NCCS starts clinical trial to examine the use of TCM in countering cancer-related symptoms

The National Cancer Centre Singapore (NCCS) has started a clinical trial to examine the use of Traditional Chinese Medicine (TCM) in countering cancer-related symptoms or side effects of cancer treatment to improve cancer survivors' quality of life. With advances in cancer diagnosis and treatment, cancer survivorship has improved significantly, but cancer survivors often experience a range of cancer-related and post-treatment side effects such as cancer-related fatigue.

Cancer-related fatigue (CRF) refers to a distressing and persistent sense of physical, emotional and/or cognitive tiredness which is a side-effect of cancer or anti-cancer treatments. CRF is frequently experienced by cancer survivors and can interfere with their daily functioning. The HEalth-Related quality of life-intervention in survivors of Breast and other cancers experiencing CRF using TraditionAL Chinese Medicine, or the HERBAL trial, aims to evaluate the benefit of using TCM to manage side-effects experienced by cancer survivors.

Current recommended treatments for CRF include non-pharmacological management such as exercise, cognitive behavioural therapy and patient education. Pharmacological therapies are still under investigation but have shown limited efficacy so far. This is partly because the biological mechanism underlying CRF has not been fully established.

As the recommended management of CRF is limited, both in scope and efficacy, many patients continue to have persistent symptoms. More research in this arena is required and culturally appropriate interventions should be tailored to each individual patient. We observe many of our patients seeking adjunctive therapies, such as TCM, to manage their symptoms."

Dr Tira Tan, Principal Investigator of the HERBAL trial and Consultant in the Division of Medical Oncology, NCCS

Scientific data validating the benefits of TCM is sparse which prompted a team of investigators to design the HERBAL trial.

Conducting a first-of-its-kind TCM trial to manage side effects of cancer treatment

The HERBAL trial will evaluate the use of an investigational modified TCM formula known as Xiang Bei Yang Rong Tang (XBYRT) in alleviating CRF. The formula used in the research study was developed by study Co-Investigator Prof Alexandre Chan, Visiting Professor, Oncology Pharmacy, NCCS in consultation with TCM physicians from Singapore Thong Chai Medical Institution (STCMI).

In TCM literature XBYRT is believed to be able to augment qi, nourish the blood, improve appetite and calm the mind with the aim of alleviating CRF in cancer survivors.

"Post-treatment cancer patients commonly present with qi and blood deficiencies, due to the exhaustive nature of tumour and treatment induced side-effects to the body," explained Zheng Huangfang, Chief Medical Officer and TCM Physician from STCMI. "From our observations, cancer patients also commonly present with stagnated qi, potentially caused by emotional distress from cancer diagnosis, their inherent personality, sedentary lifestyle or other factors. Based on this, XBYRT should be effective in treating these type of post-treatment cancer patients."

The HERBAL trial aims to enrol 80 cancer survivors in the research study, which will examine the use of XBYRT. Individuals who are in remission from cancer and have completed active treatment including surgery, chemotherapy and/or radiotherapy for at least a month are eligible. They will be screened onsite at NCCS by certified TCM physicians for having a qi and blood deficiency before being enrolled on the trial. Participants will be randomised into two groups and administered the TCM treatment or placebo for eight weeks. Participants' quality of life, fatigue levels and cognitive function will be assessed using well validated assessment tools over serial time points. A TCM physician will also assess the participants' response to the treatments to determine if levels of qi are restored.

Goals and recruitment for the HERBAL trial

Currently, there is limited research and scientific data that support the use of TCM for managing symptoms in cancer survivors, so the results of this trial would be a valuable addition to existing literature. Results can provide both clinical and biochemical basis guiding the design of future studies to facilitate a better understanding of possible biological mechanisms contributing to the effects of TCM.