Optimization Of TCM Dynamic Intervention Treatment Strategy For Advanced Colorectal Cancer And Preliminary Exploration Of Health Economic

Background:Global Cancer Statistics 2020 shows that colorectal cancer ranks third in cancer incidence at 10%of all cancers and second in cancer mortality at 9.4%of total cancer deaths.Nearly 50%of colorectal cancer(CRC)patients will gradually develop metastases over time,and most mCRC patients cannot be cured.While the level of treatment for mCRC is constantly improving,survival benefits are also increasing,but the resulting economic burden is becoming heavier and the decline in quality of life needs more attention.Integrative Chinese and Western medicine,as a unique treatment method in China,plays an important role in the treatment of mCRC.However,the dynamic changes of the disease and personalized treatment based on syndrome differentiation and treatment make it difficult to form standardized recommendations.In addition,because mCRC is difficult to cure,the cost of treatment and quality of life become important factors affecting patient and physician treatment decisions.Therefore,developing a dynamic optimal intervention treatment strategy model for late-stage colorectal cancer in traditional Chinese medicine to improve clinical efficiency,while considering treatment costs and quality of life,is an important problem that needs to be urgently addressed in clinical practice.It can also benefit both doctors and patients.Optimization of Traditional Chinese Medicine Treatment Recommendation Model for Advanced Colorectal CancerObjective:Based on the previous Traditional Chinese Medicine(TCM)treatment recommendation model for advanced colorectal cancer(CRC),follow-up was conducted on patients who had not yet reached the survival outcome,and the model was updated and optimized in a timely manner.Methods:Telephone follow-up was conducted on 103 previously enrolled metastatic colorectal cancer(mCRC)patients who had not yet reached the survival outcome.Building upon the previous model,patients were divided into three groups:pure TCM treatment,TCM treatment as an adjunct to Western medicine,and combined TCM and Western medicine treatment.Survival time was used as the final evaluation indicator,and multiple decision factors were determined as covariates(including age,site and resection status of the disease,site of metastasis,pathological classification,genetic classification,initial treatment status at outpatient clinics,ECOG performance status,TCM syndrome differentiation,TCM intervention time,etc.).The survival data were re-calculated using the Cost-Sensitive Classification Learning for Survival(CSCLSurv)algorithm to optimize the TCM treatment recommendation model based on the latest follow-up data.Results:In this study,follow-up was conducted on patients who had not reached the survival outcome,obtaining the latest survival data.The data were strictly included according to the inclusion criteria for the population with advantages in TCM.A total of 189 subjects were included in the study,but due to loss to follow-up or other reasons,20 subjects were excluded.The actual analysis population consisted of 169 individuals,with a loss rate of 14.6%,which was 14.3%lower than that of the previous model.The consistency rate of the model was 55%,a 13%improvement compared to the previous model.Conclusion:Conducting follow-up on patients and updating the data based on the previous "TCM treatment recommendation model for advanced colorectal cancer" can significantly reduce the data loss rate.Limiting the model selection to the population with advantages in TCM can significantly improve the model performance and increase the consistency of the TCM treatment recommendation model for advanced colorectal cancer.Exploratory Study of Health Economics Based on the Traditional Chinese Medicine Treatment Recommendation Model for Advanced Colorectal CancerObjective:Through health economic analysis of model cases,this study aims to explore the cost-effectiveness of Traditional Chinese Medicine(TCM)based on the model.It provides reference for clinicians to comprehensively consider medical expenses after integrating the model’s predictive results,thereby increasing the rationality of treatment recommendations.Methods:In order to improve the practicality of the Traditional Chinese Medicine Treatment Recommendation Model for advanced colorectal cancer in real-world applications,this study explores the health economics of pure TCM treatment,TCM treatment as an adjunct to Western medicine,and combined TCM and Western medicine treatment in an exploratory manner.Quality-adjusted life years(QALYs)were used as the health economic evaluation indicator to compare the differences in health economics between treatment plans that followed the model recommendations and those that did not.The treatment plan following the model recommendation was labeled as the "optimal treatment group," while the others were labeled as the "non-optimal