Abstract
To the Editor,
We read with great interest the article by Sheng et al, 1 recently published in Integrative Cancer Therapies, titled “Efficacy of Astragalus membranaceus (Huang Qi) for Cancer-Related Fatigue: A Systematic Review and Meta-Analysis of Randomized Controlled Studies.” The authors addressed a highly relevant topic in the field of integrative oncology and conducted a systematic review and meta-analysis that contributes meaningfully to the growing evidence supporting the role of traditional Chinese medicine in supportive cancer care. We appreciate the authors’ diligent efforts and rigorous methodology, and would like to respectfully offer several supplementary perspectives that may help further strengthen the interpretation and application of their findings.
First, the methodological quality of the included studies may warrant more cautious interpretation of the pooled estimates. Although the authors conducted risk of bias assessments and evaluated the evidence using the GRADE approach, it is worth noting that several studies lacked clarity in allocation concealment and blinding procedures. While we recognize the challenges of conducting high-quality RCTs in this field, we suggest that future systematic reviews more explicitly discuss how these methodological limitations may have influenced the observed treatment effects, particularly when the overall quality of evidence is rated as low or very low.
Second, the heterogeneity of interventions across studies may introduce conceptual inconsistencies. The included trials employed different forms of A. membranaceus (eg, polysaccharide injection [PG2] vs full-spectrum herbal injection) and different administration routes (eg, intravenous vs acupoint injection). These variations may involve distinct pharmacological mechanisms. To enhance internal validity, future reviews might consider subgroup analyses based on formulation type or delivery method, which could offer clearer insights into which specific preparations are most effective for cancer-related fatigue.
Third, variability in outcome measurement tools may affect the comparability of results. Fatigue and quality of life were assessed using diverse instruments (eg, BFI-T, PFS, FSI, KPS, EORTC QLQ-C30), each with different sensitivity profiles and cultural contexts. While the use of standardized mean differences helps to harmonize diverse measures, the heterogeneity of assessment tools may still affect interpretability. We recommend that future studies consider either limiting inclusion to studies using comparable instruments, or applying conversion methods or weighting adjustments based on tool characteristics.
In summary, Sheng et al have made a commendable contribution to the literature on integrative therapies for cancer-related fatigue. Their work highlights the potential of A. membranaceus as a supportive intervention, and we hope our comments may provide useful considerations for future research aiming to refine the clinical application and evidence synthesis of herbal therapies in oncology.
With sincere academic respect,
