51
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Arring NM, Millstine D, Barton DL, Lyons KS, Girardo M, Hutson A, Nail LM. Trends in integrative medicine and health consults: differences between cancer survivors and patients without cancer. Support Care Cancer 2020; 29:3103-3112. [PMID: 33057818 DOI: 10.1007/s00520-020-05815-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/06/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The objectives were to compare patients with and without cancer who sought an integrative health (IH) consult and reasons for seeking a consult. DESIGN Descriptive cross-sectional study that employed a secondary analysis of an integrative health database supplemented by a retrospective medical record review. SETTING/LOCATION Integrative Medicine and Health program in a Southwestern United States academic medical center. SUBJECTS Eight hundred thirty-nine adults over the age of 18 seeking IH consultation. RESULTS The number of complementary therapies reported prior to consult were not significantly different between groups. The most reported complementary therapies used by cancer survivors were multivitamins, exercise, and turmeric. Patients without cancer reported significantly higher pain levels than cancer survivors. Cancer survivors reported significantly higher energy, sleep levels, overall health, spiritual wellbeing, and significantly better relationships compared to patients without cancer. Cancer survivors reported fatigue and cancer as the top reasons for IH consult. CONCLUSION Participants without cancer reported higher levels of pain and lower levels of energy, sleep, overall health, spiritual wellbeing, and relationships compared to cancer survivors. However, cancer survivors still reported levels of unmanaged symptoms. Complementary therapy use prior to IMH consult was similar between groups; however, IMH providers recommended more treatments for patients without cancer. Our results highlight that more evidence is needed to guide IMH recommendations, especially for cancer survivors who may still be in treatment. Additionally, our results support evidence-based recommendations that all cancer survivors should be assessed for complementary therapy use and provided counseling by qualified providers on their advantages and limitations.
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Affiliation(s)
- Noël M Arring
- School of Nursing, University of Michigan, 400 North Ingalls St, RM 4320, Ann Arbor, MI, 48108, USA. .,Department of Nursing, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA.
| | - Denise Millstine
- Division of General Internal Medicine, Division of Women's Health Internal Medicine, Mayo Clinic, 13737 North 92nd Street, Scottsdale, AZ, 85260, USA
| | - Debra L Barton
- School of Nursing, University of Michigan, 400 North Ingalls St, RM 4320, Ann Arbor, MI, 48108, USA
| | - Karen S Lyons
- William F. Connell School of Nursing, Boston College, Maloney Hall, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA
| | - Marlene Girardo
- Research Biostatistics Division, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Amy Hutson
- Department of Nursing, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Lillian M Nail
- Oregon Health & Science University, School of Nursing, 3455 SW US Veterans Hospital Rd, OR, 97239, Portland, USA
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52
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Gentile D, Blake S, Greiner R, Kneuss T, Spencer L, Yaguda S, Bailey-Dorton C, Parala-Metz A. Integrative and Palliative Medicine Synergy: Structures and Solutions. J Altern Complement Med 2020; 26:766-768. [PMID: 32924557 DOI: 10.1089/acm.2019.0398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Danielle Gentile
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Sarah Blake
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Rebecca Greiner
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Tiffany Kneuss
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Latoya Spencer
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Susan Yaguda
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Chasse Bailey-Dorton
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Armida Parala-Metz
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
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Thronicke A, Matthes B, von Trott P, Schad F, Grah C. Overall Survival of Nonmetastasized NSCLC Patients Treated With Add-On Viscum album L: A Multicenter Real-World Study. Integr Cancer Ther 2020; 19:1534735420940384. [PMID: 32856476 PMCID: PMC7457695 DOI: 10.1177/1534735420940384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Recent data suggest a beneficial effect of add-on treatment with Viscum album L (VA) on the survival in cancer patients. The objective of this study was to compare the impact of standard oncological therapy plus add-on VA treatment (S+VA) versus standard oncological therapy alone (S) on the overall survival (OS) of patients with nonmetastasized non–small cell lung carcinoma (NSCLC). Methods: The multicenter real-world data study was conducted using data from the Network Oncology Clinical Registry. The primary end point was OS. OS and impact on hazard in both treatment groups were compared. Results: A total of 275 patients with stages I to IIIA NSCLC were enrolled (mean age = 67.6 years, 57.2% male patients). No significant difference of OS was observed between both groups. Even though not significant, for a subgroup of unresected patients with stage I NSCLC, adenocarcinoma or squamous cell carcinoma, a medium effect size OS improvement was observed for S+VA compared to S. Conclusions: Our findings support the importance of surgery as the most effective intervention in nonmetastasized NSCLC patients. Add-on VA therapy shows here no additional effect in resected patients. However, a small subgroup analysis suggests a possible role of add-on VA for nonresected subgroups. Our results complement existing knowledge on the clinical impact of add-on VA therapy in NSCLC patients and may serve as hypothesis-generating data for further examinations in this cohort. Further research could be directed towards the role of combined therapy for nonresected early-stage NSCLC.
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Affiliation(s)
| | - Burkhard Matthes
- Research Institute Havelhöhe, Berlin, Germany.,Interdisciplinary Oncology and Palliative Care, Hospital Havelhöhe, Berlin, Germany
| | - Philipp von Trott
- Interdisciplinary Oncology and Palliative Care, Hospital Havelhöhe, Berlin, Germany
| | - Friedemann Schad
- Research Institute Havelhöhe, Berlin, Germany.,Interdisciplinary Oncology and Palliative Care, Hospital Havelhöhe, Berlin, Germany
| | - Christian Grah
- Research Institute Havelhöhe, Berlin, Germany.,Lung Cancer Center and Department of Pneumology, Hospital Havelhöhe, Berlin, Germany
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Abstract
Pain management for cancer patients should include pharmacologic and nonpharmacologic interventions. Integrative medicine therapies, such as mind-body practice, acupuncture, massage therapy, and music therapy, have been studied for their roles in pain management. Data from randomized controlled trials support the effect of hypnosis, acupuncture, and music therapy in reduction of pain. Mindfulness meditation, yoga, qigong, and massage therapy, although may not reduce pain per se, can relieve anxiety and mood changes, which are commonly associated with pain. In clinical practice, one should also consider burdens and risks to patients, patient preference, and the presence or absence of better alternatives when making decisions on whether an integrative medicine therapy is of clinical value.
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Emerging Role of Integrative Medicine in Hematologic Malignancies: a Literature Review and Update on Current Trends in Complementary Medical Practices in Hematologic Cancers. Curr Hematol Malig Rep 2020; 14:328-336. [PMID: 31209644 DOI: 10.1007/s11899-019-00526-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW This review discusses the emerging role of integrative hematology. It reinforces the growing interest of CAM among patients, and the importance of provider knowledge and participation in discussions with patients about the subject. The main question asked in this review, "Is there evidence for the use of integrative medicine practices in the field of malignant hematology?" is answered by examining current research and providing relevant summaries. RECENT FINDINGS Data suggests that practices such as meditative movement, exercise, nutrition and supplements and touch therapy can be used for symptom alleviation, preventive measures, and novel treatment development. Integrative hematology is a needed part of complete patient care, and it is the role of providers to be knowledgeable and open to ensure patients are engaging in practices that are evidence-informed and safe. More studies are needed in the field in order to make concrete and robust recommendations.
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56
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Fabi A, Bhargava R, Fatigoni S, Guglielmo M, Horneber M, Roila F, Weis J, Jordan K, Ripamonti CI. Cancer-related fatigue: ESMO Clinical Practice Guidelines for diagnosis and treatment. Ann Oncol 2020; 31:713-723. [PMID: 32173483 DOI: 10.1016/j.annonc.2020.02.016] [Citation(s) in RCA: 221] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 02/27/2020] [Indexed: 12/18/2022] Open
Affiliation(s)
- A Fabi
- Division of Medical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - R Bhargava
- William Osler Health System, Corporate Department of Research, Department of Oncology and Division of Palliative Care, Brampton, Canada
| | - S Fatigoni
- Division of Medical Oncology, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - M Guglielmo
- Oncology-Supportive Care Unit, Department Onco-Haematology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - M Horneber
- Department of Internal Medicine, Division of Oncology and Hematology & Division of Pneumology, Paracelsus Medical University, Klinikum, Nuremberg, Germany
| | - F Roila
- Division of Medical Oncology, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - J Weis
- Department of Self Help Research in Oncology, Comprehensive Cancer Center, University Medical Center, Freiburg, Germany
| | - K Jordan
- Department of Medicine V, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - C I Ripamonti
- Oncology-Supportive Care Unit, Department Onco-Haematology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Tristão Parra M, Esmeaeli N, Kohn J, Henry BL, Klagholz S, Jain S, Pruitt C, Vicario D, Jonas W, Mills PJ. Greater Well-Being in More Physically Active Cancer Patients Who Are Enrolled in Supportive Care Services. Integr Cancer Ther 2020; 19:1534735420921439. [PMID: 32456467 PMCID: PMC7265567 DOI: 10.1177/1534735420921439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Cancers are one of the leading causes of mortality
worldwide. Cancer patients are increasingly seeking integrative care clinics to
promote their health and well-being during and after treatment.
Aim: To examine relationships between physical activity (PA)
and quality of life (QoL) in a sample of cancer patients enrolling in
integrative care in a supportive care clinic. Also, to explore circulating
inflammatory biomarkers and heart rate variability (HRV) in relationship to PA
and QoL. Methods: A cross-sectional design of adult patients who
sought care in the InspireHealth clinic, Vancouver, British Columbia, Canada.
Patients with complete PA data (n = 118) answered psychosocial questionnaires,
provided blood samples, and received HRV recordings before enrollment. Patients
were stratified into “less” versus “more” active groups according to PA
guidelines (150 minutes of moderate or 75 minutes of vigorous PA or an
equivalent combination). Results: Breast (33.1%) and prostate
(10.2%) cancers were the most prevalent primary diagnoses. Patients engaging in
more PA reported better physical (U = 1265.5,
P = .013), functional (U = 1306.5,
P = .024), and general QoL (U = 1341,
P = .039), less fatigue (U = 1268,
P = .014), fewer physical cancer-related symptoms
(U = 2.338, P = .021), and less general
distress (U = 2.061, P = .021). Between PA
groups, type of primary cancer diagnosis differed (χ2 = 41.79,
P = .014), while stages of cancer did not (χ2 =
3.95, P = .412). Fewer patients reported depressed mood within
the more active group (χ2 = 6.131, P = .047). More
active patients were also less likely to have ever used tobacco (χ2 =
7.41, P = .025) and used fewer nutritional supplements
(χ2 = 39.74, P ≤ .001). An inflammatory
biomarker index was negatively correlated with vigorous PA
(rs = −0.215, P = .022).
Multivariable linear regression (R2 = 0.71) revealed
that age (β = 0.22; P = .001), fatigue (β = −0.43;
P ≤ .001), anxiety (β = −0.14; P = .048),
and social support (β = 0.38; P = .001) were significant
correlates of QoL.
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Affiliation(s)
| | - Naghmeh Esmeaeli
- Samueli Integrative Health Programs, H&S Ventures, Alexandria, VA, USA
| | - Jordan Kohn
- University of California San Diego, La Jolla, CA, USA
| | - Brook L Henry
- University of California San Diego, La Jolla, CA, USA
| | | | - Shamini Jain
- University of California San Diego, La Jolla, CA, USA
| | | | | | - Wayne Jonas
- Samueli Integrative Health Programs, H&S Ventures, Alexandria, VA, USA
| | - Paul J Mills
- University of California San Diego, La Jolla, CA, USA
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58
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Sheng JY, Visvanathan K, Thorner E, Wolff AC. Breast cancer survivorship care beyond local and systemic therapy. Breast 2020; 48 Suppl 1:S103-S109. [PMID: 31839149 DOI: 10.1016/s0960-9776(19)31135-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Despite persistent inequities in access to care and treatments, advances in combined modality care have led to a steady improvement in outcomes for breast cancer patients across the globe. When estimating the magnitude of clinical benefit of therapies, providers and patients must contend with a multitude of factors that impact treatment decisions and can have long-term effects on quality of life and survival. These include commonly described early toxicities, like aromatase inhibitor-associated musculoskeletal syndrome and neuropathy. But longer-term comorbidities often observed among cancer survivors including weight gain, obesity, infertility, psychological distress, sexual dysfunction, second cancers, bone loss, and body image issues can have lasting effects on quality of life. Equally important, system-level factors such as access to care and resource allocation can have a systemic impact on survival and on the quality of survivorship. Financial toxicity including underemployment can have a lasting impact on patients and caregivers. The resulting disparities in access to treatment can help explain much of the observed variability in outcomes, even within high-income countries like the US. This article revisits some of secondary effects from therapies discussed in a prior 2015 review article, along with other impediments to the optimal delivery of breast cancer care that can affect patients anywhere.
