Complementary and alternative medicine status in ovarian cancer guidelines: A systematic review

Complementary and alternative medicine mention and recommendations in pancreatic cancer clinical practice guidelines: A systematic review and quality assessment

Background

Pancreatic cancer is the third leading cause of cancer death in the United States, which is attributed to limited treatment options. Complementary and alternative medicine (CAM) therapies have been proposed to provide benefits in treating pancreatic cancer. Despite its importance in treatment, clinicians are not generally well equipped to counsel their patients about CAM therapies. This review identified the quantity and assessed the quality of clinical practice guidelines (CPGs) providing CAM recommendations for the treatment and/or management of pancreatic cancer.

Methods

A systematic review was conducted to identify pancreatic cancer CPGs. MEDLINE, EMBASE and CINAHL were searched from 2011 to 2022. The Guidelines International Network (GIN) and the National Center for Complementary and Integrative Health (NCCIH) websites were also searched. Eligible CPGs published by non-profit agencies on treatment and/or management of pancreatic cancer for adults were assessed using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument.

Results

From 31 eligible search results, 7 CPGs mentioned CAM and 3 CPGs made CAM recommendations. The mean scaled domain percentages of the CPGs in this study (overall, CAM-specific) were as follows: scope and purpose (81.3%, 77.8%), stakeholder involvement (63.9%, 42.6%), rigor-of-development (51.0%, 40.3%), clarity-of-presentation (83.3%, 54.6%), applicability (42.3%, 30.5%), and editorial independence (58.3%, 58.3%).

Conclusions

Evaluation of the CPGs demonstrated that quality varied both within and between CPGs. CPGs that scored well could be used by patients and clinicians as the basis for discussion for the use of CAM therapies. Future research should identify other appropriate CAM therapies for further development of CPGs for pancreatic cancer.

Registration

The protocol was registered on PROSPERO (registration number: CRD42022334025).

The Provision of Complementary, Alternative, and Integrative Medicine Information and Services: a Review of World Leading Oncology Hospital Websites

BACKGROUND

Many cancer patients use complementary, alternative, and integrative medicine (CAIM) to improve their psychological and functional health. However, there is little known about the extent of CAIM information and services provided on oncology hospital websites.

METHODS

This study reviewed public-facing websites to determine the degree of CAIM information provided and services offered by the world's leading cancer hospitals in 2021; this ranking was informed by a large survey of medical professionals led by Newsweek and Statista. Nine authors extracted data from hospital websites individually and in triplicate, prior to meeting to revise data extractions. Data analysis was then performed by two authors to determine how many hospitals provided CAIM descriptions and offered CAIM services, and the extent of CAIM information provided.

RESULTS

A total of 131 hospitals were included in this study. Of the eligible hospitals, 50.38% (n = 66) provided a theoretical description of CAIM; 48.09% (n = 63) provided a description of one or more CAIM therapies; 63.36% (n = 83) offered one or more CAIM therapies to cancer patients. The most common therapies described were the same as the most common therapies offered. These therapies are massage, special foods and diets, acupuncture, meditation, yoga, and creative outlets. While CAIM therapies were commonly offered, information surrounding the benefits and side effects associated with these therapies varied.

CONCLUSIONS

Due to the lack of CAIM standardization worldwide, there is a need for increased CAIM information provision on hospital websites to better inform and empower patients to make well-informed decisions about their health.

A Systematic Review and Quality Assessment of Breast Cancer Clinical Practice Guidelines Providing Complementary and Alternative Medicine Recommendations

PURPOSE OF REVIEW

Up to 80% of patients with breast cancer are reported to use complementary and alternative medicine (CAM). Despite this high prevalence, many healthcare providers have little knowledge and education surrounding this topic and may be inadequately prepared to discuss such therapies with their patients. Given this knowledge gap, the purpose of this study was to systematically identify the quantity and assess the quality of CAM recommendations in clinical practice guidelines (CPGs) for the treatment and/or management of breast cancer.

