1
|
Von Reusner MJ, Märtens B, Barthel S, Weiser A, Ziert Y, Steinmann D, Babadağ-Savaş B. Interdisciplinary Integrative Oncology Group-Based Program: Evaluation of Long-Term Effects on Resilience and Use of Complementary and Alternative Medicine in Patients With Cancer. Integr Cancer Ther 2024; 23:15347354241269931. [PMID: 39155547 PMCID: PMC11331462 DOI: 10.1177/15347354241269931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/06/2024] [Accepted: 07/22/2024] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND Cancer often causes reduced resilience, quality of life (QoL) and poorer overall well-being. To mitigate these problems, complementary and alternative medicine (CAM) is widely used among patients with cancer. This study aimed to evaluate the long-term effects of an interdisciplinary integrative oncology group-based program (IO-GP) on the resilience and use of CAM in patients with cancer. METHODS This was a prospective, observational, single-center study. Resilience (RS-13), CAM usage (I-CAM-G), QoL (SF-12) and health-related lifestyle factor (nutrition, smoking, alcohol consumption and physical exercise) data were collected for 70 patients who participated in a 10-week IO-GP between January 2019 and June 2022 due to cancer. The IO-GP is offered at the setting of a university hospital and is open to adult patients with cancer. It contains elements from mind-body medicine and positive psychology, as well as recommendations on healthy diet, exercise and CAM approaches. Patients who completed the IO-GP at least 12 months prior (1-4.5 years ago) were included in this study. Statistical analysis included descriptive analysis and parametric and nonparametric tests to identify significant differences (P < .05). RESULTS Resilience increased significantly ≥12 months after participation in the IO-GP (n = 44, P = .006, F = 8.274) and had a medium effect size (r = .410). The time since the IO-GP was completed ("12-24 months," "24-36 months," and ">36 months") showed no statistically significant interaction with changes in resilience (P = .226, F = 1.544). The most frequently used CAM modalities within the past 12 months were vitamins/minerals (85.7%), relaxation techniques (54.3%), herbs and plant medicine (41.1%), yoga (41.4%) and meditation (41.4%). The IO-GP was the most common source informing study participants about relaxation techniques (n = 24, 64.9%), meditation (n = 21, 72.4%) and taking vitamin D (n = 16, 40.0%). Significantly greater levels of resilience were found in those practicing meditation (P = .010, d = -.642) or visualization (P = .003, d = -.805) compared to non-practitioners. CONCLUSION IO-GPs have the potential to empower patients with cancer to continue using CAM practices-especially from mind-body medicine-even 1 to 4.5 years after completing the program. Additionally, resilience levels increased. These findings provide notable insight into the long-term effects of integrative oncology interventions on resilience and the use of CAM, especially in patients with breast cancer.
Collapse
Affiliation(s)
| | - Bettina Märtens
- Department of Radiotherapy, Hannover Medical School, Hannover, Germany
- CCC Hannover (Claudia von Schilling Center), Klaus Bahlsen Center for Integrative Oncology, Hannover Medical School, Hannover, Germany
| | - Stephanie Barthel
- CCC Hannover (Claudia von Schilling Center), Klaus Bahlsen Center for Integrative Oncology, Hannover Medical School, Hannover, Germany
| | - Axel Weiser
- Quality Management, Hannover Medical School, Hannover, Germany
| | - Yvonne Ziert
- Institute of Biometrics, Hannover Medical School, Hannover, Germany
| | - Diana Steinmann
- Department of Radiotherapy, Hannover Medical School, Hannover, Germany
- CCC Hannover (Claudia von Schilling Center), Klaus Bahlsen Center for Integrative Oncology, Hannover Medical School, Hannover, Germany
| | | |
Collapse
|
2
|
