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      Effectiveness of Chinese herbal medicine for cancer palliative care: overview of systematic reviews with meta-analyses

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          Abstract

          Chinese herbal medicines (CHM) are often used in managing cancer related symptoms but their effectiveness and safety is controversial. We conducted this overview of meta-analyses to summarize evidence on CHM for cancer palliative care. We included systematic reviews (SRs) with meta-analyses of CHM clinical trials on patients diagnosed with any type of cancer. Methodological quality of included meta-analyses was assessed with the Methodological Quality of Systematic Reviews (AMSTAR) Instrument. Fifty-one SRs with meta-analyses were included. They covered patients with lung (20 SRs), gastric (8 SRs), colorectal (6 SRs), liver (6 SRs), breast (2 SRs), cervical (1 SR), esophageal (1 SR), and nasopharyngeal (1 SR) cancers. Six SRs summarized evidence on various types of cancer. Methodological quality of included meta-analyses was not satisfactory. Overall, favorable therapeutic effects in improving quality of life among cancer patients have been reported. Conflicting evidence exists for the effectiveness of CHM in prolonging survival and in reducing chemotherapy and/or radiotherapy related toxicities. No serious adverse effects were reported in all included studies. Evidence indicated that CHM could be considered as an option for improving quality of life among patients receiving palliative care. It is unclear if CHM may increase survival, or reduce therapy related toxicities.

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          Most cited references15

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          Palliative Care: the World Health Organization's global perspective.

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            Do certain countries produce only positive results? A systematic review of controlled trials.

            To determine whether clinical trials originating in certain countries always have positive results. Abstracts of trials from Medline (January 1966-June 1995). Two separate studies were conducted. The first included trials in which the clinical outcome of a group of subjects receiving acupuncture was compared to that of a group receiving placebo, no treatment, or a nonacupuncture intervention. In the second study, randomized or controlled trials of interventions other than acupuncture that were published in China, Japan, Russia/USSR, or Taiwan were compared to those published in England. Blinded reviewers determined inclusion and outcome and separately classified each trial by country of origin. In the study of acupuncture trials, 252 of 1085 abstracts met the inclusion criteria. Research conducted in certain countries was uniformly favorable to acupuncture; all trials originating in China, Japan, Hong Kong, and Taiwan were positive, as were 10 out of 11 of those published in Russia/USSR. In studies that examined interventions other than acupuncture, 405 of 1100 abstracts met the inclusion criteria. Of trials published in England, 75% gave the test treatment as superior to control. The results for China, Japan, Russia/USSR, and Taiwan were 99%, 89%, 97%, and 95%, respectively. No trial published in China or Russia/USSR found a test treatment to be ineffective. Some countries publish unusually high proportions of positive results. Publication bias is a possible explanation. Researchers undertaking systematic reviews should consider carefully how to manage data from these countries.
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              Systematic review found AMSTAR, but not R(evised)-AMSTAR, to have good measurement properties.

              To summarize all available evidence on measurement properties in terms of reliability, validity, and feasibility of the Assessment of Multiple Systematic Reviews (AMSTAR) tool, including R(evised)-AMSTAR.
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                Author and article information

                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group
                2045-2322
                16 December 2015
                2015
                : 5
                : 18111
                Affiliations
                [1 ]Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong , Hong Kong
                [2 ]Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong , Hong Kong
                [3 ]Comprehensive Cancer Trials Unit, The Chinese University of Hong Kong , Hong Kong
                [4 ]Chinese Medicine Department, Hong Kong Hospital Authority , Hong Kong
                [5 ]Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong , Hong Kong
                [6 ]Department of Medicine & Therapeutics, The Chinese University of Hong Kong , Hong Kong
                Author notes
                Article
                srep18111
                10.1038/srep18111
                4680970
                26669761
                c0331974-e5eb-4570-8ada-742fca6798bb
                Copyright © 2015, Macmillan Publishers Limited

                This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

                History
                : 27 March 2015
                : 12 November 2015
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