The perceptions and experiences of osteopathic treatment among cancer patients in palliative care: a qualitative study

Investigating the safety and feasibility of osteopathic medicine in the pediatric oncology outpatient setting

CONTEXT

Pediatric patients receiving chemotherapy experience unwanted therapy-induced side effects, commonly constipation and pain that diminish quality of life. To date, few studies have investigated the safety and feasibility of osteopathic manipulative treatment (OMT) in pediatric oncology.

OBJECTIVES

The primary objective of this study is to investigate the safety and feasibility of OMT in pediatric oncology outpatient clinics.

METHODS

This is a single institutional pilot study evaluating children aged ≥2-21 years receiving chemotherapy for an oncological diagnosis at Nationwide Children's Hospital (NCH). Permission was obtained from the NCH Institutional Review Board. Participants were enrolled for 8 weeks and received weekly OMT. OMT was deemed feasible by participating in six out of eight weekly treatments, and safety was assessed through adverse event grading per Common Terminology Criteria for Adverse Events (CTCAE). During the clinic visit, patients answered validated surveys on constipation (Bristol Stool Scale) and pain (FACES Scale) pre/post-OMT. Feasibility was analyzed utilizing a one-sided exact binomial test while validated tools and adverse events were summarized descriptively.

RESULTS

A total of 23 patients were enrolled, with 21 included in feasibility analyses. The majority of the patients were female (n=13, 61.9%), with a median age of 12 years at enrollment (range, 2.7-20.8 years). There were no serious adverse events attributed to OMT intervention, and among the patients assessed for feasibility, 100% of them participated in at least two-thirds of their weekly OMT treatments, meeting our defined feasibility criteria. The intervention lasted an average of 14.2 min (range, 7.2-19.2 min). There were no FACES or Bristol Stool Scale scores that correlated with worsening pain on constipation post-OMT intervention.

CONCLUSIONS

Pediatric oncology patients were feasibly and safely able to receive OMT during a regularly scheduled chemotherapy visit. The limitations include the small sample size. These findings support the need to further investigate the safety and feasibility, as well as efficacy, of OMT in the pediatric oncology clinical setting.

Osteopathic Treatment and Evaluation in the Clinical Setting of Childhood Hematological Malignancies

Simple Summary

Children: adolescents, and young adults who are affected by hematological malignancies and who are undergoing intensive phases of cancer treatment including hematopoietic stem cell transplantation, experience diminished functional ability. This study was aimed at assessing if osteopathic treatment and evaluation can be used when an 11-week precision-based exercise program is run inside the hospital. Our results support that osteopathy plus precision-based intervention could be a desirable support in the clinical prise en charge of these children and adolescents. Osteopathy is a safe method for the evaluation of clinical conditions and requires strong multidisciplinary synergy between pediatricians and exercise physiologists.

Abstract

Children: adolescents, and young who are adults affected with hematological malignancies (CAYA-H) and who are undergoing intensive phases of cancer treatment, including hematopoietic stem cell transplantation (HSCT), experience diminished functional ability. This study was aimed at assessing the feasibility, efficacy, safety, and satisfaction of an osteopathic intervention in CAYA-H attending an 11-week precision-based exercise program (PEx). All of the participants were given 4–10 treatments according to the prescription ordered by the sports medicine doctor in charge of the PEx, and the following outcomes were assessed: (1) spinal column range of motion (ROM) by palpation; (2) lower and upper limb joints ROM by a goniometer; (3) orthostatic posture by plumb line assessment; (4) chest and abdomen mobility by inspection and palpation; (5) cranial-sacral rhythmic impulse (CRI) by palpation; and (6) adverse effects. Goal attainment scaling (GAS) was used to identify the accomplishment of a desired clinical result. Moreover, HSCT patients who were affected with graft-versus-host disease and/or osteonecrosis had their joints assessed in terms of ROM as tools to monitor the effectiveness of immunosuppressive treatment. A total of 231 CAYA-H were identified, and 104 participated in the study (age 10.66 ± 4.51 yrs; 43% F). PEx plus osteopathy reached positive GAS scores by improving the ROMs of the spinal column and/or limbs (81% and 78%, respectively), chest and abdomen mobility (82%), and CRI (76%). Only minor reversible adverse effects were noticed during the study. Together, our data seem to initiate a new course where osteopathy could be useful in evaluating structural edges due to the clinical history of each CAYA-H. Given the contributions that were obtained by the GAS scores, osteopathic treatment seems to reveal interesting potential that can be targeted in the future.

