Ancient remedies find a fresh role: integration with modern treatments
Conventional treatments for many cancers - lung, colorectal, breast and liver, for example - don't offer much success, especially if diagnosed in later stages, according to Professor Bian Zhaoxiang, acting dean of the school of Chinese medicine at Baptist University. That is why his team of traditional Chinese medicine (TCM) oncology specialists and the Hong Kong Anti-Cancer Society have been collaborating on an integrative clinical approach.
For two years, the team has been conducting an outpatient pilot study to assess patient response to combined approach of conventional chemotherapy treatments integrated with TCM. 'The integrative approach is the new direction for oncology, and because it's safe, it's working,' says Bian.
Although stronger data and more evidence are needed, Bian says this approach has shown to improve the quality of life for cancer patients during and after highly toxic courses of chemotherapy treatment.
There are more than 50 different cytotoxic chemotherapy drugs, with side effects such as fatigue, nausea, diarrhoea, constipation, visceral pain, insomnia, loss of appetite, weakened immune system and vulnerability to bacterial or viral infections. In the pilot study led by Bian, patients experienced a significant reduction in side effects such as nausea and were able to sleep better and function at a relatively high level.
'After taking the Chinese herbs, many patients were able to increase the potency of their chemotherapy treatment, which, in turn, increased their overall chance for improved survival rates,' says Bian. 'Patients also indicated they felt happier, which is significant, as most of these patients might be living longer, but aren't living well.'
He believes the future is bright for an integrative medical approach, especially where cure rates are low. Based on these and other protocols, Baptist University's school of Chinese medicine will now begin clinical trials for further study.
In Hong Kong, the number of new cancer patients rose from 8,900 in the mid-1970s to about 26,000 in 2009. Lung, colorectal, breast, liver, prostate, stomach, nasopharynx, non-melanoma skin, non-Hodgkin's lymphoma and corpus uteri cancers account for 75 per cent of all new cancer cases and will continue to rise at a steady rate, according to the Hong Kong Cancer Registry website. The top two leading cancers - in both incidence and mortality rate - are lung, first, and colorectal.
Dr Joshua Ko Ka-shun, associate professor at Baptist University's Centre for Cancer and Inflammation Research, has been studying the effects of Chinese herbs on colorectal cancer patients. He has witnessed the reversal of low white blood cell count, or leucopenia; the restoration of depleted platelets; and a reduction of pain, such as neuropathy, in patients. 'Western drugs retain their potency, but Chinese medicine minimises side effects and strengthens immunity, giving people a fighting chance,' Ko says.
Worldwide, particularly in the US and Europe, medical schools are also beginning to take notice. Tommy Cheng Yung-chi, professor of pharmacology at the Yale University School of Medicine and honorary professor at SCM, has made some profound discoveries about the therapeutic effects of Chinese medicine on chemotherapy cancer treatments. Named as one of Yale's most prolific inventors, Cheng created a botanical drug called PHY906 to reduce the toxic effects of chemotherapy based on a 1,800-year-old ancient herbal remedy. Cheng, in conjunction with the US National Cancer Institute, is exploring PHY906's mechanism of action and what the future might hold for its therapeutic promise.
According to a survey conducted last year at Baptist University, more than half of the 786 cancer patients interviewed in outpatient clinics in Hong Kong were using at least one form of Chinese medicine along with Western treatments, and more than two-thirds of those in this group were not telling their oncologists. This is a dangerous practice because the risk of contraindications is high without monitoring, and certain Chinese compounds may interfere with conventional treatment.
The key reason for keeping quiet is physicians' attitudes toward TCM, which are sceptical at best. Baptist University researchers found most oncologists and general physicians have too many theoretical concerns about Chinese medicine, so they forbid it. Curiously, when patients have finished a six-week course of chemotherapy treatment, they are often told that the hospital can no longer do anything for them, whereas patients in the final stages of cancer are advised to use alternative therapies for relief.
According to Ko, while cannabis and morphine are generally perceived to be drugs which can effectively reduce pain, neither of these offers long-term, sustainable relief. Cannabis acts on the central nervous system, he says, 'so a patient's increased tolerance makes it ineffective after a month or two. Morphine can be used only short term or in the final stages of cancer as it adversely affects the heart and brain.'
Professor Tony Mok Shu-kam of Chinese University's department of clinical oncology, named the leading light in Hong Kong oncology by medical journal The Lancet last year, believes that Chinese medicine has merits; but until there is evidence to support its efficacy, he won't depend on it. 'There is a reasonable amount of evidence for the use of acupuncture for pain control or to reduce the state of nausea,' says Mok, but he adds that Chinese medicine will be used only by a few patients, such as those who refuse pain medication or wish to supplement conventional treatments.
Mok is focusing on investigating drugs that target the molecular characteristics of a tumour, and has had a 70 per cent success rate in non-small-cell lung cancer patients. 'One of my patients told me: 'Your pill worked really well with my Chinese medicine', and I understand what she means,' he says. 'However, I use science rather than pure belief to cure my patients.'
In the past, toxic herbs were used to treat the highly potent properties of carcinomas, but are no longer used today for fear of fatalities. Instead, many anti-carcinogenic herbs are familiar and often mild in nature. TCM uses decoctions that are generally prescribed following a patient examination. 'Most cancer patients display a heat deficiency as all the Western treatments are cold,' explains Bian. So, to offset the imbalance, different combinations of herbs are used:
Group 1 targets the origin and development of the cancer - for example, barbat skullcap, giant knotweed rhizome, iris rhizome root.
Group 2 tonifies the qi, blood, yin and yang. Examples are ginseng, Chinese desert-thorn, rehmannia root.
Group 3 - such as coix seed, fleece flower root, chuling - modulate the immune system.
Group 4 - such as germinated barley and prepared liquorice root - integrates with other ingredients.