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Dürsch H, Boltenhagen U, Mahler C, Joos S, Szecsenyi J, Klafke N. A Qualitative Analysis of Cancer Patients' Perceptions of an Interprofessional Counseling Service on Complementary and Integrative Healthcare. QUALITATIVE HEALTH RESEARCH 2024:10497323241231530. [PMID: 38441438 DOI: 10.1177/10497323241231530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
Medical guidelines recommend actively addressing patients' information needs regarding complementary and integrative healthcare (CIH). Within the CCC-Integrativ study, an interprofessional counseling program on CIH was developed and implemented at four comprehensive cancer centers (CCCs) in Germany. As part of the process evaluation, this study examines cancer patients' experiences with interprofessional CIH counseling sessions conducted by a physician and a nurse. Forty problem-centered interviews were conducted using a semi-structured interview guide. All interviews were audio-recorded, transcribed verbatim, and analyzed using deductive-inductive content analysis based on Kuckartz and Rädiker's approach. Findings revealed that most participants had prior experience with CIH approaches and were burdened by physiological and psychological symptoms. Counseling sessions focused on cancer- and treatment-related symptoms and appropriate CIH recommendations (e.g., herbal poultice against anxieties and acupressure against nausea). Participants appreciated the mutual exchange and integration of perspectives from different healthcare professions within the interprofessional approach. They noted that the counseling team comprehensively addressed their healthcare and CIH information needs. Suggestions for improvement included the specificity of the CIH recommendations. As the participants only received counseling and no CIH treatments, information about reputable CIH providers was particularly important to many seeking advice. Patients with cancer receiving tailored CIH counseling from two healthcare professionals experienced benefits in CIH counseling for symptom management. The interprofessional teams offered a comprehensive perspective on patients' needs, proposing personalized recommendations for symptom control. These insights may foster collaboration between healthcare professionals interested in CIH counseling, enabling them to expand and consolidate their counseling services.
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Affiliation(s)
- Helena Dürsch
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Ursula Boltenhagen
- Department of Nursing Science, University Hospital Tuebingen, Tuebingen, Germany
| | - Cornelia Mahler
- Department of Nursing Science, University Hospital Tuebingen, Tuebingen, Germany
| | - Stefanie Joos
- Institute of General Practice and Interprofessional Care, University Hospital Tuebingen, Tuebingen, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Nadja Klafke
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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Asakitogum DA, Nutor JJ, Pozzar R, Hammer M, Miaskowski C. Systematic Review of the Literature on Multiple Co-occurring Symptoms in Patients Receiving Treatment for Gynecologic Cancers. Semin Oncol Nurs 2024; 40:151572. [PMID: 38246840 DOI: 10.1016/j.soncn.2023.151572] [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: 09/09/2023] [Revised: 11/23/2023] [Accepted: 12/07/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE Patients with gynecologic cancers experience a very high symptom burden that has a negative impact on their quality of life. This systematic review aims to identify the common co-occurring symptoms, the prevalence of common symptoms, common instruments used to measure symptoms, associated risk factors, and the symptom burden in patients with gynecologic cancers. DATA SOURCES A search of four databases (ie, PubMed, Embase, Web of Science, and CINAHL) was done from January 1, 2012, through September 5, 2022. A qualitative synthesis of the extant literature was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA 2020). CONCLUSION A total of 118 studies met the prespecified inclusion criteria. Ninety-six symptoms were assessed across these studies. The top six symptoms and their grand mean prevalence rates were lack of energy (64.4%), fatigue (62.1%), abdominal pain (53.3%), depression (52.6%), concentration dysfunction (52.0%), and drowsiness (51.9%). Numerous methodologic challenges were evident across studies. Future research needs to develop a disease-specific symptom assessment measure, evaluate for risk factors associated with a higher symptom burden, and determine the impact of multiple symptoms on patient outcomes. IMPLICATION FOR NURSING PRACTICE The results are relevant for oncology clinicians to assess patients with gynecologic cancers for the presence of common symptoms and risk factors for higher symptom burden in the patients and to offer effective management interventions.
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Affiliation(s)
- David Ayangba Asakitogum
- Doctoral student, Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, CA.
| | - Jerry John Nutor
- Assistant Professor, Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, CA
| | - Rachel Pozzar
- Nurse Scientist and Instructor, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA
| | - Marilyn Hammer
- Nurse Scientist and Instructor, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA; Director, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA
| | - Christine Miaskowski
- Professor, Departments of Physiological Nursing and Anesthesia, School of Nursing and Medicine, University of California, San Francisco, CA
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Samuels N, Cohen N, Katz D, Ben-Arye E. Identifying cultural, demographic, personal health and cancer-related barriers to integrative oncology care: a retrospective case-cohort study. J Cancer Res Clin Oncol 2023; 149:10143-10148. [PMID: 37264264 DOI: 10.1007/s00432-023-04912-x] [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: 05/01/2023] [Accepted: 05/20/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE Integrative oncology (IO) provides complementary and integrative medicine within conventional supportive and palliative cancer care. The present study set out to identify barriers to attending an integrative physician (IP) consultation, provided without charge within an IO treatment program. STUDY METHODS Electronic files of adult oncology patients undergoing chemotherapy were studied. Patient-related characteristics were examined to identify factors associated with attendance at the IP consultation: socio-demographic (age, gender, country of birth, place of residence, primary language spoken); health- related (BMI, smoking, independent functioning); and cancer- related (primary tumor site, localized vs. metastatic). RESULTS Only 257 of the 1912 patients studied (13.4%) attended the IP consultation, with female patients more likely to attend (p < 0.001), as well as younger patients (p = 0.002); those residing outside the Jerusalem municipality (p = 0.008); and patients whose primary language was Hebrew (p < 0.001). Non-smokers and functionally independent patients were also more likely to attend (p = 0.007 and 0.008, respectively), as were those diagnosed with breast/gynecological (p = 0.005) or gastrointestinal tumors (p = 0.002). Multivariate analysis showed a significantly greater likelihood of attending the consultation among females (OR 1.619, 95% CI 1.065-2.460; p = 0.024); younger patients (OR 1.019, 95% CI 1.007-1.031; p = 0.001); non-Arabic speakers (OR 8.220, 95% CI 3.310-20.413; p < 0.001); and patients diagnosed with a tumor other than lung cancer (OR 2.954, 95% CI 1.259-6.933; p = 0.013). CONCLUSION Further prospective research addressing socio-demographic, personal health- and cancer-related characteristics of oncology patients is needed to address potential barriers to the provision of IO care within a diverse, equitable and inclusive setting of care.
