Evidence mapping of traditional Chinese medicine interventions for cancer-related fatigue_Chinese Journal of Evidence-Based Medicine

Authors：

XU Ling ¹ , DAI Lingyun ¹ , REN Ying ¹ , LI Qingqing ¹ , LIU Baoyu ¹ , SUN Yumei ¹ , SU Tao ¹ , CHEN Yu ¹ ,  PANG Xiaoli ² , LI Huhu ³

1. Graduate School of Tianjin University of Traditional Chinese Medicine, Tianjin 301617, P. R. China;
2. School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, P. R. China;
3. School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, P. R. China;

Corresponding?author：

PANG Xiaoli, Email: 403033115@qq.com

Keywords：

Traditional Chinese medicine; Cancer-related fatigue; Randomized controlled trial; Systematic review; Meta-analysis; Clinical research; Evidence mapping

DOI：

10.7507/1672-2531.202407125

Video：

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Objective To identify, describe, and evaluate the evidence of traditional Chinese medicine (TCM) interventions for cancer-related fatigue (CRF) using an evidence mapping approach. Methods The CNKI, WanFang Data, VIP, SinoMed, PubMed, Web of Science and Embase databases were electronically searched to collect studies on TCM interventions for CRF from inception to June 4, 2024. Evidence mapping was employed to present the characteristics of study populations, interventions, studies included in systematic review/meta-analysis (SR/MA), and conclusions. Results A total of 94 randomized controlled trials (RCT) and 17 SR/MA/network MA were included. The number of publications has shown an overall fluctuating upward trend in the past 15 years. The RCT included literature with a high focus on mixed cancers, involving a total of 51 TCM therapeutic measures, including 40 herbal treatments, 5 external TCM treatments, and 5 TCM integrative therapies. The outcome indicators were classified into 14 categories, with the most frequent ones being CRF scores, TCM syndrome scores, clinical efficacy, quality of life scores, immune function indicators, adverse event rates, and serum indicators. The SR/MA included 7-81 original studies with sample sizes of 551-7 547 cases, involving 5 intervention measures: herbal medicine (9 studies), moxibustion (3 studies), TCM injection (2 studies), moxibustion (2 studies), and acupuncture (1 study). The quality of RCT and SR/MA was generally low, and the evidence quality was low. Most studies showed that TCM interventions for CRF had potential efficacy, but there was still a lack of definitive clinical evidence. Conclusion The results suggest that TCM interventions for CRF have advantages but also problems. There is still a lack of high-quality research. More large-sample, multicenter RCT and high-quality SR/MA are needed to further explore the advantages of TCM interventions for CRF and provide strong support for the effectiveness and safety of TCM interventions for CRF.

Citation： XU Ling, DAI Lingyun, REN Ying, LI Qingqing, LIU Baoyu, SUN Yumei, SU Tao, CHEN Yu, PANG Xiaoli, LI Huhu. Evidence mapping of traditional Chinese medicine interventions for cancer-related fatigue. Chinese Journal of Evidence-Based Medicine, 2025, 25(4): 440-446. doi: 10.7507/1672-2531.202407125 Copy

