A pilot cross-sectional study on incidence of liver toxicity in cancer patients on western anti-cancer drug therapy with or without concurrent Chinese herbal medicine

Abstract

Background: Both Western and Chinese medicine, despite different in methods and systems, are well accepted in Hong Kong. According to a survey on cancer patients in Hong Kong conducted by the Hong Kong Baptist University in 2009, 57% of cancer patients used at least one form of Chinese Medicine therapy. Among those who were on chemotherapy, 60% of them are concurrently receiving Traditional Chinese Medicine (TCM) herbal therapy. This pilot study addressed the problem of hepatotoxicity of concurrent Traditional Chinese Medicine (TCM) herbal therapy use, which is the major hurdle of integrated Chinese-Western medicine practice in cancer medicine. We evaluated the difference in incidence of liver toxicity of cancer patients receiving systemic therapy with or without concurrent TCM herbal therapy. Methods: 187 patients were prospectively recruited in the Department of Clinical Oncology of Queen Mary Hospital. Through questionnaires and the online Clinical Management System (CMS), they were followed up for 3 months, their current Western systemic therapy, TCM herbal therapy taken, and liver function tests results (bilirubin, ALT, AST, ALP) were retrieved. Patients were divided into the TCM herbal therapy and non-TCM herbal therapy group, depending on whether TCM herbal therapy was taken concurrently with systemic therapy. Liver function derangement was graded by CTCAE v4.0. The differences between the TCM herbal therapy and nonTCM herbal therapy groups were analysed by Pearson’s chi square test and MannWhitney U tests. Multivariable analysis was performed by Cox proportional hazard models to identify the prognostic factors for TCM herbal therapy coverag