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Affiliation(s)
- Noah Samuels
- Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, P.O.B. 3235, 9103102, Jerusalem, Israel.
| | - Neora Cohen
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Daniela Katz
- Integrated Oncology Institute, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin Carmel, and Zebulun Medical Centers, Clalit Health Services, Haifa, Israel
- Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Ben-Arye E, Lavie O, Heyl W, Ramondetta L, Berman T, Samuels N. Integrative Medicine for Ovarian Cancer. Curr Oncol Rep 2023; 25:559-568. [PMID: 36939963 DOI: 10.1007/s11912-023-01359-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 03/21/2023]
Abstract
PURPOSE OF REVIEW Integrative oncology (IO) services provide a wide range of complementary medicine therapies, many of which can augment the beneficial effects of conventional supportive and palliative care for patients with ovarian cancer. This study aims to assess the current state of integrative oncology research in ovarian cancer care. RECENT FINDINGS We review the clinical research both supporting the effectiveness of leading IO modalities in ovarian cancer care as well as addressing potential safety-related concerns. There is growing amount of clinical research supporting the use of IO and implementation of integrative gynecological oncology models of care within the conventional supportive cancer care setting. Additional research is still needed in order to create clinical guidelines for IO interventions for the treatment of female patients with ovarian cancer. These guidelines need to address both effectiveness and safety-related issues, providing oncology healthcare professionals with indications for which these patients can be referred to the IO treatment program.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin, Carmel & Zebulun Medical Centers, Clalit Health Services, Haifa, Western Galilee District, Israel. .,Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel and Clalit Health Services, Haifa, Western Galilee District, Israel.
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Gynecologic Oncology Service, Carmel Medical Center, Haifa, Israel
| | - Wolfgang Heyl
- Department of Obstetrics and Gynecology, Cancer Center North Wurttemberg, Ludwigsburg, Germany
| | - Lois Ramondetta
- Department of Gynecologic Oncology and Reproductive Medicine And Department of Palliative, Rehabilitation, & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tara Berman
- Department of Medical Oncology, Inova Schar Cancer Institute, Fairfax, VA, USA
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Faculty of Medicine, Shaarei Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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Stöcker A, Mehnert-Theuerkauf A, Hinz A, Ernst J. Utilization of complementary and alternative medicine (CAM) by women with breast cancer or gynecological cancer. PLoS One 2023; 18:e0285718. [PMID: 37172048 PMCID: PMC10180689 DOI: 10.1371/journal.pone.0285718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/01/2023] [Indexed: 05/14/2023] Open
Abstract
BACKGROUND Complementary and Alternative Medicine (CAM) has become increasingly popular among cancer patients. The prevalence of CAM use differs worldwide and depends on different sociodemographic and medical characteristics. Findings on predictors for CAM use and its benefits for quality of Life (QoL) have been inconclusive in recent studies. OBJECTIVE The aim of the study was to determine the prevalence and methods of CAM use in breast cancer (BC) and gynecological cancer (GC) patients, to compare CAM users vs. non-CAM users regarding their sociodemographic and medical characteristics, and to investigate the relationship between CAM use and QoL. METHODS In a sub-analysis from a multicenter, cross-sectional study in Germany, we examined 1,214 female cancer patients (897 with BC and 317 with GC). We obtained data from self-reports via standardized questionnaires and measured QoL with the EORTC QLQ-C30. RESULTS In total, 565 of the 1,214 patients (46.5%) used some form of CAM. Its use was higher in BC than in GC patients (48.6% vs. 40.7%). In both cancer groups, the users evaluated CAM as being helpful (BC: 60.8%, GC: 59.6%) The most frequently used CAM methods were vitamins/minerals/micronutrients, homeopathy, and mistletoe therapy. CAM users are younger, more highly educated, and financially better off than non-CAM users. They are also characterized by having been diagnosed with cancer a longer time ago, being at more advanced stages of the disease, and experiencing higher distress levels. CAM use is significantly associated with a lower global health status/ QoL in GC patients. Predictors for CAM use are: high level of vocational education, middle or high monthly income, time span since diagnosis of more than 12 months, the status of currently ongoing chemotherapy or hormone therapy treatment, and distress. CONCLUSION Our data support the findings of previous studies and highlight the need to develop a consistent CAM definition with respect to comparability and evaluation of CAM services. More longitudinal studies are desirable to establish viable associations between CAM use and relevant outcomes such as QoL or disease management.
