Chinese herbal medicine for chemotherapy induced gastrointestinal side effects: a systematic review of randomized controlled trials

Objective: To determine how safe and effective Chinese Herbal Medicine (CHM) is in alleviating the nausea, vomiting, oral ulceration, diarrhea and constipation for cancer patients with chemotherapy. Methods: Data sources: A systematic review of Chinese and English articles using Ovid SP, CNKI, VIP Database and Traditional Chinese Medicine Database System. Study selection: Only randomized controlled trials (RCTs) for the prevention or treatment of any one of gastrointestinal side effects, namely nausea, vomiting, oral ulceration, diarrhea and constipation, of CHM with or without western medicine (WM) vs WM, placebo or no treatment were included. Data Extraction: Independent extraction of articles was first performed by four medical students using predefined data fields. Then, all data, including study quality indicators, was checked by two authors. Results: Eighty-six RCTs involving 7076 cancer patients were found and analyzed in this review. Because of the heterogeneity of study design and low overall methodological quality, only descriptive summaries were performed. Beneficial effects were found in some CHM interventions, regardless of being taken alone or taken with WM. Moreover, none of serious adverse effect was reported. However, same intervention had not been repeatedly investigated by different research teams. Conclusions: Implications of the analysis support the efficacy and safety of CHM for the management of gastrointestinal side effects. However, definite clinical recommendation for particular CHM intervention still cannot be made due to low methodological quality of included studies and lack of duplicated verification. Further large scale and high quality RCTs on the same CHM interventions are suggested.