Clinical application of Chinese herbal injection for cancer care: Evidence-mapping of the systematic reviews, meta-analyses and randomized controlled trials

Background and objective: Cancer is a life threatening disease worldwide. The standard therapy cannot fulfill all the clinical needs and Chinese herbal injection has been widely used for cancer in Chinese and Western hospitals in China. This study aimed to apply evidence mapping to draw an overview picture of the clinical application of Chinese herbal injection in cancer care based on randomized controlled trials, systematic reviews and meta-analyses. Methods and results: Seven databases were systematically searched, eligible randomized controlled trials, systematic reviews and meta-analyses for ten Chinese herbal injections used in cancer treatment and covered in the national essential health insurance program. Excel 2016 and RStudio were used to integrate and process the data. In total 366 randomized controlled trials, 48 systematic reviews and meta-analyses were included in the evidence mapping, including Compound Kushen, Shenqi Fuzheng, Aidi, Kangai, Kanglaite, Xiaoaiping, Cinobufacin, Brucea javanica oil emulsion, Polyporus polysaccharide injection and Astragalus polysaccharide for injection. The health insurance restricted the scoping of clinical application for ten herbal injections. The numbers of studies published increased especially around 2013-2015. The most studied cancer types were lung cancer (118, 32.2%), colorectal cancer (39, 10.7%) and gastric cancer (39, 10.7%), and the most used injections were Compound Kushen (78, 21.3%), Shenqi Fuzheng (76, 20.8%), and Aidi (63, 17.2%). The most consistently reported benefits were observed for Compound Kushen, Shenqi Fuzheng, Aidi and Kangai for tumor response, quality of life, myelosuppression, and enhancing immunity. Conclusion: The current evidence mapping provides a visual overview of the outcomes and effects for Chinese herbal injection in cancer care, and offers information on clinical application which warrants further evidence-based research in order to inform clinical and policy decision-making.