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Affiliation(s)
- Anja Stöcker
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Jochen Ernst
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
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Ben-Arye E, Nijk N, Lavie O, Gressel O, MD ES, Samuels N. Can integrative oncology increase adherence to chemotherapy in advanced gynecologic cancer? Support Care Cancer 2022; 30:4345-4354. [DOI: 10.1007/s00520-022-06865-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/24/2022] [Indexed: 11/30/2022]
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Yeh YC. Symptom distress, stress, and quality of life in the first year of gynaecological cancers: A longitudinal study of women in Taiwan. Eur J Oncol Nurs 2021; 53:101984. [PMID: 34275743 DOI: 10.1016/j.ejon.2021.101984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/22/2021] [Accepted: 05/28/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess changes in symptom distress, stress, and quality of life (QOL) during chemotherapy and three months after its completion, as well as to identify predictors of QOL in the first year after a gynaecological cancer diagnosis in Taiwanese women. METHODS A prospective, longitudinal study was conducted from August 2017 to July 2019, recruiting 97 patients with gynaecological cancer at a large teaching hospital in central Taiwan. Data were obtained at four time points: after the first, third, and sixth chemotherapy cycles, and three months after treatment completion. Participants completed Chinese versions of three validated questionnaires: World Health Organization QOL Brief version, Symptom Distress Scale, and Perceived Stress Scale. Linear regression analyses with generalised estimating equations were used to examine the associations between symptom distress, stress, and QOL over time. RESULTS Fatigue, feeling desperate about the future, and peripheral limb numbness were the three major problems during the first year of gynaecological cancers. Feeling desperate about the future and stress were significant predictors of QOL in all domains. Noticeably, the level of stress increased over time, especially at three months after treatment completion. Participants reported fair QOL levels that gradually improved over time. CONCLUSIONS Stress and chemotherapy-induced symptom distress were factors that most interfered with QOL in women with gynaecologic cancers. Therefore, integrating psychological care and symptom support is an essential part of meeting patients' QOL needs.
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Affiliation(s)
- Yueh-Chen Yeh
- Department of Nursing, College of Health, National Taichung University of Science and Technology, Taichung, Taiwan.
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Correlation between an integrative oncology treatment program and survival in patients with advanced gynecological cancer. Support Care Cancer 2021; 29:4055-4064. [PMID: 33404816 DOI: 10.1007/s00520-020-05961-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/16/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Integrative oncology (IO) is increasingly becoming part of palliative cancer care. This study examined the correlation between an IO treatment program and rates of survival among patients with advanced gynecological cancer. METHODS Patients were referred by their oncology healthcare professionals to an integrative physician (IP) for consultation and IO treatments. Those undergoing at least 4 treatments during the 6 weeks following the consultation were considered adherence to the integrative care program (AIC), versus non-adherent (non-AIC). Survival was monitored for a period of 3 years, comparing the AIC vs. non-AIC groups, as well as controls who did not attend the IP consultation. RESULTS A total of 189 patients were included: 71 in the AIC group, 44 non-AIC, and 74 controls. Overall 3-year survival was greater in the AIC group (vs. non-AIC, p = 0.012; vs. controls, p = 0.003), with no difference found between non-AIC and controls (p = 0.954). Multimodal IO programs (≥ 3 modalities) were correlated in the AIC group with greater overall 3-year survival (p = 0.027). Greater rates of survival were also found in the AIC group at 12 (p = 0.004) and 18 months (p = 0.001). When compared with the AIC group, a multivariate analysis found higher crude and adjusted hazard ratios for 3-year mortality in the non-AIC group (HR 95% CI 2.18 (1.2-3.9), p = 0.010) and controls (2.23 (1.35-3.7), p = 0.002). CONCLUSION Adherence to an IO treatment program was associated with higher survival rates among patients with advanced gynecological cancer. Larger prospective trials are needed to explore whether the IO setting enhances patients' resilience, coping, and adherence to oncology treatment.
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Lee YJ, Park A, Roberge M, Donovan H. What Can Social Media Tell Us About Patient Symptoms: A Text-Mining Approach to Online Ovarian Cancer Forum. Cancer Nurs 2020; 45:E27-E35. [PMID: 32649337 DOI: 10.1097/ncc.0000000000000860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ovarian cancer (OvCa) patients suffer from symptoms that severely affect quality of life. To optimally manage these symptoms, their symptom experiences must be better understood. Social media have emerged as a data source to understand these experiences. OBJECTIVE The objective of this study was to use topic modeling (ie, latent Dirichlet allocation [LDA]) to understand the symptom experience of OvCa patients through analysis of online forum posts from OvCa patients and their caregivers. INTERVENTIONS/METHODS Ovarian cancer patient/caregiver posts (n = 50 626) were collected from an online OvCa forum. We developed a symptom dictionary to identify symptoms described therein, selected the top 5 most frequently discussed symptoms, extracted posts that mentioned at least one of those symptoms, and conducted LDA on those extracted posts. RESULTS Pain, nausea, anxiety, fatigue, and skin rash were the top 5 most frequently discussed symptoms (n = 4536, 1296, 967, 878, and 657, respectively). Using LDA, we identified 11 topic categories, which differed across symptoms. For example, chemotherapy-related adverse effects likely reflected fatigue, nausea, and rash; social and spiritual support likely reflected anxiety; and diagnosis and treatment often reflected pain. CONCLUSION The frequency of a symptom discussed on a social media platform may not include all symptom experience and their severity. Indeed, users, who are experiencing different symptoms, mentioned different topics on the forum. Subsequent studies should consider the influence of additional factors (eg, cancer stage) from discussions. IMPLICATIONS FOR PRACTICE Social media have the potential to prioritize and answer the questions about clinical care that are frequently asked by cancer patients and their caregivers.
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Affiliation(s)
- Young Ji Lee
- Author Affiliations: School of Nursing and (Drs Lee and Donovan and Ms Roberge); Department of Biomedical Informatics (Dr Lee), University of Pittsburgh, Pennsylvania; College of Computing and Information Science, University of North Carolina, Charlotte (Dr Park); Department of Obstetrics, Gynecology and Reproductive Science, University of Pittsburgh, Pennsylvania (Dr Donovan)
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Culha I, Gursoy E, Bulut H. Investigating the Effect of a Structured Discharge Training Program on Patient Outcomes Following Gynecologic Oncology Surgery. Clin Nurs Res 2020; 29:616-626. [PMID: 32456449 DOI: 10.1177/1054773820917299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to investigate the effect of a discharge training program structured according to the Roy adaptation model (RAM) on patient outcomes (quality of life, coping-adaptation, self-esteem) following gynecologic oncology surgery. This nonrandomized intervention studies consisted of two stages. In the first stage, patients were interviewed, patient needs after discharges were determined. Interview data were analyzed, and RAM-based training booklet was prepared. This booklet was prepared in line with a number of themes. In the second stage, the study was conducted with a sample of 36 control and 36 intervention patients, who were included in the discharge training program. Data was collected preoperatively, at 9th and 13th weeks after discharge. The mean quality of life and coping/adaptation scores of the intervention group at 13th weeks were significantly higher than those of the control group, however, no significant difference was found between the groups in terms of mean self-esteem scores.