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24.	張方圓, 沈傲梅, 曾憲濤, 等. 系統評價方法學質量評價工具AMSTAR2解讀. 中國循證心血管醫學雜志, 2018, 10(1): 14-18.
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27.	陳琳儷, 張阿潤, 卜文璐, 等. 中藥治療化療后癌因性疲乏有效性及安全性的Meta分析. 云南中醫中藥雜志, 2024, 45(5): 31-39.
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30.	陳柳茵, 林桂嬌, 楊柳, 等. 灸法對癌因性疲乏患者干預效果的網狀Meta分析. 中國醫藥指南, 2023, 21(8): 1-5.
31.	許可依, 胡凱文, 孫健豪, 等. 中藥注射液治療癌因性疲乏的網狀Meta分析. 世界科學技術-中醫藥現代化, 2023, 25(12): 4017-4031.
32.	Wang Z, Wu Z, Xiang Q, et al. Effects of botanical drugs in the treatment of cancer-related fatigue in patients with gastric cancer: a meta-analysis and prediction of potential pharmacological mechanisms. Front Pharmacol, 2022, 13: 979504.
33.	曾悅, 羅秀麗, 李成銀, 等. 中藥治療胃癌患者癌因性疲乏療效的Meta分析. 醫學信息, 2022, 35(5): 63-68, 79.
34.	胡靜溫, 楊柳, 陳錦秀, 等. 健脾類方劑治療癌因牲疲乏的Meta分析. 湖南中醫雜志, 2021, 37(2): 115-121.
35.	韓金錢, 張宜佳, 蔣恩社. 艾灸對癌癥病人癌因性疲乏干預效果的Meta分析. 循證護理, 2021, 7(6): 719-726.
36.	胡月, 蔣運蘭, 李征, 等. 灸法治療癌因性疲乏的臨床有效性和安全性的系統評價. 成都中醫藥大學學報, 2020, 43(3): 65-72.
37.	余婷, 劉杰, 楊兵, 等. 灸法治療癌因性疲乏臨床療效的薈萃分析. 世界科學技術-中醫藥現代化, 2020, 22(12): 4175-4184.
38.	Huang Z, Zhang Q, Fan Y, et al. Effect of traditional Chinese medicine injection on cancer-related fatigue: a meta-analysis based on existing evidence. Evid Based Complement Alternat Med, 2020, 2020: 2456873.
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40.	張洲姬, 郭毅峻, 蔡霄月, 等. 中藥治療Ⅲ~Ⅳ期肺癌含鉑兩藥化療患者癌因性疲乏的Meta分析. 河北中醫, 2019, 41(10): 1462-1469.
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46.	邱瑞瑾, 魏旭煦, 關之玥, 等. 中醫藥領域核心指標集研究現狀及展望. 中國循證醫學雜志, 2023, 23(2): 211-220.
47.	Schulz KF, Chalmers I, Hayes RJ, et al. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA, 1995, 273(5): 408-412.
48.	姜俊杰, 井媛媛, 黎元元, 等. 近5年常用中成藥治療2型糖尿病的隨機對照試驗證據圖分析. 中國中藥雜志, 2024, 49(4): 1102-1112.

