Clinical trials in integrative therapies

Complementary therapies for fatigue after hematopoietic stem cell transplantation: an integrative review

Fatigue after hematopoietic stem cell transplantation (HSCT) is a persistent problem that limits activities and causes distress. Complementary therapies have shown promising results in improving fatigue in several patient populations. However, it is unknown whether they have the same effect on fatigue in the HSCT population. This integrative review aimed to explore the literature that evaluated complementary therapies for fatigue among HSCT patients. Only eight studies were considered eligible for inclusion in this review. The eight studies evaluated music therapy, relaxation, mindfulness, and massage techniques with mixed results. These studies had major methodological limitations, such as the small sample sizes and not blinding participants to the treatment allocation, introducing possible bias. Furthermore, most of these studies used 'usual care' control groups, leaving it unclear to what extent the observed effects are based on the effects of complementary therapies, or rather on psychosocial factors such as personal attention. More research is needed to more rigorously evaluate these and other complementary therapies for the prevalent problem of fatigue in the HSCT population.

The effect of guided imagery on physiological and psychological outcomes of adult ICU patients: A systematic literature review and methodological implications

OBJECTIVES

Guided imagery (GI) is a relaxation technique that is being increasingly explored in various patients' populations. We systematically reviewed evidence on the effects of GI on physiological and psychological outcomes of adult critically ill patients and extracted implications for future research.

REVIEW METHOD USED

Systematic literature review of published studies based on the Cochrane Guidelines.

DATA SOURCES

Studies were located through literature searches of CINAHL, PubMed, Embase, Cochrane Database of Systematic Reviews and Psych-Info.

REVIEW METHODS

We explored effects of GI in critically illness. The outcome measures included pain, anxiety, hemodynamic measurements, stress neuropeptides, length of stay, sleep quality, inflammatory markers, patient satisfaction and cost of care. The Cochrane Collaboration's tool for assessing risk of bias was employed. Extracted data included pathophysiological framework, sample, diagnoses of participants, specifics of intervention, design, experimental groups, analyses and main outcomes.

RESULTS

Based on the selection criteria, 10 studies were identified, involving N=1391 critically ill patients. The main limitations include incomplete outcome data and selective reporting, incomplete blinding and lack of experimental group allocation concealment. Due to heterogeneity and incomplete reporting, a meta-analysis was not feasible. Our findings included: (a) favourable effects of the intervention with regard to decrease of pain, anxiety and LOS; (b) many studies employing randomised controlled trial designs; (c) a predominant focus on patients with cardiac surgery; (d) large heterogeneity in measurement of outcomes. Moreover, the evidence suggests that improvements in sleep quality, patient satisfaction and cost of care merit further investigation. Methodological implications include the need to clarify the underlying physiological framework, the use of repeated measure designs and the adjustment for confounders.

CONCLUSIONS

On the basis of these results, and of the absence of reported side-effects, we conclude that GI is a promising patient-centered approach for the improvement of a number of patients' outcomes that merits further investigation in critical care.

Bioenergy and Breast Cancer: A Report on Tumor Growth and Metastasis

As many as 80% of the 296,000 women and 2,240 men diagnosed with breast cancer in the United States will seek out complementary and alternative medicine (CAM) treatments. One such therapy is Healing Touch (HT), recognized by the National Center for Complementary and Integrative Health (NCCIH) as a treatment modality. Using a multiple experimental groups design, fifty-six six- to eight-week-old Balb/c mice were injected with 4T1 breast cancer tumor cells and randomly divided into intervention and positive control groups. Five days after tumor cell injection, mice in the intervention groups received HT either daily or every other day for 10 minutes by one HT practitioner. At 15 days after tumor cell injection, tumor size was measured, and metastasis was evaluated by a medical pathologist after necropsy. Tumor size did not differ significantly among the groups (F(3,52) = 0.75, p value = 0.53). The presence of metastasis did not differ across groups (chi-square(3) = 3.902, p = 0.272) or when compared within an organ (liver: chi-square(3) = 2.507, p = 0.474; lungs: chi-square(3) = 3.804, p = 0.283; spleen: chi-square(3) = 0.595, p = 0.898). However, these results did indicate a moderate, though insignificant, positive impact of HT and highlight the need for continued research into dose, length of treatment, and measurable outcomes (tumor size, metastasis) to provide evidence to suggest application for nursing care.

Complementary medicine in guidelines of the German Guideline Program in Oncology: comparison of the evidence base between complementary and conventional therapy. huebner@med.uni-frankfurt.de

INTRODUCTION

The German Guideline Program in Oncology (GGPO) comprises guidelines aiming at epidemiology, prevention, diagnosis, treatment and aftercare of different types of cancer. As many patients in Germany use complementary and alternative medicine (CAM), the aim of our study was to assess the information on CAM presented in these guidelines compared to conventional, supportive and psychosocial therapy.

METHODS

We assessed all recommendations and statements from guidelines published from 2010 to 2012 from the program according to level of evidence (LoE) as given in the guideline. We differentiated between conventional cancer treatment, conventional supportive treatment, psychosocial interventions and complementary treatment.

RESULTS

A total of 9 guidelines (ovarian, colorectal, pancreatic, gastric, breast, prostate, oral cancer, melanoma and Hodgkin lymphoma) were included in our analysis. The total number of statements is highly diverse, ranging from 35 to 150. Only few statements and recommendations are given regarding supportive, psychosocial or complementary therapy. Regarding conventional treatments, only two guidelines (ovarian and oral cancer) have more than 50 % statements and recommendations on level 1. Considering supportive treatments, the LoE is lower, except the guideline on pancreatic cancer (40 % level 1). In breast cancer, all statements are based on expert consensus. Four guidelines do not include any statement at all. All guidelines beside that on Hodgkin lymphoma include at least one statement or recommendation on psychosocial therapy. Most recommendations are GCP.CAM is discussed in 8 guidelines; LoE is low with GCP statements dominating.

DISCUSSION

There may be different reasons for the low number of statements and recommendations on supportive, psychosocial and CAM therapies. Often, these topics are considered less important, and evidence is assumed as being low. In the GGPO, guidelines focusing on psychosocial and supportive therapy are under development. Thus, cancer-specific guidelines will be able to refer to these guidelines and only include recommendations on psychosocial care and supportive therapy which are specific for the type of cancer. A national guideline on CAM would close the gap of information for physicians and patients. In case of missing or low evidence, a transparent description of this uncertainty would be valuable information to professionals and patients.

The evolution of mindfulness-based physical interventions in breast cancer survivors

Survivors of breast cancer are faced with a multitude of medical and psychological impairments during and after treatment and throughout their lifespan. Physical exercise has been shown to improve survival and recurrence in this population. Mind-body interventions combine a light-moderate intensity physical exercise with mindfulness, thus having the potential to improve both physical and psychological sequelae of breast cancer treatments. We conducted a review of mindfulness-based physical exercise interventions which included yoga, tai chi chuan, Pilates, and qigong, in breast cancer survivors. Among the mindfulness-based interventions, yoga was significantly more studied in this population as compared to tai chi chuan, Pilates, and qigong. The participants and the outcomes of the majority of the studies reviewed were heterogeneous, and the population included was generally not selected for symptoms. Yoga was shown to improve fatigue in a few methodologically strong studies, providing reasonable evidence for benefit in this population. Improvements were also seen in sleep, anxiety, depression, distress, quality of life, and postchemotherapy nausea and vomiting in the yoga studies. Tai chi chuan, Pilates, and qigong were not studied sufficiently in breast cancer survivors in order to be implemented in clinical practice.