RECENT FINDINGS

Thirty-four CPGs were deemed eligible, 5 of which mentioned CAM, and 4 of which made CAM recommendations. Eligible CPGs containing CAM recommendations were assessed with the AGREE II instrument. Scaled domain percentages from highest to lowest were (% overall, % CAM) as follows: scope and purpose (100.0%, 100.0%), editorial independence (100.0%, 100.0%), clarity of presentation (97.2%, 80.6%), rigour of development (80.2%, 80.2%), stakeholder involvement (88.9%, 77.8%), and applicability (58.3%, 58.3%). CPGs with favourable scores may provide practitioners with guidance on safe and effective use of CAM therapies. A need exists to improve the quality of CAM recommendations in CPGs.

The Presence of Complementary and Alternative Medicine Recommendations in Head and Neck Cancer Guidelines: Systematic Review and Quality Assessment

PURPOSE OF REVIEW

A high proportion of head and neck cancer (HNC) patients use complementary and alternative medicine (CAM), however, healthcare professionals generally have little knowledge about the safety and efficacy of these therapies. The purpose of this study was to determine the quantity and assess the quality of CAM recommendations across clinical practice guidelines (CPGs) for the treatment and/or management of HNC.

RECENT FINDINGS

MEDLINE, EMBASE, and CINAHL were systematically searched for HNC CPGs published between 2009 and April 2020; the Guidelines International Network and the National Center for Complementary and Integrative Health websites were also were searched. Eligible CPGs containing CAM recommendations were assessed twice with the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument, once for the overall CPG and once for the CAM sections. Of 305 unique search results, 7 CPGs mentioned CAM and 4 CPGs made CAM recommendations. The overall CPG scored higher than the CAM section for 4 of 6 domains (overall, CAM): scope and purpose (93.8%, 93.8%), clarity of presentation (88.2%, 64.6%), stakeholder involvement (68.8%, 39.6%), rigor of development (58.3%, 34.6%), editorial independence (42.7%, 42.7%), and applicability (51.6%, 19.8%). Quality varied within and between CPGs. Highly scoring CPGs serve as evidence-based resources that clinicians can use to inform their patients about safe and effective CAM use; CPGs achieving variable or lower scores could be improved in future updates based on currently available guideline development/implementation tools. Future research should identify CAM therapies supported by sufficient evidence to be included as part of HNC CPGs.

Guidelines for Cancer-Related Pain: A Systematic Review of Complementary and Alternative Medicine Recommendations

BACKGROUND AND OBJECTIVE

Although up to 85% of patients with cancer use complementary and alternative medicine (CAM), they commonly do not disclose this information to their healthcare providers. Cancer-related pain (CRP) is one of the most common symptoms among those who may seek CAM. This study was conducted to identify the quantity and assess the quality of CAM recommendations across clinical practice guidelines (CPGs) for the treatment and/or management of CRP, as this has not been explored in the literature.

METHODS

A systematic review was conducted to identify cancer pain CPGs. MEDLINE, EMBASE, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from 2009 to 2020. The Guideline International Network and the National Centre for Complementary and Integrative Health websites were also searched. Eligible CPGs on CRP in adults were assessed using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument.

RESULTS

Of 771 unique search results, 13 mentioned CAM and 11 made CAM recommendations. Eligible CPGs were published in 2009 or later and focused on the treatment/management of CRP. Scaled domain percentages from highest to lowest ranged from (overall, CAM): 88.1%, 88.1% (for scope and purpose) to 21.0%, 8.5% (for applicability). Quality varied within and across CPGs. One CPG was recommended by both appraisers; 6 were recommended as "Yes" or "Yes with modifications."

CONCLUSIONS

The present study has identified and summarized a number of CPGs that clinicians may consult to understand what CAMs are recommended in the context of the treatment and/or management of CRP.