1. NCCN Guidelines. Cancer-related fatigue: NCCN clinical practice guidelines in oncology (version 2). 2023.
2. Fabi A, Bhargava R, Fatigoni S, et al. Cancer-related fatigue: ESMO clinical practice guidelines for diagnosis and treatment. Ann Oncol, 2020, 31(6): 713-723.
3. Bower JE. Cancer-related fatigue--mechanisms, risk factors, and treatments. Nat Rev Clin Oncol, 2014, 11(10): 597-609.
4. 生金, 潘宏銘. 2023年第2版NCCN癌因性疲乏診治指南述評. 實用腫瘤雜志, 2023, 38(5): 416-420.
5. Cella D, Davis K, Breitbart W, et al. Cancer-related fatigue: prevalence of proposed diagnostic criteria in a United States sample of cancer survivors. J Clin Oncol, 2001, 19(14): 3385-3391.
6. 曹瑩, 陳湘玉, 陳玉華. 宮頸癌同步放化療患者治療后癌因性疲乏癥狀體驗的質性研究. 解放軍護理雜志, 2017, 34(2): 18-22.
7. 李娟, 楊柱, 龍奉璽, 等. 國醫大師劉尚義治療癌性疲乏用藥數據挖掘. 遼寧中醫雜志, 2018, 45(4): 703-706.
8. 韓金鳳. 癌因性疲乏的中醫藥治療研究概況. 光明中醫, 2018, 33(6): 902-904.
9. Strebkova R. Cancer-related fatigue in patients with oncological diseases: causes, prevalence, guidelines for assessment and management. Folia Med (Plovdiv), 2020, 62(4): 679-689.
10. Thong MSY, van Noorden CJF, Steindorf K, et al. Cancer-related fatigue: causes and current treatment options. Curr Treat Options Oncol, 2020, 21(2): 17.
11. Mao JJ, Pillai GG, Andrade CJ, et al. Integrative oncology: addressing the global challenges of cancer prevention and treatment. CA Cancer J Clin, 2022, 72(2): 144-164.
12. 許博文, 吳靜遠, 李杰, 等. 腫瘤中成藥上市后生存獲益評價的探索與實踐. 中國中藥雜志, 2021, 46(8): 1980-1987.
13. Zuo S, Cheng H, Wang Z, et al. Nonpharmacological interventions for cancer-related fatigue: a literature review. Asia Pac J Oncol Nurs, 2023, 10(5): 100230.
14. Mustian KM, Alfano CM, Heckler C, et al. Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. JAMA Oncol, 2017, 3(7): 961-968.
15. Finnegan-John J, Molassiotis A, Richardson A, et al. A systematic review of complementary and alternative medicine interventions for the management of cancer-related fatigue. Integr Cancer Ther, 2013, 12(4): 276-290.
16. 高亞, 李沐陽, 孫月, 等. 證據圖研究合作能力與研究主題分析. 中國藥物評價, 2019, 36(3): 165-168.
17. Miake-Lye IM, Hempel S, Shanman R, et al. What is an evidence map. A systematic review of published evidence maps and their definitions, methods, and products. Syst Rev, 2016, 5: 28.
18. Katz DL, Williams AL, Girard C, et al. The evidence base for complementary and alternative medicine: methods of evidence mapping with application to CAM. Altern Ther Health Med, 2003, 9(4): 22-30.
19. 李沐陽, 張福利, 蔡潤津, 等. 證據圖研究現狀分析. 中國藥物評價, 2019, 36(3): 161-164.
20. 北京DRGs-PPS項目組. 國際疾病分類第十次修訂本(ICD-10)BJ-臨床版. 2012.
21. Higgins JPT, Chandler J, Cumpston M, et al. Cochrane handbook for systematic reviews of interventions version 6.0. 2019.
22. 李佳璐, 李玲玲, 馬新萍, 等. Cochrane偏倚風險評估工具(RoB 2. 0)的介紹及示范性應用. 中華現代護理雜志, 2023, 29(22): 2951-2956.
23. 陶歡, 楊樂天, 平安, 等. 隨機或非隨機防治性研究系統評價的質量評價工具AMSTAR2解讀. 中國循證醫學雜志, 2018, 18(1): 101-108.