Complementary medicine visits by palliative care patients: a cross-sectional survey

BACKGROUND

The paucity of empirical research examining complementary medicine (CM) use in palliative care in France compared with other countries results in a gap in scientific knowledge. This study aims to describe the frequency and the cause of palliative care patients consulting with a CM clinician along with the conventional physicians.

METHODS

This study is an observational cross-sectional survey conducted in three palliative care centres in Lyon, France, between July 2017 and May 2018: two tertiary hospitals and one palliative care unit in a private hospital. Inpatients and outpatients visiting the palliative care clinics with a primary diagnosis of cancer were invited to participate in the study. Using a 19-item paper-based survey instrument, we collected data on the participants' personal characteristics, health service utilisation and attitudes towards CM.

RESULTS

From the 138 participants meeting the inclusion criteria, 100 (72.4%) were included in the study. On average, they were 62.9 years old (SD 12.4) and the majority were women (60%). The primary cancer site was mostly colorectal (29.0%), breast (15.0%) and gynaecological (11.0%). The most commonly visited CM clinician was the aromatherapist (72.7%), recording more than six consultations (78.1%) for symptom management (21.9%). Visits to an osteopath were reported by 28.6% of patients, and 45.8% of osteopathy users reported visiting an osteopath more than six times for symptom management (62.5%). Participants visiting a naturopath (15.3%) reported less than four visits and indicated symptom management as the most common reason (76.9%).

CONCLUSIONS

Our findings show a substantial proportion of palliative care patients visit CM clinicians and primarily seek symptom management from CM clinical care.

Visceral osteopathic manipulative treatment reduces patient reported digestive toxicities induced by adjuvant chemotherapy in breast cancer: A randomized controlled clinical study

OBJECTIVE

Breast cancer patients often benefit from adjuvant chemotherapy, a protocol whose effectiveness is accompanied by disabling adverse effects. The aim of this controlled clinical study was to determine the impact of visceral osteopathy on the incidence of nausea/vomiting, constipation and overall quality of life (QoL) in women operated for breast cancer and undergoing adjuvant chemotherapy in Centre Georges François Leclerc, CGFL.

STUDY DESIGN

Ninety-four women operated for a breast cancer stage 1-3, in complete resection and to whom a 3 FEC 100 chemotherapy was prescribed, were randomly allocated to experimental or placebo group. Experimental group underwent a visceral osteopathic technique and placebo group was subjected to a superficial manipulation after each chemotherapy cycle. Rate of grade ≥1 nausea/vomiting or constipation, on the first 3 cycles of FEC 100, were reported. QoL was evaluated using the EORTC QLQ-C30 questionnaire.

RESULTS

Rate of nausea/vomiting episodes of grade ≥1 was high in both experimental and placebo group. Constipation episodes of grade ≥1 were also frequent. No significant differences were found between the two groups concerning the rate of nausea/vomiting (p = 0.569) or constipation (p = 0.204) according to clinician reported side-effects but patient reported impact of constipation and diarrhoea on quality of life was significantly lower in experimental group (p = 0.036 and p = 0.038, respectively).

CONCLUSION

Osteopathy does not reduce the incidence of nausea/vomiting in women operated for breast cancer and undergoing adjuvant chemotherapy. In contrast, patient reported digestive quality of life was significantly ameliorated by osteopathy. Clinicaltrials.gov Identifier: NCT02840890.