Cancer is one of the diseases with high morbidity and mortality in the world. Traditional Chinese medicine (TCM) plays an alternative and complementary role in adjuvant cancer therapy. However, TCM still has many controversial problems in cancer therapy, such as the name and diagnosis of cancers, unscientific theory and lack of english evidence-based studies. This article explains how TCM can be integrated with western medicine in cancer therapy, in the hope to gain recognition from the western medical world.
by Ng Pu Jue
According to global cancer statistics 2018, there are 18,078,957 new cancer cases and 9,555,027 cancer deaths worldwide.
63.4 per cent of new global cases are concentrated in the top 10 cancers and the top five were lung cancer (11.6%), female breast cancer (11.6%), colorectal cancer (10.2%), prostate cancer (7.1%), and gastric cancer (5.7%). The top 10 cancers in mortality accounted for 70.7 per cent of the total mortality, while lung cancer ranked first (18.4%), followed by colorectal cancer (9.2%), gastric cancer (8.2%), liver cancer (8.2%) and female breast cancer (6.6%).1
Cancer is one of the diseases with high morbidity and mortality in the world. It is a major problem that needs to be solved in the medical field. Traditional Chinese medicine (TCM) plays an alternative and complementary role in treatment of various diseases.2 Such example is adjuvant cancer therapy that is increasingly valued by many health professionals.
However, TCM still has many controversial problems in cancer therapy, such as the name and diagnosis of cancers, unscientific theory, lack of english evidence-based studies, etc.3 This article explains how TCM can be integrated with western medicine in cancer therapy, in the hope to gain recognition from the western medical world.
In different stages of cancer, modern chinese physician select and individualise the best treatment plan for the patient based on the type and stage of cancer. The application of Chinese herbal medicines especially formula based on syndrome differentiation is highly prevalent. TCM is able to complement and assist modern medicine at different stages and method of treatments.4 Integrating east and west treatments would benefit patients the most, speeding up their recovery.
Different stages of treatment
Due to the large difference in tumour biological characteristics, individual body condition and stages, treatment methods always differ. For example, in early stages of the cancer, the general physical condition of the patient is fit and well.
Modern conventional treatment would use surgery, radiotherapy, chemotherapy and localised treatment (cryotherapy, laser) in removing the tumour actively. In this case, TCM could assist by boosting patient’s immune system and physical state to tolerate the side effect and enhance the treatment at the same time.
- Boost physical wellness, before and after surgery
Patient with surgical indications, TCM would use immune boosting herbs, promoting blood circulation and energy boosting herbs to improve patient’s physical wellness, ensuring smooth operation and promote early recovery of patient's postoperative injury. With the enhanced immunity, it would help patients reduce their cancer recurrence and metastasis probability.5 For late stage cancer palliative surgery, TCM could help to relieve symptoms, prolong life and improve quality of life.
- Aid in chemotherapy
Chemotherapy is an important method of cancer treatment, but balancing treatment and toxicity has always been a big issue. Although treatment might kill the cancer, the patient will have a series of toxic side effects, which might give rise to patient intolerance, leading to failure in treatment or even death. This could cause great fear in patients leading them to abandon the treatment. This kind of deep fear can even prompt new cancer to occur. In view of this, reducing side effects of chemotherapy to ensure a smooth progression of treatment is key to benefit cancer patient from chemotherapy.6
Currently, common chemotherapy side effects include gastrointestinal reactions, myelosuppression and peripheral neuropathy.
- Gastrointestinal reactions
Nausea, vomiting, and poor appetite are some examples of gastrointestinal reactions caused by chemotherapy. TCM would use nourishing herbs such as astragalus root and codonopsis root, to prevent or relieve these side effects.7 It will improve the completion rate of chemotherapy and promote patient’s early recovery.
With the help of Chinese herbs, such as Psoralea corylifolia and Rehmannia glutinosa. It helps stimulate bone marrow hematopoiesis, improving blood count and prevent leukopenia.8
- Peripheral neuropathy
Oxaliplatin is a commonly used chemotherapy drug for the treatment of colorectal cancer. However peripheral neurotoxicity (dose-limiting toxicity) usually occurring more than 30 per cent of the time, causes symptoms like numbness or abnormal feeling (foreign body sensation and pins and needles feeling) at distal limb and will worsen in cold environment. Herbs such as notoginseng and turmeric can help promote blood circulation to lessen or prevent the side effects.
