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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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