Meridian-based traditional Chinese medicine interventions for supportive care in children, adolescents, and young adults with cancer: a systematic review and meta-analysis.

Background: Meridian-based traditional Chinese medicine (TCM) interventions are increasingly used as adjunctive approaches to manage treatment-related toxicities in children, adolescents, and young adults (CAYAs) with cancer. However, their effectiveness remains uncertain. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating meridian-based TCM interventions for supportive symptom management in CAYAs with cancer. Eight electronic databases, including PubMed, the Cochrane Library, and CNKI, were searched from inception to October 2024, with an updated search conducted in November 2025. Primary outcomes included treatment-related symptoms such as nausea and vomiting. Continuous outcomes (e.g., symptom severity) and dichotomous outcomes (e.g., response rates) were analyzed separately. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: Twelve RCTs involving 732 participants were included. Compared with sham controls, meridian-based TCM interventions did not significantly reduce nausea severity (SMD: -0.25; 95% CI: -0.78 to 0.28) or vomiting frequency (SMD: -0.37; 95% CI: -0.90 to 0.16). When added to conventional antiemetic therapy, these interventions were associated with better control of nausea and vomiting than antiemetic therapy alone (OR: 0.26; 95% CI: 0.15 to 0.47). Evidence for fatigue and other supportive-care outcomes was limited and could only be synthesized narratively. The overall certainty of evidence was low because of methodological limitations, small sample sizes, and imprecision. Conclusion: The available sham-controlled evidence was insufficient to determine whether meridian-based TCM interventions improve chemotherapy-induced nausea and vomiting in CAYAs with cancer. Their addition to conventional antiemetic therapy may provide symptomatic benefit, but the certainty of evidence is low. Future trials should be adequately powered and, where feasible, use multicenter designs, credible sham controls, appropriate blinding, prespecified protocols, validated and standardized symptom measures, and longer follow-up. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024607724, identifier: CRD42024607724.