal cancer: PF AE: Guidelines of Diagnosis and Treatment for Common Cancers in China compiled by the ministry of health of the People’s Republic of China After treatment:
  1. The rates of anorexia: T < C (P<0.05)

Mao, 201320) 2-arm RCT Malignant tumor(type of cancer was not reported) Total N=63 (31; 32)
0%(0%; 0%)
21 days External external use of herbs (中藥敷臍) 2g Chemotherapy Tropisetron 5mg and dexamethasone 5mg combined with chemotherapy Symptom :4-point gradingscale suggested by researchers After treatment:
  1. The severity of anorexia: T < C (P<0.01)

  2. The rates of anorexia: T < C (P<0.01)

Zhuang,201221) 2-arm RCT Breast cancer Total N=58 (31; 27)
12.1%(6.1%;18.2%)
6 weeks Oral RG-CMH capsules 9 capsules/day Chemotherapy and/or radiotherapy Placebo capsules combined with chemotherapy and/or radiotherapy AE: NCI-CTCAEv3.0 After treatment:
  1. The rates of anorexia: N/S

Yao, 201222) 2-arm RCT Non-small cell lung cancer Total N=118 (57; 61)
15.7%(N/R; N/R)
3+56 days (56 days = 2 cycles of chemotherapy) Oral Feiji Decoction soothing the liver (疏肝肺積方) Psychotherapy combined with chemotherapy(NP or GP) Chemotherapy (NP or GP) QOL: EORTC QLQ-C30 After treatment:
  1. The severity of anorexia after treatment: T < C (P<0.001)

  2. T: anorexia improved(P<0.001).

    C: anorexia worsened (P<0.001).
Jiang, 201223) 2-arm RCT Hepatic metastasis Total N=62 (31; 31)
N/R
2 months I.V Coix Seed(薏苡仁)Extract 200ml TACE TACE AE: NCI-CTCAEv3.0 After treatment:
  1. The rates of anorexia: T < C (P=0.04)

Wang, 201224) 2-arm RCT Colorectal cancer Total N=40 (20; 20)
N/R
42 days (2 cycles of chemotherapy) Oral Tongtai Decoction (通泰合劑)200ml/day Chemotherapy(XELOX regimen) Chemotherapy(XELOX regimen) Symptom :4-pointgradingscalesuggestedbyClinicalguidelinesforclinicalresearch on new drug of Traditional Chinese Medicine After treatment:
  1. The improvement in anorexia: T > C (P>0.05)

Tian, 201025) 3-arm RCT Non-small cell lung cancer Total N=60 (20; 20; 20)
14.3%(There was error in reporting the drop out rate of each group)
2 months Oral T1: Feiji Recipe(肺積方) 250ml × 2 T2: T1 + chemotherapy(NP or GP) Chemotherapy (NP or GP) QOL: EORTC QLQ-C30 After treatment:
  1. The severity of anorexia after treatment: T1 < T2, C (P < 0.01).

  2. T1: anorexia improved(P<0.01).

    T2, C: anorexia worsened (P<0.01).
Liu, 201026) 2-arm RCT Primary liver cancer Total N=74 (38; 36)
N/R
56 days(2 cycles of chemotherapy) I.V Shenqi Fuzheng injection(蔘芪扶正注射液)250ml Chemotherapy (CAFI) Chemotherapy (CAFI) AE: WHO toxicity grade After treatment:
  1. The rates of anorexia: T < C (P<0.01)

Li, 200927) 2-arm RCT Advanced lung cancer Total N=69 (36; 33)
N/R
56 days(2 cycles of chemotherapy) I.V Shenqi Fuzheng injection(蔘芪扶正注射液)250ml Chemotherapy (NP) Chemotherapy (NP) AE: WHO toxicity grade After treatment:
  1. The rates of anorexia: T < C (P<0.05)

Fu, 200628) 2-arm RCT Advanced lung cancer Total N=64 (32; 32)
N/R
1 month Oral Qigekaiwei Decoction (自擬啓膈開胃湯) Megestrol acetate tablet 160mg/day Megestrol acetate tablet 160mg/day Symptom :5-point gradingscale suggested by Tchekmedyian40) After treatment:
  1. The improvement in anorexia: T > C (P>0.05)

