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Traditional Medicine Research  2018, Vol. 3 Issue (2): 95-105    DOI: 10.12032/TMR201810068
Review     
Pharmacological intervention of traditional Chinese medicine for the quality of life in patients with colorectal cancer: a systematic review and meta-analysis
Wen-Qi Huang1, Zhu Yang1, Dong-Xin Tang2,*(), Feng-Xi Long1, Li Luo2, Bing Yang1, Juan Li1, Jie Chen1
1Guiyang College of Traditional Chinese Medicine, Guiyang, Guizhou, China.
2The First Affiliated Hospital of Guiyang College of Traditional Chinese Medicine, Guiyang, Guizhou, China.
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Highlights

Though exerting no influence in recent clinical response, traditional Chinese medicine significantly improve KPS scores, reduce the toxicity after chemotherapy, and improve the overall quality of life in patients with CRC.

Editor’s Summary

As one of the palliative and adjuvant therapies, the usage of traditional Chinese medicine should be paid enough attention in patients with CRC who were at an advanced stage or metastasis.

Abstract

Objective: The objective of this study is to evaluate the impact of various traditional Chinese medicine (TCM) approaches on the quality of life in patients with colorectal cancer. Methods: In this study, we systematically performed the screening of randomized controlled trials from Cochrane Library, Pubmed, Embase, Medline, and Web of Science. The data were extracted by two reviewers independently, and then risk assessment was performed. All the analyses were conducted using Review Manager 5.3. Results: A total of 18 eligible studies containing 1312 patients were included. Experimental group were treated with TCM combined with Western medicine or TCM alone (N = 688) and control group were treated with Western medicine treatment alone (N = 624). The results showed that the recent clinical efficiency between the two groups was not statistically significant (P = 0.06). KPS scores of the experimental group were higher than those in the control group [P < 0.001, WMD = 9.60, 95%CI = (5.62, 13.57)]. The toxicity comparison showed that the occurrence of toxicities, such as leucopenia, thrombocytopenia, nausea and vomiting, diarrhea, and neurotoxicity in the experimental group was lower than that in the control group [P < 0.001, OR = 0.31, 95%CI = (0.19, 0.50)], [P = 0.003, OR = 0.49, 95%CI = (0.31, 0.78)], [P < 0.001, OR = 0.30, 95%CI = (0.16, 0.54)], [P < 0.001, OR = 0.40, 95%CI = (0.27, 0.58)], and [P < 0.001, OR = 0.43, 95%CI = (0.30, 0.61)]. The immunological test comparison demonstrated that the immunological parameters (CD3, CD4, and CD4/CD8) showed higher values in the experimental group than those in the control group [P < 0.001, MD = 5.55, 95%CI = (4.83, 6.28)], [P < 0.0001, MD = 6.75, 95%CI = (5.25, 8.26)], and [P = 0.001, MD = 0.26, 95%CI = (0.10, 0.41)]. Conclusions: TCM did not show significant recent clinical efficiency. However, treatment with TCM showed increase in KPS scores in patients with colorectal cancer, alleviation of toxicity associated with chemotherapy, regulation of autoimmunity, and improvement in the quality of life of patients.



Key wordsColorectal cancer      Traditional Chinese medicine      Quality of life      Meta-analysis     
Published: 05 March 2018
Fund:  Funding: National Natural Science Foundation of China (81460697, 81460691, 81673862). Project of Science and Technology Department of Guizhou Province. SY Word of Science and Technology Cooperation of Qian (2013, 3026;2014, 3008-1;2014, 3026;2015, 3028). Talents of Science and Technology Cooperation of Qian (2016, 4032).
Corresponding Authors: Tang Dong-Xin     E-mail: tangdongxin@sina.com.
Cite this article:

Wen-Qi Huang, Zhu Yang, Dong-Xin Tang, Feng-Xi Long, Li Luo, Bing Yang, Juan Li, Jie Chen. Pharmacological intervention of traditional Chinese medicine for the quality of life in patients with colorectal cancer: a systematic review and meta-analysis. Traditional Medicine Research, 2018, 3(2): 95-105. doi: 10.12032/TMR201810068

URL:

https://www.tmrjournals.com/tmr/EN/10.12032/TMR201810068     OR     https://www.tmrjournals.com/tmr/EN/Y2018/V3/I2/95