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Affiliation(s)
- Jennifer Y Sheng
- The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Kala Visvanathan
- The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Elissa Thorner
- The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Antonio C Wolff
- The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.
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Wei TT, Tian X, Zhang FY, Qiang WM, Bai AL. Music interventions for chemotherapy-induced nausea and vomiting: a systematic review and meta-analysis. Support Care Cancer 2020; 28:4031-4041. [PMID: 32328772 DOI: 10.1007/s00520-020-05409-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Chemotherapy-induced nausea and vomiting (CINV) is the most common and severe side effects brought by chemotherapeutics. The role of music interventions in relieving CINV is uncertain. The aim of this systematic review was to test the effects of music interventions on three categories of CINV. METHODS A systematic search was conducted in Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, EMBASE, China National Knowledge Infrastructure (CNKI), WanFang, and Chinese Biomedical Database (CBM) in order to capture randomized controlled trials (RCTs) investigating the comparative efficacy of music interventions and others. Two investigators screened, sorted, and extracted the data, and appraised the risk of bias. All statistical analyses were performed using RevMan 5.3 software. RESULTS The literature search yielded 608 studies of which only ten RCTs fulfilled the eligibility criteria with 632 patients retrieved. Although the duration, the frequency of interventions, and the type of selected music varied across studies, commonly used elements included music listening. Results showed that music interventions were associated with reducing the incidence of anticipatory CINV and lowering the severity of delayed vomiting (MD = - 0.65, 95% CI = - 1.08 to - 0.23). However, strongly controversial results existed in terms of reducing the incidence of acute and delayed CINV, the severity of acute CINV, the severity of delayed nausea, and improving patients' quality of life. CONCLUSIONS Music interventions may effectively reduce the incidence of anticipatory CINV and relieve the severity of delayed vomiting in patients with chemotherapy based on limited data. However, the conclusion should be interpreted with caution and further research is required to design with large-scale and rigorous methods.
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Affiliation(s)
- Ting-Ting Wei
- Tianjin Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, The Third Department of Breast Surgery, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xu Tian
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Department of Gastroenterology, Chongqing University Cancer Hospital, Chongqing, China
| | - Fang-Yuan Zhang
- Tianjin Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Nursing Department, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Wan-Min Qiang
- Tianjin Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Nursing Department, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
| | - Ai-Li Bai
- Beichen District Center for Disease Control and Prevention, Tianjin, China
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del-Rosal-Jurado A, Romero-Galisteo R, Trinidad-Fernández M, González-Sánchez M, Cuesta-Vargas A, Ruiz-Muñoz M. Therapeutic Physical Exercise Post-Treatment in Breast Cancer: A Systematic Review of Clinical Practice Guidelines. J Clin Med 2020; 9:E1239. [PMID: 32344683 PMCID: PMC7230832 DOI: 10.3390/jcm9041239] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/06/2020] [Accepted: 04/22/2020] [Indexed: 02/06/2023] Open
Abstract
Advances achieved in diagnosis and improvements in treatment for breast cancer have resulted in a favourable survival rate. Therapeutic physical exercise (TPE) is presented as an intervention strategy that seeks to improve the functional capabilities of the subject. To analyse if clinical practice guidelines recommend therapeutic physical exercise to reduce the adverse effects of treatment in breast cancer survivors, and on what level of scientific evidence are these recommendations based. This systematic review was prepared by searching nine electronic databases to identify eligible studies. Thirteen met the criteria for inclusion. The Appraisal of Guidelines for Research and Evaluation (AGREE II) scale was used to analyse the quality of Clinical Practice Guideline (CPGs). The percentages obtained ranged between 30.07% and 75.70%. Specifically, the highest degree of evidence could be found in the application of TPE to offset adverse effects leading to effects such as: an increase in the quality of life, fatigue reduction, and reduction in body weight alterations. TPE is presented as an optimal intervention strategy to alleviate the negative effects that patients with breast cancer suffer as a result of the treatments received. The level of evidence that supports this claim is very strong for the majority of the side effects analysed. However, this evidence is not always included in the clinical practice guidelines.
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Affiliation(s)
- Alicia del-Rosal-Jurado
- Department of Physiotherapy, Institute of Biomedicine of Málaga (IBIMA), Clinimetric Group (F-14), Chair of Physiotherapy and Disability, Faculty of Health Sciences, Andalucía Tech, University of Málaga, 29071 Málaga, Spain; (A.d.-R.-J.); (M.T.-F.); (A.C.-V.)
| | - Rita Romero-Galisteo
- Department of Physiotherapy, Faculty of Health Sciences, Andalucía Tech, University of Málaga, 29071 Málaga, Spain
| | - Manuel Trinidad-Fernández
- Department of Physiotherapy, Institute of Biomedicine of Málaga (IBIMA), Clinimetric Group (F-14), Chair of Physiotherapy and Disability, Faculty of Health Sciences, Andalucía Tech, University of Málaga, 29071 Málaga, Spain; (A.d.-R.-J.); (M.T.-F.); (A.C.-V.)
| | - Manuel González-Sánchez
- Department of Physiotherapy, Institute of Biomedicine of Málaga (IBIMA), Clinimetric Group (F-14), Chair of Physiotherapy and Disability, Faculty of Health Sciences, Andalucía Tech, University of Málaga, 29071 Málaga, Spain; (A.d.-R.-J.); (M.T.-F.); (A.C.-V.)
| | - Antonio Cuesta-Vargas
- Department of Physiotherapy, Institute of Biomedicine of Málaga (IBIMA), Clinimetric Group (F-14), Chair of Physiotherapy and Disability, Faculty of Health Sciences, Andalucía Tech, University of Málaga, 29071 Málaga, Spain; (A.d.-R.-J.); (M.T.-F.); (A.C.-V.)
- School of Clinical Sciences of the Faculty of Health, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Maria Ruiz-Muñoz
- Department of Nursing, Institute of Biomedicine of Málaga (IBIMA), Clinimetric Group (F-14), Chair of Physiotherapy and Disability, Faculty of Health Sciences, Andalucía Tech, University of Málaga, 29071 Málaga, Spain;
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Wong CHL, Sundberg T, Chung VCH, Voiss P, Cramer H. Prevalence and predictors of mind-body medicine use among women diagnosed with gynecological cancer: Findings from the 2017 US National Health Interview Survey. Gynecol Oncol 2020; 157:740-744. [PMID: 32197714 DOI: 10.1016/j.ygyno.2020.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/08/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Gynecological cancer is a major health burden globally. In the US, it is common for cancer patients to utilize different types of complementary medicine. This study aims to investigate the prevalence of mind-body medicine use among US women diagnosed with gynecological cancer. METHODS We used data from the 2017 National Health Interview Survey (NHIS) to investigate prevalence and predictors of mind-body medicine utilization in the past 12 months among gynecological cancer patients in a representative sample of the US population (N = 26,742). We descriptively analyzed the 12-month prevalence of any mind-body medicine use, separately for women with a prior diagnosis of gynecological cancer and those without. Using and b multiple logistic regression analyses, we identified predictors of mind-body medicine use. RESULTS A weighted total of 2,526,369 women (2.0%) reported having received a diagnosis of gynecological cancer. More women diagnosed with gynecological cancer (weighted n = 964,098; 38.2%) than those not diagnosed with gynecological cancer (weighted mean = 36,102,852; 28.8%) had used mind-body medicine in the past 12 months. A higher prevalence of mind-body medicine use was associated with being non-Hispanic White, living in Western US and having received higher education. Spiritual meditation was found to be the most frequently used mind-body medicine modality, followed by yoga and progressive relaxation. CONCLUSIONS While mind-body medicine is popular among US gynecological cancer patients, clinical evidence supporting the effectiveness of different mind-body medicine modalities is yet to be established. Randomized controlled trials should be conducted to evaluate the effectiveness of popular modalities like spiritual meditation or yoga to inform clinical decision and patient choice.
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Affiliation(s)
- Charlene H L Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Tobias Sundberg
- Musculoskeletal and Sports Injury Epidemiology Center (MUSIC), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Vincent C H Chung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong; Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia; School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Petra Voiss
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Holger Cramer
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia; Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.
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62
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Yan A, Millon-Underwood S, Walker A, Patten C, Nevels D, Dookeran K, Hennessy R, Knobloch MJ, Egede L, Stolley M. Engaging young African American women breast cancer survivors: A novel storytelling approach to identify patient-centred research priorities. Health Expect 2020; 23:473-482. [PMID: 31916641 PMCID: PMC7104646 DOI: 10.1111/hex.13021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/02/2019] [Accepted: 12/12/2019] [Indexed: 12/02/2022] Open
Abstract
Background Patient‐centredness is considered an essential aspiration of a high‐quality health‐care system, and patient engagement is a critical precursor to patient‐centred care. Objectives To engage patients, health‐care providers and stakeholders in identifying recommendations to address research and practice gaps that impact young African American breast cancer survivors. Methods This paper reported an approach for research priority setting. This approach applies an engagement process (January‐September 2018) of using patient and stakeholder groups, patient storytelling workshops and a culminating storytelling conference in Wisconsin to generate relevant research topics and recommendations. Topics were prioritized using an iterative engagement process. Research priorities and recommendation were ranked over the conference by counting participants’ anonymous votes. Results One hundred attendees (43 patients/family members, 20 providers/researchers and 37 community members) participated in the conference. Five topics were identified as priorities. The results showed that three priority areas received the most votes, specifically community outreach and education, providing affordable health care and engaging in complementary care practice. Stakeholders also agreed it is critical to ‘include youth in the conversation’ when planning for cancer support and educational programmes for caregivers, friends and family members. Conclusion Storytelling as a patient engagement approach can build trust in the patient‐research partnership, ensure that patients are meaningfully engaged throughout the process and capture the diversity of patient experiences and perspectives.
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Affiliation(s)
- Alice Yan
- Joseph J. Zilber School of Public Health, University of Wisconsin Milwaukee, Milwaukee, WI, USA
| | | | - Alonzo Walker
- Division of Surgical Oncology, Breast Care Center, Froedtert & The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Caitlin Patten
- Division of Surgical Oncology, Breast Care Center, Froedtert & The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Debra Nevels
- American Cancer Society - North Region, Waukesha, WI, USA
| | - Keith Dookeran
- Joseph J. Zilber School of Public Health, University of Wisconsin Milwaukee, Milwaukee, WI, USA
| | - Rose Hennessy
- Joseph J. Zilber School of Public Health, University of Wisconsin Milwaukee, Milwaukee, WI, USA
| | - Mary Jo Knobloch
- School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI, USA
| | - Leonard Egede
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Melinda Stolley
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
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Jones E, Nissen L, McCarthy A, Steadman K, Windsor C. Exploring the Use of Complementary and Alternative Medicine in Cancer Patients. Integr Cancer Ther 2019; 18:1534735419846986. [PMID: 31072149 PMCID: PMC7242794 DOI: 10.1177/1534735419846986] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
In Australia, it is estimated that around 17% to 87% of cancer patients have used
one form of complementary therapy during their cancer treatment. There are
numerous reasons and contributing factors for cancer patients to consider using
complementary and alternative medicine (CAM). CAM information and products are
readily available. However, the level of evidence to support the benefits of use
in the cancer setting is limited, and the associated adverse effects and
interactions with conventional medicine may not be fully studied. Besides, not
all health professionals favor the concept of integrative health approaches, or
have the confidence in dealing with CAM due to a lack of knowledge and
standardization of practices. A thematic review of the literature was performed
on the main contributing factors to cancer patients’ use of CAM, as well as the
current issues that may be encountered by the patients and health
professionals.
