Background
History of kampo medicine
Use of Kampo and CAM in Japan
Methods
Study sample and data collection
Questionnaire development
Ethical considerations
Data analysis
Results and discussion
Respondents (n = 311) | Average ± SD | Minimum value | Maximum value | ||||
---|---|---|---|---|---|---|---|
Age | 49 ± 8 | 28 | 75 | ||||
Years of experience | 23 ± 8 | 4 | 50 | ||||
Responses | % | ||||||
Institution (n = 549) * | |||||||
Core cancer treatment hospital (n = 388) | 226 | 58.2 | |||||
Palliative Care Unit in medical institution (n = 161) | 79 | 49.1 | |||||
n | % | ||||||
Age group | |||||||
20–29 years | 1 | 0.3 | |||||
30–39 years | 39 | 12.8 | |||||
40–49 years | 119 | 39.1 | |||||
50–59 years | 118 | 38.8 | |||||
≥ 60 years | 27 | 8.9 | |||||
Sex | |||||||
Male | 273 | 90.1 | |||||
Female | 30 | 9.9 | |||||
Palliative Care Specialists certified by JSPM** | |||||||
Specialists (including provisional medical advisors) | 128 | 41.2 | |||||
Non-specialists | 183 | 58.8 | |||||
Region*** | Hokkaido–Tohoku | Kanto | Chubu | Kinki | Chugoku | Shikoku | Kyushu–Okinawa |
Number of questionnaires distributed | 79 | 116 | 92 | 91 | 47 | 27 | 97 |
Number of responses | 26 | 43 | 41 | 33 | 25 | 11 | 37 |
Response rate (%) | 32.9 | 37.1 | 44.6 | 36.3 | 53.2 | 40.7 | 38.1 |
Difficult to treat cancer-related symptoms
Symptoms | All physicians (n = 311) | Palliative care teams (n = 226) | PCUs (n = 79) | p-value | Specialists (n = 128) | Non-specialists (n = 183) | p-value | |||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
frequency | % | frequency | % | frequency | % | frequency | % | frequency | % | |||
Numbness/Hypesthesia | 240 | 77.2 | 180 | 79.6 | 55 | 69.6 | 0.165 | 99 | 77.3 | 141 | 77.0 | 1.000 |
Languor/Fatigue | 225 | 72.3 | 161 | 71.2 | 61 | 77.2 | 0.276 | 99 | 77.3 | 126 | 68.9 | 0.122 |
Delirium | 170 | 54.7 | 119 | 52.7 | 48 | 60.8 | 0.447 | 73 | 57.0 | 97 | 53.0 | 0.490 |
Taste alteration | 166 | 53.4 | 124 | 54.9 | 42 | 53.2 | 0.029 | 77 | 60.2 | 89 | 48.6 | 0.050 |
Edema (Local edema/Anasarca) | 150 | 48.2 | 109 | 48.2 | 39 | 49.4 | 0.821 | 59 | 46.1 | 91 | 49.7 | 0.565 |
Pain | 146 | 46.9 | 113 | 50.0 | 31 | 39.2 | 0.226 | 55 | 43.0 | 91 | 49.7 | 0.250 |
Anorexia/Weight loss | 140 | 45.0 | 109 | 48.2 | 30 | 38.0 | 0.108 | 64 | 50.0 | 76 | 41.5 | 0.165 |
Abdominal discomfort | 131 | 42.1 | 98 | 43.4 | 31 | 39.2 | 0.735 | 55 | 43.0 | 76 | 41.5 | 0.816 |
Stomatitis/Xerostomia | 122 | 39.2 | 89 | 39.4 | 33 | 41.8 | 0.141 | 54 | 42.2 | 68 | 37.2 | 0.409 |
