Supportive Care in Cancer

, Volume 27, Issue 12, pp 4515–4524 | Cite as

Evaluation of chemotherapy-induced toxicity and health-related quality of life amongst early-stage breast cancer patients receiving Chinese herbal medicine in Malaysia

  • Ai Ch’i LiewEmail author
  • Kok-Khiang Peh
  • Boon Seang Tan
  • Wei Zhao
  • Balamurugan Tangiisuran
Original Article



This observational study aimed to compare the outcome and health-related quality of life (HRQOL) amongst breast cancer patients using Chinese herbal medicine (CHM) and those not using CHM during chemotherapy.


A prospective, non-randomised longitudinal study was conducted in two government integrated hospitals over an 8-month period. Early-stage breast cancer patients who were (1) either already using complementary and alternative medicine (CAM) or not and (2) who were on a regime of 5-fluorouracil, epirubicin, and cyclophosphamide were included in the study. Patients who agreed to receive CHM were assigned to receive individualised CHM prescriptions deemed suitable for the individual at a particular time. Those who were not willing to take Chinese herbal medicines (CHM) were assigned to the non-CHM control group. Blood profile and chemotherapy-induced AE were recorded whilst HRQOL assessment was done using the EORTC QLQ-C30 questionnaire on first, third, and sixth cycles.


Forty-seven patients [32 female vs. 1 male, p = 0.31; mean year of age: 52.2(SD = 7.6), p = 0.28)}] were recruited during the study period. Demographics of both groups were comparable. Fifty percent of respondents reported using some kind of CAM before chemotherapy. Diet supplements (40.6%) were the most common CAM used by the respondents. The study showed that patients using CHM had significantly less fatigue (p = 0.012), nausea (p = 0.04), and anorexia (p = 0.005) during chemotherapy. There were no significant differences in patients’ HRQOL (p = 0.79). There were no AEs reported during the study.


The use of CHM as an adjunct treatment with conventional chemotherapy have been shown to reduce fatigue, nausea, and anorexia in breast cancer patients but did not reduce chemotherapy-associated hematologic toxicity. The sample size of this study was not powered to assess the significance of HRQOL between two groups of patients.


Chinese herbal medicine Integrated medicine Health-related quality of life Chemotherapy-induced adverse events Breast cancer 