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Affiliation(s)
- Ellen Jones
- 1 Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Lisa Nissen
- 2 Queensland University of Technology, Brisbane, Queensland, Australia
| | | | | | - Carol Windsor
- 2 Queensland University of Technology, Brisbane, Queensland, Australia
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Jones E, Nissen L, McCarthy A, Steadman K, Windsor C. Exploring the Use of Complementary and Alternative Medicine in Cancer Patients. Integr Cancer Ther 2019; 18:1534735419854134. [PMID: 31170844 PMCID: PMC6557018 DOI: 10.1177/1534735419854134] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In Australia, it is estimated that around 17% to 87% of cancer patients have used one form of complementary therapy during their cancer treatment. There are numerous reasons and contributing factors for cancer patients to consider using complementary and alternative medicine (CAM). CAM information and products are readily available. However, the level of evidence to support the benefits of use in the cancer setting is limited, and the associated adverse effects and interactions with conventional medicine may not be fully studied. Besides, not all health professionals favor the concept of integrative health approaches, or have the confidence in dealing with CAM due to a lack of knowledge and standardization of practices. A thematic review of the literature was performed on the main contributing factors to cancer patients’ use of CAM, as well as the current issues that may be encountered by the patients and health professionals.
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Affiliation(s)
- Ellen Jones
- 1 Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Lisa Nissen
- 2 Queensland University of Technology, Brisbane, Queensland, Australia
| | | | | | - Carol Windsor
- 2 Queensland University of Technology, Brisbane, Queensland, Australia
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Araujo RV, Fernandes AFC, Nery IS, Andrade EMLR, Nogueira LT, Azevedo FHC. Meditation effect on psychological stress level in women with breast cancer: a systematic review. Rev Esc Enferm USP 2019; 53:e03529. [PMID: 31800820 DOI: 10.1590/s1980-220x2018031303529] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 04/30/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the effect of meditation on the psychological stress level of women with breast cancer. METHOD A systematic literature review performed in the LILACS, PubMed, Scopus, CINAHL and Web of Science databases. RESULTS The sample consisted of 22 studies using Mindfulness, Transcendental Meditation, and Contemplative Self-Healing Meditation techniques. There was a significant effect of meditation on stress reduction, post-traumatic stress symptoms, self-reported stress, and chronic stress verified. In some studies, the effect was associated with decreased cortisol and increased telomerase. CONCLUSION Meditation has shown positive effects in reducing physical and emotional symptoms such as psychological stress, depression, anxiety, fatigue, fear of recurrence and rumination, representing an efficient strategy for coping with the disease and improving quality of life.
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Affiliation(s)
| | | | - Inez Sampaio Nery
- Universidade Federal do Piauí, Departamento de Enfermagem, Teresina, PI, Brasil
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Contributing to Global Health: Development of a Consensus-Based Whole Systems Research Strategy for Anthroposophic Medicine. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:3706143. [PMID: 31781267 PMCID: PMC6875260 DOI: 10.1155/2019/3706143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/22/2019] [Accepted: 09/24/2019] [Indexed: 12/30/2022]
Abstract
Background Whole medicine and health systems like traditional and complementary medicine systems (T&CM) are part of healthcare around the world. One key feature of T&CM is its focus on patient-centered and multimodal care and the integration of intercultural perspectives in a wide range of settings. It may contribute to good health and well being for people as part of the Sustainable Development Goals of the United Nations. The authentic, rigorous, and fair evaluation of such a medical system, with its inherent complexity and individualization, imposes methodological challenges. Hence, we propose a broad research strategy to test and characterize its possible contribution to health. Methods To develop a research strategy for a specific T&CM system, Anthroposophic Medicine (AM), applying multimodal integrative healthcare based on a four-level concept of man, we used a three-phase consensus process with experts and key stakeholders, consisting of (1) premeeting methodological literature and AM research review and interviews to supplement or revise items of the research strategy and tailor them to AM research, (2) face-to-face consensus meetings further developing and tailoring the strategy, and (3) postmeeting feedback and review, followed by finalization. Results Currently, AM covers many fields of medical specialties in varied levels of healthcare settings, such as outpatient and inpatient; primary, secondary, and tertiary care; and health education and pedagogy. It is by definition integrated with conventional medicine in the public healthcare system. It applies specific medicines, nursing techniques, arts therapies, eurythmy therapy, rhythmical massage, counseling, and psychotherapy, and it is provided by medical doctors, nurses, therapists, midwives, and nutritionists. A research strategy authentic to this level of complexity should comprise items with a focus on (I) efficacy and effectiveness, divided into (a) evaluation of the multimodal and multidisciplinary medical system as a whole, or of complex multimodal therapy concept, (b) a reasonable amount of methodologically rigorous, confirmatory randomized controlled trials on exemplary pharmacological and nonpharmacological therapies and indications, (c) a wide range of interventions and patient-centered care strategies with less extensive formats like well-conducted small trails, observational studies, and high-quality case reports and series, or subgroup analyses from whole-system studies, or health service research; (II) safety; (III) economics; (IV) evidence synthesis; (V) methodologic issues; (VI) biomedical, physiological, pharmacological, pharmaceutical, psychological, anthropological, and nosological issues as well as innovation and development; (VI) patient perspective and involvement, public needs, and ethics; (VII) educational matters and professionalism; and (IX) disease prevention, health promotion, and public health. Conclusion The research strategy extends to and complements the prevailing hierarchical system by introducing a broad “evidence house” approach to evaluation, something many health technology assessment boards today support. It may provide transparent and comprehensive insight into potential benefits or risks of AM. It can serve as a framework for an evidence-informed approach to AM for a variety of stakeholders and collaborating networks with the aim of improving global health.
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67
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Johnson SB, Park HS, Gross CP, Yu JB. Complementary Medicine, Refusal of Conventional Cancer Therapy, and Survival Among Patients With Curable Cancers. JAMA Oncol 2019; 4:1375-1381. [PMID: 30027204 DOI: 10.1001/jamaoncol.2018.2487] [Citation(s) in RCA: 172] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance There is limited information on the association among complementary medicine (CM), adherence to conventional cancer treatment (CCT), and overall survival of patients with cancer who receive CM compared with those who do not receive CM. Objectives To compare overall survival between patients with cancer receiving CCT with or without CM and to compare adherence to treatment and characteristics of patients receiving CCT with or without CM. Design, Setting, and Participants This retrospective observational study used data from the National Cancer Database on 1 901 815 patients from 1500 Commission on Cancer-accredited centers across the United States who were diagnosed with nonmetastatic breast, prostate, lung, or colorectal cancer between January 1, 2004, and December 31, 2013. Patients were matched on age, clinical group stage, Charlson-Deyo comorbidity score, insurance type, race/ethnicity, year of diagnosis, and cancer type. Statistical analysis was conducted from November 8, 2017, to April 9, 2018. Exposures Use of CM was defined as "Other-Unproven: Cancer treatments administered by nonmedical personnel" in addition to at least 1 CCT modality, defined as surgery, radiotherapy, chemotherapy, and/or hormone therapy. Main Outcomes and Measures Overall survival, adherence to treatment, and patient characteristics. Results The entire cohort comprised 1 901 815 patients with cancer (258 patients in the CM group and 1 901 557 patients in the control group). In the main analyses following matching, 258 patients (199 women and 59 men; mean age, 56 years [interquartile range, 48-64 years]) were in the CM group, and 1032 patients (798 women and 234 men; mean age, 56 years [interquartile range, 48-64 years]) were in the control group. Patients who chose CM did not have a longer delay to initiation of CCT but had higher refusal rates of surgery (7.0% [18 of 258] vs 0.1% [1 of 1031]; P < .001), chemotherapy (34.1% [88 of 258] vs 3.2% [33 of 1032]; P < .001), radiotherapy (53.0% [106 of 200] vs 2.3% [16 of 711]; P < .001), and hormone therapy (33.7% [87 of 258] vs 2.8% [29 of 1032]; P < .001). Use of CM was associated with poorer 5-year overall survival compared with no CM (82.2% [95% CI, 76.0%-87.0%] vs 86.6% [95% CI, 84.0%-88.9%]; P = .001) and was independently associated with greater risk of death (hazard ratio, 2.08; 95% CI, 1.50-2.90) in a multivariate model that did not include treatment delay or refusal. However, there was no significant association between CM and survival once treatment delay or refusal was included in the model (hazard ratio, 1.39; 95% CI, 0.83-2.33). Conclusions and Relevance In this study, patients who received CM were more likely to refuse additional CCT, and had a higher risk of death. The results suggest that mortality risk associated with CM was mediated by the refusal of CCT.
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Affiliation(s)
- Skyler B Johnson
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Henry S Park
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Cary P Gross
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut
| | - James B Yu
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.,Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut
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Riba MB, Donovan KA, Andersen B, Braun II, Breitbart WS, Brewer BW, Buchmann LO, Clark MM, Collins M, Corbett C, Fleishman S, Garcia S, Greenberg DB, Handzo RGF, Hoofring L, Huang CH, Lally R, Martin S, McGuffey L, Mitchell W, Morrison LJ, Pailler M, Palesh O, Parnes F, Pazar JP, Ralston L, Salman J, Shannon-Dudley MM, Valentine AD, McMillian NR, Darlow SD. Distress Management, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 17:1229-1249. [PMID: 31590149 PMCID: PMC6907687 DOI: 10.6004/jnccn.2019.0048] [Citation(s) in RCA: 352] [Impact Index Per Article: 70.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Distress is defined in the NCCN Guidelines for Distress Management as a multifactorial, unpleasant experience of a psychologic (ie, cognitive, behavioral, emotional), social, spiritual, and/or physical nature that may interfere with the ability to cope effectively with cancer, its physical symptoms, and its treatment. Early evaluation and screening for distress leads to early and timely management of psychologic distress, which in turn improves medical management. The panel for the Distress Management Guidelines recently added a new principles section including guidance on implementation of standards of psychosocial care for patients with cancer.
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Affiliation(s)
| | | | - Barbara Andersen
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - IIana Braun
- Dana-Farber/Brigham and Women's Cancer Center
| | | | | | | | | | | | | | | | - Sofia Garcia
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | - Laura Hoofring
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | | | | | | | | | | | - Janice P Pazar
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Laurel Ralston
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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69
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Birch S, Lee MS, Alraek T, Kim TH. Evidence, safety and recommendations for when to use acupuncture for treating cancer related symptoms: a narrative review. Integr Med Res 2019; 8:160-166. [PMID: 31304088 PMCID: PMC6600712 DOI: 10.1016/j.imr.2019.05.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/11/2019] [Accepted: 05/13/2019] [Indexed: 12/17/2022] Open
Abstract
Background Recently research on acupuncture for cancer related symptoms has significantly increased. To what extent have medical professionals recommended to use acupuncture in light of that evidence? Methods Evidence of effectiveness and safety was found by searching Pubmed for reviews to identify for what conditions and general results. Publications that recommend acupuncture in oncology were searched in the database of an ongoing general search for publications that recommend acupuncture. This database was developed by searching google for publications that recommend the use of acupuncture with the terms ‘name of symptom’ and ‘clinical practice guideline’ or ‘treatment guideline’. Results Acupuncture is moderately or weakly effective for 19 symptoms in patients with cancer and cancer survivors. Acupuncture is a safe therapy in cancer care if administered by trained acupuncturists. Acupuncture is targeted to improve symptoms associated with the cancer and different cancer treatments, not to treat the cancer itself. More than 350 publications by clinical practice guideline groups and expert groups, including public health statements made by national and government agencies recommended the use of acupuncture for 61 cancer related symptoms many with positive evidence of effectiveness. Conclusion The strength of evidence is weak for many indications, however the evidence for many standard therapies is either not very strong or if stronger, the incidence of adverse events is more, which makes acupuncture a treatment option despite the weak evidence. We have found evidence that many oncologists around the world have started to incorporate acupuncture into the treatment of various cancer related symptoms.
