Yanju, B., Yang, L., Hua, B., Hou, W., Shi, Z., Li, W., . . . Lv, W. (2014). A systematic review and meta-analysis on the use of traditional Chinese medicine compound kushen injection for bone cancer pain. Supportive Care in Cancer, 22, 825–836.

STUDY PURPOSE: To assess the efficacy of compound kushen injection (CKI) for bone pain in cancer

TYPE OF STUDY: Meta-analysis and systematic review

DATABASES USED: MEDLINE, Cochrane Collaboration, four Chinese databases, two Korean databases, and one Japanese medical database

KEYWORDS: kushen, yanshu, matrine, and various terms for bone cancer pain

INCLUSION CRITERIA: RCT, adult patients with cancer-related bone pain; patients in the control group were given radiotherapy, opioids, non-steroidal anti-inflammatory drugs, or bisphosphonates

EXCLUSION CRITERIA: Nonrandomized trials

TOTAL REFERENCES RETRIEVED = 170

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Used the GRADES system for quality evaluation

• FINAL NUMBER STUDIES INCLUDED =  7
• SAMPLE RANGE ACROSS STUDIES, TOTAL PATIENTS INCLUDED IN REVIEW: 521 total patients; sample size per study not reported
• KEY SAMPLE CHARACTERISTICS: Variety of tumor types

• PHASE OF CARE: Late effects and survivorship     
• APPLICATIONS: Palliative care

All studies were done in China at a single center. Analysis showed that CKI relieved pain when compared to bisphosphonates or radiotherapy (RR 1.25, p < .0001). The quality of all studies included was low, and risk of bias was high. Not all studies examined adverse effects. In four studies, patients who received CKI had less nausea and leukopenia. Analysis showed positive results, indicating publication bias.

CKI may have beneficial effects and reduce cancer-related bone pain. However, the small number of trials and low quality of the evidence is insufficient to show efficacy.

• Small number of studies
• Low quality of studies
• All studies done at the same institution

Evidence is insufficient to determine efficacy of the Chinese herbal medicine kushen.