Huebner J, Muecke R, Micke O, Prott FJ, Josfeld L, Büntzel J, Büntzel J. Lay etiology concepts of cancer patients do not correlate with their usage of complementary and/or alternative medicine. J Cancer Res Clin Oncol 2023; 149:6067-6074. [PMID: 36653538 PMCID: PMC10356643 DOI: 10.1007/s00432-022-04528-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/08/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND The usage of complementary and alternative medicine (CAM) is widespread among cancer patients. While reasons for and aims of using CAM have been evaluated in many studies, less is known about whether patients' concepts of how and why cancer develops has an influence on the choice of the CAM method. METHODS We pooled the data from all studies of our working group containing questions on lay etiological concepts and CAM usage and reanalyzed them with respect to the associations between these parameters. RESULTS The pooled dataset from 12 studies included 4792 patients. A third (1645 patients) reported using CAM. Most often used were supplements (55.9%), relaxation techniques (43.6%), and homeopathy (37.9%). Regarding perceived causes, patients most often marked stress (35.4%) followed by genes (31.9%). While all lay etiological beliefs were highly significantly associated with usage of CAM in general, there was no association between single lay etiological concepts and types of CAM used. Yet, in a network analysis, we found two associations: one comprising trauma, mistletoe, genes, and nutritional supplements, the other yoga, vitamin C, nutritional supplements, and TCM herbs. In the correlation heatmap, one cluster comprises etiological concepts of personality, immune system and trauma, and two clusters of CAM methods emerged: one comprising praying, yoga, meditation, and relaxation procedures, the other nutritional supplements, selenium, vitamins A and C. CONCLUSION While physicians are trained to derive treatment strategies from etiological concepts, lay people choosing CAM do not follow these rules, which may point to other needs of patients addressed by CAM.
Collapse
Affiliation(s)
- J Huebner
- Klinik Für Innere Medizin II, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - R Muecke
- Strahlentherapie RheinMain, Rüsselsheim, Germany
| | - O Micke
- Klinik für Strahlentherapie und Radioonkologie, Franziskus Hospital, Bielefeld, Germany
| | - F-J Prott
- RNS Praxisgemeinschaft, Radiologie und Strahlentherapie, Wiesbaden, Germany
| | - L Josfeld
- Klinik Für Innere Medizin II, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - J Büntzel
- Klinik für HNO-Erkrankungen, Kopf-Hals-ChirurgieInterdisziplinäre Palliativstation, Südharz Klinikum Nordhausen, Nordhausen, Germany
| | - J Büntzel
- Klinik für Hämatologie und Onkologie, Universitätsklinikum Göttingen, Göttingen, Germany
| |
Collapse
|
3
|
HOPPE CATALINA, BUNTZEL JENS, VON WEIKERSTHAL LUDWIGFISCHER, JUNGHANS CONSTANZE, ZOMORODBAKHSCH BIJAN, STOLL CHRISTOPH, PROTT FRANZJOPSEF, FUXIUS STEFAN, MICKE OLIVER, RICHTER ACHIM, SALLMANN DOREEN, HUBNER JUTTA. Usage of Complementary and Alternative Methods, Lifestyle, and Psychological Variables in Cancer Care. In Vivo 2023; 37:106-114. [PMID: 36593056 PMCID: PMC9843784 DOI: 10.21873/invivo.13059] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND/AIM People who are undergoing cancer treatment often ask themselves what they can do in addition to conventional medical therapy with regard to nutrition, activity, and complementary methods. However, we know little about the motivation why people opt for one or the other measure. The aim of this study was therefore to examine the extent of physical activity (PA), healthy nutrition, and the use of complementary methods in relation to both demographic and psychological data. MATERIALS AND METHODS A questionnaire was used to collect data on demographic data, resilience, coherence, self-efficacy, spirituality, satisfaction, and complementary and alternative medicine (CAM) behavior, PA, and diet. Between March and July 2021, data from 446 patients were collected. Regression models and correlation analyzes were used to examine the associations between CAM use, diet and PA with the other variables surveyed. RESULTS CAM usage could only be predicted based on the patient's spirituality. Women used CAM more often and ate more healthily. Healthy eating was also related to younger age, shorter medical history, resilience, satisfaction, and coherence. In addition, the results showed that daily PA was related to the level of resilience, spirituality, and self-efficacy. CONCLUSION Which people or why patients use CAM remains a question to be further investigated. Our data suggest that CAM seeks to address similar needs that others find in spirituality. In order to promote a healthy diet and PA in cancer patients in the future, various psychological variables seem conceivable. Resilience stands out, which is related to an overall healthier lifestyle.