Figure 1 Flow chart
Sequence Author Year Group No. Therapy Outcome
1 Tao Wang 2014 Experiment group 58 ADI +FOLFOX4 chemotherapy KPS, adverse events, effective rate
Control group 63 FOLFOX4 chemotherapy alone
2 Weirong Zhu 2005 Experiment group 36 SMI +IPC (5-FU+CDDP) KPS, immunological examination
Control group 22 IPC (5-FU+CDDP)
3 Guolin Wu 2010 Experiment group 33 Fupiyiwei Decotion+ FOLFOX4 KPS, immunological examination, adverse events, effective rate
Control group 25 FOLFOX4 chemotherapy alone
4 Zhixiong Guo 1999 Experiment group 38 Fuzhengyiai Decoction + MeF (V) chemotherapy KPS, immunological examination, adverse events
Control group 31 MeF ( V)
5 Xiao Han 2011 Experiment group 23 Modified Sijunzi Decotion + FOLFOX4 chemotherapy KPS, immunological examination, adverse events
Control group 22 FOLFOX4 chemotherapy alone
6 Haijin Li 2007 Experiment group 65 ADI + FOLFOX4 chemotherapy KPS, adverse events, effective rate
Control group 52 FOLFOX4 chemotherapy alone
7 Yan Zhang 2010 Experiment group 20 Shenqifuzheng Injection + FOLFOX4 chemotherapy Immunological examination, adverse events
Control group 20 FOLFOX4 chemotherapy alone
8 Yan Yang 2005 Experiment group 55 Bowel rehabilitation Capsule KPS, adverse events, effective rate
Control group 55 5-FU
9 Jun Jin 2004 Experiment group 30 Daan Pill +CF+5-FU chemotherapy Adverse events
Control group 30 CF+5-FU chemotherapy
10 Fengshan Hu 2007 Experiment group 38 Gubenxiaoliu Capsule + FOLFOX4 KPS, immunological examination, adverse events, effective rate
Control group 40 FOLFOX4
11 Jing Liu 2005 Experiment group 52 Jianpihuoxue Decoction +FOLFOX4 Immunological examination, effective rate
Control group 26 FOLFOX4
12 Jingxian Chen 2012 Experiment group 60 Qisheng Decoction + FOLFOX4 /XELOX KPS, adverse events
Control group 60 FOLFOX4 /XELOX
13 Yufei
Yang
2008 Experiment group 18 Quxie Capsule+Chemotherapy KPS
Control group 19 Chemotherapy
14 Yufei Yang 2007 Experiment group 23 Quxie Capsule+Postoperative adjuvant therapy KPS, immunological examination
Control group 21 Placebo+Postoperative adjuvant therapy
15 Qing Zhang 2006 Experiment group 38 Yiqihuoxue Decoction TCM+L-OHP+CF+5-FU KPS, immunological examination, adverse events, effective rate
Control group 30 L-OHP+CF+5-FU
16 Ping Liu 2007 Experiment group 45 Boerning Capsules + FOLFOX4 Immunological examination, adverse events
Control group 49 FOLFOX4
17 Lingchang Li 2011 Experiment group 15 Fufangchangtai Decoction + FOLFOX4 KPS, immunological examination, adverse events
Control group 15 FOLFOX4 chemotherapy alone
18 Bo Cao 2012 Experiment group 41 YiqiJianpi Decoction + FOLFOX4 KPS, adverse events
Control group 44 FOLFOX4
Table 1 Basic information of the included literatures
Figure 2 Summary of the evaluation of risk of bias of the included literatures
Figure 3 Comparison of the clinical response rate between the experiment and control groups
Figure 4 Funnel plots of the comparison of the clinical response rates between the experimental control groups
Figure 5 Comparison of post-treatment KPS scores between the experiment control groups
Figure 6 Funnel plot of post-treatment KPS scores between the experiment control groups
Name Model OR/MD and 95%CI Statistical Z-score P - value
Response rate Fixed effects model 1.38[0.98,1.95] 1.86 =0.06
Random effects model 1.38[0.98,1.95] 1.85 =0.06
KPS score Fixed effects model 8.66[7.61,9.72] 16.11 <0.001
