My name is Jianping Liu from Beijing University of Chinese Medicine. I'm the head of the Center for Evidence-Based Chinese Medicine and I'm working in the integrative medicine field for more than 20 years. I was trained in Western medicine and I did my postgraduate education in infectious disease. And so after my PhD degree, I did some clinical practice for several years and then I transferred to clinical research, and also training, teaching and mainly focused on research. So, my background is also interested in traditional Chinese medicine, how to incorporate into the Western medicines setting. So, that is the work we have done for many years. Faye, can you present yourself please? My name Wong Faye, we come from the same place. Okay. I was an acupuncturist. Before I begin to learn clinical research methodologies. And then I did some acupuncture trial in the [inaudible] cancer patients to reduce their chemotherapy induced nausea and vomiting. I'm very happy to be here. I'm an associate professor. Thank you. I would like to ask you regarding the integration of herbal medicine in China regarding supportive cancer care and cancer care as a whole. I mean, what's the prevalence of herbal use among patients with cancer in China. How many patients really use herbs and for which reasons? That's a question sometimes we also try to ask but we have looked at the literature but there is an official epidemiology data for what is exactly prevalence of using Chinese medicine for cancer patient. But based on our experience and mainly talking with the oncologists in China, almost 100 percent of the patients were somehow using Chinese medicine in the different stages. So, what's the motivation of patients? Is it to improve their quality of life? Is it to cure cancer or extend survival? What are the expectations of patients in China regarding herbal use during chemotherapy for example? Okay. From culture and philosophy point of view, Chinese people naturally prefer traditional Chinese medicine, not only for cancer. So, they have two choices. One is Western medicine and traditional Chinese medicine. So for cancer patients, I believe a lot of patients when they got the diagnosis, it must be made by the Western medicine diagnosis. Then there are different situations why they choose TCM. One, if the patient got to the surgical procedures, all chemotherapy treatment in the Western medicine hospital, majority of the oncologists in Western medicine hospital they will recommend to the patient to use herbal medicine or sometimes acupuncture. The purpose is to relieve the adverse effects of chemotherapy. For example, nausea and vomiting and sometime its kind of hematology problem caused by the chemotherapy or sometimes by radiotherapy. And another reason is using herbal medicine to prevent the relapse after the surgical procedures. For the cancer patient with a later stage, when the Western medicine recommends nothing to treat because it's in a very advanced stage, so could not do some surgery or chemotherapy and then they refer the patient to the TCM doctors. So, TCM doctors were using the holistic approach to the cancer patient. So that included very complex interventions such as lifestyle advice, and dietary advice, and some herbal medicine and even they will advise patient receiving some Tai chi and Qigong because there is a very famous Qigong, it's called the Guolin Qigong, very popular 30 years ago among the Chinese cancer patients. So, sometimes they will also practice Qigong and Tai chi. So, all of these could be usually you can see in TCM hospital for advanced oncology patient. So, that is the major part of the supportive care for the advanced cancer patient. So in practice, patients with cancer who undergo chemotherapy, they receive at the same in the same hospital the chemotherapy and the Chinese herbs or acupuncture, its in the same facility? Yeah. Because the Chinese healthcare system is different from West. We have two basic different types of hospitals. One is the Western medicine hospital, another one is traditional Chinese medicine hospital. But actually it should be called the integrative medicine hospital because they use both. So, for the Western medicine hospital they normally have a department of TCM. So, they normally will ask advise or consultation with TCM doctors in their hospital to give some TCM treatment for their patient with chemotherapy. Otherwise, if they are hospitalized in the TCM hospital, so the TCM doctors can themselves provide chemotherapy treatment, that is a TCM oncology department, and also at the same time they will provide TCM treatment. So, that treatment is more than just taking some herbal medicine. It's included other holistic approach like I just mentioned. Even in some hospitals, they also added music therapies using the traditional cultural music and plus the acupuncture combined together. So, it's called a music acupuncture treatment because the electric acupuncture, they are with the electric flow with music line. So, it's a kind of a combination treatment. Yeah. So, in practice, when you look at oncologists in China, do you see any hesitation or opposition regarding the inclusion of Chinese herbs and other TCM practices? At the time of chemotherapy, is there any concern or they're just open to any collaboration? Yeah. I said that it depends. Some of the Western Medicine oncologist, they have different opinions toward the TCM. But majority of these people are positive to TCM. So, they were naturally refer patients to TCM hospital after chemotherapy or surgery. But some of the few oncologists in the Western hospital, they are concerned about actually some herb and a drug interaction. For example, if the patient not taking chemotherapy, they probably suggests that you don't take herbal medicine at this time, and they even advise the patient not to take herbal medicine. But that's a few of the oncologists. But in general, the attitude is positive toward taking some TCM. But we also got some concern from the public or Western oncologist about herb and drug interaction. So, we also looked at the literature, there's annual report on that. Unfortunately, there's not much concern about the data that showing herbal medicine and the chemotherapy drugs have an interaction. But I think in this area we'll need more evidence. We need to concern and the collected data intensively if the patient taking the both treatment at the same time. Do you have any interest regarding research, education, clinical practice collaboration with other countries which has other traditional medicine systems like the ones in the Middle East for example or other countries with traditional medicine in regard to the cancer cure? Yes. I think in general, Chinese government is very encouraging the Traditional Chinese Medicine to be modernized or internationalized. So for example, we have the World Federation for Chinese medicine society that was based in Beijing and they have more than a hundred societies around the world. So, there is academic collaboration, now the consortium. The second one I can give you is that the United States, NCI, they also established a TCM Consortium for cancer. So, they collaborated with one hospital in Beijing and we have already have three seminars on how to use in TCM in oncology area. So, what I heard from the Harvard University Medical Cancer Center, they also already incorporate acupuncture treatment in their clinical practice. For example, some of the issue that could not easily deal with Western medicine during cancer treatment for example nausea, vomiting, fatigue, pen, and the depression, so something like that. So, they can use acupuncture to relieve this kind of disease. So, I think the Chinese government for research funding, they have an international collaboration funding to go with other countries to collaborate on this area to provide more evidence, so that TCM can be disseminated to the wider regions to benefit the patient. So, I think generally, the government is positive. In other way, I think there are some barriers for the collaboration. One barrier is the system is quite different. The second one is a language barrier. So, we'll need to use the International platform like this international congress that people can talk face-to-face and discussion about facilitators and the barriers and how to make collaboration. What area should be incorporated to the research? So, I think that there would be a chance even for the different countries and China also. Look at the developing countries, how could we help with acupuncture and TCM in developing country well, the western medicine that is not accessible or is not affordable in that setting. So, traditional medicine may help. Yeah. Maybe I can ask Fu about specific herbs that you just find useful in the treatment of supportive care and palliative care. In different conditions, patients will prescribe different herbs. Generally speaking, herbs that could reinforce the patients energy and their health conditions will be prescribed. Just like ginseng. [inaudible] If you know that [inaudible] Oh yes, some of the patent medicine are also prescribed. I see. For which indications they would be prescribed? Almost in all the process of the cancer, but only they will receive different kinds of treatment. Okay. Thank you very much. Thank you very much.
