title: Chinese medical herbs for chemotherapy side effects in colorectal cancer patients.
abstract: BACKGROUND
  Side effects, including nausea and vomiting, sore mouth , diarrhoea, hepatotoxicity, myelosuppression, and immunosuppression , are commonly encountered in patients with colorectal cancer who are treated with chemotherapy. A variety of Chinese herbal medicines have been used for managing these adverse effects.
  
  
  OBJECTIVE
  To assess the effect of herbal medicines plus chemotherapy, compared with chemotherapy alone, on the side effects of chemotherapy on the quality of life, and on adverse events in patients with colorectal cancer.
  
  
  METHODS
  We searched the Cochrane Library, MEDLINE, EMBASE, CBM, and handsearched the relevant Chinese journals.
  
  
  METHODS
  Randomised trials comparing either chemotherapy only or chemotherapy plus anti-emetics (tropisetron, sulpiride etc) with chemotherapy plus Chinese herbs.
  
  
  METHODS
  Trial quality was assessed independently by two reviewers. Data were extracted by one reviewer and checked by the second reviewer. Since the four included studies differed significantly in design, we could only perform limited meta-analyses. We have therefore presented the majority of the data in narrative form.
  
  
  RESULTS
  We included four relevant trials. All of them were of low quality. All of studies used a decoction containing Huangqi compounds as the intervention with chemotherapy. The intervention groups of three studies were compared to a chemotherapy alone control group, the fourth study compared the decoction of Huangqi compounds with two other Chinese herbal interventions. None of the studies reported on primary outcome using Common Toxicity Criteria (CTC). There was a significant reduction in the proportion of patients who experienced nausea & vomiting when decoctions of Huangqi compounds were given in addition to chemotherapy. There was also a decrease in the rate of leucopenia (WBC <3 x 10(9) per L). Huangqi compounds were also associated with increases in the proportions of T-lymphocyte subsets: CD3; CD4 and CD8. Huangqi decoctions had no significant effects on Immunoglobulins G, A or M.
  
  
  CONCLUSIONS
  Despite the included studies being of low quality, the results suggest that decoctions of Huangqi compounds may stimulate immunocompetent cells and decrease side effects in patients treated with chemotherapy. Due to the methodological limitations of the studies, there is no robust demonstration of benefit. We found no evidence of harm arising from the use of Chinese herbs. We need high quality randomised controlled studies investigating the effects of decoctions of Chinese herbs, particularly Astragalus spp.(as in Huangqi), upon chemotherapy-related side effects.
authors.affiliation: Clinical Epidemiology, West China Hospital of Sichuan University, No. 17, Ren Min Nan Lu 3 Duan, Chengdu, Sichuan, China, 610041. txwutx@public.cd.sc.cn
authors.forename: W
authors.initials: W
authors.lastname: Taixiang
authors.forename: A J
authors.initials: AJ
authors.lastname: Munro
authors.forename: L
authors.initials: L
authors.lastname: Guanjian
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D027883:Astragalus Plant; D027885:Astragalus propinquus; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D004365:Drugs, Chinese Herbal / Q000627:therapeutic use*; D006801:Humans; D008517:Phytotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000970:Antineoplastic Agents; D004365:Drugs, Chinese Herbal; C027492:Huang Qi