Integrative oncology in the Middle East: from traditional herbal knowledge to contemporary cancer care

Nutritional and pharmacological potentials of orphan legumes: Subfamily faboideae

Legumes are a major food crop in many developing nations. However, orphan or underutilized legumes are domesticated legumes that have valuable properties but are less significant than main legumes due to use and supply restrictions. Compared to other major legumes, they are better suited to harsh soil and climate conditions, and their great tolerance to abiotic environmental circumstances like drought can help to lessen the strains brought on by climate change. Despite this, their economic significance in international markets is relatively minimal. This article is aimed at carrying out a comprehensive review of the nutritional and pharmacological benefits of orphan legumes from eight genera in the sub-family Faboidea, namely Psophocarpus Neck. ex DC., Tylosema (Schweinf.) Torre Hillc., Vigna Savi., Vicia L., Baphia Afzel. ex G. Lodd., Mucuna Adans, Indigofera L. and Macrotyloma (Wight & Arn.) Verdc, and the phytoconstituents that have been isolated and characterized from these plants. A literature search was conducted using PubMed, Google Scholar, and Science Direct for articles that have previously reported the relevance of underutilized legumes. The International Union for Conservation of Nature (IUCN) red list of threatened species was also conducted for the status of the species. References were scrutinized and citation searches were performed on the study. The review showed that many underutilized legumes have a lot of untapped potential in terms of their nutritional and pharmacological activities. The phytoconstituents from plants in the subfamily Faboideae could serve as lead compounds for drug discovery for the treatment of a variety of disorders, indicating the need to explore these plant species.

Chemopreventive potential of plant-derived epigenetic inhibitors silibinin and quercetin: an involvement of apoptotic signaling cascade modulation

Background

Epigenetic deregulation of the cellular apoptotic mechanism is the common hallmark of cancer. Silibinin (SBN) and quercetin (QCT) are two bioflavonoids well known for their epigenetic inhibition property. The objective of the present study was to explore the preventive anti-cancer efficacy of the SBN and QCT in both in vitro as well as in vivo tumor xenograft model through regulating cellular apoptotic signaling pathway.

Results

SBN and QCT inhibited the growth of A549 and MDA-MB-468 cancer cells in the concentration dependent manner. The treatment caused significant (p < 0.05) reduction of the size and the number of colonies formed by the cancer cells. In vitro apoptosis assay using the fluorescence microscopy revealed that the treatment noticeably increased the percentage of apoptotic cells as compared to the untreated control. Dosing with SBN (200mg/kg), QCT (100mg/kg) alone and in combination was initiated in 3-week-old C57BL6 mice. Interestingly, the treatment prevented tumor progression significantly (p < 0.05) in adult mice without causing any toxicity. Furthermore, SBN and QCT triggered apoptosis via modulating p53 and Bcl2 gene expression and the SOD enzyme activity.

Conclusion

Daily oral intake of SBN and QCT alone and in combination from the very early stage of life might prevent tumor growth in adult mice through activating cellular apoptotic signaling cascade.

Vicia plants-A comprehensive review on chemical composition and phytopharmacology

The plants belonging to the genus Vicia are of great interest as a source of many bioactive compounds and micronutrients. A snapshot of their cultivation, habitat, main components, from which essential oils can be obtained, is given. The traditional medicinal uses of Vicia plants are also reported, as well as the wide spectrum of the main biological activities attributed to Vicia plants is discussed regarding potential health beneficial properties, in particular anti-Parkinson, anticholinesterase, antidepressant, anticonvulsant, antimicrobial, cytotoxic, antioxidant, antiinflammatory and antinociceptive, antidiabetic, antihemolytic, anticoagulant, estrogenic, diuretic, antihypoxic activities.

Integrating Complementary and Traditional Practices in Middle-Eastern Supportive Cancer Care

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.

Medicinal Plants from Near East for Cancer Therapy

Background: Cancer is one of the major problems affecting public health worldwide. As other cultures, the populations of the Near East rely on medicinal herbs and their preparations to fight cancer. Methods: We compiled data derived from historical ethnopharmacological information as well as in vitro and in vivo results and clinical findings extracted from different literature databases including (PubMed, Scopus, Web of Science, and Google Scholar) during the past two decades. Results: In this survey, we analyzed the huge amount of data available on anticancer ethnopharmacological sources used in the Near East. Medicinal herbs are the most dominant ethnopharmacological formula used among cancer's patients in the Near East. The data obtained highlight for the first time the most commonly used medicinal plants in the Near East area for cancer treatment illustrating their importance as natural anticancer agents. The literature survey reveals that various Arum species, various Artemisia species, Calotropis procera, Citrullus colocynthis, Nigella sativa, Pulicaria crispa, various Urtica species, Withania somnifera, and others belong to the most frequently used plants among cancer patients in the Near East countries. Molecular modes of action that have been investigated for plant extracts and isolated compounds from Near East include cell cycle arrest and apoptosis induction with participation of major player in these processes such as p53 and p21, Bcl-2, Bax, cytochrome c release, poly (ADP-ribose) polymerase cleavage, activation of caspases, etc. Conclusion: The ethnopharmacology of the Near East was influenced by Arabic and Islamic medicine and might be promising for developing new natural and safe anticancer agents. Further research is required to elucidate their cellular and molecular mechanisms and to estimate their clinical activity.

