By Concepta Merry, MB, BCh, BAO, BA

Associate Professor, Global Health, School of Medicine, Trinity College Dublin; Integrative Medicine Fellow,
University of Arizona, Tucson

Dr. Merry reports no financial relationships relevant to this field of study.

SYNOPSIS: Although Chinese herbal medicine probably does not slow disease progression or improve survival in esophageal cancer patients, it may improve quality of life and reduce adverse effects of radiotherapy and chemotherapy.

SOURCE: Chen X, et al. Chinese medicinal herbs for oesophageal cancer. Cochrane Database Syst Rev 2016 Jan 22; CD004520.

SUMMARY POINT

  • This Cochrane review found that Chinese herbal medicines for esophageal cancer may help improve quality of life and stave off the side effects of chemotherapy and radiation, but not benefit cancer overall.

Esophageal cancer ranks as the seventh leading cause of cancer deaths globally.1 Triggers for the disease are largely lifestyle-related and include nutrition,2 cigarette smoking,2 alcohol consumption,3 or drinking hot beverages.4 Traditional Chinese herbal medicine is sometimes used for advanced esophageal cancer.

There are 3813 published studies examining the use of Chinese herbal medicine in esophageal cancer.5 Two possible reasons for the high level of interest in Chinese herbal medicine for esophageal cancer are: 1) Esophageal cancer is relatively common in northern China,1 and 2) A limited number of effective allopathic treatment options for advanced esophageal cancer are available.

Several papers have suggested possible benefits of Chinese herbal medicines in esophageal cancer. For example, herbs such as mugwort (Artemisia annua, qinghaosu)6 and Hedyotis diffusa (Oldenlandia diffusa, spreading hedyotis)7 may play a role in inhibiting tumor growth.

Chen et al reviewed the efficacy and tolerability of Chinese herbal medicine when added to chemotherapy or radiotherapy for patients with esophageal cancer.5 They assessed 3813 published studies and even phoned authors to get more detail. Only 9 of the 3813 studies were deemed methodologically sound and of high enough quality to be included in the final Cochrane review. Overall, the authors found no evidence that Chinese herbal medicine is an effective adjunctive treatment for esophageal cancer. However, they concluded that Chinese herbal medicine probably is beneficial in terms of quality of life and increased tolerance of the side effects caused by radiotherapy or chemotherapy.

The Chinese herbal medicines studied were tailored to the root cause of the illness for each individual patient, which meant using a wide variety of treatments. Most Chinese herbal medicines prescribed consisted of a variety of different herbs and not a single herb. This variability would mean that a large number of patients would have to be studied to draw any reliable conclusions using the randomized, controlled trial model. The reviewers also commented that the Chinese physicians appeared to “misunderstand” the importance of random allocation in the research process. Finally, no placebo was used in any of the control groups.

Larger, more rigorously designed studies are needed to detect clinically important effects and minimize the risk of bias. Perhaps another conclusion could be that the randomized, controlled trial is not the ideal way to evaluate some types of treatments, especially those stemming from whole medical systems or individualized treatments.

REFERENCES

  1. World Cancer Research Fund International. Oesophageal cancer statistics. Available at: http://www.wcrf.org/int/cancer-facts-figures/data-specific-cancers/oesophageal-cancer-statistics. Accessed Feb. 12, 2016.
  2. Broitman SA, Vitale JJ. Ethanolic beverage consumption, cigarette smoking, nutritional status, and digestive tract cancers. Semin Oncol 1983;10:322-329.
  3. Tuyns AJ, et al. Esophageal cancer and alcohol consumption: Importance of type of beverage. Int J Cancer 1979;23:443-447.
  4. Victora CG, et al. Hot beverage and oesophageal cancer in southern Brazil: A case-control study. Int J Cancer 1987;39:710-716.
  5. Chen X, et al. Chinese medicinal herbs for oesophageal cancer. Cochrane Database Syst Rev 2016 Jan 22; CD004520.
  6. Chen HH, et al. Inhibition of human cancer cell line growth and human umbilical vein endothelial cell angiogenesis by artemisinin derivatives in vitro. Pharmacol Res 2003;48:231-236.
  7. Zhou J, Wang Y. Chinese herbs combined with local chemotherapy and microwave for oesophageal cancer. Henan J Trad Chinese Med 1996;16:365.