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Affiliation(s)
- Stephen Birch
- Department of Health Sciences, Kristiania University College, Oslo, Norway
| | - Myeong Soo Lee
- Clinical Medicine Division, Korean Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Terje Alraek
- Department of Health Sciences, Kristiania University College, Oslo, Norway.,National Research Centre in Complementary and Alternative Medicine, Faculty of Medicine, Department of Community Medicine, UiT The Arctic University of Norway, Tromso, Norway
| | - Tae-Hun Kim
- Clinical Trial Center, Kyung-Hee University, Korean Medical Hospital, Seoul, Republic of Korea
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70
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Deliana M, Suza DE, Tarigan R. Advanced Stage Cancer Patients Experience in Seeking Treatment in Medan, Indonesia. Open Access Maced J Med Sci 2019; 7:2194-2203. [PMID: 31456851 PMCID: PMC6698112 DOI: 10.3889/oamjms.2019.590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Proper treatment of cancer can make it easier for the healing process. Delay in patients seeking treatment is a problem that often occurs today. Handling of complementary and alternative therapies, which is not appropriate is one of the causes of delay in seeking treatment, which worsens the patient's condition. Patients usually come to health services already diagnosed with advanced cancer. AIM The purpose of this study is to explore the experience of advanced cancer patients in seeking treatment. METHODS This study is qualitative research with descriptive phenomenology approach. Participants in this study were 15 advanced cancer patients who were treated in the chemotherapy room at Adam Malik General Hospital Medan and Murni Teguh Hospital using purposive sampling technique. Data collection was done with in-depth interviews. All interviews were first recorded and then transcribed. This study was analysed using the Colaizzi approach method. RESULTS The six main themes indicated that advanced-stage cancer patients for seeking treatment. Themes such as 1) choose the complementary and alternative treatment rather than medical treatment, 2) seek medical treatment as a final decision, 3) integrating complementary treatment as supportive therapy in addition to medical treatment, 4) external sources influence patient decisions, 5) reduce negative feelings by surrendering to God, and 6) lack of involvement of basic health services. CONCLUSION Advanced cancer patients have experience using complementary and alternative therapies, which are not appropriate before using a medical treatment on the grounds of distrust of medical treatment and advice from the environment around patients. The importance of nurses in providing appropriate education related to complementary and alternative treatment to cancer patients according to the stage of the disease.
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Affiliation(s)
- Muthia Deliana
- Master Student of Medical-Surgical Nursing, Universitas Sumatra Utara, Medan, Indonesia
| | - Dewi Elizadiani Suza
- Faculty of Nursing, Universitas Sumatera Utara, Jl. Prof. T. Ma’as No 3, Kampus USU, Medan, Indonesia
| | - Rosina Tarigan
- Faculty of Nursing, Universitas Sumatera Utara, Jl. Prof. T. Ma’as No 3, Kampus USU, Medan, Indonesia
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71
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Raghunathan NJ, Korenstein D, Li QS, Mao JJ. Awareness of Yoga for Supportive Care in Cancer: Implications for Dissemination. J Altern Complement Med 2019; 25:809-813. [PMID: 31274335 DOI: 10.1089/acm.2018.0510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: Evidence indicates there are beneficial physical and psychosocial effects from practicing yoga in cancer patients and survivors. Despite yoga having been incorporated into National Comprehensive Cancer Network guidelines for symptoms ranging from fatigue to pain, patients' use of yoga for supportive care is low, ranging from 6% to 12%. This study aims to evaluate the awareness of yoga as therapy in an academic cancer center and the preferences for information delivery in this population. Design: We conducted a cross-sectional survey study at an urban academic cancer center. Responses regarding awareness and use of yoga were evaluated; those responding "not aware" were analyzed for preferences in information delivery. Univariate analysis was used to further characterize awareness of yoga for supportive care. Results: Of 303 respondents, 68% were female, 77% were white, and 75% were college educated. Despite access to yoga at the cancer center, 171 (56%) patients expressed they were not aware of the availability of yoga. Male patients were more likely to be unaware of yoga (72.4% vs. 48.8%, p = 0.045). Awareness did not vary by age, race, educational attainment, marital status, cancer type, or cancer stage. Of the 171 "not aware" patients, 87.6% expressed desire for information in the form of printed material, followed by 80.4% for e-mail, 37.6% for smartphone application, and 27.6% for social media. Non-white respondents were more likely to express interest in receiving information by smartphone. Conclusions: More than half of cancer patients were unaware of the yoga program despite advertising across the institution. Patients prefer varying methods for information receipt, with preferences differing by sociodemographic factors. Targeted education and outreach using appropriate engagement is needed to improve the awareness of yoga for symptom control in cancer patients.
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Affiliation(s)
| | - Deborah Korenstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Qing S Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jun J Mao
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Nutrition and Breast Cancer: A Literature Review on Prevention, Treatment and Recurrence. Nutrients 2019; 11:nu11071514. [PMID: 31277273 PMCID: PMC6682953 DOI: 10.3390/nu11071514] [Citation(s) in RCA: 197] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/28/2019] [Accepted: 07/01/2019] [Indexed: 12/13/2022] Open
Abstract
Breast cancer (BC) is the second most common cancer worldwide and the most commonly occurring malignancy in women. There is growing evidence that lifestyle factors, including diet, body weight and physical activity, may be associated with higher BC risk. However, the effect of dietary factors on BC recurrence and mortality is not clearly understood. Here, we provide an overview of the current evidence obtained from the PubMed databases in the last decade, assessing dietary patterns, as well as the consumption of specific food-stuffs/food-nutrients, in relation to BC incidence, recurrence and survival. Data from the published literature suggest that a healthy dietary pattern characterized by high intake of unrefined cereals, vegetables, fruit, nuts and olive oil, and a moderate/low consumption of saturated fatty acids and red meat, might improve overall survival after diagnosis of BC. BC patients undergoing chemotherapy and/or radiotherapy experience a variety of symptoms that worsen patient quality of life. Studies investigating nutritional interventions during BC treatment have shown that nutritional counselling and supplementation with some dietary constituents, such as EPA and/or DHA, might be useful in limiting drug-induced side effects, as well as in enhancing therapeutic efficacy. Therefore, nutritional intervention in BC patients may be considered an integral part of the multimodal therapeutic approach. However, further research utilizing dietary interventions in large clinical trials is required to definitively establish effective interventions in these patients, to improve long-term survival and quality of life.
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73
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Kang S, Yoo S, Baek H, Lee J, Choi Y, Kim H, Yi H, Yang EJ. Potentials of Smart dynamometer use for clinical and self-management of rehabilitation in breast cancer survivors: a feasibility study. Biomed Eng Lett 2019; 9:211-219. [PMID: 31168426 DOI: 10.1007/s13534-019-00101-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 12/26/2022] Open
Abstract
The aim of this study was to examine the feasibility of the Smart dynamometer as a rehabilitation exercise device in a daily care by comparing with the existing medical devices. We used and analyzed clinical and measurement data of breast cancer survivors who have used Smart dynamometer during their rehabilitation after breast cancer surgery. The Smart dynamometer was compared with the two existing devices of Takei dynamometer and surface electromyography (sEMG) that were used in routine care, respectively. Three key components of the rehabilitation exercise devices were analyzed to validate the feasibility of the Smart dynamometer: grip strength, reaction time, and grip endurance time. Pearson's correlation analysis was performed to compare the statistical significance between the devices. The data of 12 and 15 female breast cancer patients were analyzed for comparing the Smart dynamometer with Takei dynamometer and sEMG, respectively. There was a very weak correlation between the maximum values from the Takei and the Smart dynamometers in the affected and non-affected arms of breast cancer patients (r = 0.5321, 0.4733). Comparisons of 3 features between the Smart dynamometer and sEMG showed that there were strong positive correlations for both reaction time and endurance time in the affected and non-affected arms (r > 0.9). The feasibility of the Smart dynamometer for the possible use in a daily rehabilitation exercise was partially verified. Moreover, since the Smart dynamometer was highly correlated with time-related variables, it was important and significant to measure both grip strength and time-related information.
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Affiliation(s)
- Seungjin Kang
- 1Healthcare ICT Research Center, Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sooyoung Yoo
- 1Healthcare ICT Research Center, Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyunyoung Baek
- 1Healthcare ICT Research Center, Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Junheon Lee
- 2Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, 173, Gumi-ro, Bundang-gu, Seongnam-si, 13620 Republic of Korea
| | - Younggeun Choi
- 3Department of Applied Computer Engineering, Dankook University, Yongin, Gyeonggi Republic of Korea
| | | | - Hyoseok Yi
- NEOFECT, Yongin, Gyeonggi Republic of Korea
| | - Eun Joo Yang
- 2Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, 173, Gumi-ro, Bundang-gu, Seongnam-si, 13620 Republic of Korea
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Han S, Jang BH, Suh HS, Hwang DS. Complementary medicine use and costs in patients with breast cancer who experienced treatment-related side effects: A cross-sectional survey in Korea. Complement Ther Med 2019; 44:210-217. [DOI: 10.1016/j.ctim.2019.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 03/08/2019] [Accepted: 04/18/2019] [Indexed: 12/01/2022] Open
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75
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Eaton LH, Hulett JP, Langford DJ, Doorenbos AZ. How Theory Can Help Facilitate Implementing Relaxation as a Complementary Pain Management Approach. Pain Manag Nurs 2019; 20:207-213. [PMID: 31097374 DOI: 10.1016/j.pmn.2018.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/29/2018] [Accepted: 12/14/2018] [Indexed: 11/30/2022]
Abstract
Complementary therapies provide cancer survivors and clinicians with options for managing chronic pain. Recent published clinical guidelines and research findings support the use of relaxation therapy for managing chronic pain in cancer survivors. However, translating research findings into clinical practice remains a challenge. Using theory to guide implementation of a new practice can increase the likelihood of successful adoption. This article uses relaxation therapy for cancer survivors to describe how clinicians could use Rogers' Diffusion of Innovation Theory and the related Collaborative Research Utilization Model to implement a complementary therapy and ensure that it becomes standard practice.
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Affiliation(s)
- Linda H Eaton
- School of Nursing & Health Studies, University of Washington Bothell, Bothell, Washington.
| | - Jennifer P Hulett
- College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Dale J Langford
- School of Medicine, University of Washington, Seattle, Washington
| | - Ardith Z Doorenbos
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois
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Lopez G, Salas CA, Cadiz F, Barriga C, Gonzalez P, Acevedo S, Raimilla P, Pincheira P, Naing A, Quiroga M. Complementary and Integrative Medicine Use in Individuals Seeking Conventional Medical Oncology Care in Chile: Prevalence and Patient Characteristics. J Glob Oncol 2019; 5:1-6. [PMID: 31095454 PMCID: PMC6550051 DOI: 10.1200/jgo.18.00190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Complementary and integrative medicine (CIM) use during cancer care has increased in Western medical settings. Little is known about interest in and use of CIM approaches by oncology patients in Chile and South America. PATIENTS AND METHODS Patients presenting for conventional outpatient or inpatient medical oncology care at the Clinica Alemana in Santiago, Chile, from March to June 2017 were asked to complete a survey about their interest in and use of CIM approaches. Goals included determining the prevalence of CIM use and exploring associations between CIM use and patient characteristics. Statistical analyses included a two-tailed t test for continuous variables, Fischer's exact test for categorical variables, and logistic regression for association between CIM use and other variables. RESULTS Of 432 patients surveyed, 66.9% were diagnosed with breast cancer, 84.8% were women, the majority of patients (58.1%) were between age 40 and 60 years, and 51.5% (n = 221) reported CIM use. No association was found between CIM use and the sociodemographic variables of sex, age, education, or income. In all, 44.6% of patients with breast cancer reported CIM use compared with 64.8% of patients with other cancer types (P > .001). Most commonly reported types of CIM used included herbals (49.1%), vitamins and minerals (40.8%), and prayer or meditation (40.4%). Most frequent reasons for CIM use were to "do everything possible" (72%) and to "improve my immune function" (67.8%). Most patients (43.4%) reported starting CIM use at the time of cancer diagnosis, with only 55.4% sharing information regarding CIM use with their medical team. CONCLUSION The majority of patients surveyed reported engaging in CIM use, with just over half the users communicating with their oncology team about their CIM use. Increased awareness of regional differences in CIM use may help increase communication regarding this subject and contribute to improved outcomes.