Ethnopharmacological survey of home remedies used for treatment of hair and scalp and their methods of preparation in the West Bank-Palestine

Background

Natural products have many uses and purposes, including those linked to pharmaceutics and cosmetics. The aim of this study was to investigate the use of natural remedies for the treatment of hair and scalp disorders in the West Bank, Palestine.

Methods

An ethnopharmacological survey of herbal remedies and other natural products used in cosmetics and cosmeceuticals was carried out in the West Bank, Palestine. A questionnaire was distributed to 267 herbalists, traditional healers, hairdressers and rural dwellers. Collected information included: the names of plants and other natural products, the parts used, hair conditions, diseases and problems for which these products were used and also their methods of preparation. To identify the most important species used, the factor of informant’s consensus (F_ic), fidelity level (Fl) and the use-value (UV) were calculated.

Results

Collected data showed that 41 plants are utilized for the treatment of hair and scalp disorders, belonging to 27 families; among them Lamiaceae and Rosaceae, which were the most commonly used. Plant oils and their fruits are the most commonly used parts. Hair loss, dandruff, split hair endings and lice treatment, are reported as the most treated disorders. The number of plant species used consisted of 19, 14, 13, and again 13 with a factor of informant’s consensus (Fic) for these disorders corresponding to 0.93, 0.94, 0.95 and 0.92, respectively. Fl was 100% for many plants; the highest UV value (0.84) was registered for Lawsonia inermis, which belongs to the Lythraceae family.

Conclusions

This study showed that many natural remedies are still used in Palestine for the treatment of scalp and hair disorders as well as for cosmeceutical purposes. This study is of great importance as it allows us to have a greater perspective on our folkloric use of these natural products. A combined scientific effort between informants and the scientific community, working in this field, may help in the discovery of new cosmetics, cosmeceutical and nutraceutical products.

Knowledge, attitude and use of complementary and integrative health strategies: a preliminary survey of Iranian nurses

BACKGROUND

BACKGROUND

Disagreement exists regarding the need for knowledge about complementary and integrative health (CIH) strategies, as well as for the need to consider such strategies in clinical nursing practice.

OBJECTIVE

This study was conducted to assess the knowledge, attitude and use of CIH strategies among nurses in Iran.

DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS

A cross-sectional study of nurses working in two hospitals of Zabol University of Medical Sciences, in southeast Iran, was conducted from October 2014 to April 2015. The questionnaire, developed specifically for this research, was used to assess the knowledge, attitude and use of CIH by nurses. Descriptive and inferential statistics were used to interpret the survey responses.

RESULTS

Most nurses (n=95, 60.5%) have average knowledge about CIH strategies with most holding a positive attitude about use (n=81, 51.6%). The majority (n=90, 57.3%) of nurses, however, never applied CIH methods. Where CIH was used, massage was most often clinically applied (n=129, 82.2%) and a large percentage believed it useful for treating illness (n=136, 87.9%). Other CIH methods commonly used included prayer and herbal medicine.

CONCLUSION

Nurses have positive attitudes about CIH though knowledge was typically weak. Educational programs should carefully consider how knowledge about CIH methods could be strengthened within curricula.

Ethnopharmacological survey of herbal remedies used for treatment of various types of cancer and their methods of preparations in the West Bank-Palestine

BACKGROUND

Plants have been the primary source of medicines since life on earth; more than 50 % of existing cancer treatments are derived from plants.

METHODS

An ethnopharmacological survey of herbal remedies used in cancer treatment was carried out in the West Bank/ Palestine. A questionnaire was distributed to one hundred and fifty herbalists, traditional healers and rural dwellers. Collected information included the names of plants, the used parts, types of cancers for which these plants were used and also their methods of preparation. To identify the most important species used, Factor of informant's consensus (F(ic)), Fidelity level (Fl) and the Use-value (UV) were calculated.