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Affiliation(s)
- Ilkay Culha
- Nursing Department, Faculty of Health Science, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Elif Gursoy
- Nursing Department, Faculty of Health Science, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Hulya Bulut
- Nursing Department, Faculty of Health Science, Gazi University, Ankara, Turkey
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Kirsch JL, Robinson ME, McCrae CS, Kacel EL, Wong SS, Patidar S, Sannes TS, Garey S, Castagno JC, Pereira DB. Associations Among Sleep Latency, Subjective Pain, and Thermal Pain Sensitivity in Gynecologic Cancer. PAIN MEDICINE 2020; 21:5-12. [PMID: 30481329 DOI: 10.1093/pm/pny236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Pain is common among women with gynecologic cancer and contributes to depressed mood, sleep disturbances, and likelihood of future chronic pain. Little is known about how psychosocial factors are associated with central sensitization of pain in gynecologic cancer. This study examined relations among depressive symptoms, sleep, subjective pain, and aftersensation pain (a proxy for central sensitization of pain) in gynecologic cancer. METHODS Participants were 42 women (mean age [SD] = 59.60 [10.11] years) enrolled in a randomized clinical trial examining psychological intervention effects on sleep, pain, mood, and stress hormones/cytokines in gynecologic cancer. Six to eight weeks after surgery, participants completed an assessment of depressive symptoms, sleep, and subjective pain and a temporal summation of pain protocol via quantitative sensory testing (QST). RESULTS Controlling for recent chemotherapy, history of chronic pain, and analgesic medication use, regression analyses revealed that longer sleep onset latency (SOL; B = 3.112, P = 0.039, bias-corrected and accelerated (BCa) 95% confidence interval [CI] = 0.371 to 6.014) and greater sensory pain (B = 0.695, P = 0.023, BCa 95% CI = 0.085 to 1.210) were associated with greater aftersensation pain at 15 seconds. Greater sensory pain scores were associated with greater aftersensation pain at 30 seconds (B = 0.286, P = 0.045, BCa 95% CI = 0.008 to 0.513). Depression was not associated with aftersensation pain. The overall models accounted for 44.5% and 40.4% of the variance in aftersensation pain at 15 and 30 seconds, respectively. Conclusions. Longer SOL and higher subjective sensory pain were related to greater aftersensation of experimentally induced pain in women postsurgery for gynecologic cancers. Interventions that improve sleep and subjective sensory pain during the perisurgical period may reduce risk for central sensitization of pain.
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Affiliation(s)
- Janae L Kirsch
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida
| | - Michael E Robinson
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida
| | | | - Elizabeth L Kacel
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida
| | - Shan S Wong
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Seema Patidar
- Department of Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Timothy S Sannes
- Division of Hematology, University of Colorado-Denver Anschutz Medical Campus, Aurora, Colorado
| | | | - Jacqueline C Castagno
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida, USA
| | - Deidre B Pereira
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida
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Klafke N, Mahler C, von Hagens C, Uhlmann L, Bentner M, Schneeweiss A, Mueller A, Szecsenyi J, Joos S. The effects of an integrated supportive care intervention on quality of life outcomes in outpatients with breast and gynecologic cancer undergoing chemotherapy: Results from a randomized controlled trial. Cancer Med 2019; 8:3666-3676. [PMID: 31115192 PMCID: PMC6639168 DOI: 10.1002/cam4.2196] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/01/2019] [Accepted: 04/10/2019] [Indexed: 12/12/2022] Open
Abstract
The aim of the Complementary Nursing in Gynecologic Oncology study was to investigate the effects of a complex, nurse‐led, supportive care intervention using Complementary and Integrative Medicine (CIM) on patients’ quality of life (QoL) and associated patient‐reported outcomes. In this prospective, pragmatic, bicentric, randomized controlled trial, women with breast or gynecologic cancer undergoing a new regimen of chemotherapy (CHT) were randomly assigned to routine supportive care plus intervention (intervention group, IG) or routine care alone (control group, CG). The intervention consisted of CIM applications and counseling for symptom management, as well as CIM information material. The primary endpoint was global QoL measured with the EORTC‐QLQ‐C30 before and after CHT. Mixed linear models considering fixed and random factors were used to analyze the data. In total, 126 patients were randomly assigned into the IG and 125 patients into the CG (median age 51 years). The patients’ medical and socio‐demographic characteristics were homogenous at baseline and at follow‐up. No group effects on QoL were found upon completion of CHT (estimate −1.04 [−4.89; 2.81]; P = 0.596), but there was a significant group difference in favor of the IG 6 months later (estimate 6.643 [1.65; 11.64]; P = 0.010). IG patients did also experience significant better emotional functioning (P = 0.007) and less fatigue (P = 0.027). The tested supportive intervention did not improve patients’ QoL outcomes directly after CHT (T3), but was associated with significant QoL improvements when considering the change from baseline to the time point T4, which could be assessed 6 months after patients’ completion of CHT. This delayed effect may have resulted due to a strengthening of patients’ self‐management competencies.