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Affiliation(s)
- Gabriel Lopez
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | | | - Aung Naing
- The University of Texas MD Anderson Cancer Center, Houston, TX
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77
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Abstract
OBJECTIVES To describe mind-body interventions used in the management of chronic cancer pain including their mechanisms of action, dosing, and delivery methods based on available evidence to date. DATA SOURCES Peer-reviewed publications. CONCLUSION Further high-quality research is needed to establish the effectiveness and mechanisms of actions for mind-body interventions in chronic cancer pain management. IMPLICATIONS FOR NURSING PRACTICE Mind-body interventions for chronic cancer pain management are generally safe and well-accepted by individuals with cancer. Nurses need to be knowledgeable about these interventions to explain their level of effectiveness and any safety issues with patients.
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78
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Palese A, Rossettini G, Colloca L, Testa M. The impact of contextual factors on nursing outcomes and the role of placebo/nocebo effects: a discussion paper. Pain Rep 2019; 4:e716. [PMID: 31583342 PMCID: PMC6749917 DOI: 10.1097/pr9.0000000000000716] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/23/2018] [Accepted: 01/05/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Placebo and nocebo effects represent one of the most fascinating topics in the health care field. OBJECTIVES the aims of this discussion paper were (1) to briefly introduce the placebo and nocebo effects, (2) to elucidate the contextual factors able to trigger placebo and nocebo effects in the nursing field, and (3) to debate the impact of contextual factors on nursing education, practice, organisation, and research. METHODS a narrative review was conducted based on the available evidence. RESULTS Placebo responses (from Latin "I shall please") are a beneficial outcome(s) triggered by a positive context. The opposite are the nocebo effects (from Latin "I shall harm"), which indicates an undesirable outcome(s) caused by a negative context. Both are complex and distinct psychoneurobiological phenomena in which behavioural and neurophysiological changes arise subsequent to an interaction between the patient and the health care context. CONCLUSION Placebo and nocebo concepts have been recently introduced in the nursing discipline, generating a wide debate on ethical issues; however, the impact on nursing education, clinical practice, nursing administration, and research regarding contextual factors triggering nocebo and placebo effects has not been debated to date.
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Affiliation(s)
- Alvisa Palese
- Department Biological and Medical Science, University of Udine, Italy, Udine, Italy
| | - Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Italy, Savona, Italy
| | - Luana Colloca
- Department of Pain Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, USA
- Departments of Anesthesiology and Psychiatry, School of Medicine, Center to Advance Chronic Pain Research, University of Maryland, Baltimore, MD, USA
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Italy, Savona, Italy
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79
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Shallwani SM, King J, Thomas R, Thevenot O, De Angelis G, Aburub AS, Brosseau L. Methodological quality of clinical practice guidelines with physical activity recommendations for people diagnosed with cancer: A systematic critical appraisal using the AGREE II tool. PLoS One 2019; 14:e0214846. [PMID: 30969981 PMCID: PMC6457630 DOI: 10.1371/journal.pone.0214846] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 03/21/2019] [Indexed: 12/31/2022] Open
Abstract
Evidence suggests physical activity (PA) is beneficial for people diagnosed with cancer. Clinical practice guidelines provide specific recommendations based on available research and are useful in informing evidence-based practice and guiding future research. Little is known on the extent and quality of guidelines on PA targeted to the cancer population. The objectives of this systematic review were to: 1) identify recent clinical practice guidelines including PA or exercise recommendations for people with cancer and 2) critically appraise the methodological quality of the included guidelines. A systematic search of four electronic databases (MEDLINE, EMBASE, CINAHL and PEDro) and supplementary sources was conducted. Two reviewers independently scanned articles and selected guidelines for inclusion according to the following criteria: published in English, developed or updated in previous five years (January 2012-June 2017), published in peer-reviewed scientific journals, including ≥1 specific recommendation on PA or exercise, and relevant to adults diagnosed with cancer. Subsequently, two trained assessors independently appraised the included guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. Average scores for six domains (scope and purpose; stakeholder involvement; rigour of development; clarity of presentation; applicability; and editorial independence) and overall quality were calculated. From the literature search, we identified 29 articles, representing 20 sets of guidelines meeting the selection criteria. The guidelines were applicable to the following cancer populations: general (n = 9), breast (n = 5), lung (n = 2), colorectal (n = 1), head and neck (n = 1), myeloma (n = 1) and prostate (n = 1). The guidelines were generally of moderate methodological quality (mean AGREE II overall quality score: 4.6/7, range 2.5-6). The area of lowest quality was in the domain of applicability (mean AGREE II quality domain score: 40%), whereas the strongest domains were related to scope and purpose (81%) and clarity of presentation (77%). Although there are limitations in the primary research informing the recommendations, guidelines of acceptable quality exist to direct stakeholders on targeted PA recommendations for a range of cancer populations. Improvement is needed in the applicability of guidelines to enhance their relevance and clinical use. Health professionals can play an important role in supporting people with cancer throughout the disease trajectory and benefit from access to well-developed and appropriate materials to interpret research knowledge on effective rehabilitation strategies, including PA.
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Affiliation(s)
- Shirin M. Shallwani
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Lymphedema Program & Physiotherapy Department, McGill University Health Centre, Montreal, Quebec, Canada
| | - Judy King
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Roanne Thomas
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Odette Thevenot
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Gino De Angelis
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Ala’ S. Aburub
- Physical Therapy Department, Faculty of Allied Medical Sciences, Isra University, Amman, Jordan
| | - Lucie Brosseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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80
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Gramaglia C, Gambaro E, Vecchi C, Licandro D, Raina G, Pisani C, Burgio V, Farruggio S, Rolla R, Deantonio L, Grossini E, Krengli M, Zeppegno P. Outcomes of music therapy interventions in cancer patients-A review of the literature. Crit Rev Oncol Hematol 2019; 138:241-254. [PMID: 31121392 DOI: 10.1016/j.critrevonc.2019.04.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Effectiveness of music-based interventions (MI) on cancer patients' anxiety, depression, pain and quality of life (QoL) is a current research theme. MI are highly variable, making it challenging to compare studies. OBJECTIVE AND METHODS To summarize the evidence on MI in cancer patients, 40 studies were reviewed following the PRISMA statement. Studies were included if assessing at least one outcome among anxiety, depression, QoL and pain in patients aged ≥ 18, with an active oncological/onco-haematological diagnosis, participating to any kind of Music Therapy (MT), during/after surgery, chemotherapy or radiotherapy. RESULTS A positive effect of MI on the outcomes measured was supported. Greater reductions of anxiety and depression were observed in breast cancer patients. MI involving patients admitted to a hospital ward were less effective on QoL. CONCLUSION The increasing evidence about MI effectiveness, tolerability, feasibility and appreciation, supports the need of MI implementation in Oncology, Radiotherapy and Surgery wards, and promotion of knowledge among health operators.
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Affiliation(s)
- Carla Gramaglia
- Psychiatry Institute, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy; Psychiatry Ward, Azienda Ospedaliera Universitaria Maggiore della Carità, Corso Mazzini 18, Novara, Via Solaroli 17, Italy.
| | - Eleonora Gambaro
- Psychiatry Institute, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - Camilla Vecchi
- Psychiatry Institute, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - Davide Licandro
- School of Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - Giulia Raina
- Laboratory of Physiology and Experimental Surgery, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - Carla Pisani
- Radiotherapy Unit, Azienda Ospedaliera Universitaria Maggiore della Carità, Corso Mazzini 18, 28100, Novara, Italy
| | - Vincenzo Burgio
- Radiotherapy Unit, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - Serena Farruggio
- Laboratory of Physiology and Experimental Surgery, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - Roberta Rolla
- Clinical Chemistry Unit, Azienda Ospedaliero Universitaria Maggiore della Carità, Corso Mazzini 18, 28100, Novara, Italy; Department of Health Sciences, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - Letizia Deantonio
- Radiotherapy Unit, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy; Radiotherapy Unit, Azienda Ospedaliera Universitaria Maggiore della Carità, Corso Mazzini 18, 28100, Novara, Italy
| | - Elena Grossini
- Laboratory of Physiology and Experimental Surgery, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - Marco Krengli
- Radiotherapy Unit, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy; Radiotherapy Unit, Azienda Ospedaliera Universitaria Maggiore della Carità, Corso Mazzini 18, 28100, Novara, Italy
| | - Patrizia Zeppegno
- Psychiatry Institute, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy; Psychiatry Ward, Azienda Ospedaliera Universitaria Maggiore della Carità, Corso Mazzini 18, Novara, Via Solaroli 17, Italy
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81
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Latte-Naor S, Mao JJ. Putting Integrative Oncology Into Practice: Concepts and Approaches. J Oncol Pract 2019; 15:7-14. [PMID: 30629900 PMCID: PMC6333385 DOI: 10.1200/jop.18.00554] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 01/28/2023] Open
Abstract
Unmet symptom needs and a desire for holistic health approaches or even cure are among the motivations patients have for seeking out complementary and alternative medicine. Using complementary and alternative medicine instead of conventional cancer treatment can have a negative impact on clinical outcomes and survival. Integrative oncology is a patient-centered, evidence-informed field of comprehensive cancer care that uses mind-body practices, natural products, and lifestyle modifications from different traditions alongside conventional cancer treatments. It prioritizes safety and best available evidence to offer appropriate therapeutic interventions along with conventional care. This review summarizes the underlying principles of integrative oncology and how it is distinct from alternative medicine, and it provides a practical guide for the effective application of evidence-based complementary and alternative medicine interventions in patient-centered care. In addition, we recommend resources for patients and clinicians and provide algorithms for appropriate integrative medicine referrals. Finally, we offer suggestions on developing and implementing an integrative oncology program and addressing current challenges in the field.
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Affiliation(s)
| | - Jun J. Mao
- Memorial Sloan Kettering Cancer Center, New York, NY
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82
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Lopez G, Eddy C, Liu W, Li Y, Chen M, Bruera E, Cohen L. Physical Therapist-Led Exercise Assessment and Counseling in Integrative Cancer Care: Effects on Patient Self-reported Symptoms and Quality of Life. Integr Cancer Ther 2019; 18:1534735419832360. [PMID: 30862209 PMCID: PMC6416745 DOI: 10.1177/1534735419832360] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Exercise - contributes to improved treatment-related outcomes. We reviewed characteristics of cancer patients referred for physical therapist-led exercise counseling at a comprehensive cancer center and its effects on self-reported symptoms and quality of life. METHODS Patients presenting for outpatient exercise counseling from February 2016 to May 2017 completed the Edmonton Symptom Assessment Scale (ESAS; 0-10 scale, 10 most severe) pre-encounter/post-encounter and Patient-Reported Outcomes Measurement Information System (PROMIS10) global health assessment pre-encounter. Counseling included assessment and education. ESAS individual items and subscales of physical distress (PHS), psychological distress, and global distress (GDS) were analyzed. We used paired t-tests to compare (1) ESAS symptoms pre-encounter/post-encounter and (2) ESAS and PROMIS10 scores at baseline (pre-encounter) and first follow-up. RESULTS Of 350 participants, most were female (77.7%), Caucasian (66.3%), and had breast cancer (43%). Baseline (pre-encounter) symptom scores (frequency; mean) included poor sleep (68.2%; 3.5), poor well-being (67.4%; 3.2), and fatigue (64.7%; 3.1). Comparing pre-encounter/postencounter ESAS outcomes, we observed statistically and clinically significant reduction in GDS (-3.32; SD = 6.52; P < .001). On follow-up, statistically and clinically significant improvements were observed for fatigue (-1.22; P = .01), GDS (-4.81; P = .01), PHS (-3.1; P = .03) and PROMIS10 global health, mental health, and physical health scores (all P <.05). CONCLUSION Patients presenting for exercise counseling had a low to moderate symptom burden and experienced significant improvement in GDS. Longitudinal evaluation revealed improvement in global health and fatigue. Additional research is needed to learn more about patient selection and timing of exercise counseling.