This study is supported by research development Ministry of Health of Malaysia. We would like to thank the Director General of Health for permission to publish the article. We would also like to thank Associate Professor Lim Kean Ghee and Dr. Andrew Kiyu for their proofreading and advice in writing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376CrossRefGoogle Scholar
  2. 2.
    Adams M, Jewell AP (2007) The use of complementary and alternative medicine by cancer patients. Int Semin Surg Oncol 4:7CrossRefGoogle Scholar
  3. 3.
    Bensoussan A, Talley NJ, Hing M, Menzies R, Guo A, Ngu M (1998) Treatment of irritable bowel syndrome with Chinese herbal medicine: a randomized controlled trial. JAMA 280:1585–1589CrossRefGoogle Scholar
  4. 4.
    Burstein HJ, Gelber S, Guadagnoli E, Weeks JC (1999) Use of alternative medicine by women with early-stage breast cancer. N Engl J Med 340:7CrossRefGoogle Scholar
  5. 5.
    Chan KKL, YAO TJ, Jones B, Zhao JF, Ma FK, Leung CY, Lau SK, Yip MW, Ngan HYS (2011) The use of Chinese herbal medicine to improve quality of life in women undergoing chemotherapy for ovarian Cancer: a double-blind placebo-controlled randomized trial with immunological monitoring. Ann Oncol 22:9CrossRefGoogle Scholar
  6. 6.
    Chao L-F, Zhang AL, Liu H-E, Cheng M-h, Lam H-B, Lo SK (2009) The efficacy of acupoint stimulation for the management of therapy-related adverse events in patients with breast cancer: a systematic review. Breast Cancer Res Treat 118:255–267CrossRefGoogle Scholar
  7. 7.
    Chen S, Flower A, Ritchie A, Liu J, Molassiotis A, Yu H, George L (2010) Oral Chinese herbal medicine (CHM) as an adjuvant treatment during chemotherapy for non-small cell lung cancer: a systematic review. Lung Cancer 68:8CrossRefGoogle Scholar
  8. 8.
    Cochrane S, Smith CA, Possamai-Inesedy A, Bensoussan A (2014) Acupuncture and women’s health: an overview of the role of acupuncture and its clinical management in women’s reproductive health. Int J Women's Health 6:313–325CrossRefGoogle Scholar
  9. 9.
    Cui Y, Shu X-O, Gao Y, Wen W, Ruan Z-X, Jin F, Zheng W (2004) Use of complementary and alternative medicine by Chinese women with breast cancer. Breast Cancer Res Treat 85:263–270CrossRefGoogle Scholar
  10. 10.
    Damery S, Gratus C, Grieve R, Warmington S, Jones J, Routledge P, Greenield S, Dowswell G, Sherriff J, Wilson S (2011) The use of herbal medicines by people with cancer: a cross-sectional survey. Br J Cancer 104:7CrossRefGoogle Scholar
  11. 11.
    Dong TTX, Zhao KJ, Gao QT, Ji ZN, Zhu TT, Li J, Duan R, Cheung AWH, Tsim KWK (2006) Chemical and biological assessment of a Chinese herbal decoction containing Radix astragali and Radix angelicae sinensis: determination of drug ratio in having optimized properties. J Agric Food Chem 54:2767–2774CrossRefGoogle Scholar
  12. 12.
    Downer SM, Cody MM, Cluskey PM, Arnott SJ, Lister TA, Slevin ML (1994) Pursuit and practice of complementary therapies by cancer patients receiving conventional treatment. BMJ 309:4CrossRefGoogle Scholar
  13. 13.
    EORTC (2001) EORTC QLQ-C30 scoring manual. In: Editor (ed)^(eds) Book EORTC QLQ-C30 scoring manual. European Organisation for Research and Treatment of Cancer, Brussels 2001, City, pp 78Google Scholar
  14. 14.
    Gao Y, Chen Y (2000) Advances in the study of the effects of danggui buxue decoction and its modified recipes on immunity and hematopoietic function. Zhong Yao Cai 23:177–180PubMedGoogle Scholar
  15. 15.
    Guo L, Bai S-P, Zhao L, Wang X-H (2011) Astragalus polysaccharide injection integrated with vinorelbine and cisplatin for patients wit advanced non-small cell lung cancer: effects on quality of life and survival. Med Oncol 29:1656-62Google Scholar
  16. 16.
    Hasan SS, Ahmed SI, Bukhari NI, Loon WCW (2009) Use of complementary and alternative medicine among patients with chronic diseases at outpatient clinics. Complement Ther Clin Pract 15:152–157CrossRefGoogle Scholar
  17. 17.
    Hisham AN, Yip C-H (2004) Overview of breast Cancer in Malaysian women: a problem with late diagnosis. Asian J Surg 27:130–133CrossRefGoogle Scholar
  18. 18.
    Huang G-C, Wu L-S, Chen L-G, Yang L-L, Wang C-C (2007) Immuno-enhancement effects of Huang Qi Liu Yi Tang in a murine model of cyclophosphamide-induced leucopenia. J Ethnopharmacol 109:229–235CrossRefGoogle Scholar
  19. 19.
    Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61:69–90CrossRefGoogle Scholar
  20. 20.
    Lall R, Mistry D, Bridle C, Lamb SE (2012) Telephone interviews can be used to collect follow-up data subsequent to no response to postal questionnaires in clinical trials. J Clin Epidemiol 65:90–99CrossRefGoogle Scholar
  21. 21.
    Lee JJ, Lee JJ (2010) A phase II study of an herbal decoction that includes Astragali Radix for cancer-associated anorexia in patients with advanced cancer. Integr Cancer Ther 9:8Google Scholar
  22. 22.
    Li P, Qi L-W, Liu EH, Zhou J-L, Wen X-D (2008) Analysis of Chinese herbal medicines with holistic approaches and integrated evaluation models. TrAC Trends Anal Chem 27:66–77CrossRefGoogle Scholar
  23. 23.
    Li SG, Chen HY, Ou-Yang CS, Wang XX, Yang ZY (2013) The efficacy of chinese herbal medicine as an adjunctive therapy for advanced non-small cell lung cancer: a systematic review and meta-analysis. PLoS One 8(2):e57604CrossRefGoogle Scholar
