The Effect of Traditional Oriental Herbal Medicine for Anorexia in Cancer Patients: A Systematic Review

Joon-Ho Lee; Kyeore Bae; Hwa-Seung Yoo; Lee, Joon-Ho; Bae, Kyeore; Yoo, Hwa-Seung

doi:10.13048/jkm.17002

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

Original Article

The Journal of Korean Medicine 2017; 38(1): 8-20.

Published online: March 31, 2017

DOI: https://doi.org/10.13048/jkm.17002

The Effect of Traditional Oriental Herbal Medicine for Anorexia in Cancer Patients: A Systematic Review

Joon-Ho Lee¹^{, 2}, Kyeore Bae¹

, Hwa-Seung Yoo¹

¹East-West Cancer Center, Dunsan Korean Medicine Hospital, Daejeon University, Shanghai, China

²Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China

Correspondence to：유화승(Hwa-Seung Yoo) 대전광역시 서구 대덕대로 176번길 75 대전대학교 둔산한방병원 동서암센터 Tel：+82-42-470-9132, Fax：+82-42-470-9006, E-mail: altyhs@dju.kr

Received December 9, 2016 Revised March 14, 2017 Accepted March 14, 2017

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.

Keywords: Herbal medicine, Anorexia, Neoplasms, Quality of life, Korean 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.

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
First author and year of publication	Study design	Patients	Sample size (T; C) Dropout rate	Duration of treatment	Route of administration	Herbal medicine	Conventional medicine	Control group	Observation indexes	Results
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: 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: The severity of anorexia: T < C (P<0.01) 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: 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: The severity of anorexia after treatment: T < C (P<0.001) 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: 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: 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: The severity of anorexia after treatment: T1 < T2, C (P < 0.01). 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: 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: 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: 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: 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 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. 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. 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. 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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