- Assist in radiotherapy
Radiation therapy is also one of the important approaches in cancer treatment. It can prevent local recurrence and lessen patient’s symptoms. However, radiotherapy has the same toxic effect on the surrounding normal tissue cells while inhibiting or killing the cancer cells. The toxic side effects and sequelae often lead to declining quality of life in patients, affecting the effectiveness of radiotherapy.
TCM could alleviate the side effects of radiotherapy while enhancing its efficacy.9,10 Common side effects are dry mouth, thirst, sore throat, dry cough, and shortness of breath. Serious side effects such as hematemesis, hemoptysis and blood stool, can be resolved with the help of Chinese herbs such as reed rhizome and cogongrass rhizomes. In addition, patient who took nourishing herbs two to four days before radiotherapy, can reduce the occurrence of radiation damage and will have a better therapeutic effect than those who used after radiation damage occurred.
- Molecular targeted therapy
Molecular targeted therapy is a new type of cancer treatment. It works by targeting the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. These genes and proteins are found in cancer cells or in cells related to cancer growth, like blood vessel cells.
Ever since its application, it has achieved remarkable results, because of its high selectivity, low toxicity, high therapeutic index and long-term medication. It has become a milestone in cancer treatment. However, with the widely used of molecular targeted drugs, adverse reactions such as rashes and diarrhoea gradually emerge. Some patients have only mild side effects, but some intolerant ones are seen having severe side effects.11 TCM uses herbs such as Japanese honeysuckle, forsythia suspensa and paeonia suffruticosa root for the rashes; Atractylodes rhizome and Wolfiporia extensa herbs to ease diarrhoea side effects.
Personalise TCM palliative care, surviving with cancer
The goal of modern conventional cancer treatment is to heal the tumour, enabling the patient to achieve "cancer-free survival." As in radical surgery, excision of the primary tumour or visible metastatic lesion, including normal tissue with potential malignant transformation around the tumour. Radiotherapy and chemotherapy also follow the "curative treatment" concept, by maximising the killing of cancer cells with radioactive rays or chemicals, in the hope of curing the cancer.
Theoretically, "curative treatment" concept can reduce cancer recurrence and metastasis effectively. However, doctors often encounter the problem of "over-treatment" that is the intensity of treatment exceeds the area of tumour invasion and patient’s level of tolerance, which results in undesirable effects.
Personalising care for each and every patient is very crucial in TCM concepts. In view of the “over treatment”, TCM advocates “Personalise therapy” based treatment, through the evaluation of patient’s physical status, frailty and mental health, to prescribe the right formula for them, in order to fight cancer with a sturdy body, in the hope to improve the quality of their life while extending their lifespan. Especially, late stage and advanced age patients who have declined physically and immunity, they are often intolerant of surgery, radiotherapy and chemotherapy etc. As a consequence, their five years survival rate drop drastically. Such patients could choose the appropriate TCM palliative care that advocate “to live with the disease and survive with the cancer”.
Clinically, we have seen patients who seek TCM complementary treatment, and have controlled the progression of cancer, giving them another treatment opportunity. Not only did these patients successfully crossed the death period predicted by doctors, their symptoms were significantly alleviated, their weight increased, and their quality of life was greatly improved. Some even went back to work. “Building up the immunity, suppressing the cancer and surviving with cancer” treatment concept is the advantages of TCM in cancer therapy.12
In China, there are numerous clinical trials using Chinese medicine in treating cancer.13 In Asia, there are many patients who seek after Chinese medicine, but they are too intimidated by their doctors to seek alternative treatments.14 Thus, they will not review the truth to their doctors, keeping it a secret and problem arises when patient consumes chinese medicine without consulting TCM physician, as the herbs or products are not personalised for their body.
Since the dawn of science, scientist have been using scientific means to prove the ancient TCM theory and their effectiveness.15 In this modern world, where east meet west, doctors should keep an open mind, while monitoring their patients’ health when integrating TCM with western medicine. After all, both western doctor and TCM physician want the patient to get the best out of their treatment. Therefore, integrating both western and eastern medicine truly merges both worlds of cancer medicine into a single, potentially powerhouse approach.
The above mention herbs are some of the examples that would be used in some common circumstances. It should only be used under physician’s close supervision as personalised and individualised prescriptions are always given based on syndrome differentiation to specific patient.
