This is the first of a 3-part series of 'Questions and Answers' on Traditional Chinese Medicine (TCM) and Cancer written by Dr Linn Yeh Ching (Senior Consultant, SGH Department of Haematology).
When a patient is diagnosed with cancer, whether complementary therapy recommended by well-meaning relatives and friends is advisable is what many patients visiting the oncology clinic want to know. They may ask their doctors or may eventually choose to make their own decision, depending on how they perceive their western trained oncologists will respond to their questions.
There are various schools of complementary medicine, here we shall focus on Traditional Chinese Medicine (TCM). There are many reviews written on the integration of TCM with treatment of cancer, here we shall be evidence-based and focus on some higher-quality evidence provided by relatively well conducted clinical trials.
We emphasize on “good evidence” and “well conducted clinical trials” here. Evidence can be of various levels of relevance to the clinical scenario. There is a lot of work done showing the in vitro (in the test tube, outside the body) activities of herbs, as well as animal (usually mice) experiments showing improvement in some measurements. We cannot assume that these observations can be extrapolated to human beings. Similarly, we have heard of cases of miraculous cure by herbal medicine, but what is the denominator? It may be 1 in 5 or 1 in 5,000 --- without a proper study with objective analysis, it is difficult to assess the chances that one can benefit from a particular treatment. Even for formal clinical trials, the methods by which these are carried out will decide whether the conclusion is valid. Unfortunately it is a fact that most clinical trials carried out in herbal medicine are of sub-optimal quality due to flaws in methodology [1].
We are not denying the importance of basic laboratory studies, as these provide the necessary knowledge for further research. Neither do badly designed clinical trials negate the efficacy of good formulations, it only means that the conclusion cannot be trusted and have to be further verified by more rigorously conducted studies.
It is with the above considerations that the studies cited in this article are chosen. We include acupuncture here as it is also a treatment modality in TCM practice.
1. Can I take only TCM and not do other treatments?
This is an easy question to answer. Even in renowned TCM hospitals in China, treatment of cancer is never solely with TCM, unless the intention is purely palliative, i.e. symptom control, in patients who are unfit for any form of cancer treatment. TCM is never a substitution for conventional, well established modern cancer therapy.
It is true that many anti-cancer drugs originated from traditional medicine and have in fact been used in TCM as cancer treatment for many years. The best example is arsenic compounds in the treatment of acute promyelocytic leukemia (a type of acute leukemia), from which the current arsenic trioxide injection is derived. There is an oral TCM formulation Realgar-Indigo naturalis formula which has demonstrated comparable efficacy to the injection form [2]. This is a case where the formulation has been specially developed for this particular disease and rigorously tested in clinical studies. Many other anti-cancer drugs such as etoposide derived from podophyllum, vincristine from the periwinkle plant, paclitaxel from the Pacific Yew, homoharringtonine from the Chinese coniferous tree, to name a few, are similarly discovered from plant extract but subsequently developed into drugs and produced in synthetic forms. For a clinically effective dose, many bamboo baskets of raw herbs will have to be ingested to achieve the equivalent amount, which is neither achievable in any TCM formulation nor practised as such in TCM.
2. In that case, can I take TCM to reduce the side effect of chemotherapy and radiotherapy?
There are indeed numerous studies exploring how TCM can ameliorate the side effects of cancer treatment.
Nausea and vomiting
Nausea and vomiting are common side effects of cancer therapy. In one study on 120 patients with breast or colon cancer given chemotherapy and anti- vomiting medications, the group using customized TCM prescription experienced reduced nausea and vomiting, as compared to placebo formulation [3].
An alternative non-pharmacological method of reducing nausea and vomiting induced by chemotherapy is acupuncture. Several randomized controlled trials done on acupuncture with drug treatment as comparator or in addition to drug treatment have shown that acute vomiting can be reduced by both manual and electroacupuncture [4].
Dry mouth
Radiation for head and neck cancers commonly causes dry mouth both during and after completion of treatment, significantly affecting quality of life. In a non-randomized study comparing patients given individualized TCM formulations for various radiation and chemotherapy-related symptoms vs the group which did not, severity of dry mouth was less in the TCM group [5]. Acupuncture was also found to relieve dry mouth refractory to western drug therapy that stimulates salivary flow, in a similar patient population [6] .
Fatigue
Cancer patients often complain of fatigue during and long after completion of treatment. There is no effective medication for this. Advice given by doctors are common sense measures such as lifestyle modification, exercise and proper nutrition. In a double -blind randomized control trial involving 364 cancer patients, half of whom were still undergoing chemotherapy treatment, 8 weeks of treatment with Panax quinquefolium (American ginseng 西洋参) reduced cancer- related fatigue compared to placebo, without any adverse reaction [7]. Many TCM studies of various standards on various types of cancers using various personalized TCM formulations also showed improvement in cancer-related fatigue.
Marrow suppression
Suppression of blood counts is a common side effect inherent in most chemotherapy. There are many in vitro and mice studies on the effect of “blood nourishing” herbs in stimulating marrow precursors in forming blood cells. A retrospective review on women undergoing chemotherapy for breast cancer found that those who took “nourishing” concoction Shi Quan Da Bu Tang (十全大补汤) had a less pronounced reduction in red and white blood cells after chemotherapy compared to a comparison group that did not take the TCM concoction[8]. However, this was not found in all studies. Some studies did not observe any effect on blood counts [3].
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