title: Chinese Herbal Medicine for Improving Quality of Life Among Nonsmall Cell Lung Cancer Patients: Overview of Systematic Reviews and Network Meta-Analysis.
abstract: For patients with nonsmall cell lung cancer (NSCLC) receiving chemotherapy, current clinical evidence has indicated add-on benefit of Chinese herbal medicine (CHM) in improving quality of life (QoL). However, the relative performance among different CHM is unknown. The aim of this overview of systematic reviews (SRs) and network meta-analyses (NMA) is to evaluate the comparative effectiveness of different CHM. Seven electronic databases including both international databases and Chinese databases were searched. SRs focus on randomized controlled trials (RCTs) with comparison of CHM plus chemotherapy against chemotherapy alone on QoL among NSCLC patients were considered eligible. Data from RCTs were extracted for random effect pairwise meta-analyses. Pooled relative risk (RR) with 95% confidence interval (CI) was used to quantify the impact of CHM on QoL. NMA was used to explore the most effective CHM for improving QoL when used with chemotherapy. From 14 SRs, 61 RCTs (n = 4247) assessing 11 different CHM were included. Result from pairwise meta-analyses showed 6 CHM (Kang-lai-te injection, Shei-qi-fu-zheng injection, Compound ku-shen injection, Kang-ai injection, Zi-jin-long tablet, and Shen-fu injection) has significant beneficial effect on QoL among NSCLC patients when used with chemotherapy, even after adjustment for publication bias. Pooled RR varied from 1.38 (95% CI: 1.11-1.72, I2 = 0.0%, Kang-lai-te injection) to 3.36 (95% CI: 1.30-8.66, I2 = 0.0%, Zi-jin-long tablet). One trial comparing Hai-shen-su (a protein extract from Tegillarca granosa L.) plus chemotherapy with chemotherapy also demonstrated beneficial effect of combined treatment (RR = 3.13, 95% CI: 1.41-6.98). Results from NMA showed no differences on the comparative effectiveness among CHM, but Hai-shen-su plus chemotherapy has the highest probability (62.3%) of being the best option for improving QoL. Use of CHM on top of chemotherapy can significantly improve QoL in NSCLC patients. Although Hai-shen-su showed the highest probability of being the best add-on to chemotherapy, the effectiveness of all 11 CHM reviewed appeared to be similar. In the future, rigorous placebo controlled trials with proper blinding are needed to confirm the effectiveness of CHM.
authors.affiliation: From the Hong Kong Institute of Integrative Medicine (XW, VCHC, LP, SYSW), Jockey Club School of Public Health and Primary Care (XW, VCHC, EPH, AYLL, SYSW, JCYW), Comprehensive Cancer Trials Unit (EPH), and Department of Medicine and Therapeutics (AYLL, JCYW), The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong; School of Information Technologies, The University of Sydney, Sydney, Australia (SKP); and Centre for Integrative Medicine, University of Toronto, Toronto, ON, Canada (LGB).
authors.forename: Xinyin
authors.initials: X
authors.lastname: Wu
authors.forename: Vincent C H
authors.initials: VCH
authors.lastname: Chung
authors.forename: Ping
authors.initials: P
authors.lastname: Lu
authors.forename: Simon K
authors.initials: SK
authors.lastname: Poon
authors.forename: Edwin P
authors.initials: EP
authors.lastname: Hui
authors.forename: Alexander Y L
authors.initials: AYL
authors.lastname: Lau
authors.forename: Lynda G
authors.initials: LG
authors.lastname: Balneaves
authors.forename: Samuel Y S
authors.initials: SYS
authors.lastname: Wong
authors.forename: Justin C Y
authors.initials: JCY
authors.lastname: Wu
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D004333:Drug Administration Routes; D004359:Drug Therapy, Combination; D004365:Drugs, Chinese Herbal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic
chemical_list: D000970:Antineoplastic Agents; D004365:Drugs, Chinese Herbal; C492793:Shen-Fu; C499781:kang-lai-te