Background. Lung cancer is the leading cause of cancer death, and colon cancer the third leading cause. Complementary and alternative medicines (CAM) are used by up to 48% of people with lung cancer and up to 75% of those with colon cancer. This high prevalence of use makes recruitment of patients into randomized CAM trials difficult, suggesting a need for other study designs. Methods. Chapter 1 presents a brief discussion of the origins of East-West medical integration. Chapter 2 is a meta-analysis of randomized trials of Astragalus-based Chinese herbal medicines combined with platinum-based chemotherapy. Chapters 3 and 4 are cohort analyses of non-small cell lung cancer (n=239) and colon cancer patients (n=193) presenting for treatment at a center of Chinese medicine (Pine Street Clinic, San Anselmo CA). I analyze survival with Kaplan-Meier, Cox regression, the propensity score and marginal structural models. Results. In my meta-analysis, I showed that by adding herbal medicine to chemotherapy, the risk of death from lung cancer at 12-months was reduced by 33% (RR=0.67; 95% CI 0.52, 0.87), the risk of death at 24-months was reduced by 42% (RR=0.58; 95% CI 0.49, 0.69), and tumor response was improved by 34% (RR=1.34; 95% CI 1.24, 1.46). In my lung cancer survival analysis, PAM+V combined with conventional therapy reduced risk of death in stage IIIA by 60% (HR=0.40; 95% CI 0.30, 0.52), in stage IIIB by 86% (HR=0.14; 95% CI 0.07, 0.28), and in stage IV by 75% (HR=0.25; 95% CI 0.08, 0.41), compared to conventional therapy alone. In my colon cancer survival analysis PAM+V combined with conventional therapy reduced risk of death in stage II by 64% (HR=0.36; 95% CI 0.17, 0.76), in stage III by 29% (HR=0.71; 95% CI 0.50, 0.99), and in stage IV by 75% (HR=0.25; 95% CI 0.18, 0.35), compared to conventional therapy alone. Conclusions . Astragalus-based Chinese herbal medicine increases survival in non-small cell lung cancer. In lung cancer, long-term use of PAM+V showed survival than short-term use. PAM+V combined with conventional therapy increased survival benefit in patients with both lung and colon cancers, compared to conventional therapy alone.
|Advisor:||Colford, John M.|
|School:||University of California, Berkeley|
|School Location:||United States -- California|
|Source:||DAI-B 70/04, Dissertation Abstracts International|
|Subjects:||Nutrition, Epidemiology, Medicine|
|Keywords:||Cancer survival, Chinese herbal medicines, Colon cancer, Lung cancer, Vitamins|
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