Effects of herbal medicine for xerostomia in head and neck cancer patients: an observational study in a tertiary cancer hospital

  • Ren Jye LimEmail author
  • Wan Najbah Nik Nabil
  • Si Yan Chan
  • Yoke Fui Wong
  • Li Xian Han
  • Jia Ying Gong
  • Kun Ling Ho
  • Yee Siang Shew
  • Li Xu
Original Article



More than 80% head and neck cancer patients endured radiotherapy-induced xerostomia which impacts their quality of life (QoL). This observational study evaluated the effect of herbal treatment on head and neck cancer patients’ xerostomia and QoL.


Head and neck cancer patients were recruited from July 2016 till March 2017 at National Cancer Institute, Ministry of Health, Malaysia. All study participants continued their standard oncology surveillance. Treatment group participants additionally received Chinese herbal treatment. The assessments included unstimulated salivary flow rate (USFR), stimulated salivary flow rate (SSFR), and QoL questionnaire.


Of 42 recruited participants, 28 were in the treatment group and 14 were in the control group. Participants were mainly Chinese (71.4%), stage III cancer (40.5%), and had nasopharynx cancer (76.2%). The commonly used single herbs were Wu Mei, San Qi, and Tian Hua Fen. Sha Shen Mai Dong Tang, Liu Wei Di Huang Wan, and Gan Lu Yin were the frequently prescribed herbal formulas. The baseline characteristics, USFR, SSFR, and QoL between control and treatment groups were comparable (p > 0.05). USFR between control and treatment groups were similar throughout the 6-month study period. SSFR for the treatment group significantly improved from 0.15 ± 0.28 ml/min (baseline) to 0.32 ± 0.22 ml/min (p = 0.04; at the 3rd month) and subsequently achieved 0.46 ± 0.23 ml/min (p = 0.001; at the 6th month). The treatment group had better QoL in terms of speech (p = 0.005), eating (p = 0.02), and head and neck pain (p = 0.04) at the 6th month.


Herbal treatment may improve xerostomia and QoL in post-radiotherapy head and cancer patients.


Chinese herbal drugs Xerostomia Radiotherapy Head and neck neoplasms 





Interquartile range




National Cancer Institute


Quality of life


Standard deviation


Stimulated salivary flow rate


Traditional and complementary medicine


Unstimulated salivary flow rate



The authors would like to thank the Director of Health Malaysia for permission to publish this paper. We thank the Director of National Cancer Institute, Malaysia, for supporting this research. Appreciation also goes to Professor Jeffrey E. Terrell (University of Michigan, USA) for sharing his QoL questionnaire. We appreciate the research support provided by Dr. Foo Yoke Ching (Subang Jaya Medical Centre, Malaysia), Dr. Wong Wei Kong, Mr. Teng Chee Wi, and the nursing team at our unit (namely Ms. Yuhanis Mat Nasir and Ms. Son Hui Wen).

Author contributions

Study design: Dr. Lim Ren Jye, Wan Najbah Nik Nabil, Dr. Wong Yoke Fui, Dr. Xu Li. Data acquisition: Dr. Lim Ren Jye, Dr. Wong Yoke Fui, Han Li Xian, Gong Jia Ying, Ho Kun Ling, Dr. Shew Yee Siang. Quality control of data: Chan Si Yan, Wan Najbah Nik Nabil, Han Li Xian, Gong Jia Ying. Data analysis and interpretation: Chan Si Yan, Wan Najbah Nik Nabil. Manuscript preparation: Dr. Lim Ren Jye, Wan Najbah Nik Nabil, Chan Si Yan. Manuscript editing: Dr. Lim Ren Jye, Dr. Xu Li.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study (involving human participants) were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Ren Jye Lim
    • 1
    • 2
    Email author
  • Wan Najbah Nik Nabil
    • 1
    • 3
  • Si Yan Chan
    • 3
    • 4
  • Yoke Fui Wong
    • 5
  • Li Xian Han
    • 1
  • Jia Ying Gong
    • 1
    • 3
  • Kun Ling Ho
    • 1
  • Yee Siang Shew
    • 6
  • Li Xu
    • 2
  1. 1.Traditional & Complementary Medicine (T&CM) Unit, National Cancer Institute (NCI)Ministry of HealthPutrajayaMalaysia
  2. 2.First Clinical Medicine College, Jiangsu Province Hospital of Traditional Chinese MedicineAffiliated Hospital of Nanjing University of Chinese MedicineNanjingPeople’s Republic of China
  3. 3.Pharmacy Department, National Cancer Institute (NCI)Ministry of HealthPutrajayaMalaysia
  4. 4.Department of Chinese Pharmaceutical Sciences and Chinese Medicine Resources, College of Chinese MedicineChina Medical UniversityTaichungTaiwan
  5. 5.Department of Radiotherapy and Oncology, National Cancer Institute (NCI)Ministry of HealthPutrajayaMalaysia
  6. 6.Cancer CentreTung Shin HospitalKuala LumpurMalaysia

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