24. 張方圓, 沈傲梅, 曾憲濤, 等. 系統評價方法學質量評價工具AMSTAR2解讀. 中國循證心血管醫學雜志, 2018, 10(1): 14-18.
25. Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 2017, 358: j4008.
26. Li Y, Wei Z, Zhang J, et al. Wearing masks to reduce the spread of respiratory viruses: a systematic evidence mapping. Ann Transl Med, 2021, 9(9): 811.
27. 陳琳儷, 張阿潤, 卜文璐, 等. 中藥治療化療后癌因性疲乏有效性及安全性的Meta分析. 云南中醫中藥雜志, 2024, 45(5): 31-39.
28. 何思穎, 云潔, 周子淇, 等. 雷火灸治療癌因性疲乏臨床療效與安全性的Meta分析. 中國民族民間醫藥, 2024, 33(1): 106-111.
29. Yang J, Li Y, Chau CI, et al. Efficacy and safety of traditional Chinese medicine for cancer-related fatigue: a systematic literature review of randomized controlled trials. Chin Med, 2023, 18(1): 142.
30. 陳柳茵, 林桂嬌, 楊柳, 等. 灸法對癌因性疲乏患者干預效果的網狀Meta分析. 中國醫藥指南, 2023, 21(8): 1-5.
31. 許可依, 胡凱文, 孫健豪, 等. 中藥注射液治療癌因性疲乏的網狀Meta分析. 世界科學技術-中醫藥現代化, 2023, 25(12): 4017-4031.
32. Wang Z, Wu Z, Xiang Q, et al. Effects of botanical drugs in the treatment of cancer-related fatigue in patients with gastric cancer: a meta-analysis and prediction of potential pharmacological mechanisms. Front Pharmacol, 2022, 13: 979504.
33. 曾悅, 羅秀麗, 李成銀, 等. 中藥治療胃癌患者癌因性疲乏療效的Meta分析. 醫學信息, 2022, 35(5): 63-68, 79.
34. 胡靜溫, 楊柳, 陳錦秀, 等. 健脾類方劑治療癌因牲疲乏的Meta分析. 湖南中醫雜志, 2021, 37(2): 115-121.
35. 韓金錢, 張宜佳, 蔣恩社. 艾灸對癌癥病人癌因性疲乏干預效果的Meta分析. 循證護理, 2021, 7(6): 719-726.
36. 胡月, 蔣運蘭, 李征, 等. 灸法治療癌因性疲乏的臨床有效性和安全性的系統評價. 成都中醫藥大學學報, 2020, 43(3): 65-72.
37. 余婷, 劉杰, 楊兵, 等. 灸法治療癌因性疲乏臨床療效的薈萃分析. 世界科學技術-中醫藥現代化, 2020, 22(12): 4175-4184.
38. Huang Z, Zhang Q, Fan Y, et al. Effect of traditional Chinese medicine injection on cancer-related fatigue: a meta-analysis based on existing evidence. Evid Based Complement Alternat Med, 2020, 2020: 2456873.
39. Zhao Y, Wang S, Li J, et al. Effectiveness and safety of traditional Chinese medical therapy for cancer-related fatigue: a systematic review and meta-analysis of randomized controlled trials. J Tradit Chin Med, 2020, 40(5): 738-748.
40. 張洲姬, 郭毅峻, 蔡霄月, 等. 中藥治療Ⅲ~Ⅳ期肺癌含鉑兩藥化療患者癌因性疲乏的Meta分析. 河北中醫, 2019, 41(10): 1462-1469.
41. 李娟, 楊柱, 龍奉璽, 等. 基于益氣法治療癌因性疲乏的Meta分析. 成都中醫藥大學學報, 2017, 40(3): 117-122.
42. 朱琦, 唐文富, 張穎. 補氣中藥治療癌性疲勞隨機對照臨床研究文獻Meta分析. 海軍醫學雜志, 2015, 36(4): 302-307.
43. Ling WM, Lui LY, So WK, et al. Effects of acupuncture and acupressure on cancer-related fatigue: a systematic review. Oncol Nurs Forum, 2014, 41(6): 581-592.
44. 凡全女. 中藥合理應用常見問題及應對措施. 臨床合理用藥雜志, 2017, 10(29): 84-85.
45. 莊銘, 安佳麗, 鐘夢媛, 等. 中醫藥臨床療效評價方法研究進展. 中國中藥雜志, 2023, 48(12): 3263-3268.
46. 邱瑞瑾, 魏旭煦, 關之玥, 等. 中醫藥領域核心指標集研究現狀及展望. 中國循證醫學雜志, 2023, 23(2): 211-220.
47. Schulz KF, Chalmers I, Hayes RJ, et al. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA, 1995, 273(5): 408-412.
48. 姜俊杰, 井媛媛, 黎元元, 等. 近5年常用中成藥治療2型糖尿病的隨機對照試驗證據圖分析. 中國中藥雜志, 2024, 49(4): 1102-1112.

Chinese Journal of Evidence-Based Medicine

Evidence mapping of traditional Chinese medicine interventions for cancer-related fatigue

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