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Affiliation(s)
- Nadja Klafke
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Cornelia Mahler
- Department of Nursing, Institute for Health Sciences, University Hospital Tuebingen, Tuebingen, Germany
| | - Cornelia von Hagens
- Division of Naturopathy and Integrative Medicine, Department of Gynaecological Endocrinology and Reproductive Medicine, University Womens' Hospital Heidelberg, Heidelberg, Germany
| | - Lorenz Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Martina Bentner
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Schneeweiss
- Division Gynaecologic Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Mueller
- Womens' Clinic, Community Hospital Karlsruhe, Karlsruhe, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefanie Joos
- Institute of General Practice and Interprofessional Care, University Hospital Tuebingen, Tuebingen, Germany
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Jolliffe RC, Durrant JR, Seers HE, Churchward SF, Griffiths M, Naidoo M, Ben-Arye E, Polley MJ, Zollman C. Impact of Penny Brohn UK's Living Well Course on Informal Caregivers of People with Cancer. J Altern Complement Med 2018; 24:974-980. [PMID: 30247959 DOI: 10.1089/acm.2018.0195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES This study evaluated the change in the concerns, wellbeing, and lifestyle behaviors of informal caregivers of people with cancer attending Penny Brohn UK's Living Well Course (LWC), a self-management education intervention. DESIGN A pre-postcourse design collected self-reported quantitative and qualitative data from informal caregivers attending a LWC. SETTING/LOCATION Penny Brohn UK is a United Kingdom-based charity (not-for-profit) providing specialist integrative, whole person support, free of charge, to people affected by cancer. SUBJECTS Informal caregivers taking part in a Penny Brohn UK LWC between June 2014 and May 2016 attending alongside the person with cancer. INTERVENTION The LWC is a structured 15 h, multimodal group self-management educational course, designed to help people affected by cancer learn tools and techniques to help build resilience. Trained facilitators deliver LWCs to around 12 people with various types and stages of cancer and their informal caregivers. OUTCOME MEASURES Measure Yourself Concern and Wellbeing (MYCaW) completed precourse and at 6 weeks postcourse; and bespoke 6-week follow-up Patient Reported Experience Measure. RESULTS Four hundred eighty informal caregivers attended a LWC June 2014 to May 2016. One hundred eighteen completed a 6-week follow-up MYCaW: MYCaW Concerns 1 and 2 showed statistically significant improvements (p < 0.0001), there was no significant improvement in wellbeing. Informal caregivers' most reported concerns relating to themselves were psychological and emotional issues (59%). The primary concern of the caregiver for the care recipient was related to the physical health of the person with cancer (40%). Eighty-seven percent of responding informal caregivers stated that the LWC enabled health self-management. CONCLUSIONS The LWC was followed by an improvement in informal caregivers' concerns, and increased self-management of their own health needs. More studies, with larger sample size, are needed to explore if better self-management by informal caregivers may also lead to improvements in patients' health and wellbeing.
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Affiliation(s)
| | | | | | | | | | | | - Eran Ben-Arye
- 2 Integrative Oncology Program, The Oncology Service and Lin Medical Center , Clalit Health Services, Haifa, Israel .,3 Faculty of Medicine, Technion-Israel Institute of Technology , Haifa, Israel
| | - Marie J Polley
- 4 Department of Life Sciences, Faculty of Science and Technology, University of Westminster , London, United Kingdom
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Zhou JG, Zhou NJ, Zhang Q, Feng YY, Zhou H. Apatinib for patients with advanced or recurrent cervical cancer: study protocol for an open-label randomized controlled trial. Trials 2018; 19:500. [PMID: 30223869 PMCID: PMC6142681 DOI: 10.1186/s13063-018-2858-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 08/12/2018] [Indexed: 12/28/2022] Open
Abstract
Background In China, cervical cancer is the fifth most commonly diagnosed cancer, and the outcomes for patients with advanced or recurrent disease are poor. Apatinib, a small molecule inhibitor of vascular endothelial growth factor receptor (VEGFR-2), is an orally bioavailable agent, which has shown survival benefit in multiple solid tumors. Based on previous research, this phase II clinical trial aims to verify apatinib’s efficacy and safety in patients with advanced or recurrent cervical cancer. Methods/design This randomized, parallel arm, open-label, interventional trial will be carried out to evaluate the efficacy and the safety of apatinib for advanced or recurrent cervical cancer. A total of 60 eligible patients will be allocated by intention, in a ratio of 1:1, to either the experimental group or the control group. The primary endpoint is progression-free survival, the secondary endpoints include overall survival, disease control rate, objective response rate, quality of life, and adverse events. Assessments will be carried out before enrolment (baseline) and every 4 weeks after treatment. Discussion The aim of this trial is to demonstrate the clinical effect, safety, and side effects of apatinib in the treatment of advanced or recurrent cervical cancer. This study will clarify the efficacy and safety of this regimen. Trial registration Chinese Clinical Trials Registry, ChiCTR-OIN-17012164. Registered on 24 July 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2858-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jian-Guo Zhou
- Department of Oncology, Affiliated Hospital of Zunyi Medical University, NO.149, Dalian Road, Zunyi, 563000, China.
| | - Nan-Jing Zhou
- Department of Oncology, Affiliated Hospital of Zunyi Medical University, NO.149, Dalian Road, Zunyi, 563000, China
| | - Qiong Zhang
- Department of Oncology, Affiliated Hospital of Zunyi Medical University, NO.149, Dalian Road, Zunyi, 563000, China
| | - Yao-Yao Feng
- Department of Oncology, Affiliated Hospital of Zunyi Medical University, NO.149, Dalian Road, Zunyi, 563000, China
| | - Hang Zhou
- Department of Oncology, Affiliated Hospital of Zunyi Medical University, NO.149, Dalian Road, Zunyi, 563000, China.