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Affiliation(s)
- Gabriel Lopez
- Department of Palliative Care,
Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer
Center, Houston, TX, USA
| | - Carol Eddy
- Department of Palliative Care,
Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer
Center, Houston, TX, USA
| | - Wenli Liu
- Department of Palliative Care,
Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer
Center, Houston, TX, USA
| | - Yisheng Li
- Department of Biostatistics, The
University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Minxing Chen
- Department of Biostatistics, The
University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative Care,
Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer
Center, Houston, TX, USA
| | - Lorenzo Cohen
- Department of Palliative Care,
Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer
Center, Houston, TX, USA
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83
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Francis LK, Weiss MP, Faria C. Development of an Oncologist-Driven Integrative Intervention for Symptom Management in an Academic Cancer Center. J Oncol Pract 2018; 15:30-34. [PMID: 30526236 DOI: 10.1200/jop.18.00289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Lanie K Francis
- 1 UPMC Hillman Cancer Center, Pittsburgh, PA.,2 University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Mia P Weiss
- 3 Celgene Corporation, Summit, NJ.,4 Columbia University Mailman School of Public Health, New York, NY
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84
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Jordan B. [Are « complementary » cancer therapies actually indirectly harmful?]. Med Sci (Paris) 2018; 34:999-1002. [PMID: 30526822 DOI: 10.1051/medsci/2018216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A recent paper shows that cancer patients using complementary therapies in addition to conventional treatment have distinctly worse outcomes. Analysis of the data shows that they are much more likely to refuse one component of conventional treatment: this explains the negative effects of recourse to complementary approaches and underlines the need for great caution in approving their use while ensuring correct adherence to the anti-tumour treatment.
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Affiliation(s)
- Bertrand Jordan
- UMR 7268 ADÉS, Aix-Marseille, Université/EFS/ CNRS ; CoReBio PACA, case 901, Parc scientifique de Luminy, 13288 Marseille Cedex 09, France
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85
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Castanhel FD, Liberali R. Mindfulness-Based Stress Reduction on breast cancer symptoms: systematic review and meta-analysis. EINSTEIN-SAO PAULO 2018; 16:eRW4383. [PMID: 30540032 PMCID: PMC6282865 DOI: 10.31744/einstein_journal/2018rw4383] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 06/27/2018] [Indexed: 12/30/2022] Open
Abstract
Mindfulness-Based Stress Reduction practices increase the capacity for concentration and attention, and these practices are particularly effective for people with breast cancer. To analyze the effects of the application of Mindfulness-Based Stress Reduction on breast cancer symptoms. Systematic review and meta-analysis were carried out. To find suitable studies, the PubMed/ MEDLINE database was searched using the keywords "breast cancer" and "Mindfulness-Based Stress Reduction". Studies included were published between 2013 and 2017, written in English and showed methodological quality through the PEDro scale (score greater than 3). They also presented empirical evidence, had an experimental study design (randomized or non-randomized), and had full text available. For the meta-analysis, we used a random-effects model, with standardized mean differences and 95% confidence intervals. Seven studies were included, one non-randomized and containing only an intervention group of Mindfulness-Based Stress Reduction, and six randomized including samples of two or three groups. The non-randomized study showed 6 points on the PEDro scale, the randomized studies of two groups 6 to 7 points and studies with three groups showed 7 points. In the meta-analysis of the two randomized studies, the results, although not significant, revealed a moderate effect for Mindfulness-Based Stress Reduction on the outcome of fatigue, with a mean difference of -0.42 (95%CI -0.92- -0.07; p=0.09). Mindfulness-Based Stress Reduction seems to be a promising alternative for treatment of this disease's symptoms.
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Affiliation(s)
| | - Rafaela Liberali
- Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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86
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Zoorob RJ, Salemi JL, Mejia de Grubb MC, Modak S, Levine RS. A nationwide study of breast cancer, depression, and multimorbidity among hospitalized women and men in the United States. Breast Cancer Res Treat 2018; 174:237-248. [PMID: 30465155 DOI: 10.1007/s10549-018-5059-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 11/16/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Breast cancer is the most common and second most deadly cancer for women in the US. Comorbidities like depression exacerbate the burden. This national study provides data on depression and comorbidity for both women and men with breast cancer. METHODS We conducted a serial cross-sectional analysis of the 2002-2014 National Inpatient Sample, the largest all-payer inpatient discharge database in the United States. We identified patients with primary site breast cancer, and captured information on their concomitant depression and other major chronic comorbidities. Logistic regression was used to generate adjusted odds ratios representing associations between patient and hospital characteristics and depression. Joinpoint regression was used to estimate temporal trends in depression rates. RESULTS Depression prevalence was higher for women than men, with little difference between cancer subtypes. Comorbidity burden was nearly twice as high for men. From 2002 to 2014, the average number of comorbidities doubled. Depression rates were highest for patients with four or more chronic comorbidities and those with unplanned hospitalizations. Significant yearly increases of 6-10% in depression were also observed. CONCLUSIONS Breast cancer patient depression rates were higher than the general inpatient population with a strong gradient effect between increasing numbers of comorbidities and the odds of depression. Comorbidities, including mental health-related, negatively impact breast cancer prognosis, increasing cancer-specific mortality as well as mortality for other conditions. Unplanned hospitalization episodes in a patient with breast cancer can be noted as an opportunity for mental health screening and intervention.
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Affiliation(s)
- Roger J Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Dr., Suite 600, MS: BCM700, Houston, TX, 77098, USA.
| | - Jason L Salemi
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Dr., Suite 600, MS: BCM700, Houston, TX, 77098, USA
| | - Maria C Mejia de Grubb
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Dr., Suite 600, MS: BCM700, Houston, TX, 77098, USA
| | - Sanjukta Modak
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Dr., Suite 600, MS: BCM700, Houston, TX, 77098, USA
| | - Robert S Levine
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Dr., Suite 600, MS: BCM700, Houston, TX, 77098, USA
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87
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Smith CA, Hunter J, Delaney GP, Ussher JM, Templeman K, Grant S, Oyston E. Integrative oncology and complementary medicine cancer services in Australia: findings from a national cross-sectional survey. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 18:289. [PMID: 30373631 PMCID: PMC6206936 DOI: 10.1186/s12906-018-2357-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/19/2018] [Indexed: 01/01/2023]
Abstract
Background Individuals living with and beyond a cancer diagnosis are increasingly using complementary therapies and medicines (CM) to enhance the effectiveness of cancer treatment, manage treatment-related side effects, improve quality-of-life, and promote self-efficacy. In response to the increasing use and demand for CM by cancer patients, interest in the implementation of Integrative Oncology (IO) services that provide CM alongside conventional cancer care in Australia and abroad has developed. The extent that cancer services in Australia are integrating CM is uncertain. Thus, the aim of this study was to identify IO services in Australia and explore barriers and facilitators to IO service provision. Methods A national, cross-sectional survey of healthcare organisations was conducted in 2016. Organisations in the public and private sectors, including not-for-profit organisations that provided cancer care in hospital or community setting, were included. Results A response rate of 93.2% was achieved (n = 275/295). Seventy-one organisations (25.8%) across all states/territories, except the Northern Territory, offered IO albeit in a limited amount by many. Most common IO services included massage, psychological-wellbeing, and movement modalities in hospital outpatient or inpatient settings. There were only a few instances where biological-based complementary medicine (CM) therapies were prescribed. Funding was often mixed, including patient contributions, philanthropy, funding by the organisation, and volunteer practitioners. Of the 204 non-IO providers, 80.9% had never provided any IO service. Overwhelmingly, the most common barrier to IO was a lack of funding, followed by uncertainty about patient demand, choice of services, and establishing such services. Less-common barriers were a lack of evidence, and support from oncologists or management. More funding, education and training, and building the evidence-base for CM were the most commonly suggested solutions. Conclusion IO is increasingly being provided in Australia, although service provision remains limited or non-existent in many areas. Mismatches appear to exist between low IO service provision, CM evidence, and high CM use by cancer patients. Greater strategic planning and policy guidance is indicated to ensure the appropriate provision of, and equitable access to IO services for all Australian cancer survivors. Electronic supplementary material The online version of this article (10.1186/s12906-018-2357-8) contains supplementary material, which is available to authorized users.
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88
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Ochalek K, Partsch H, Gradalski T, Szygula Z. Do Compression Sleeves Reduce the Incidence of Arm Lymphedema and Improve Quality of Life? Two-Year Results from a Prospective Randomized Trial in Breast Cancer Survivors. Lymphat Res Biol 2018; 17:70-77. [PMID: 30339481 DOI: 10.1089/lrb.2018.0006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In a previous randomized controlled trial it has been demonstrated that arm compression sleeves worn immediately after breast cancer surgery, including axillary lymph node removal in addition to physical therapy are able to reduce the occurrence of early postoperative swelling and of arm lymphedema up to 1 year and to improve quality of life. The aim of the present investigation was to check the further development of the arm swelling in patients using compression sleeves or not, and to compare the quality of life in women treated due to breast cancer 2 years after surgery. MATERIALS AND METHODS Twenty from originally 23 patients who still wore their compression sleeves (15 mmHg) and 21 from 22 patients who had been randomized into the control group without compression could be seen after one more year. Arm volume measurements were performed and quality of life (QLQ-C30 and QLQ-BR23 questionnaires) was assessed. RESULTS Three from 20 patients in the compression group (CG) and 6 from 21 without compression showed arm lymphedema, defined by an increase of the arm volume exceeding 10% compared with the preoperative values. Significant improvement of several quality of life parameters were found in the CG. CONCLUSION Light compression sleeves worn for 2 years are not only able to reduce the incidence of early postoperative edema and of lymphedema, but also lead to a significant improvement of important quality-of-life parameters like physical functioning, fatigue, pain, arm and breast symptoms, and future perspectives.
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Affiliation(s)
- Katarzyna Ochalek
- 1 Department of Clinical Rehabilitation, Faculty of Motor Rehabilitation, University of Physical Education, Krakow, Poland.,2 Lymphoedema Clinic, St. Lazarus Hospice, Krakow, Poland
| | - Hugo Partsch
- 3 Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Zbigniew Szygula
- 4 Department of Physiotherapy, State University of Applied Sciences in Nowy Sacz, Nowy Sacz, Poland
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89
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Lemanne D, Maizes V. Advising Women Undergoing Treatment for Breast Cancer: A Narrative Review. J Altern Complement Med 2018; 24:902-909. [PMID: 30247957 DOI: 10.1089/acm.2018.0150] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A majority of women undergoing conventional treatment for breast cancer also undertake complementary and integrative approaches. Practitioners knowledgeable about the evidence base behind common integrative approaches can help patients attain improved quality of life, and at times, improved survival. Evidence-based recommendations include the following: a plant-based diet for general health after diagnosis, and carbohydrate restriction for patients with estrogen receptor-positive postmenopausal breast cancer may be prudent. Other dietary recommendations include a 13-h daily overnight fast. Carefully selected patients may choose to fast the day before and the day of chemotherapy to decrease side effects. Specific food recommendations include avoidance or limitation of alcohol, and liberal culinary use of cruciferous vegetables, coffee, green tea, soy, and flaxseed. Promising supplements include diindolylmethane and melatonin. Omega 3 fatty acids may help with bone density in patients on aromatase inhibitors, but may increase chemotherapy resistance. Findings regarding the usefulness of multivitamins, vitamin D, vitamin C, and vitamin E are weak and/or mixed different exercise modalities may have different effects and thus play different roles in breast cancer therapy. Aerobic and resistance training combined during breast cancer chemotherapy may confer a survival benefit, while yoga may improve outcome in lymphedema patients. Current evidence suggests that meditation, yoga, breathing, music therapy, guided imagery, and hypnosis may improve mood and quality of life during breast cancer treatment. Acupuncture is useful for treating side effects of breast cancer therapies, including hot flushes, aromatase inhibitor-induced joint pain, chemotherapy-induced peripheral neuropathy, and vulvodynia. Vaginal moisturizers and vaginal rings supplying low-dose estrogen can be useful in the treatment of symptoms of estrogen-deprivation states caused by breast cancer treatments; such symptoms include vaginal dryness, dyspareunia, and sexual dysfunction. Carbon dioxide laser technology can rejuvenate atrophied vaginal mucosa and relieve dyspareunia, allowing avoidance of estrogen therapy. Tertiary sexual health centers are available for referral.