Depression | 116 | 37.3 | 86 | 38.1 | 30 | 38.0 | 0.175 | 41 | 32.0 | 75 | 41.0 | 0.122 |
Adjustment disorder | 113 | 36.3 | 73 | 32.3 | 39 | 49.4 | 0.014 | 47 | 36.7 | 66 | 36.1 | 1.000 |
Dyspnea/Breathlessness | 113 | 36.3 | 77 | 34.1 | 35 | 44.3 | 0.162 | 48 | 37.5 | 65 | 35.5 | 0.811 |
Nausea/Vomiting (other) | 101 | 32.5 | 75 | 33.2 | 24 | 30.4 | 0.893 | 38 | 29.7 | 63 | 34.4 | 0.392 |
Dysphagia/Deglutition disorder | 100 | 32.2 | 68 | 30.1 | 31 | 39.2 | 0.281 | 50 | 39.1 | 50 | 27.3 | 0.036 |
Sleep disorder/Insomnia | 93 | 29.9 | 69 | 30.5 | 23 | 29.1 | 0.796 | 42 | 32.8 | 51 | 27.9 | 0.379 |
Constipation (caused by opioid use) | 84 | 27.0 | 69 | 30.5 | 15 | 19.0 | 0.038 | 34 | 26.6 | 50 | 27.3 | 0.898 |
Nausea/Vomiting (during chemotherapy) | 76 | 24.4 | 71 | 31.4 | 5 | 6.3 | 0.000 | 27 | 21.1 | 49 | 26.8 | 0.284 |
Muscle weakness | 65 | 20.9 | 46 | 20.4 | 19 | 24.1 | 0.346 | 34 | 26.6 | 31 | 16.9 | 0.047 |
Nausea/Vomiting (caused by opioid use) | 61 | 19.6 | 51 | 22.6 | 10 | 12.7 | 0.690 | 24 | 18.8 | 37 | 20.2 | 0.774 |
Constipation (not caused by opioid use) | 59 | 19.0 | 47 | 20.8 | 11 | 13.9 | 0.377 | 28 | 21.9 | 31 | 16.9 | 0.305 |
Muscle cramp | 42 | 13.5 | 31 | 13.7 | 11 | 13.9 | 0.741 | 23 | 18.0 | 19 | 10.4 | 0.064 |
Diarrhea | 40 | 12.9 | 34 | 15.0 | 6 | 7.6 | 0.136 | 16 | 12.5 | 24 | 13.1 | 1.000 |
Anemia | 29 | 9.3 | 24 | 10.6 | 5 | 6.3 | 0.344 | 16 | 12.5 | 13 | 7.1 | 0.177 |
Others | 11 | 3.5 | 6 | 2.7 | 5 | 6.3 | 0.325 | 4 | 3.1 | 7 | 3.8 | 0.770 |
Prescription of Kampo medicines
Symptoms | All physicians (n = 200) | Palliative care teams (n = 149) | PCUs (n = 46) | p-value | |||
---|---|---|---|---|---|---|---|
frequency | % | frequency | % | frequency | % | ||
Numbness/Hypesthesia | 99 | 49.5 | 86 | 57.7 | 12 | 26.1 | 0.000 |
Constipation (not caused by opioid use) | 76 | 38 | 56 | 37.6 | 20 | 43.5 | 0.182 |
Anorexia/Weight loss | 72 | 36 | 60 | 40.3 | 12 | 26.1 | 0.046 |
Muscle cramp | 71 | 35.5 | 54 | 36.2 | 17 | 37.0 | 0.279 |
Languor/Fatigue | 64 | 32 | 49 | 32.9 | 14 | 30.4 | 0.818 |
Constipation (caused by opioid use) | 48 | 24 | 37 | 24.8 | 11 | 23.9 | 0.490 |
Abdominal discomfort | 46 | 23 | 29 | 19.5 | 16 | 34.8 | 0.088 |
Diarrhea | 45 | 22.5 | 39 | 26.2 | 5 | 10.9 | 0.090 |
Delirium | 40 | 20 | 27 | 18.1 | 13 | 28.3 | 0.155 |
Pain | 38 | 19 | 35 | 23.5 | 3 | 6.5 | 0.020 |
Edema (Local edema/Anasarca) | 31 | 15.5 | 25 | 16.8 | 6 | 13.0 | 0.546 |
Nausea/Vomiting (other) | 27 | 13.5 | 22 | 14.8 | 5 | 10.9 | 0.566 |
