Coprescription of Chinese herbal medicine and Western medication among female patients with breast cancer in Taiwan: analysis of national insurance claims

Abstract

Bih-Ru Wang,1,2,* Yuh-Lih Chang,1,2,* Tzeng-Ji Chen,3,4 Jen-Hwey Chiu,5,6 Jing Chong Wu,7 Min-Shan Wu,1 Chia-Lin Chou,1 Yueh-Ching Chou1,2,81Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan; 2Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan; 3Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 4Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan; 5Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; 6Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 7Traditional Medicine Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; 8College of Pharmacy, Taipei Medical University, Taipei, Taiwan*These authors contributed equally to this workBackground: Many female breast cancer (FBC) patients take Chinese herbal medicine (CHM) and Western medication (WM) concurrently in Taiwan. Despite the possibility of interactions between the CHM and WM mentioned in previous studies, the pattern of these coprescriptions in FBC patients remains unclear. Hence, the aim of the present study is to investigate the utilization of coprescriptions of CHM and WM among the FBC patients in Taiwan.Methods: The study was a cross-sectional survey using the sampled cohort in 2009 obtained from the National Health Insurance Research Database in Taiwan. There were 3,507 FBC patients identified from the registry for catastrophic illness patients. Ambulatory visit records, corresponding prescriptions, and the data of beneficiaries belonging to the FBC patients were further extracted. A total of 1,086 FBC patients used CHM at least once. CHM and WM prescribed within any overlapping duration were defined as coprescriptions.Results: There were 868 (80.0%) patients simultaneously receiving CHM and WM. A total of 4,927 CHM prescriptions and 6,358 WM prescriptions were prescribed concurrently. Among these coprescriptions, the most frequently used CHM was jia-wei-xiao-yao-san (21.2%), and the most frequently coprescribed WM was acetaminophen (38.9%), followed by tamoxifen (25.5%). There were 346 patients using systemic adjuvant therapy and CHM concurrently. The most commonly coprescribed CHM with chemotherapy, endocrine therapy, and trastuzumab was xiang-sha-liu-jun-zi-tang, jia-wei-xiao-yao-san, and zhi-gan-cao-tang, respectively.Conclusion: The combined use of CHM with WM is prevalent. The main purpose of combining CHM with systemic cancer treatment is to alleviate the treatment-related adverse effects. However, the combination may result in the potential risk of drug–herb interactions. Further clinical studies are needed to evaluate the efficacy and safety of the CHM and WM coprescriptions for FBC patients.Keywords: drug utilization patterns, complementary and alternative medicine, pharmacoep-idemiology