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15
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Ben-Arye E, Samuels N, Lavie O. Integrative Medicine for Female Patients with Gynecologic Cancer. J Altern Complement Med 2018; 24:881-889. [DOI: 10.1089/acm.2018.0163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin and Carmel Medical Centers, Clalit Health Services, Haifa, Israel
- Complementary and Traditional Medicine Unit, Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Clalit Health Services, Haifa, Israel
| | - Noah Samuels
- Tal Center for Integrative Medicine, Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Gynecologic Oncology Service, Carmel Medical Center, Haifa, Israel
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16
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Providing integrative care in the pre-chemotherapy setting: a pragmatic controlled patient-centered trial with implications for supportive cancer care. J Cancer Res Clin Oncol 2018; 144:1825-1833. [DOI: 10.1007/s00432-018-2700-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
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17
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Witt CM, Balneaves LG, Cardoso MJ, Cohen L, Greenlee H, Johnstone P, Kücük Ö, Mailman J, Mao JJ. A Comprehensive Definition for Integrative Oncology. J Natl Cancer Inst Monogr 2018; 2017:4617827. [PMID: 29140493 DOI: 10.1093/jncimonographs/lgx012] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 08/14/2017] [Indexed: 11/12/2022] Open
Abstract
Background Integrative oncology, which is generally understood to refer to the use of a combination of complementary medicine therapies in conjunction with conventional cancer treatments, has been defined in different ways, but there is no widely accepted definition. We sought to develop and establish a consensus for a comprehensive definition of the field of integrative oncology. Methods We used a mixed-methods approach that included a literature analysis and a consensus procedure, including an interdisciplinary expert panel and surveys, to develop a comprehensive and acceptable definition for the term "integrative oncology." Results The themes identified in the literature and from the expert discussion were condensed into a two-sentence definition. Survey respondents had very positive views on the draft definition, and their comments helped to shape the final version. The final definition for integrative oncology is: "Integrative oncology is a patient-centered, evidence-informed field of cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside conventional cancer treatments. Integrative oncology aims to optimize health, quality of life, and clinical outcomes across the cancer care continuum and to empower people to prevent cancer and become active participants before,during, and beyond cancer treatment." Conclusions This short and comprehensive definition for the term integrative oncology will facilitate a better understanding and communication of this emerging field. This definition will also drive focused and cohesive effort to advance the field of integrative oncology.
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Affiliation(s)
- Claudia M Witt
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lynda G Balneaves
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maria J Cardoso
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lorenzo Cohen
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heather Greenlee
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Peter Johnstone
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ömer Kücük
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Josh Mailman
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jun J Mao
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
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Ben-Arye E, Samuels N, Daher M, Turker I, Nimri O, Rassouli M, Silbermann M. Integrating Complementary and Traditional Practices in Middle-Eastern Supportive Cancer Care. J Natl Cancer Inst Monogr 2018; 2017:4617831. [PMID: 29140497 DOI: 10.1093/jncimonographs/lgx016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 07/25/2017] [Indexed: 02/06/2023] Open
Abstract
The Middle East is a promising arena in which researchers can explore the interchange between cross-cultural traditional medicine and supportive cancer care, as provided within an integrative oncology setting. Integrative oncology research and clinical practice in this part of the world have been focusing, for the most part, on the use of herbal medicine and mind-body-spiritual modalities, both of which are deeply rooted in traditional medical care. A regional, multinational, and interdisciplinary collaboration is currently being undertaken as part of the academic activities of the Middle-East Research Group in Integrative Oncology (MERGIO). This group is part of the Middle-East Cancer Consortium, a body supported by the National Cancer Institute. MERGIO currently facilitates a number of innovative educational, basic science, and clinical research projects that are investigating the effectiveness and safety of traditional herbal remedies. In order to create a structured, pragmatic "bedside-to-bench" and subsequent "back-to-bedside" approach, MERGIO has designed a patient-tailored integrative oncology model of supportive-palliative care. This approach addresses both patients' individual health belief models and the larger social-cultural-religious context, as defined by the health-related values of the patient's community.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Tal Center for Integrative Oncology, Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel; University of Balamand, Saint George Hospital, UMC, Beirut, Lebanon; Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey; Jordan Cancer Registry, Ministry of Health, Amman, The Hashemite Kingdom of Jordan; Shahid Beheshti University of Medical Sciences, Teheran, Iran; Middle East Cancer Consortium, Haifa, Israel
| | - Noah Samuels
- Integrative Oncology Program, The Oncology Service, Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Tal Center for Integrative Oncology, Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel; University of Balamand, Saint George Hospital, UMC, Beirut, Lebanon; Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey; Jordan Cancer Registry, Ministry of Health, Amman, The Hashemite Kingdom of Jordan; Shahid Beheshti University of Medical Sciences, Teheran, Iran; Middle East Cancer Consortium, Haifa, Israel
| | - Michel Daher
- Integrative Oncology Program, The Oncology Service, Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Tal Center for Integrative Oncology, Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel; University of Balamand, Saint George Hospital, UMC, Beirut, Lebanon; Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey; Jordan Cancer Registry, Ministry of Health, Amman, The Hashemite Kingdom of Jordan; Shahid Beheshti University of Medical Sciences, Teheran, Iran; Middle East Cancer Consortium, Haifa, Israel
| | - Ibrahim Turker
- Integrative Oncology Program, The Oncology Service, Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Tal Center for Integrative Oncology, Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel; University of Balamand, Saint George Hospital, UMC, Beirut, Lebanon; Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey; Jordan Cancer Registry, Ministry of Health, Amman, The Hashemite Kingdom of Jordan; Shahid Beheshti University of Medical Sciences, Teheran, Iran; Middle East Cancer Consortium, Haifa, Israel
| | - Omar Nimri
- Integrative Oncology Program, The Oncology Service, Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Tal Center for Integrative Oncology, Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel; University of Balamand, Saint George Hospital, UMC, Beirut, Lebanon; Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey; Jordan Cancer Registry, Ministry of Health, Amman, The Hashemite Kingdom of Jordan; Shahid Beheshti University of Medical Sciences, Teheran, Iran; Middle East Cancer Consortium, Haifa, Israel
| | - Maryam Rassouli