RESULTS

Collected data has shown that 72 plants are utilized for treatment of cancer, belonging to 44 families; from them Compositae and Lamiaceae were the most common. Leaves and fruits were the most commonly used parts, while decoctions, infusions and syrups were the main methods of preparation. Lung cancer was the most common type of cancer treated with these plants and Ephedra alata was the most commonly used plant for treatment of cancer in Palestine. The Fic was high for all the plants; Fl was 100% for many plants, the highest UV (0.72) was for Ephedra alata.

CONCLUSIONS

This study showed that many herbal remedies are still used by herbalists in Palestine for treatment of cancer; some of them have been approved scientifically while others are not. A combined effort between informants and scientific institutions working in this field can help in the discovery of new anticancer agents. Moreover, scientists must explore the most suitable method of extraction, formulation and dose determination in order to achieve the best benefits from these herbals.

Evaluation of the cytotoxic effects of Cyperus longus extract, fractions and its essential oil on the PC3 and MCF7 cancer cell lines

Cyperus longus is one of the Iranian endemic species. However, to date, and to the best of our knowledge, there are no availale academic reports on the cytotoxicity of this plant. Thus, this study was carried out to examine the in vitro anti-proliferative and anti-apoptotic effects of Cyperus longus extract, fractions and essential oil (EO) on MCF7 and PC3 cell lines. The chemical constituents of EO were identified using gas chromatography (GC)-mass spectrometry (MS) analysis. The cells were cultured in RPMI-1640 medium and incubated with various concentrations of the plant extract and fractions. Cell viability was quantified by MTT assay following 24, 48 and 72 h of exposure to (12.5–200 µg/ml) of the methanol extract, the dichloromethane (CH₂Cl₂), ethyl acetate (EtOAc) and water fractions, as well as the EO of the plant. The percentage of apoptotic cells was determined using propidium iodide staining of DNA fragments by flow cytometry (sub-G1 peak). The most effective fraction in the MCF7 cell line was the CH₂Cl₂ fraction (IC₅₀ after 48 h, 25.34±2.01). The EtOAc fraction (IC₅₀ after 48 h, 35.2±2.69) and the methanol extract (IC₅₀ after 48 h, 64.64±1.64) were also found to be effective. The IC₅₀ values obtained for the PC3 cell line were 37.97±3.87, 51.57±3.87 and 70.33±2.36 for the CH₂Cl₂ fraction, the EtOAc fraction and the methanol extract, respectively. Based on these data and due to the partial polarity of the most effective fraction (the CH₂Cl₂ fraction), we also examined the cytotoxicity of the plant EO. The IC₅₀ values after 48 h were 22.25±4.25 and 12.55±3.65 in the PC3 and MCF7 cell lines, respectively. DNA fragmentation assay also confirmed these data. Performing GC-MS analysis for the plant EO revealed that β-himachalene (10.81%), α-caryophyllene oxide (7.6%), irisone (4.78%), β-caryophyllene oxide (4.36%), humulene oxide (12%), viridiflorol (4.73%), aristolone (6.39%) and longiverbenone (6.04%) were the main constituents. Our results demonstrated that two of the constituents of Cyperus longus, viridiflorol and longiverbenone, should be investigated further as possible promising chemotherapeutic agents in cancer treatment.

Compared perspectives of Arab patients in Palestine and Israel on the role of complementary medicine in cancer care

CONTEXT

Complementary medicine (CM) is extensively used by patients with cancer across the Middle East.

OBJECTIVES

We aimed to compare the perspectives of two Arab populations residing in diverse socioeconomic-cultural settings in Palestine and Israel regarding the role of CM in supportive cancer care.

METHODS

A 27-item questionnaire was constructed and administered to a convenience sample of Arab patients receiving cancer care in four oncology centers in northern Israel and Palestine.

RESULTS

Each of the two groups had 324 respondents and was equally distributed by age and marital status. Compared with the Israeli-Arab group, Palestinian participants reported significantly higher CM use for cancer-related outcomes (63.5% vs. 39.6%, P < 0.001), which included more herbal use (97.6% vs. 87.9%, P = 0.001) and significantly lower use of dietary supplements, acupuncture, mind-body and manual therapies, and homeopathy. Most respondents in both groups stated that they would consult CM providers if CM was integrated in oncology departments. Related to this theoretical integrative scenario, Palestinian respondents expressed fewer expectations from their oncologists to actively participate in building their CM treatment plan. Treatment expectations in both groups focused on improving quality of life (QOL), whereas Palestinian respondents had fewer expectations for CM to improve fatigue, emotional concerns, sleep, and daily functioning.

CONCLUSION

Arab patients with cancer from Palestine and Israel highly support CM integration within their oncology institutions aiming to improve QOL. Nevertheless, respondents differed in their perceived model of CM integration, its treatment objectives, and their oncologists' role in CM integration.