  24. 24.
    Li X-J, Zhang H-Y (2008) Synergy in natural medicines: implications for drug discovery. Trends Pharmacol Sci 29:331–332CrossRefGoogle Scholar
  25. 25.
    MacLennan AH, Wilson DH, Tailor AW (2002) The escalating cost and prevalence of alternative medicine. Prev Med 35:166–173CrossRefGoogle Scholar
  26. 26.
    Maskarinac G, Shimmy DM, Kakai H, Gouty CC (2000) Ethnic difference in complementary and alternative medicine use among cancer patients. J Altern Complement Med 6:8Google Scholar
  27. 27.
    Maskarinec G, Shumay DM, Kakai H, G CC (2000) Ethinic differences in complementary and alternative medicine use among cancer patients. J Altern Complement Med 6:8CrossRefGoogle Scholar
  28. 28.
    Mok TSK, Yeo W, Johnson PJ, Hui P, Ho WM, Lam KC, Xu M, Chak K, Chan A, Wong H, Mo F, Zee B (2007) A double-blind placebo-controlled randomized study of Chinese herbal medicine as complementary therapy for reduction of chemotherapy-induced toxicity. Ann Oncol 18:768–774Google Scholar
  29. 29.
    Molassiotis A, Fernadez-Ortega P, Pud D, Ozden G, Scott JA, Panteli V, Margulies A, Browall M, Magri M, Selvekerova S, Madsen E, Milovics L, Bruyns I, Gudmunsdottir G, Hummerston S, Ahmad AMA, Platin N, Kearney N, Patiraki E (2005) Use of complementary and alternative medicine in cancer patients: a European survey. Ann Oncol 16:9CrossRefGoogle Scholar
  30. 30.
    Naranjo CA, Usoa Busto M, Sellers E, Sandor P, Ruiz I, Roberts EA, Janecek E, Domecq C, Greenblatt DJ (1981) A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 30:7CrossRefGoogle Scholar
  31. 31.
    Navo MA, Phan J, GVaughan C, Plalmer JL, Michaud L, Jones KI, Bodurka DG, Basen-Engquist K, Hortobogyi GN, Kavanagh JJ, Smith JA (2004) An assessment of the utilization of complementary and alternative medication in women with gynecologic or breast malignancies. J Clin Oncol 22:7CrossRefGoogle Scholar
  32. 32.
    National Institutes of Health NCI (2009) Common Terminology Criteria for Adverse Events (CTCAE)V..4.0. p.190Google Scholar
  33. 33.
    Norsa'adah B, Rampal KG, Rahmah MA, Naing NN, Biswal BM (2011) Diagnosis delay of breast cancer and its associated factors in Malaysian women. BMC Cancer 11:8Google Scholar
  34. 34.
    Oh B, Butow P, Mullan B, Beale P, Pavlakis N, Rosenthal D, Clarke S (2010) The use and perceived benefits resulting from the use of complementary and alternative medicine by cancer patients in Australia. Asia Pac J Clin Oncol 6:8CrossRefGoogle Scholar
  35. 35.
    Reid K (2015) Chinese herbal medicine for female infertility: an updated meta-analysis complementary therapies in. Medicine 23:13Google Scholar
  36. 36.
    Richardson MA, Sanders T, Lynn Palmer J, Greisinger A, Eva Singletary S (2000) Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology. J Clin Oncol 18:10CrossRefGoogle Scholar
  37. 37.
    Scott NW, Fayers P, Aaronson NK, Bottomley A, de Graeff A, Groenvold M, Gundy C, Koller M, Petersen MA, Sprangers MA (2008) EORTC QLQ-C30 reference values. In: Editor (ed)^(eds) Book EORTC QLQ-C30 Reference Values. EORTC, CityGoogle Scholar
  38. 38.
    Shih V, Chiang JYL, Chan A (2009) Complementary and alternative medicine (CAM) usage in Singaporean adult cancer patients. Ann Oncol 20:752–757CrossRefGoogle Scholar
  39. 39.
    Siti ZM, Tahir A, Farah AI, Fazlin SMA, Sondi S, Azman AH, Maimunah AH, Haniza MA, Siti Haslinda MD, Zulkarnain AK, Zakiah I, Zaleha WCW (2009) Use of traditional and complementary medicine in Malaysia: a baseline study. Complement Ther Med 17:292–299CrossRefGoogle Scholar
  40. 40.
    Xu L, Li H, Xu Z, Wang Z, Liu L, Tian J, Sun J, Zhou L, Yao Y, Jiao L, Su W, guo H, Chen P, Liu J (2012) Multi-center randomized double-blind controlled clinical study of chemotherapy combined with or without traditional Chinese medicine on quality of life of postoperative non-small cell lung cancer patients. BMC Complement Altern Med 12:6Google Scholar
  41. 41.
    Zhang W, Leonard T, Bath-Hextall FJ, Chambers C, Lee C, Humphreys R, Williams HC (2004) Chinese herbal medicine for atopic eczema. Cochrane Database Syst Rev 18:4Google Scholar
  42. 42.
    Zhao FR, Mao HP, Zhang H, Hu LM, Wang H, Wang YF, Yanagihara N, Gao XM (2010) Antagonistic effects of two herbs in Zuojin Wan, a traditional Chinese medicine formula, on catecholamine secretion in bovine adrenal medullary cells. Phytomedicine 17:659–668CrossRefGoogle Scholar
  43. 43.
    Zhuang S-R, Chen S-L, Tsai J-H, Huang C-C, Wu T-C, Liu W-S, Tseng H-C, Lee H-S, Huang M-C, Shane G-T, Yang C-H, Cheng S-Y, Yan Y-Y, Wang C-K (2009) Effect of citronellol and the Chinese medical herb complex on cellular immunity of cancer patients receiving chemotherapy/ radiotherapy. Phytother Res 23:6CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Clinical Research CentreHospital Seberang JayaPeraiMalaysia
  2. 2.School of Pharmaceutical SciencesUniversiti Sains MalaysiaGelugorMalaysia
  3. 3.Department of Clinical Oncology and RadiotherapyPenang General HospitalGeorge TownMalaysia
  4. 4.Traditional Chinese Medicine Oncology PhysicianGuang’anmen Hospital (of Traditional Chinese Medicine), BeijingBeijingChina
  5. 5.National Poison CentreUniversiti Sains MalaysiaGelugorMalaysia

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