- Integrative Oncology Program, The Oncology Service, Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Tal Center for Integrative Oncology, Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel; University of Balamand, Saint George Hospital, UMC, Beirut, Lebanon; Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey; Jordan Cancer Registry, Ministry of Health, Amman, The Hashemite Kingdom of Jordan; Shahid Beheshti University of Medical Sciences, Teheran, Iran; Middle East Cancer Consortium, Haifa, Israel
| | - Michael Silbermann
- Integrative Oncology Program, The Oncology Service, Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Tal Center for Integrative Oncology, Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel; University of Balamand, Saint George Hospital, UMC, Beirut, Lebanon; Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey; Jordan Cancer Registry, Ministry of Health, Amman, The Hashemite Kingdom of Jordan; Shahid Beheshti University of Medical Sciences, Teheran, Iran; Middle East Cancer Consortium, Haifa, Israel
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Ben-Arye E, Dahan O, Shalom-Sharabi I, Samuels N. Inverse relationship between reduced fatigue and severity of anemia in oncology patients treated with integrative medicine: understanding the paradox. Support Care Cancer 2018; 26:4039-4048. [PMID: 29882024 DOI: 10.1007/s00520-018-4271-5] [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] [Received: 01/23/2018] [Accepted: 05/14/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the impact of integrative medicine (IM) on cancer-related fatigue in patients undergoing chemotherapy for early and advanced breast and gynecological (ovarian, endometrial, and cervical) cancer. METHODS Patients reporting significant levels of fatigue (on the Edmonton Symptom Assessment Scale (ESAS), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), or Measure Yourself Concerns and Wellbeing questionnaire (MYCAW)) were offered complementary and integrative medicine (CIM) treatments in addition to standard supportive care. Patients who did not undergo IM treatments were designated as controls. Attending at least five CIM treatments less than 30 days between each session was considered as high adherence to integrative care (AIC). RESULTS Of 258 eligible patients reporting significant fatigue, follow-up assessment at 6 and 12 weeks was considered optimal for 120 patients in the intervention group and for 64 controls; 88 of treated patients found to be adherent to the IM intervention. At 12 weeks, ESAS (P < 0.001) and EORTC (p = 0.001) scores for fatigue improved more significantly in treated patients, with a higher percent with optimal relative dose intensity in the AIC subgroup, both at 6 weeks (P = 0.002) and at 12 weeks (P < 0.001). IM treatment was paradoxically associated with a greater decrease in hemoglobin levels at 12 weeks (P = 0.016), more so in the AIC subgroup (P = 0.024). CONCLUSION Integrative medicine program may alleviate cancer-related fatigue in patients with breast and gynecological cancer undergoing chemotherapy.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, Lin and Carmel Medical Centers, Clalit Health Services, Haifa, Israel.
| | - Ofer Dahan
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilanit Shalom-Sharabi
- Integrative Oncology Program, Lin and Carmel Medical Centers, Clalit Health Services, Haifa, Israel
| | - Noah Samuels
- Tal Center for Integrative Oncology, Institute of Oncology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
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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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Cavaletti G, Marmiroli P. Pharmacotherapy options for managing chemotherapy-induced peripheral neurotoxicity. Expert Opin Pharmacother 2017; 19:113-121. [DOI: 10.1080/14656566.2017.1415326] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Guido Cavaletti
- School of Medicine and Surgery and Experimental Neurology Unit, University of Milano-Bicocca, Monza, Italy
| | - Paola Marmiroli
- School of Medicine and Surgery and Experimental Neurology Unit, University of Milano-Bicocca, Monza, Italy
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Shalom-Sharabi I, Keinan-Boker L, Samuels N, Lavie O, Lev E, Ben-Arye E. Effect of a 12-week integrative oncology intervention on gastro-intestinal concerns in patients with gynecological and breast cancer undergoing chemotherapy. Med Oncol 2017; 34:155. [DOI: 10.1007/s12032-017-1016-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 07/29/2017] [Indexed: 01/22/2023]
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Shalom-Sharabi I, Samuels N, Lev E, Lavie O, Keinan-Boker L, Schiff E, Ben-Arye E. Impact of a complementary/integrative medicine program on the need for supportive cancer care-related medications. Support Care Cancer 2017; 25:3181-3190. [DOI: 10.1007/s00520-017-3726-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/17/2017] [Indexed: 01/29/2023]
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Shalom-Sharabi I, Samuels N, Lavie O, Lev E, Keinan-Boker L, Schiff E, Ben-Arye E. Effect of a patient-tailored integrative medicine program on gastro-intestinal concerns and quality of life in patients with breast and gynecologic cancer. J Cancer Res Clin Oncol 2017; 143:1243-1254. [DOI: 10.1007/s00432-017-2368-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/09/2017] [Indexed: 11/12/2022]
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Sagar SM. Integrative oncology: are we doing enough to integrate psycho-education? Future Oncol 2016; 12:2779-2783. [DOI: 10.2217/fon-2016-0345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Stephen M Sagar
- Faculty of Medicine, Departments of Medicine & Oncology, McMaster University, Hamilton, Ontario, Canada
- Juravinski Cancer Centre, 3rd Floor, 699 Concession Street, Hamilton, Ontario, L8V 5C2, Canada
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Sharabi IS, Levin A, Schiff E, Samuels N, Agour O, Tapiro Y, Lev E, Keinan-Boker L, Ben-Arye E. Quality of life-related outcomes from a patient-tailored integrative medicine program: experience of Russian-speaking patients with cancer in Israel. Support Care Cancer 2016; 24:4345-55. [PMID: 27169571 DOI: 10.1007/s00520-016-3274-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/05/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Complementary/integrative medicine (CIM) is increasingly being integrated with standard supportive cancer care. The effects of CIM on quality of life (QOL) during chemotherapy need to be examined in varied socio-cultural settings. We purpose to explore the impact of CIM on QOL-related outcomes among Russian-speaking (RS) patients with cancer. PATIENTS AND METHODS RS patients undergoing chemotherapy receiving standard supportive care were eligible. Patients in the treatment arm were seen by an integrative physician (IP) and treated within a patient-tailored CIM program. Symptoms and QOL were assessed at baseline, at 6, and at 12 weeks with the Edmonton Symptom Assessment Scale (ESAS), the Measure Yourself Concerns and Wellbeing (MYCAW) questionnaire, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). RESULTS Of 70 patients referred to the treatment arm, 50 (71.4 %) underwent IP assessment and CIM treatments. Of 51 referred to the control arm, 38 (76 %) agreed to participate. At 6 weeks, CIM-treated patients reported improved ESAS scores for fatigue (P = 0.01), depression (P = 0.048), appetite (P = 0.008), sleep (P < 0.0001), and general wellbeing (P = 0.004). No improvement was observed among controls. Between-group analysis found CIM-treated patients had improved sleep scores on ESAS (P = 0.019) and EORTC (P = 0.007) at 6 weeks. Social functioning improved between 6 and 12 weeks (EORTC, P = 0.02), and global health status/QOL scale from baseline to 12 weeks (EORTC, P = 0.007). CONCLUSION A patient-tailored CIM treatment program may improve QOL-related outcomes among RS patients undergoing chemotherapy. Integrating CIM in conventional supportive care needs to address cross-cultural aspects of care. TRIAL REGISTRATION The study protocol was registered at ClinicalTrials.gov ( https://clinicaltrials.gov/ct2/show/NCT01860365 ).
