Page 178 - HA Convention 2016 [Full Version]

HOSPITAL AUTHORITY CONVENTION 2016 Special Topics

T16.1 Integrative Chinese-Western Medicine 13:15 Room 423 & 424

Integrative Chinese-Western Medicine Pilot Programme – Clinical Experience in Cancer Palliative Care
LO SH
Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong

The Integrative Chinese-Western Medicine (ICWM) pilot programme was started in September 2014. The Hospice and
Palliative Care Ward in Tuen Mun Hospital is one of the three pilot sites of the programme (the other two sites are focused
on low back pain and acute stroke management). We are working in partnership with Yan Oi Tong – The CUHK Chinese
Medicine Center for Training and Research to provide Chinese Medical in-patient treatment to advanced palliative cancer
patient. The clinical objective of the programme is to provide symptom relief to cancer patients. The target symptoms include
pain, constipation, insomnia, lymphedema, lethargy and anorexia. Only patients with one or more of these symptoms and
failed western medicine treatment were recruited to the programme. Patients with active anti-cancer treatment were excluded
from the programme. Written patient consent was required prior to programme entry. The treatment modalities include
herbal medicine and acupuncture. The programme went through the process of protocol and standard development, service
model exploration, staff training and logistic arrangement. Particular attention has been paid to safety issues (such as herb-
drug interaction, acupuncture needle disposal), IT support and patient costing. Up to February 2016, we have recruited 111
patients out of 214 screened patients. The three most common symptoms were lethargy, pain and anorexia. Satisfaction
survey showed patients were overall satisfied with the service provided apart from consultation fee. There was no major
safety issue reported.

T16.2 Integrative Chinese-Western Medicine 13:15 Room 423 & 424

Wednesday, 4 May Herb and Tablet at the Same Time? Herb-drug Interaction
Tse ML
Hong Kong Poison Information Centre, Hospital Authority, Hong Kong

The safety of concomitant drug and herb use is a major concern in integrative medicine practice. In the integrated Chinese
and Western Medicine (ICWM) pilot projects that commenced in 2015, two modalities of medical treatment based on diversely
different philosophies were administered together to selected and consenting patient groups. To address this unavoidable
safety issue, the Expert Panel on Chinese Medicine Safety for ICWM Pilot was formed to develop safety guidelines for herb-
drug use. Members of the panel included clinical oncologist, rehabilitation medicine specialists, hepatologist, nephrologist,
pharmacists, clinical pharmacologist, clinical toxicologist together with experts in Chinese medicine and Chinese medicine
pharmacy was formed. Comprehensive scientific information searches on reported toxicities and herb-drug interaction (HDI)
were performed for each of the 232 Chinese herbs to be used in first phase the project. The panel systematically reviewed
the scientific evidence found. Panel members evaluated the significance of all available evidence on herb-drug toxicities
with a defined methodology developed that two-dimensionally assessed the severity and validity of the reported adverse
events. Through several rounds of meeting, the panel arrived at consensus assigning each herb or herb-drug pair to 1 out of
4 risk levels. According to the risk level and the specific adverse effect of each herb, the panel recommended on the need
of enhanced safety measures for its use. Such measures included prohibition of use, dose limitation and specific biological
monitoring for herbs or herb-drug pairs with higher risk levels.

In the planned three-year running of the ICWM pilot projects, on one hand the expert panel will periodically review new
scientific evidence, and on the other, it will monitor and evaluate all adverse herb-drug events identified by the project team.
It is hoped that our effort can provide us better knowledge and experience in the co-use of Chinese herbs and conventional
drugs, and to provide directions for future research on safe integrative medicine practice.

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