Collapse
Affiliation(s)
- CATALINA HOPPE
- Klinik für Innere Medizin II, Hämatologie und Internistische, Internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - JENS BUNTZEL
- Klinik für HNO-Erkrankungen, Kopf-Hals-Chirurgie, Interdisziplinäre Palliativstation Südharz Klinikum Nordhausen, Nordhausen, Germany
| | | | | | | | | | | | - STEFAN FUXIUS
- Onkologische Schwerpunktpraxis Heidelberg, Heidelberg, Germany
| | | | - ACHIM RICHTER
- Inselsberg Klinik Wicker GmbH & Co. OHG, Bad Tabarz, Germany
| | | | - JUTTA HUBNER
- Klinik für Innere Medizin II, Hämatologie und Internistische, Internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| |
Collapse
|
4
|
Zhao Q, Guo R, Fan Z, Hu L, Hu Z, Liu Y. Medical Conditions and Preference of Traditional Chinese Medicine: Results from the China Healthcare Improvement Evaluation Survey. Patient Prefer Adherence 2023; 17:227-237. [PMID: 36718438 PMCID: PMC9883991 DOI: 10.2147/ppa.s398644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/14/2023] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Although complementary and alternative medicine (CAM) is used around the world, there has been a lack of comprehensive understanding of major factors affecting patients' decision to use CAM. This study aimed to describe the preferences of Chinese patients regarding what conditions they will use Traditional Chinese Medicine (TCM) for and to determine the factors associated with these preferences. PATIENTS AND METHODS This study used data from the China Healthcare Improvement Evaluation Survey in January 2021, a national cross-sectional survey conducted at 163 hospitals across 31 provinces. A convenient sampling method was used to conduct the patient satisfaction survey, and 28,993 patients in an ambulatory setting constituted our study sample on TCM use. A multiple-choice question regarding TCM listed nine medical conditions and asked the patient about what condition he/she and his/her family members would use TCM. In addition to descriptive statistics, we used a binary logistic regression model to investigate factors affecting the likelihood of patients' decision to use TCM for multiple conditions. RESULTS The majority of the surveyed patients (76.3%) would use TCM for the purpose of disease prevention, and more than half (67.3%) for multiple medical/health conditions, 34.0% for dealing with chronic diseases, 33.0% for common symptoms, 26.9% for rehabilitation, and 26.3% for sleeping disorder. Female and older patients, as well as patients with a higher education level, urban residency, and higher family income, were found to be associated with a higher probability of using TCM for multiple conditions than their counterparts (odd ratios [OR]>1, P<0.05). CONCLUSION This study reveals a preference for TCM in a large sample of Chinese patients, especially used for prevention. Generally, patients with a higher socioeconomic status had a more positive attitude toward TCM.
Collapse
Affiliation(s)
- Qi Zhao
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Ran Guo
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Zixuan Fan
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Linlin Hu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Zhimin Hu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
- Correspondence: Yuanli Liu, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 9 Dongdansantiao, Dongcheng District, Beijing, 100730, People’s Republic of China, Email
| |
Collapse
|
5
|
Predictors of herbal medicine use among cancer patients. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04451-x. [DOI: 10.1007/s00432-022-04451-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022]
|
6
|
Patient activation, self-efficacy and usage of complementary and alternative medicine in cancer patients. MEDICAL ONCOLOGY (NORTHWOOD, LONDON, ENGLAND) 2022; 39:192. [PMID: 36071252 PMCID: PMC9452424 DOI: 10.1007/s12032-022-01796-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/15/2022] [Indexed: 11/08/2022]
Abstract
Complementary and alternative medicine (CAM) is used by many cancer patients by themselves. Therefore, we conducted a survey regarding the association between CAM, self-efficacy, and patient activation in adult cancer patients. A standardized questionnaire, consisted of the ASKU, the PAM 13-D, and a structured questionnaire on CAM usage from our own working group, was distributed to 880 potential participants. Six hundred and thirty-nine (639) patients (male 32.9%, female 63.2%; gynecological cancer 41%, gastrointestinal 19.2%, urogenital 15.6%) took part. 60% of all patients used CAM in the last 3 months (biological 73%, holistic 63%, mind–body methods 62%). Higher self-efficacy was associated with higher interest in CAM (p = 0.03), but not usage of CAM, compared to patients with lower self-efficacy (p = 0.099). Higher patient activation was associated with higher interest in CAM (p = 0.004) and usage of CAM (p = 0.012). Patients with higher activation significantly more often used homeopathy (p = 0.007), prayer (p = 0.002), yoga, etc. (p = 0.032), meditation (p = 0.002), low carb or ketogenic diets (p < 0.001) (but not vegan or other cancer diets). Higher patient activation is associated with higher usage of CAM. Focusing on patient activation as a goal in patient–physician relationship will help patients to adhere to a healthy lifestyle and to actively participate in the whole treatment process.
