Addition of certain herbal medicines to chemotherapy may increase survival and quality of life in patients with advanced colorectal cancer
- Correspondence to: Oluwadamilola Olaku
Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, 6116 Executive Blvd, Suite 609, Bethesda, MD 20892, USA;
Commentary on: Search Google Scholar
Implications for practice and research
Well-conducted randomised clinical trials are needed to confirm the benefit(s) of Chinese herbal medicine in the treatment of advanced colorectal cancer.
The strength of evidence of this review is not adequate to support the use of Chinese herbal medicines with chemotherapy in the treatment of colorectal cancer.
The objective of this review was to evaluate the beneficial effects and safety of Chinese herbal medicine therapy for advanced stage colorectal cancer, and its influence on patients’ quality of life. Colorectal cancer is the fourth most common cancer in men and the third most common cancer in women worldwide.1 ,2 It is estimated that there are nearly 1.2 million men and women living in the USA with a previous diagnosis of colorectal cancer, and an additional 143 460 will be diagnosed in 2012. The median age at diagnosis of colorectal cancer is 68 years for males and 72 years for females. The 1-year and 5-year relative survival rates are 83.2% and 64.3%, respectively. Survival continues to decline to 57.6% at 10 years after diagnosis.3 The use of Traditional Chinese Medicine (TCM) for cancer treatment dates back more than 2000 years in China and is still prevalent.4 In the past 50 years, Chinese herbal medicine combined with the conventional therapy (mainly chemotherapy) has been used to alleviate clinical symptoms, prolong survival time, and minimise the adverse effects of chemotherapy in Asia.5 Although TCM is generally accepted as a complementary approach, in addition to conventional treatment of cancer, high-level evidence of its efficacy is still lacking.
A search of eight electronic databases and a manual search of 16 Chinese journals were performed by the authors. The following electronic databases were searched: BIOSIS Previews, Cochrane Controlled Trials Register, Medline, EMBASE and Biological Abstracts. The search date was from inception of each publication to August 2011. Also included in the search were unpublished abstracts from meetings, Chinese post-graduate dissertations, conference proceedings and other unpublished articles. This yielded 14 003 articles; 13 936 were excluded after reading the abstracts. Another 47 articles were excluded after reading the full text leaving 20 trials that met the inclusion criteria. There was no language restriction for the search. The 20 randomised controlled trials included 1304 participants. The trials compared the use of herbal medicines with chemotherapy, and chemotherapy alone in the treatment of advanced stage colorectal cancer. Only randomised and quasi-randomised controlled trials were included in this review. The studies considered were both blinded and non-blinded studies. The minimum follow up of the trials was 6 months. The data were extracted independently by two reviewers and validated by a third party. All disagreements were resolved by discussion. The quality of the trials was assessed according to the following: randomisation, allocation concealment, double blinding, and drop-out rates.
One of the trials showed that compared with chemotherapy alone the use of Quxie capsule combined with chemotherapy could reduce the mortality rate. Three trials showed that when you combine Jianpi Jiedu, Xiaozheng or Yiqi Huoxue formula with chemotherapy, the 1 year survival rate improved. One trial showed that when you combine Xiaozheng formula with chemotherapy, the 3 year survival rate improved compared to chemotherapy alone. The quality of life improved in 10 trials combining herbal medicine with chemotherapy. The herbal medicines did not show any additional benefit in response or stability rate. None of the 20 trials reported any serious adverse events.
The authors conducted an extensive search of the literature to identify randomised clinical trials combining Chinese herbal medicines with chemotherapy. The clinical trials included in this review did not follow the guidelines of CONSORT (Consolidated Standards of Reporting Trials) statement. Seven trials described the allocation sequence and none described allocation concealment. There was no power calculation in any of the studies and only one study described the type of blinding. The analysis of the trials did not account for patients that dropped out or were lost to follow-up. Although the review showed some positive findings, the quality of the trials preclude making any definitive statements. Well-conducted randomised clinical trials are needed to confirm any benefit of Chinese herbal medicine in the treatment of colorectal cancer.