Random effects model 9.60[5.62,13.57] 4.73 <0.001
Leukopenia Fixed effects model 0.32[0.23,0.43] 7.38 <0.001
Random effects model 0.31[0.19,0.50] 4.74 <0.001
Thrombocytopenia Fixed effects model 0.49[0.31,0.78] 2.99 =0.003
Random effects model 0.50[0.31,0.81] 2.84 =0.004
Nausea and vomiting Fixed effects model 0.33[0.24,0.46] 6.84 <0.001
Random effects model 0.30[0.16,0.54] 26.35 <0.001
Diarrhea Fixed effects model 0.40[0.27,0.58] 4.76 <0.001
Random effects model 0.40[0.27,0.59] 4.54 <0.001
Neurotoxicity Fixed effects model 0.43[0.30,0.61] 4.67 <0.001
Random effects model 0.42[0.25,0.71] 3.27 =0.001
CD3 Fixed effects model 5.55[4.83,6.28] 15.05 <0.001
Random effects model 5.55[4.83,6.28] 15.05 <0.001
CD4 Fixed effects model 7.27[6.65,7.89] 22.09 <0.001
Random effects model 6.75[5.25,8.26] 8.79 <0.001
CD4/CD8 Fixed effects model 0.08[0.03,0.13] 3.36 <0.001
Random effects model 0.26[0.10,0.41] 3.22 =0.001
Table 2 Sensitivity among different effect models of each evaluating indicator
1.   Siegel RL, Naishadham D, Jemal A.Cancer statistics. CA Cancer J Clin 2012, 62: 10-29.
doi: 10.3322/caac.20138
2.   Siegel RL, Miller KD, Jemal A.Cancer statistics. CA Cancer J Clin 2015, 65: 5-29.
doi: 10.3322/caac.21254
3.   Moriarity A,O’Sullivan J, Kennedy J, et al. Current targeted therapies in the treatment of advanced colorectal cancer: a review. Ther Adv Med Oncol 2016, 8: 276-293.
doi: 10.1177/1758834016646734 pmid: 27482287
4.   Goldberg R, Sargent D, Morton R,et al. A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer. J Clin Oncol 2004, 22: 23-30.
doi: 10.1200/JCO.2004.09.046 pmid: 14665611
5.   Tournigand C, André T, Achille E, et al.FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol 2004, 22: 229-237.
doi: 10.1200/JCO.2004.05.113
6.   Cao HJ, Mu YJ, Li X, et al.A systematic review of randomized controlled trials on oral Chinese herbal medicine for prostate cancer. PLoS One 2016, 11: e0160253.
doi: 10.1371/journal.pone.0160253 pmid: 27490098
7.   Wang T, Nan HL, Zhang CZ, et al.Aidi injection combined with FOLFOX4 chemotherapy regimen in the treatment of advanced colorectal carcinoma. J Cancer Res Ther 2014, 10: 52-55.
doi: 10.4103/0973-1482.139760 pmid: 25207892
8.   Zhu WR, Zheng L, Guo YB, et al.Clinical research of intraperitoneal chemotherapy plus Shenmai Injection intreating advanced colorectal cancer. Chin J Integr Med 2005, 3: 266-269.
doi: 10.3736/jcim
9.   Wu G, Yu G, Li J,et al. Short term therapeutic effect on treatment of postoperational large intestinecarcinoma by Fupiyiwei decoction combined with chemotherapy and it’s effecton immune function. Zhongguo Zhong Yao Za Zhi 2010, 35: 782-785.
doi: 10.4268/cjcmm20100627 pmid: 20545209
10.   Guo Z.Clinical observation on treatment of 38 cases of postoperational large intestinal cancer by fuzheng yiai decoction combined with chemotherapy. Chin J Integr Med 1999, 19: 20-22.
pmid: 11783254
11.   Xiao H, Yang J.Immune enhancing effect of modifid Sijunzi Decoction on patients with colorectal cancer undergoing chemotherapy. Chin J Integr Med 2011, 31: 164-167.
doi: 10.1088/1009-0630/13/1/25 pmid: 21425566
12.   Li HJ, Dong L, Fu SY.Comparative study on treatment of advanced colorectal cancer by Aidi injection combined with FOLFOX4 regimen and by FOLFOX4 regimen alone. Chin J Integr Med 2007, 27: 1086-1089.
pmid: 18198641