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Affiliation(s)
- Ilanit Shalom Sharabi
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel
| | - Anna Levin
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel
| | - Elad Schiff
- Department of Internal Medicine, and Integrative Medicine Service, Bnai-Zion Hospital, Haifa, Israel; The Department for Complementary Medicine, Law and Ethics, The International Center for Health, Law and Ethics, Haifa University, Haifa, Israel
| | - Noah Samuels
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel.,Tal Center for Integrative Medicine, Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Olga Agour
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel.,Social-Work Service, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel
| | - Yehudith Tapiro
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel
| | - Efraim Lev
- Department of Eretz Israel Studies, University of Haifa, Haifa, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control, Israel Ministry of Health, Jerusalem, Israel.,School of Public Health, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel. .,Complementary and Traditional Medicine Unit, Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. .,Clalit Health Services, Haifa and Western Galilee District, Israel. .,The Oncology Service, Lin Medical Center, 35 Rothschild St., Haifa, Israel.
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Polley MJ, Jolliffe R, Boxell E, Zollman C, Jackson S, Seers H. Using a Whole Person Approach to Support People With Cancer: A Longitudinal, Mixed-Methods Service Evaluation. Integr Cancer Ther 2016; 15:435-445. [PMID: 27060342 PMCID: PMC5739159 DOI: 10.1177/1534735416632060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 12/23/2015] [Accepted: 01/14/2016] [Indexed: 12/29/2022] Open
Abstract
Introduction. Improved models of care are needed to meet all the support needs of people with cancer, which encompass psychological, emotional, physical, spiritual, sexual, occupational, social and existential needs. The aim of this article is to (a) evaluate short- and long-term impacts of using a whole person approach to support people with cancer on the Living Well with the Impact of Cancer Course (LWC) and (b) use these data to inform strategic decisions about future service provision at Penny Brohn UK. Methods. Longitudinal mixed-methods service evaluation (n = 135). Data collected included health-related quality of life (HRQoL) (FACIT-SpEx); Concerns (types and severity–MYCaW); lifestyle behavior (bespoke questionnaire), and participants’ experiences over 12 months postcourse. Results. Statistically and clinically significant improvements from baseline to 12 months in severity of MYCaW Concerns (n = 64; P < .000) and mean total HRQoL (n = 66; P < .000). The majority of MYCaW concerns were “psychological and emotional” and about participants’ well-being. Spiritual, emotional, and functional well-being contributed most to HRQoL improvements at 12 months. Barriers to maintaining healthy lifestyle changes included lack of support from family and friends, time constraints, and returning to work. Three to 6 months postcourse was identified as the time when more support was most likely to be needed. Conclusions. Using a whole person approach for the LWC enabled the needs of participants to be met, and statistically and clinically significant improvements in HRQoL and MYCaW Concerns were reported. Qualitative data analysis explored how experiencing whole person support enabled participants to make and sustain healthy lifestyle changes associated with improved survivorship. Barriers experienced to making health behavior change were also identified. These data then informed wider and more person-centered clinical provision to increase the maintenance of positive long-term behavior changes. Comparison of whole person approaches to cancer treatment and support and standard care are now urgently needed.
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Designing an integrative gynecologic oncology model of supportive care: call for a cross-cultural international collaboration. Support Care Cancer 2016; 24:1457-8. [PMID: 26803834 DOI: 10.1007/s00520-016-3093-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 01/17/2016] [Indexed: 10/22/2022]
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Abstract
Peripheral neuropathies are frequent in association with systemic diseases as well as isolated disorders. Recent advances in the therapy of specific neuropathies led to the approval of new drugs/treatments. This review selected those peripheral neuropathies where the most recent approvals were provided and revised the potential future developments in diabetic and toxic-induced neuropathies, although they do not have a currently available causal therapy in view of their epidemiological and social relevance. Data have been extracted from the most important published trials and from clinical experience. In addition, data from the Food and Drug Administration and European Medicine Agency indications on the treatment of the selected peripheral neuropathies and from recently updated international guidelines have also been included. The website of the U.S. National Institutes of Health www.clinicaltrials.gov registry has been used as the reference database for phase III clinical trials not yet published or ongoing. This review gives a general overview of the most recent advances in the treatment of amyloid, inflammatory, and paraproteinemic peripheral neuropathies. Moreover, it briefly describes the unmet medical need in disabling and frequent conditions, such as diabetic and chemotherapy-induced neuropathy, highlighting the most promising therapeutic approaches to their treatment.
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Affiliation(s)
- Paola Marmiroli
- a Experimental Neurology Unit, School of Medicine and Surgery and Milan Center for Neuroscience , University of Milano-Bicocca , Monza , Italy
| | - Guido Cavaletti
- a Experimental Neurology Unit, School of Medicine and Surgery and Milan Center for Neuroscience , University of Milano-Bicocca , Monza , Italy
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Integrative medicine, quality of life and gynecological cancer : Comments on the article titled "Quality-of-life outcomes in patients with gynecologic cancer referred to integrative oncology treatment during chemotherapy". Support Care Cancer 2015; 24:1455-6. [PMID: 26563181 DOI: 10.1007/s00520-015-3022-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 11/08/2015] [Indexed: 10/22/2022]
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