| Objective:To study the efficacy and safety of the treatment of CRF in cancer patients with Ginseng and ginseng related medicine Methods:Literature search of randomized control trial(RCT)studies of clinical study of the treatment of Cancer related fatigue(CRF)in cancer patients with ginseng and ginseng related medicine was conducted.The follow data bases were searched for all the related papers till October 2016:CNKI,?????,??,CBM,CINAHL,EMBASE,Medline,PsycINFO,the Cochrane Library and PubMed.One researcher carefully searched the papers,gathered and assessed information and after checking for Risk of Bias,conducted Meta-analysis employing RevMan5.3 software and Trial Sequential Analysis(TSA)software to assess whether the size of sample for meta-analysis was adequate or not.Results:13 studies with a total of 1326 patients were included for this study.Among the patients,486 were male and 750 were female(2 studies did not give gender of patients).Among the studies,10 from China,1 from Korea,2 from USA.The patient sample sizes ranged from 30 to 364 and age between from 18 to 80 years old,with various types of cancer(mainly lung cancer,rectalcolon cancer,liver cancer and bile duct cancer).All subject presented with symptoms of fatigue and cancer stages ranged from stage I to IV.The follow up periods were from 2 week to 12 week,where 6 studies were considered short period(2 to 4 week)and the other 7 studies were classified as medium period(6 to 12 week).The type of Ginseng and ginseng related medicine intervention in the 13studies include:Shenqi-Fuzheng injection(???????)(6),Ginseng-Yonwing soup(?????)(3),Panax Quinquefolius(4),Panax Ginseng(1)and Ginsenoside(1).Shenqi-Fuzheng injection(???????)250ml IV daily;Ginseng-Yonwing soup(?????)50ml bd IV;,P Quinquefolius 750mg per day,1000mg per day and 2000mg per day,Panax Ginseng 3000mg daily and Ginsenoside 500mg daily.The control groups included: placebo(4),regular treatments(4)and other treatments(5).Placebo was in the form of capsule similar outlook as intervening medication.Regular treatments included analgesic,antiemetic,cough mixture,antiasthmatic,nutritional support and general measures(exercise,educational and cognitive behavior).Other treatments meant chemotherapy.Result:(1)Ginseng and ginseng related medicine treatment vs PlaceboMeta analysis of BFI,FACIT-F and Traditional Chines Medicine(TCM)symptoms revealed Ginsenoside was more effective than placebo in the treatment of CRF in short term follow up.But with TSA testing showing the sample size was not adequate and further testing was necessary.Meta analysis of MFSI and POMS,Panax Quinquefolius was more effective than placebo in improving body fatigue and improving insomnia in medium term follow up group.Result for patient assessed with WHOQOL-BREF and GHQ-12,P Ginseng was more effective than placebo in improving the quality of life especially in psychological health.There was no report on the efficacy of Ginseng treatment vs placebo in the dealing with the improvement of functional status and immune function.(2)Ginseng related medicine combined with regular treatment vs regular treatment alone The combined treatment of Shenqi-fuzheng Injection(???????)and regular treatment showed no improvement over regular treatment in relieving CRF in short term follow up studies.The combined treatment of Ginseng-yonwing Soup(?????)and regular treatment was more effective than regular treatment in treating CRF in medium term follow up studies but sample size was not enough.With BFI,Piper assessment,Shenqi-fuzheng Injection(???????)combined with regular treatment was more effective than regular treatment in treating CRF patients in short term studies.Shenqi-fuzheng Injection(???????)combined with regular treatment showed only 1 case of adverse reaction during a short period of follow up while no adverse reaction was reported with patients treated with regular treatment.Shenqi-fuzheng Injection(???????)combined with regular treatment improved patients functional status better than regular treatment alone as assessed with KPS.The combined treatment did not improve patients'immune-function better than regular treatment.There was no report in comparing the two treatments regarding quality of life.(3)Ginseng related medicine combined with other treatments vs other treatments Ginseng-yonwing Soup(?????)combined with chemotherapy improved the CRF better than chemotherapy alone in a study with medium term follow up period and TSA assessment indicated that the patient sample size was adequate and no further testing was necessary.With Piper assessment,ginseng related medicine combined with chemotherapy(combined therapy)improved behavior fatigue better than chemotherapy alone but not emotion,perception and cognition fatigue in the short term follow up.With BFI assessment,the combined therapy was not more effective in treating CRF.There was no adverse effect with the combined therapy in medium term follow up.There was no report in the comparison of treatment efficacy between the two forms of treatments(ginseng related medicine combined with chemotherapy and chemotherapy)regarding quality of life,functional status and immune function.Discussion:The aim of the study was to assess the efficacy and safety of Ginseng and ginseng related medicine treatment for CRF.Ginseng and/ or Ginsenoside is effective and safe in treating CRF.Ginseng related medicine with Ginseng as major active ingredient including injectable preparation,is effective and safe in treating CRF.The heterogeneity in the study was high.Study group included patients with various kind of cancer and at different stage of the disease,different types of Ginseng intervention,different fatigue assessment scales and the quality of studies included were of low quality thus affecting the quality of the outcome of this study.However,the outcome of the study was in line with the general belief of the function of Ginseng in the treatment of fatigue as medicine or health food.Most importantly,despite there are different kinds of Ginseng and Ginseng related medicine,they were all safe to use.In the future with stricter study design,better standardization of Ginseng intervention,special designed fatigue of scale for Chinese patients,adequate test samples,and high quality of study can help to demonstrate Ginseng is effective and safe in the treatment of CRF. |
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