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Affiliation(s)
- Dawn Lemanne
- 1 The University of Arizona Center for Integrative Medicine , Tucson, Arizona.,2 Oregon Integrative Oncology , Ashland, Oregon.,3 National Institute of Integrative Medicine , Melbourne, Australia
| | - Victoria Maizes
- 1 The University of Arizona Center for Integrative Medicine , Tucson, Arizona
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Stoerkel E, Bellanti D, Paat C, Peacock K, Aden J, Setlik R, Walter J, Inman A. Effectiveness of a Self-Care Toolkit for Surgical Breast Cancer Patients in a Military Treatment Facility. J Altern Complement Med 2018; 24:916-925. [PMID: 30247967 PMCID: PMC6157373 DOI: 10.1089/acm.2018.0069] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective: To assess whether a self-care toolkit (SCT) provided to breast cancer patients undergoing surgery could mitigate distress and lessen symptoms associated with surgery. Design: One hundred women with breast cancer, planning to undergo initial surgery, were randomly assigned to either one of two groups: treatment as usual (TAU; n = 49) or TAU with the addition of an SCT (n = 51). The SCT contained an MP3 player with audio-files of guided mind–body techniques (breathing, progressive muscle relaxation, meditation, guided imagery, and self-hypnosis) and acupressure antinausea wristbands. Anxiety, pain, nausea, sleep, fatigue, global health, and quality of life (QOL) were assessed using validated outcome measures. Two inflammatory blood markers (erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]) were measured serially. Data were collected at baseline (T1), immediately before surgery (T2), within 10 h postoperatively (T3), and ∼2 weeks postsurgery (T4). Settings: Numerous studies have shown that psychological distress associated with a cancer diagnosis can affect pain perception and QOL. Results: Between T1 and T4, there were significant between-group differences in Patient-Reported Outcomes Measurement Information System (PROMIS)-57 scores of Pain Interference, Fatigue, and Satisfaction with Social Roles, favoring the SCT group compared with TAU (p = 0.005, p = 0.023, and p = 0.021, respectively). There was a significant mean change in Defense and Veterans Pain Rating Scale (DVPRS) scores from T2 to T3, with the SCT group having significantly smaller increases in postoperative pain (p = 0.008) and in postoperative ESR (p = 0.0197) compared with the TAU group. Clinically significant reductions in anxiety occurred in the SCT group during the main intervention period. Conclusion: These results suggest that using the SCT in the perioperative period decreased pain perceptions, fatigue, and inflammatory cytokine secretion.
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Affiliation(s)
- Erika Stoerkel
- 1 Thought Leadership and Innovation Foundation , McLean, VA
| | - Dawn Bellanti
- 1 Thought Leadership and Innovation Foundation , McLean, VA
| | - Charmagne Paat
- 1 Thought Leadership and Innovation Foundation , McLean, VA
| | - Kimberly Peacock
- 2 Department of Epidemiology & Biostatistics, University of Texas Health San Antonio , San Antonio, TX
| | - James Aden
- 3 Brooke Army Medical Center , Fort Sam Houston, TX
| | | | | | - Alice Inman
- 3 Brooke Army Medical Center , Fort Sam Houston, TX
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Kienle GS, Mussler M, Fuchs D, Kiene H. The Subjective Dimension of Integrative Cancer Care: A Qualitative Study Exploring the Perspectives, Themes, and Observations of Experienced Doctors from the Area of Anthroposophic Medicine. Explore (NY) 2018; 14:342-351. [PMID: 30181043 DOI: 10.1016/j.explore.2018.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 02/06/2018] [Accepted: 03/14/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Integrative cancer care (ICC) is used by approximately 50% of cancer patients to complement oncologic treatments and to address unmet needs. One ICC practice is anthroposophic medicine, integrating conventional and complementary cancer care. It specifically provides mistletoe therapy (MT), but also intensive counselling, natural remedies, creative and movement therapies, nursing procedures, nutrition, and others. The objective of this study was to explore perceptions, themes, goals, procedures, and observations of experienced AM doctors with regard to the subjective dimensions of ICC. METHOD A guideline-based qualitative interview study was conducted with 35 AM doctors working in hospitals and office-based practices in Germany and other countries. Structured qualitative content analysis was applied to examine the data. Triangulation was done with published studies investigating patients' perspectives on AM and MT. RESULTS The interviewed doctors integrated conventional and holistic cancer concepts. Overarching therapeutic themes were: to enable patients to live with or overcome their disease, to find their own way through their disease, and to possibly reframe their situation. A broad variety of therapeutic goals were pursued, depending on the situation and priorities of the particular patient. Doctors described varying levels of patients' improved strength; increased vitality, thermal comfort, and recovery; relief from suffering, particularly in the areas of fatigue, appetite, sleep, pain, infections, and reactions to toxic anti-cancer therapies. The doctors also described how they perceived changes of patients' emotional level, their coping, autonomy, functional abilities, and finding their own way to deal with the disease. This is consistent with patients' perspectives described in published studies. CONCLUSION Themes, goals, and described benefit of ICC from doctors' and patients' perspective may be an important complementation of conventional cancer care, as it meets important needs, distresses and conditions of patients which often stay unmet and unrelieved. Further research should investigate these goals and procedures.
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Affiliation(s)
- Gunver S Kienle
- Institute for Applied Epistemology and Medical Methodology at the University of Witten Herdecke, Zechenweg 6, D-79111 Freiburg, Germany; Center for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, Medical Center - University of Freiburg, Faculty of Medicine, Breisacher Str. 115B, 79106 Freiburg, Germany.
| | - Milena Mussler
- Institute for Applied Epistemology and Medical Methodology at the University of Witten Herdecke, Zechenweg 6, D-79111 Freiburg, Germany.
| | - Dieter Fuchs
- Department of Theology, Caritas Sciences, University of Freiburg, Werthmannplatz 3, D-79098 Freiburg, Germany.
| | - Helmut Kiene
- Institute for Applied Epistemology and Medical Methodology at the University of Witten Herdecke, Zechenweg 6, D-79111 Freiburg, Germany.
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Lyman GH, Greenlee H, Bohlke K, Bao T, DeMichele AM, Deng GE, Fouladbakhsh JM, Gil B, Hershman DL, Mansfield S, Mussallem DM, Mustian KM, Price E, Rafte S, Cohen L. Integrative Therapies During and After Breast Cancer Treatment: ASCO Endorsement of the SIO Clinical Practice Guideline. J Clin Oncol 2018; 36:2647-2655. [DOI: 10.1200/jco.2018.79.2721] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose The Society for Integrative Oncology (SIO) produced an evidence-based guideline on use of integrative therapies during and after breast cancer treatment that was determined to be relevant to the American Society of Clinical Oncology (ASCO) membership. ASCO considered the guideline for endorsement. Methods The SIO guideline addressed the use of integrative therapies for the management of symptoms and adverse effects, such as anxiety and stress, mood disorders, fatigue, quality of life, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Interventions of interest included mind and body practices, natural products, and lifestyle modifications. SIO systematic reviews focused on randomized controlled trials that were published from 1990 through 2015. The SIO guideline was reviewed by ASCO content experts for clinical accuracy and by ASCO methodologists for developmental rigor. On favorable review, an ASCO Expert Panel was convened to review the guideline contents and recommendations. Results The ASCO Expert Panel determined that the recommendations in the SIO guideline—published in 2017—are clear, thorough, and based on the most relevant scientific evidence. ASCO endorsed the guideline with a few added discussion points. Recommendations Key recommendations include the following: Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-l-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy because of a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment–related adverse effects. Additional information is available at: www.asco.org/supportive-care-guidelines .
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Affiliation(s)
- Gary H. Lyman
- Gary H. Lyman and Heather Greenlee, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Ting Bao and Gary E. Deng, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York; Karen M. Mustian, University of Rochester Medical Center, Rochester, NY; Angela M. DeMichele, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Judith M. Fouladbakhsh,
| | - Heather Greenlee
- Gary H. Lyman and Heather Greenlee, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Ting Bao and Gary E. Deng, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York; Karen M. Mustian, University of Rochester Medical Center, Rochester, NY; Angela M. DeMichele, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Judith M. Fouladbakhsh,
| | - Kari Bohlke
- Gary H. Lyman and Heather Greenlee, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Ting Bao and Gary E. Deng, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York; Karen M. Mustian, University of Rochester Medical Center, Rochester, NY; Angela M. DeMichele, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Judith M. Fouladbakhsh,
| | - Ting Bao
- Gary H. Lyman and Heather Greenlee, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Ting Bao and Gary E. Deng, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York; Karen M. Mustian, University of Rochester Medical Center, Rochester, NY; Angela M. DeMichele, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Judith M. Fouladbakhsh,
| | - Angela M. DeMichele
- Gary H. Lyman and Heather Greenlee, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Ting Bao and Gary E. Deng, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York; Karen M. Mustian, University of Rochester Medical Center, Rochester, NY; Angela M. DeMichele, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Judith M. Fouladbakhsh,
| | - Gary E. Deng
- Gary H. Lyman and Heather Greenlee, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Ting Bao and Gary E. Deng, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York; Karen M. Mustian, University of Rochester Medical Center, Rochester, NY; Angela M. DeMichele, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Judith M. Fouladbakhsh,
| | - Judith M. Fouladbakhsh
- Gary H. Lyman and Heather Greenlee, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Ting Bao and Gary E. Deng, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York; Karen M. Mustian, University of Rochester Medical Center, Rochester, NY; Angela M. DeMichele, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Judith M. Fouladbakhsh,
| | - Brigitte Gil
- Gary H. Lyman and Heather Greenlee, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Ting Bao and Gary E. Deng, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York; Karen M. Mustian, University of Rochester Medical Center, Rochester, NY; Angela M. DeMichele, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Judith M. Fouladbakhsh,
| | - Dawn L. Hershman
- Gary H. Lyman and Heather Greenlee, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Ting Bao and Gary E. Deng, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York; Karen M. Mustian, University of Rochester Medical Center, Rochester, NY; Angela M. DeMichele, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Judith M. Fouladbakhsh,
| | - Sami Mansfield
- Gary H. Lyman and Heather Greenlee, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Ting Bao and Gary E. Deng, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York; Karen M. Mustian, University of Rochester Medical Center, Rochester, NY; Angela M. DeMichele, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Judith M. Fouladbakhsh,
| | - Dawn M. Mussallem
- Gary H. Lyman and Heather Greenlee, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Ting Bao and Gary E. Deng, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York; Karen M. Mustian, University of Rochester Medical Center, Rochester, NY; Angela M. DeMichele, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Judith M. Fouladbakhsh,
| | - Karen M. Mustian
- Gary H. Lyman and Heather Greenlee, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Ting Bao and Gary E. Deng, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York; Karen M. Mustian, University of Rochester Medical Center, Rochester, NY; Angela M. DeMichele, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Judith M. Fouladbakhsh,
| | - Erin Price
- Gary H. Lyman and Heather Greenlee, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Ting Bao and Gary E. Deng, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York; Karen M. Mustian, University of Rochester Medical Center, Rochester, NY; Angela M. DeMichele, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Judith M. Fouladbakhsh,
| | - Susan Rafte
- Gary H. Lyman and Heather Greenlee, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Ting Bao and Gary E. Deng, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York; Karen M. Mustian, University of Rochester Medical Center, Rochester, NY; Angela M. DeMichele, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Judith M. Fouladbakhsh,
| | - Lorenzo Cohen
- Gary H. Lyman and Heather Greenlee, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Ting Bao and Gary E. Deng, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York; Karen M. Mustian, University of Rochester Medical Center, Rochester, NY; Angela M. DeMichele, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Judith M. Fouladbakhsh,
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93
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Schad F, Thronicke A, Steele ML, Merkle A, Matthes B, Grah C, Matthes H. Overall survival of stage IV non-small cell lung cancer patients treated with Viscum album L. in addition to chemotherapy, a real-world observational multicenter analysis. PLoS One 2018; 13:e0203058. [PMID: 30148853 PMCID: PMC6110500 DOI: 10.1371/journal.pone.0203058] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 08/14/2018] [Indexed: 12/15/2022] Open
Abstract
Background Stage IV non-small cell lung cancer (NSCLC) is associated with a five-year survival rate of around 1%. Treatment with Viscum album L. (VA) extracts has been shown to reduce chemotherapy (CTx)-related adverse events, decrease CTx dose reductions and improve quality of life in a number of cancers. Recent data suggest a beneficial effect of add-on treatment with Viscum album L. (VA, European mistletoe) on survival in cancer patients. The objective of this study was to evaluate the effect of VA in addition to chemotherapy on survival in stage IV NSCLC patients. Methods The observational study was conducted using data from the Network Oncology clinical registry which is an accredited conjoint clinical registry of German oncological hospitals, practitioners and out-patient centers.Patients were included if they had stage IV NSCLC at diagnosis, lived at least for four weeks post-diagnosis and received chemotherapeutic treatment. Patients with EGFR mutations as well as patients receiving tyrosine kinase inhibitors or immune checkpoint inhibitors were not included. Overall survival and impact on hazard in patients with chemotherapy (CTx) to patients receiving CTx plus VA were compared. To identify factors associated with survival and to address potential sources of bias a multivariate analyses using Cox proportional hazard model was performed. Results The median age of the population was 64.1 years with 55.7% male patients. The highest proportion of patients had adenocarcinoma (72.2%) and most of the patients were current or past smokers (70.9%). Of 158 stage IV NSCLC patients, 108 received CTx only and 50 additional VA. Median survival was 17.0 months in the CTx plus VA group (95%CI: 11.0–40.0) and was 8.0 months (95%CI: 7.0–11.0) in the CTx only group (χ2 = 7.2, p = .007). Overall survival was significantly prolonged in the VA group (HR 0.44, 95%CI: 0.26–0.74, p = .002). One-year and three-year overall survival rates were greater with CTx plus VA compared to CTX alone (1y: 60.2% vs. 35.5%; 3y: 25.7% vs. 14.2%). Conclusion Our findings suggest that concomitant VA is positively associated with survival in stage IV NSCLC patients treated with standard CTx. These findings complement pre-existing knowldedge of add-on VA’s clinical impact, however, results should be interpreted with caution in light of the study’s observational character.