- Freddie Bray BSc, MSc, PhD,Jacques Ferlay ME,Isabelle Soerjomataram MD, MSc, PhD,Rebecca L. Siegel MPH,Lindsey A. Torre MSPH,Ahmedin Jemal PhD, DVM. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA: A Cancer Journal for Clinicians,2018,68(6).
- Wang WJ, Zhang T. Integration of traditional Chinese medicine and Western medicine in the era of precision medicine. J Integr Med. 2017; 15(1): 1–7.
- Li Xun,Yang Guoyan,Li Xinxue,Zhang Yan,Yang Jingli,Chang Jiu,Sun Xiaoxuan,Zhou Xiaoyun,Guo Yu,Xu Yue,Liu Jianping,Bensoussan Alan. Traditional Chinese medicine in cancer care: a review of controlled clinical studies published in chinese.[J]. PloS one,2013,8(4).
- Dan Jiang,Fan-Yi Meng,Lily Li,Fan Qu.The Role of Chinese Medicine in Cancer Care——a Critical Review[J]. World Journal of Traditional Chinese Medicine,2016,2(01):68-73.
- YANG Yu-fei,GE Jian-zhong,WU Yu,XU Yun,LIANG Bi-yan,LUO Lin,WU Xian-wen,LIU Duan-qi,ZHANG Xia,SONG Fei-xiang,GENG Zhen-ying. Cohort study on the effect of a combined treatment of traditional Chinese medicine and Western medicine on the relapse and metastasis of 222 patients with stage II and III colorectal cancer after radical operation.[J]. Chinese Journal of Integrated Medicine,2008,14(4).
- Wang Qin,Jiao Lijing,Wang Shengfei,Chen Peiqi,Bi Ling,Zhou Di,Yao Jialin,Li Jiaqi,Chen Zhiwei,Jia Yingjie,Zhang Ziwen,Shen Weisheng,Zhu Weirong,Xu Jianfang,Gao Yong,Gong Yabin,Xu Ling. Maintenance Chemotherapy With Chinese Herb Medicine Formulas vs. With Placebo in Patients With Advanced Non-small Cell Lung Cancer After First-Line Chemotherapy: A Multicenter, Randomized, Double-Blind Trial.[J]. Frontiers in pharmacology,2018,9.
- Wu T, Munro AJ, Guanjian L, Liu GJ. Chinese medical herbs for chemotherapy side effects in colorectal cancer patients. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD004540. DOI: 10.1002/14651858.CD004540.pub2.
- Li Yu,Xiong Chan,Qin Erqi,Li Lin,Zhuang Guangtong,Yu Zheng. Effectiveness of Traditional Chinese Medicine on chemo-radiotherapy induced leukaemia in patients with lung cancer: a Meta-analysis[J]. Journal of Traditional Chinese Medicine,2018,38(5).
- Wang Cong,Wang Peiguo,Ouyang Huaqiang,Wang Jing,Sun Lining,Li Yanwei,Liu Dongying,Jiang Zhansheng,Wang Bin,Pan Zhanyu. Efficacy of Traditional Chinese Medicine in Treatment and Prophylaxis of Radiation-Induced Oral Mucositis in Patients Receiving Radiotherapy: A Randomized Controlled Trial.[J]. Integrative cancer therapies,2018,17(2).
- Hsu Pei-Yu,Yang Sien-Hung,Tsang Ngan-Ming,Fan Kang-Hsing,Hsieh Chia-Hsun,Lin Jr-Rung,Hong Ji-Hong,Lin Yung-Chang,Chen Hsing-Yu,Yang Cheng-Tao,Yang Ching-Wei,Chen Jiun-Liang. Efficacy of Traditional Chinese Medicine in Xerostomia and Quality of Life during Radiotherapy for Head and Neck Cancer: A Prospective Pilot Study.[J]. Evidence-based complementary and alternative medicine : eCAM,2016,2016.
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- 15.Xu Lingyan,Zhao Wenjun,Wang Dongmei,Ma Xinran. Chinese Medicine in the Battle Against Obesity and Metabolic Diseases.[J]. Frontiers in physiology,2018,9.
Physician Ng Pu Jue is a registered Chinese physician under the Traditional Chinese Medicine Practitioners Board in Singapore. He is an understudy in oncology group at the Singapore Chung Hwa Medical Institution. He is a member of the Singapore Chinese physicians’ association and a PhD student at Nanjing University of Chinese Medicine.