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Supportive Care in Cancer
Published in: Supportive Care in Cancer 3/2014

01-03-2014 | Review Article

A systematic review and meta-analysis on the use of traditional Chinese medicine compound kushen injection for bone cancer pain

Authors: Bao Yanju, Liping Yang, Baojin Hua, Wei Hou, Zhan Shi, Weidong Li, Conghuang Li, Cihui Chen, Rui Liu, Yinggang Qin, Wenliang Lv

Published in: Supportive Care in Cancer | Issue 3/2014

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Abstract

Purpose

Bone cancer pain presents a clinical challenge with limitations of current treatments. Compound kushen injection (CKI) is a well-known traditional Chinese medicine (TCM) formulation in treatment of patients with bone cancer pain. The objective of this study is to assess the efficacy and safety of CKI for bone cancer pain.

Methods

A systematic literature search was conducted in nine databases until December 2012 to identify randomized controlled trials (RCTs) of CKI versus current western therapies for bone cancer pain. The primary outcome was total pain relief rate. The secondary outcomes were the quality of life and adverse events at the end of treatment course. The methodological quality of RCTs was assessed independently using six-item criteria according to the Cochrane Collaboration, and the level of evidence was assessed by the GRADE approach. All data were analyzed using Review Manager 5.1.0.

Results

Seven RCTs with 521 patients from 2010 to 2012 were identified. Compared with radiotherapy or bisphosphonates, seven RCTs showed significant effects of CKI for improving pain relief in patients with bone cancer pain (n = 521, risk ratio (RR) = 1.25, 95 % CI (95 % confidence intervals (CI)), 1.13 to 1.38, p < 0.0001)), three RCTs for improving Karnofsky scoring (KPS) increase rate (n = 305, RR = 1.62, 95 % CI, 1.32 to 1.99, p < 0.00001), 1 RCT for increasing KPS scores (n = 78, mean difference (MD) = 10.43, 95 % CI 4.76 to 16.10, p = 0.0003). 4 RCTs reported adverse effects in both the treatment and control groups. The patients treated with CKI achieved statistically significant reductions of incidences of leukopenia (n = 276, RR = 0.32, 95 % CI, 0.21 to 0.47, p < 0.00001) and nausea (n = 78, RR = 0.15, 95 % CI, 0.06 to 0.34, p < 0.00001). No severe adverse events were found and no treatment was stopped because of adverse events of CKI in the treatment groups. However, the studies were deemed to have a high risk of bias.

Conclusion

This systematic review showed positive but weak evidence of CKI for bone cancer pain because of the poor methodological quality and the small quantity of the included trials. Future rigorously designed RCTs are required.
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Metadata
Title
A systematic review and meta-analysis on the use of traditional Chinese medicine compound kushen injection for bone cancer pain
Authors
Bao Yanju
Liping Yang
Baojin Hua
Wei Hou
Zhan Shi
Weidong Li
Conghuang Li
Cihui Chen
Rui Liu
Yinggang Qin
Wenliang Lv
Publication date
01-03-2014
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 3/2014
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-013-2063-5

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