Nausea/Vomiting (during chemotherapy) | 22 | 11 | 22 | 14.8 | 0 | 0.0 | 0.016 |
Stomatitis/Xerostomia | 21 | 10.5 | 19 | 12.8 | 2 | 4.3 | 0.216 |
Taste alteration | 20 | 10 | 17 | 11.4 | 3 | 6.5 | 0.409 |
Depression | 20 | 10 | 17 | 11.4 | 3 | 6.5 | 0.409 |
Nausea/Vomiting (caused by opioid use) | 17 | 8.5 | 16 | 10.7 | 1 | 2.2 | 0.129 |
Adjustment disorder | 15 | 7.5 | 12 | 8.1 | 3 | 6.5 | 0.846 |
Sleep disorder/Insomnia | 14 | 7 | 10 | 6.7 | 4 | 8.7 | 0.823 |
Others | 13 | 6.5 | 6 | 4.0 | 6 | 13.0 | 0.055 |
Anemia | 11 | 5.5 | 9 | 6.0 | 2 | 4.3 | 0.805 |
Dysphagia/Deglutition disorder | 10 | 5 | 9 | 6.0 | 1 | 2.2 | 0.581 |
Dyspnea/Breathlessness | 6 | 3 | 5 | 3.4 | 1 | 2.2 | 1.000 |
Muscle weakness | 3 | 1.5 | 3 | 2.0 | 0 | 0.0 | 0.614 |
Reasons for prescription
Variety and frequency of prescriptions
Kampo Medicine | Ingredients (crude drugs) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Hangeshashinto | Pinelliae Tuber | Scutellariae Radix | Zingiberis Processum Rhizoma | Glycyrrhizae Radix | Zizyphi Fructus | Ginseng Radix | Coptidis Rhizoma | |||
Hochuekkito | Astragali Radix | Atractylodis lanceae Rhizoma | Ginseng Radix | Angelicae Radix | Bupleuri Radix | Zizyphi Fructus | Aurantii Nobilis Pericarpium | Glycyrrhizae Radix | Cimicifugae Rhizoma | Zingiberis Rhizoma |
Rikkunshito | Atractylodis lanceae Rhizoma | Ginseng Radix | Pinelliae Tuber | Poria | Zizyphi Fructus | Aurantii Nobilis Pericarpium | Glycyrrhizae Radix | Zingiberis Rhizoma | ||
Juzentaihoto | Astragali Radix | Cinnamomi Cortex | Rehmanniae Radix | Paeoniae Radix | Cnidii Rhizoma | Atractylodis lanceae Rhizoma | Angelicae Radix | Ginseng Radix | Poria | Glycyrrhizae Radix |
Yokukansan | Atractylodis lanceae Rhizoma | Poria | Cnidii Rhizoma | Uncariae Uncis cum Ramulus | Angelicae Radix | Bupleuri Radix | Glycyrrhizae Radix | |||
Shakuyakukanzoto | Glycyrrhizae Radix | Paeoniae Radix | ||||||||
Daikenchuto | Zingiberis Processum Rhizoma | Ginseng Radix | Zanthoxyli Fructus | |||||||
Goshajinkigan | Rehmanniae Radix | Achyranthis Radix | Corni Fructus | Dioscoreae Rhizoma | Plantaginis Semen | Alismatis Rhizoma | Poria | Moutan Cortex | Cinnamomi Cortex | Processi Aconiti Radix |
Kampo medicine | All physicians (n = 200) | Palliative care teams (n = 149) | PCUs (n = 46) | p-value | |||
---|---|---|---|---|---|---|---|
frequency | % | frequency | % | frequency | % | ||
Daikenchuto | 140 | 70.0 | 109 | 73.2 | 29 | 63.0 | 0.124 |
Goshajinkigan | 100 | 50.0 | 89 | 59.7 | 11 | 23.9 | 0.000 |