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Affiliation(s)
- Friedemann Schad
- Research Institute Havelhöhe, Hospital Havelhöhe, Berlin, Germany
- Interdisciplinary Oncology and Palliative Care, Hospital Havelhöhe, Berlin, Germany
- * E-mail:
| | - Anja Thronicke
- Research Institute Havelhöhe, Hospital Havelhöhe, Berlin, Germany
| | - Megan L. Steele
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Antje Merkle
- Research Institute Havelhöhe, Hospital Havelhöhe, Berlin, Germany
- Interdisciplinary Oncology and Palliative Care, Hospital Havelhöhe, Berlin, Germany
| | - Burkhard Matthes
- Research Institute Havelhöhe, Hospital Havelhöhe, Berlin, Germany
- Interdisciplinary Oncology and Palliative Care, Hospital Havelhöhe, Berlin, Germany
| | - Christian Grah
- Research Institute Havelhöhe, Hospital Havelhöhe, Berlin, Germany
- Lung Cancer Center and Department of Pneumology, Hospital Havelhöhe, Berlin, Germany
| | - Harald Matthes
- Research Institute Havelhöhe, Hospital Havelhöhe, Berlin, Germany
- Medical Clinic for Gastroenterology, Infectiology and Rheumatology CBF and Institute of Social Medicine, Epidemiology and Health Economics CCM, Charité University Medicine Berlin, Berlin, Germany
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94
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Eyigor S, Uslu R, Apaydın S, Caramat I, Yesil H. Can yoga have any effect on shoulder and arm pain and quality of life in patients with breast cancer? A randomized, controlled, single-blind trial. Complement Ther Clin Pract 2018; 32:40-45. [DOI: 10.1016/j.ctcp.2018.04.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 03/15/2018] [Accepted: 04/26/2018] [Indexed: 11/24/2022]
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95
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Complementary and alternative medicine (CAM) information and support needs of Chinese-speaking cancer patients. Support Care Cancer 2018; 26:4151-4159. [DOI: 10.1007/s00520-018-4288-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 05/21/2018] [Indexed: 10/14/2022]
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96
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Ochalek K, Gradalski T, Szygula Z, Partsch H. Physical Activity With and Without Arm Sleeves: Compliance and Quality of Life After Breast Cancer Surgery—A Randomized Controlled Trial. Lymphat Res Biol 2018; 16:294-299. [DOI: 10.1089/lrb.2017.0045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Katarzyna Ochalek
- Department of Clinical Rehabilitation, Faculty of Motor Rehabilitation, University of Physical Education, Krakow, Poland
- Lymphedema Clinic St. Lazarus Hospice, Krakow, Poland
| | | | - Zbigniew Szygula
- Department of Sports Medicine and Human Nutrition, Faculty of Physical Education and Sport, University of Physical Education, Krakow, Poland
| | - Hugo Partsch
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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97
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Hack CC, Hackl J, Hüttner NBM, Langemann H, Schwitulla J, Dietzel-Drentwett S, Fasching PA, Beckmann MW, Theuser AK. Self-reported Improvement in Side Effects and Quality of Life With Integrative Medicine in Breast Cancer Patients. Integr Cancer Ther 2018; 17:941-951. [PMID: 29845888 PMCID: PMC6142097 DOI: 10.1177/1534735418777883] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose. Although the demand from patients for integrative
medicine is increasing, complementary medicine services are still quite
heterogeneous and have not been incorporated into clinical routine. The aim of
this study was to systematically evaluate improvements in side effects and
quality of life associated with a hospital-based integrative medicine program in
the modern breast cancer patient care setting. Methods. In a
cross-sectional study, integrative health counseling and treatment were
evaluated in women with breast cancer. Over a 15-month period, data for 75
patients from an integrative medicine consultancy service with standardized
operating procedures were collected at the University Breast Center for
Franconia. At baseline, the patients answered a questionnaire on their medical
history, symptoms, and the treatment goals they were hoping to achieve with
integrative medicine. In the follow-up, patient-reported outcomes related to
side effects of conventional cancer treatment and patients’ quality of life were
analyzed. Results. Among 60 patients with the therapy goal of
reducing the side effects of conventional treatment, 46 (76.7%) were successful.
Among 57 patients hoping to improve disease-related quality of life, 46 (82%)
reported success. Whereas patients with metastatic disease achieved a reduction
in the side effects of conventional therapy, quality-of-life improvements were
predominantly achieved by patients with a good treatment prognosis.
Conclusions. Breast cancer patients benefit from the
counseling and treatment provided with integrative medicine in all phases of
tumor disease. Integrative treatment services should be included as part of
patient care in clinical routine work to offer patients the maximum quality of
care and safety with complementary therapies.
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Affiliation(s)
- Carolin C Hack
- 1 Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Janina Hackl
- 1 Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Nina B M Hüttner
- 1 Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Hanna Langemann
- 1 Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Judith Schwitulla
- 1 Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Peter A Fasching
- 1 Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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A qualitative examination of the factors related to the development and maintenance of insomnia in cancer survivors. Palliat Support Care 2018; 17:221-226. [PMID: 29764524 DOI: 10.1017/s1478951518000135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Insomnia is underrecognized and inadequately managed, with close to 60% of cancer survivors experiencing insomnia at some point in the treatment trajectory. The objective of this study was to further understand predisposing, precipitating, and perpetuating factors in the development and maintenance of insomnia in cancer survivors. METHOD A heterogeneous sample of 63 patients who had completed active treatment was recruited. Participants were required to have a score >7 on the Insomnia Severity Index and meet the diagnostic criteria for insomnia disorder. Open-ended, semistructured interviews were conducted to elicit participants' experiences with sleep problems. An a priori set of codes and a set of codes that emerged from the data were used to analyze the data. RESULT The mean age of the sample was 60.5 years, with 30% identifying as non-white and 59% reporting their sex as female. The cancer types represented were heterogeneous with the two most common being breast (30%) and prostate (21%). Participants described an inherited risk for insomnia, anxious temperament, and insufficient ability to relax as predisposing factors. Respondents were split as to whether they classified their cancer diagnosis as the precipitating factor for their insomnia. Participants reported several behaviors that are known to perpetuate problems with sleep including napping, using back-lit electronics before bed, and poor sleep hygiene. One of the most prominent themes identified was the use of sleeping medications. Participants reported that they were reluctant to take medication but felt that it was the only option to treat their insomnia and that it was encouraged by their doctors. SIGNIFICANCE OF RESULTS Insomnia is a prevalent, but highly treatable, disorder in cancer survivors. Patients and provider education is needed to change individual and organizational behaviors that contribute to the development and maintenance of insomnia and increase access to evidence-based nonpharmacological interventions.
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99
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Kienle GS, Mussler M, Fuchs D, Kiene H. On caring and sharing-Addressing psychological, biographical, and spiritual aspects in integrative cancer care: A qualitative interview study on physicians' perspectives. Complement Ther Med 2018; 40:126-132. [PMID: 30219437 DOI: 10.1016/j.ctim.2018.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 04/24/2018] [Accepted: 04/26/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Patients confronted with a cancer diagnosis experience a variety of existential needs encompassing emotional, psychological, and spiritual areas of being. A patient-centered care approach addressing such existential issues is recognized as an essential aspect of health care. The aim of this study is to explore what role psychological, biographical, and spiritual factors play for experienced doctors working in integrative cancer care. METHOD The qualitative study was based on in-depth interviews with 35 purposively sampled doctors, all practicing integrative oncology in the field of anthroposophic medicine in hospitals and/or office-based practices in Germany and other countries. Data were analyzed using structured content analysis. RESULTS Psychological, biographical, and spiritual factors are important issues in integrative cancer care. Prevailing themes identified in this study were enabling patients to participate in life, promoting autonomy and coping, stabilizing patients emotionally and cognitively, overcoming the disease, and-primarily if addressed by patients-integrating spiritual issues. Doctors offered conversation, counseling, and time, but also referred to art, music, literature, and nature, so that patients' ongoing emotional, psychological, and spiritual needs could be explored and addressed. Doctors' attitudes with regard to existential issues were seen as important, as was maintaining an attitude of openness towards existential issues. CONCLUSION Doctors in integrative cancer care utilize different methods to explore the needs of patients and employ a variety of treatment methods that address not just patients' medical issues but their existential concerns as well.
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Affiliation(s)
- Gunver S Kienle
- Institute for Applied Epistemology and Medical Methodology at the University of Witten Herdecke, Zechenweg 6, D-79111 Freiburg, Germany; Center for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, Medical Center - University of Freiburg, Faculty of Medicine, Breisacher Str. 115B, 79106, Germany.
| | - Milena Mussler
- Institute for Applied Epistemology and Medical Methodology at the University of Witten Herdecke, Zechenweg 6, D-79111 Freiburg, Germany.
| | - Dieter Fuchs
- Department of Theology, Caritas Sciences, University of Freiburg, Werthmannplatz 3, D-79098 Freiburg, Germany.
| | - Helmut Kiene
- Institute for Applied Epistemology and Medical Methodology at the University of Witten Herdecke, Zechenweg 6, D-79111 Freiburg, Germany.
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Hack CC, Antoniadis S, Hackl J, Langemann H, Schwitulla J, Fasching PA, Beckmann MW, Theuser AK. Breast cancer patients’ satisfaction with individual therapy goals and treatment in a standardized integrative medicine consultancy service. Arch Gynecol Obstet 2018; 298:147-156. [DOI: 10.1007/s00404-018-4779-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/19/2018] [Indexed: 12/23/2022]
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