Zhou, 200529) 3-arm RCT Non-small cell lung cancer Total N=294 (99; 103; 92)
9.3%(9.2%;5.5%;13.2%)
3 months Oral T1: HeChanPian (鹤蟾片)0.5g × 6/day+ ShenYi Capsule (蔘一胶囊)10mg × 4/day+ adding 4 types of herbal decoction according to TCM syndrome differentiation T2: T1 + Chemotherapy(NP or VP)
9 week (3 cycles of chemotherapy)
Chemotherapy (NP or VP)
9 week (3 cycles of chemotherapy)
Symptom :5-point gradingscale suggested by researchers After treatment:
  1. The improvement in anorexia: T1, T2 > C (P<0.05)

Abbreviations: AE: adverse event; BPF: bleomycin, cisplatin, 5-fluorouraci; BPM: bleomycin, cisplatin, mitomycin; C: control group; CAF: cyclophosphamide, adriamycin, 5-fluorouracil; CAFI: cyclophosphamide, adriamycin, 5-fluorouracil, interferon; CAO: cyclophosphamide, adriamycin, vincristine; CDF: cyclophosphamide, dacarbazine, 5-fluorouracil; CMF: cyclophosphamide, mitomycin, 5-fluorouracil; CTCAE: common terminology criteria for adverse events; EORTC QLQ-C30: european organization for research and treatment of cancerquality of life questionnaire; FAM: 5-fluorouracil, doxorubicin, mitomycin; GP: gemcitabine, cisplatin; I.V: intravenous injection; MFP: mitomycin, 5-fluorouracil, cisplatin; NCI-CTCAE: National Cancer Institute common terminology criteria for adverse events; NP: vinorelbine, cisplatin; N/R: not reported; N/S: no significant; PF: cisplatin, 5-fluorouraci; QOL: quality of life; RCT: randomized controlled trial; T: treatment group; TACE: transcatheter arterial chemoembolization; TCM: traditional chinese medicine; VP: vindesine, cisplatin; WHO: World Health Organization; XELOX: capecitabine, oxaliplatin

Table 2
Compositions, dosages of Traditional Oriental Herbal Medicine included in the systematic review.
First author and year of publication Traditional Orieantal Herbal Medicine Compositions, Dosages
Chen, 201319) Shenqi Fuzheng Injection (蔘芪扶正注射液) 250ml Codonopsis pilosula (Franch.) Nannf, Astragalus membranaceus (Fisch.) Bge
Dosages of the medicinal herbs were not reported.
Mao, 201320) External use of herbs (中藥敷臍) 2g Compositions and dosages of the medicinal herbs were not reported.
Zhuang, 201221) RG-CMH capsule A sinensis extract (64.5mg), C. pilosula extract (27.1mg), G. tsugae extract (3.0mg), rose geranium power(273.6mg), mazie starch (129.3mg), magnesium stearate (2.5mg).
Yao, 201222) Feiji Decoction soothing the liver(疏肝肺積方) Astragalus membranaceus(Fisch.) Bge (30g), Atractylodes macrocephalaKoidz (15g), Glehnia littoralisF.Schmidt ex Miq (15g), Selaginella doederleiniiHieron (30g), Paris polyphyllaSmith (24g), Oreorchis patens(Lindl.) Lindl (30g), Cornus officinalis Sieb. et Zucc (12g), Epimedium grandiflorum Morr (15g), Rosa rugosaThunb (9g), Akebia quinata (Thunb.) Decne(15g), Armeniaca mume Sieb. f. viridicalyx (Makino)T. Y. Chen (9g).
Jiang, 201223) Coix Seed(薏苡仁) Extract Coix Seed(薏苡仁) Extract 200ml.
Wang, 201224) Tongtai Decoction (通泰合劑) Astragalus mongholicus, Radix Astragli (300g), Hedyotis diffusa(Willd.) Roxb(300g), Spatholobus suberectus Dunn(300g), Coix lacryma-jobi L.var.mayuen(Roman.) Stapf(300g), Sinapis alba L.(100g), Patrinia heterophylla Bunge(150g), Curcuma zedoaria(Christm.) Rosc(150g), Atractylodes macrocephalaKoidz(150g), Agrimonia pilosa Ledeb(300g).
Tian, 201025) Feiji Recipe(肺積方) Astragalus mongholicus, Radix Astragli (30g), Radix Glehniae, Glehnia littoralis (15g), Liriope spicata, Tuber Ophiopogonis Japoninci (12g), Asparagus cochinchinensis, Tuber Asparagi Cochinchinensis (12g), Poria Cocos (Schw.) Wolf, Sclerotium Poriae Cocos (15g), Selaginella doederleinii (30g), Salvia chinensia Benth (30g), Houttuynia cordata Thunb, Herba cum radice houttuyniae ordatae(30g), Paris polyphylla, Houttuynia cordata Thunb (24g).
Liu, 201026) Shenqi Fuzheng Injection (蔘芪扶正注射液) 250ml Codonopsis pilosula (Franch.) Nannf, Astragalus membranaceus (Fisch.) Bge.
Dosages of the medicinal herbs were not reported.
Li, 200927) Shenqi Fuzheng Injection (蔘芪扶正注射液) 250ml Codonopsis pilosula (Franch.) Nannf, Astragalus membranaceus (Fisch.) Bge.
Dosages of the medicinal herbs were not reported.
Fu, 200628) Qigekaiwei Decoction (自擬啓膈開胃湯) Astragalus membranaceus (Fisch.) Bge(30g), Poria Cocos (Schw.) Wolf(30g), Coix lacryma-jobi L.var.mayuen (Roman.) Stapf(30g), Amomum villosum Lour(5g), Amomum cardamomum L(5g), Atractylodes macrocephala Koidz(15g), Phyllostachyos Caulis in Taeniam(10g), Perilla frutescens (L.) Britt(10g).
Zhou, 200529) HeChanPian (鹤蟾片) + ShenYi Capsule (蔘一胶囊) + adding 4types of herbal decoction according to TCM syndrome differentiation HeChanPian (鶴蟾片) 0.5g :
Agrimonia pilosa Ledeb, Panax ginseng C. A. Mey, Bufo bufo gargarizans Cantor, Fritillaria thunbergii, Pinellia ternata, Asparaguscochinchinensis (Lour.)Merr ect.