Collapse
|
7
|
Keinki C, Ahmadi E, Kastrati K, Zomorodbakhsch B, Hübner J. Cancer Patient Motives and Expectations on Non-medical Practitioners. In Vivo 2022; 36:2505-2513. [PMID: 36099132 PMCID: PMC9463934 DOI: 10.21873/invivo.12986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/25/2022] [Accepted: 08/06/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Non-medical practitioners (NMPs) are an ill-defined group of professionals offering patient diagnostic and therapeutic methods mostly in the field of complementary and alternative medicine (CAM). Despite a lack of quality-assessed structured professional formation, many patients with cancer visit NMPs for advice. This study aimed to learn more on patients' motives and expectations for consulting an NMP. PATIENTS AND METHODS A standardized questionnaire was distributed to adult cancer patients addressing attitudes towards NMPs, motives and expectations for consulting an NMP. RESULTS A total of 279 patients took part in the survey. Of the included patients 44.8% had already visited an NMP and 16.5% planned to do so. Reasons to visit an NMP were seeking for a supplementary treatment (72.0%) or control of side-effects (68.0%). While the oncologist ranked higher than the NMP in all aspects of physician-patient interaction and patients more often trusted in the oncologist, those patients rating their oncologist rather low in any of these questions significantly more often consulted an NMP. The methods applied or recommended by the NMPs were highly heterogenous ranging from biologically-based methods to mind-body-techniques. Most often used methods were homeopathy (72.0%) vitamin D (62.7%), selenium (42.7%), acupuncture (38.7%). CONCLUSION There is a high proportion of cancer patients visiting NMPs mostly for additional treatment. Biologically-based treatments may induce side-effects and interactions, especially as NMPs are not trained on medically accepted cancer treatment and medications. Offering information on CAM and improving the physician-patient relationship are important means to answer unmet needs from the side of the patient.
Collapse
Affiliation(s)
- Christian Keinki
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany;
| | - Emadaldin Ahmadi
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | | | | | - Jutta Hübner
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| |
Collapse
|
8
|
Complementary and Integrative Approaches to Cancer: A Pilot Survey of Attitudes and Habits among Cancer Patients in Italy. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2923967. [PMID: 35958921 PMCID: PMC9359845 DOI: 10.1155/2022/2923967] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/27/2022] [Indexed: 02/03/2023]
Abstract
Background. Cancer patients are among the main consumers of traditional, complementary, integrative, and alternative medicine (TCIM) such as natural products (herbals, integrators, etc.) and mind and body practices (yoga, acupuncture, etc.). Methods. A questionnaire on TCIM was submitted to 415 Italian cancer patients. The questionnaire consisted of three sections: (i) biographical and clinical information; (ii) use of natural substances; and (iii) use of mind-body practices. Results. 406 patients completed the questionnaire. The prevalence of TCIM use was 72.3%. Of them, 75.6% started to use TCIM after a tumor diagnosis. The main reasons for using TCIM were to mitigate side effects (65.0%), to regain physical and mental balance (35.9%), to relieve pain (18.3%), and to improve the efficacy of cancer therapy (16.0%). 44.7% of patients taking natural products used them during conventional therapies (chemotherapy, radiotherapy, etc.), and in 67.5% of cases without consulting a doctor. As a consequence, only about 50% of patients taking natural substances used these compounds appropriately, and the most common errors were related with the purpose of reducing the side effects of the therapy (52.3%) and for boosting immune system (32.1%). Conclusions. There is an impelling need to provide patients with scientifically validated information to raise awareness about the benefits and risks of using TCIM.
Collapse
|