Rikkunshito | 97 | 48.5 | 82 | 55.0 | 15 | 32.6 | 0.001 |
Shakuyakukanzoto | 96 | 48.0 | 76 | 51.0 | 20 | 43.5 | 0.069 |
Hochuekkito | 90 | 45.0 | 76 | 51.0 | 13 | 28.3 | 0.011 |
Juzentaihoto | 84 | 42.0 | 73 | 49.0 | 11 | 23.9 | 0.001 |
Yokukansan | 61 | 30.5 | 45 | 30.2 | 16 | 34.8 | 0.253 |
Hangeshashinto | 54 | 27.0 | 51 | 34.2 | 3 | 6.5 | 0.000 |
Others | 24 | 12.0 | 20 | 13.4 | 4 | 8.7 | 0.457 |
Physician-recognized effectiveness
Kampo medicine | Symptoms | Recognized as effective | ||||||
---|---|---|---|---|---|---|---|---|
All physicians | Specialists | Non-specialists | p-value | |||||
frequency/total | % | frequency/total | % | frequency/total | % | |||
Hangeshashinto | Diarrhea caused by chemotherapy | 31/58 | 53.4 | 10/22 | 45.5 | 21/36 | 58.3 | 0.420 |
Nausea | 10/45 | 22.2 | 3/21 | 14.3 | 7/24 | 29.2 | 0.296 | |
Hochuekkito | Anorexia | 44/90 | 48.9 | 14/36 | 38.9 | 30/54 | 55.6 | 0.137 |
Fatigue | 54/96 | 56.3 | 19/39 | 48.7 | 35/57 | 61.4 | 0.295 | |
Rikkunshito | Nausea | 36/82 | 43.9 | 9/34 | 26.5 | 27/48 | 56.3 | 0.012 |
Anorexia | 46/92 | 50.0 | 18/40 | 45.0 | 28/52 | 53.8 | 0.528 | |
Juzentaihoto | Fatigue | 50/88 | 56.8 | 17/33 | 51.5 | 33/55 | 60.0 | 0.508 |
AE caused by chemotherapy or radiotherapy | 27/58 | 46.6 | 7/22 | 31.8 | 20/36 | 55.6 | 0.106 | |
Yokukansan | Delirium | 38/60 | 63.3 | 18/26 | 69.2 | 20/34 | 58.8 | 0.433 |
Anxiety | 15/50 | 30.0 | 6/23 | 26.1 | 9/27 | 33.3 | 0.758 | |
Shakuyakukanzoto | Leg cramps | 79/96 | 82.3 | 36/43 | 83.7 | 43/53 | 81.1 | 0.794 |
Abdominal pain | 20/57 | 35.1 | 11/25 | 44.0 | 9/32 | 28.1 | 0.268 | |
Daikenchuto | Ileus | 101/128 | 78.9 | 35/48 | 72.9 | 66/80 | 82.5 | 0.263 |
Opioid-caused constipation and abdominal pain | 62/115 | 53.9 | 22/47 | 46.8 | 40/68 | 58.8 | 0.254 | |
Goshajinkigan | Numbness of hands and feet | 47/107 | 43.9 | 18/39 | 46.2 | 29/68 | 42.6 | 0.840 |
Nocturia | 13/60 | 21.7 | 4/26 | 15.4 | 9/34 | 26.5 | 0.358 |
Prescription considerations
Open issues for prescription
Issue | frequency | % |
---|---|---|
The dose and dosage forms need to be better devised for simpler application | 173 | 60.7 |
No evidence of efficacy from placebo-controlled studies | 109 | 38.2 |
Action mechanism of Kampo medicine is not yet elucidated | 97 | 34.0 |
No opportunity to learn about Kampo medicines | 90 | 31.6 |
Relatively weak effect | 79 | 27.7 |
Drug interaction is uncertain | 66 | 23.2 |
Production of effect is slow | 56 | 19.6 |
Others | 25 | 8.8 |
There are no issues | 12 | 4.2 |