ShenYi Capsule(蔘一胶囊): Ginsenoside Rg3 10ml/capsule
  1. lung depression with phlegm stasis (肺郁痰瘀) : Arisaema erubescens (Wall.) Schott, Pinellia ternata, Gekko japonicus Dumeril et Bibron, Coix lacryma-jobi L.var.mayuen(Roman.)Stapf, Prunella vulgaris L, Platycodon grandiflorus, Semen Armeniacae Amarum, Trichosanthes kiritowii Maxim, Bulbus Fritillariae Thunbergii, Panax notoginseng (Burk.) F.H.Chen ect.

  2. Spleen deficiency and phlegm dampness (脾虛痰濕) : Arisaema erubescens (Wall.) Schott, Pinellia ternata, Gekko japonicus Dumeril et Bibron, Coix lacryma-jobi L.var.mayuen(Roman.)Stapf, Platycodon grandiflorus, Trichosanthes kiritowii Maxim, Bulbus Fritillariae Thunbergii, Polyporus umbellatus, Poria cocos(Schw.)Wolf, Codonopsis pilosula (Franch.) Nannf, Atractylodes macrocephala ect.

  3. Yin deficiency and phlegm heat (陰虛痰熱) : Gekko japonicus Dumeril et Bibron, Coix lacryma-jobi L.var.mayuen(Roman.)Stapf, Agrimonia pilosa Ledeb,, Polyporus umbellatus, Prunella vulgaris L, Platycodon grandiflorus,, Bulbus Fritillariae Thunbergii, Adenophora stricta Miq., Ophiopogon japonicus (Linn. f.) Ker-Gawl, Rehmannia glutinosa Libosch ect.

  4. Both qi and yin deficiency (氣陰兩虛) : Gekko japonicus Dumeril et Bibron, Agrimonia pilosa Ledeb, Platycodon grandiflorus, Bulbus Fritillariae Thunbergii, Polyporus umbellatus, Lilium brownii var. viridulum Baker, Adenophora stricta Miq., Panax quinquefolius, Codonopsis pilosula (Franch.) Nannf, Ophiopogon japonicus (Linn. f.) Ker-Gawl,, Schisandra chinensis (Turcz.)Baill ect.

Dosages of the medicinal herbs were not reported.
Table 3
Assessment of risk of bias based on the Cochrane risk of bias tool.
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