treatment group." The cost per unit of QALY was calculated based on ECOG performance status,survival time,and total costs.The results of the two groups were compared.Results:Cost information was extracted from the 169 patients enrolled in Study 1,and finally,161 patients met the requirements and were included in the health economic analysis.Based on whether the treatment plan followed the recommendations of the TCM treatment recommendation model,patients were classified into the "optimal treatment group" if their actual treatment plan matched the model’s optimal treatment recommendation,and into the"non-optimal treatment group" if they did not.The results of the two groups showed that among deceased patients,those who followed the optimal treatment plan had a cost of 15.54 yuan per unit of QALY,which was a 30.9%decrease compared to 22.49 yuan per unit of QALY for those who did not receive the optimal treatment plan.Conclusion:The "optimal treatment group" has higher economic efficiency compared to the "non-optimal treatment group."Professor Yang Yufei’s Research on the Medication Regularities of Traditional Chinese Medicine for Advanced Colorectal CancerObjective:By summarizing a large number of prescriptions,explore the medication regularities of traditional Chinese medicine for the treatment of advanced colorectal cancer,and provide data for further improving specific medication models in the future.Methods:From November 2015 to January 2023,the study focused on patients with metastatic colorectal cancer(mCRC)who received treatment at the outpatient department of the Xiyuan Hospital,China Academy of Chinese Medical Sciences,under the care of Professor Yang Yufei.A total of 677 mCRC patient medical records were collected and organized,comprising 4,369 prescriptions of traditional Chinese medicine.Microsoft Excel 2019 was used to extract and standardize information such as TCM patterns,disease symptoms,prescriptions,tongue and pulse examination findings,and standardized names.The overall medication usage was summarized through frequency statistics,association rule analysis,and cluster analysis.Results:Among the 677 included patients with metastatic colorectal cancer(mCRC),a total of 4,369 traditional Chinese medicine(TCM)prescriptions were collected.The main pattern identification in TCM was dual organ pattern identification,with a mixture of deficiency and excess patterns.Common deficiency patterns included spleen-kidney deficiency(28.10%),liver-depression spleen deficiency(25.08%),and liver-kidney deficiency(10.81%).The main excess pattern was phlegm-stasis intermingling(75.10%).The most commonly described symptoms in the medical records were fatigue,poor sleep,nocturia,unformed stools,diarrhea,poor appetite,and abdominal distension.Common tongue manifestations included dark or red with teeth marks and cracks.Pulse manifestations commonly observed were wiry pulse,thin pulse,and rapid pulse.Association rule and cluster analysis of TCM prescriptions yielded multiple medication combinations,such as the combination of Qitu Erzhi Tang and Liu Jun An Wei Tang,and the combination of Liuwei Dihuang Tang.Based on this,commonly used drugs were flexibly employed,such as using Jin Ying Zi and Qian Shi for treating frequent urination.Tian Ma and Gou Teng were used to treat dizziness and headache,and Luo Bu Ma Ye was added if accompanied by hypertension.Huang Jing,Hong Jing Tian,and others were used to nourish and replenish essence.Zhi Ke and Hou Po were used to treat solid constipation.Ge Gen,Huang Qin,and Huang Lian were commonly used for diarrhea.Yan Hu Suo and Bai Qu Cai were used to relieve pain.For liver,metastasis in CRC,Lou Lu and She Liu Gu were commonly used,while when there was liver dysfunction,Ji Gu Cao and Chui Pen Cao were used together.In the case of rapid tumor progression,Nanguo Hong Dou Shan was commonly used.E Zhu and Zhe Bei Mu were combined to resolve depression and dissipate masses,and in the presence of dry mouth and superficial patterns,Chai Hu,Huang Qin,or Gui Zhi,Chi Shao,and Bai Shao were commonly used to expel pathogenic factors.Di Yu and Huai Jiao were used for rectal bleeding.In cases of hemoptysis or blood-streaked sputum,Lu Gen and Bai Mao Gen were commonly used.For patients with lung qi deficiency or yin deficiency,Tian Dong,Mai Dong,Nan Sha Shen,and Bei Sha Shen were commonly used for treatment.If there was lung heat,Sang Bai Pi,Di Gu Pi,and others were used to clear lung heat.Other commonly used antitumor medications included Bai Hua She She Cao and Ban Zhi Lian,Shi Jian Chuan and Gui Jian Yu,etc.Conclusion:The treatment of mCRC follows the principles of tonifying the spleen,nourishing the kidneys,and resolving toxins.Commonly used prescriptions for tonifying the spleen and nourishing the kidneys include Qitu Erzhi Tang,Liu Jun An Wei Tang,Liuwei Dihuang Tang,and others.The use of detoxification prescriptions is often based on individual TCM pattern identification and involves flexible adjustment of medication.