DOI: 10.14457/tu.the.2020.841
title: Cytotoxic, antioxidant and antimicrobial activities of Thai traditional remedy for cancer treatment and quantitative research on quality of life of cancer patients

description: Cancer is a leading cause of dead in Thailand. Among women, breast cancer had the highest incidence following by colorectal cancer. Thai traditional medicine uses mixed herbs including holistic methods for cancer treatment. The Jitmetta Mercy Foundation for Cancer Patients of Thailand (JFCT), Petchaburi province has offered cancer treatments for more than 30 years. However, there was no scientific research on the herbal remedy for cancer treatment. In addition, no report on treatment results and patients’ quality of lives were not studied. Thus, the objectives of this research were divided into two parts. Part one, it was to investigate cytotoxic activity of herbal remedy extract against cancer cell especially female cancer cell lines. The biological activity related to cancer treatment such as antioxidant, and antibacterial activity were also studied. Forty-four plants have been used in various Thai traditional formulae for cancer treatments. The cancer remedy and its single plant ingredients were extracted by maceration in 95% ethanol yielded the ethanolic extract and boiled in water yielded water extracts. All extracts were tested for cytotoxic activity by SRB assay against breast cancer (MCF-7), colon cancer (SW-480), ovarian cancer (SKOV3) and cervical cancer (HeLa) cell lines. Human Keratinocyte Cell Line (HaCat) as normal cell was also used for comparison with cancer cells. The biological activities related to cancer such as antioxidant was determined by DPPH assay and antimicrobial activity by broth dilution assay for minimal inhibitory concentration (MIC) against S. aureus, B subtilis, E coli, P. aeruginosa and C. albicans. The total flavonoid content was determined by using aluminium chloride (AlCl3) colorimetric method. Cytotoxic activity: The results showed that some plant ingredients in this cancer remedy were also food ingredients in Thai cuisine could be selected for health promotion in cancer patients with some specific types of cancer as well as included in the combination for cancer treatments i.e. A. galanga for breast, ovary and cervical cancers. A. comosus and T. indica for breast cancer. C. verum, T. indica, A. membranaceous, N. nucifera and L. triandra for colon cancer. P. amarus and L. striatum were active against all tested cancer cell lines, therefore these two herbs should be used for treatment of these cancers. For ovarian cancer, A. ebracteatus and L. striatum should be included as the major herbs. For cervical cancer a combination of A. ebracteatus, A. galangal, H. indicum, L. striatum and P. amarus would be beneficial.However, this cancer remedy only showed cytotoxic activity against breast cancer with IC50 as 52.325±2.054 µg/ml. Angelica dahurica Benth. ethanolic extract showed the highest selective index (10.13) with breast cancer and also showed the highest cytotoxic activity against breast cancer, but had no cytotoxic activity against other tested cancer cells and normal cells. Thus this cancer remedy should be used for breast cancer patients and Angelica dahurica ethanolic extract should be further studied.For biological activities related to cancer treatment: Mesua ferrea Linn. and Curcuma comosa Roxb. showed higher antioxidant activity by DPPH assay than BHT as positive antioxidant compound. Only five plants from 44 plants showed antimicrobial activity against S. aureus (MIC=2.5 mg/ml). The antioxidant activity appeared to be related to the total flavonoid content. Those extracts which contain low total flavonoid content (less than 100 mg/g quercetin equivalent) were not active as antioxidant.The results of study in part I , showed different activities related with cancer treatment, however, it could be suggested that these plants may also be necessary according to Thai traditional medicine theory which consider correction the imbalance of all elements. This study supported the use of these herbs and this remedy for cancer treatment. Part II; the objectives of this part were to explore the factors involved in patient’s decision for treatment at JFCT. This was a qualitative and quantitative research, using an in-depth interview for a total number of 408 cancer patients at JFCT and the data was collected between July 1st to December 31st, 2017. The structured questionnaire which were used for in-depth interview was divided into four parts: 1) personal factor, 2) contributing factors and complementary factors causing decision making in receiving the treatment with Thai traditional medicine,3) knowledge, belief and behavior on using herbal medicine and Thai traditional medicine and 4) quality of life. Data were analyzed using descriptive statistics. the relationship between variables were analyzed by using chi-square and Pearson’s Product Moment Correlation Coefficient. The results from 408 volunteers showed that their ages were between 61-70 years old, the most gender were female, the career was mostly agriculturist, income was with in the range 7,000 – 10,000 baht. Most of them have elementary education. They were diagnosed with cancer in digestive system: i.e. liver, colon and breast cancer, mostly in the fourth stage, and most of them had received two or more modern medicine methods of treatments. Most had no an experience with herbal treatment but were confident with positive attitude towards herbal treatment. The major reasons in patient’s decision were belief and faith in doctors and healthcare providers. The most influenced persons were former patients who were cured or had gotten better from the treatment who gave recommendation. Lesser influencers were the patients themselves and their family. The quality of life in the aspects of physical and mental health, social and environmental relationships were in medium level. The relationship between the variable factors which affected volunteer’s decision (p&lt;0.05) were income, type of cancer, and data from modern medicine treatment. It could be concluded that family and informants had effects on cancer patients’ decision in receiving treatment. Most of cancer types who came to treatment at JFCT were liver and breast cancer but the survival rate of patients after 6 months were lymphoma and laryngeal cancer patients (44.4 and 40.0%). This may be due to the fact that those patients with breast and liver cancers were already at their 4th stage. The patients with breast, lung, colon and renal cancers had 30% survival rate. The liver cancer patients showed 16.7% survival rate which was better than WHO prediction at only 10%. The results of Thai traditional treatment can be used to prolong life of cancer patients. Therefore, Thai traditional medicine should be considered for palliative care in cancer patients.