13.   Zhang Y, Guo LL, Zhao SP.Effect of shenqi fuzheng injection combined with chemotherapy in treating colorectal cancer. Chin J Integr Med 2010, 30: 280-282.
doi: 10.1007/s00343-010-9055-9 pmid: 20535927
14.   Yan Y, Liu BQ, Du QX.The clinical study of bowel rehabilitation capsule for treating middle-late colorectal cancer in 55 cases. Jiangsu J Tradit Chin Med 2005, 26: 18-20.
15.   Jin J, Zhang MX.Curative effect observation relieving the gastrointestinal reaction of postoperative chemotherapy for colorectal cancer with Da An Wan. Chin J Inf Tradit Chin Med 2004, 11: 823-824.
16.   Hu FS, Zhang Q, Wang XM,et al. The effects of Gubenxiaoliu Capsules in combination with FOLFOX4 regimen to treat advanced colorectal cancer. Chin J Inf Tradit Chin Med 2007, 14: 13-14.
17.   Liu J, Wang WP, Zhou YY,et al. The influence of Jianpi Huoxue Recipe combined with chemotherapy on immunology and hemorheology of postoperative patients with colorectal cancer. Jiangsu J Tradit Chin Med 2005, 26: 13-14.
18.   Chen JX, Shen XH.Effects of Qisheng Mixture on chemotherapy induced myelosuppression in patients with colorectal cancer. Chin J Integr Med 2012, 32: 1161-1165.
pmid: 23185750
19.   Yang YF, Chen ZX, Xu Y,et al. Randomized controlled study on effect of Quxie Capsule on the median survival time and qualify of life in patients with advanced colorectal carcinoma. Chin J Integr Med 2008, 28: 111-114.
doi: 10.1016/S1872-2075(08)60042-4 pmid: 18386570
20.   Yang YF, Xu Y, Wu Y,et al. Clinical randomized double-blinded controlled study on Quxie Capsule in reducing post-operational relapse and metastasis of colorectal cancer. Chin J Integr Med 2007, 27: 879-882.
pmid: 17990451
21.   Zhang Q, Zhao WS, Yu J,et al. Clinical study on advanced colorectal cancer treated by Yiqi Huoxue TCM combined with chemotherapy. Chin J Inf Tradit Chin Med 2006, 13: 17-18.
22.   Liu P, Liu JH, Zhu DQ, et al.Clinical observation of colon carcinoma treated with Boerning capsules plus FOLFOX4 regimen. Chin Ger J Clin Oncol 2007, 6: 328-330.
doi: 10.1007/s10330-007-0071-y
23.   Li LC, Fang MZ, Wang XN,et al. Clinical observation of Fufangchangtai decoction combined with FOLFOX4 regimen for postoperative colorectal cancers. Chin Ger J Clin Oncol 2011, 10: 225-227.
doi: 10.1007/s10330-011-0764-0
24.   Cao B, Den WL.Clinical observation of treatment with Yiqi Jianpi decoction combined with FOLFOX4 for the postoperation patients of colorectal cancer. Chin Ger J Clin Oncol 2012, 11: 605-608.
doi: 10.1007/s10330-012-1017-6
25.   De Vries NL, Swets M, Vahrmeijer AL,et al. The immunogenicity of colorectal cancer in relation to tumor development and treatment. Int J Mol Sci 2016, 17: 1030.
doi: 10.3390/ijms17071030 pmid: 27367680
26.   Schmoll HJ, van Cutsem E, Stein A, et al. ESMO consensus guidelines for management of patients with colon and rectal cancer. a personalized approach to clinical decision making. Ann Oncol 2012, 23: 2479-2516.
doi: 10.1093/annonc/mds236 pmid: 23012255
27.   Qi FH, Zhao L, Zhou AY,et al. The advantages of using traditional Chinese medicine as an adjunctive therapy in the whole course of cancer treatment instead of only terminal stage of cancer. Bio Science Trends 2015, 9: 16-34.
doi: 10.5582/bst.2015.01019 pmid: 25787906
28.   Nie J, Zhao CL, Deng L,et al. Efficacy of traditional Chinese medicine in treating cancer. Biomed Rep 2016, 4: 3-14.
doi: 10.3892/br.2015.537 pmid: 26870326
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