Integration of complementary medicine in supportive cancer care: survey of health-care providers' perspectives from 16 countries in the Middle East

INTRODUCTION

In this multinational Middle-Eastern study, we assessed health-care providers' (HCPs) perspectives on their patients' use of complementary and traditional medicine (CTM) and identified the leading barriers to CTM integration in supportive cancer care.

METHODS

A 17-item questionnaire was developed and administered to HCPs attending palliative medicine workshops conducted across the Middle East by the Middle East Cancer Consortium.

RESULTS

339 HCPs from 16 countries across the Middle East completed the questionnaire (80.3 % response rate). Respondents perceived their patients' reasons for CTM use primarily in the context of cancer cure (63 %) and quality of life (QOL) improvement (57 %). Expectation regarding CTM's role in cancer cure/survival was more pronounced in Turkey, Jordan, the Palestinian Authority, and the Persian Gulf area. In contrast, the expectation that CTM would improve QOL was more emphasized in Israel. A mid-position between the cure/survival and QOL poles was observed in Cyprus, Lebanon, and the North African countries. Leading barriers to CTM integration in supportive cancer care included oncologists' skepticism and a gap between patients' expectations and HCP's objectives. Respondents' leading recommendation to HCPs was to communicate integrative care emphasizing well-being and improved functioning in accordance with their patients' health beliefs.

CONCLUSION

CTM integration in supportive cancer care can be facilitated by implementing a platform for Middle Eastern clinical collaborations. HCPs' expectations and experiences with CTM have been positive in the oncology setting. These data need to be corroborated with information of patients' expectations on the provision of CTM over all phases of the oncology treatment.

Anticancer agent icaritin induces apoptosis through caspase-dependent pathways in human hepatocellular carcinoma cells

Icaritin is an active ingredient derived from the plant Herba epimedium, which exhibits various pharmacological and biological activities. However, the function, and the underlying mechanisms of icaritin on the growth of SMMC‑7721 human hepatoma cells have yet to be elucidated. The present study aimed to investigate the function and underlying mechanisms of icaritin in the growth of SMMC‑7721 cells. The cells were treated with varying concentrations of icaritin for 12, 24 and 48 h, respectively, prior to cytotoxic analysis. Apoptosis of SMMC‑7721 cells following treatment with icaritin was measured using flow cytometry. The gene expression of mitochondria‑ and Fas‑mediated caspase‑dependent pathways was detected by reverse transcription‑quantitative polymerase chain reaction and western blotting. Statistical analysis was performed by Student's t‑test and one‑way analysis or variance. The present study demonstrated that treatment with icaritin significantly inhibited growth, and induced apoptosis of SMMC‑7721 cells, in a time‑ and dose‑dependent manner. In addition, icaritin triggered the mitochondrial/caspase apoptotic pathway, by decreasing the Bcl‑2/Bax protein ratio and increasing activation of caspase‑3. Icaritin also activated the Fas‑mediated apoptosis pathway, as was evident by the increased expression levels of Fas and activation of caspase‑8. These data suggest that icaritin may be a potent growth inhibitor and induce apoptosis of SMMC‑7721 cells through the mitochondria‑ and Fas‑mediated caspase‑dependent pathways. The present study may provide experimental evidence for preclinical and clinical evaluations of icaritin for HCC therapy.

One hand cannot clap-a study of Arab practitioners of traditional and complementary medicine in Israel: identifying barriers to integrative oncology care

BACKGROUND

The integration of complementary medicine is gradually becoming an accepted part of standard care for patients with cancer. In our integrative oncology program, we have encountered difficulties in recruiting Arab patients. In order to understand the special needs of this population, we conducted interviews among Arab practitioners of complementary and traditional medicine (CTM). The characteristics of practitioners and their views regarding the therapeutic process were examined.

METHODS

Semi-structured qualitative interviews were administered to 27 Arab practitioners of CTM whose clientele was comprised primarily of Arab cancer patients. Conventional content analysis of the transcribed interviews and field notes was performed in order to identify key themes.

RESULT

Three groups of CTM practice were identified: Folk-herbal medicine (n = 9), complementary medicine (CM; n = 14), and religious healing (n = 4). Seven factors were identified in the practitioner accounts: the duration and scheduling of treatment sessions, the language of communication, the presence of family members, the appearance of the practitioner, the definition of treatment goals, the discussion of behavioral and lifestyle changes, and finally, the use of tangible elements in treatment.

CONCLUSIONS

The study of Arab CTM practitioner recommendations may help facilitate a culture-sensitive encounter with Arab patients with cancer. This approach may also have implications for other ethno-culturally unique populations.

Medicinal herbs and methodologies for their pharmaceutical compounding in the West Bank/Palestine

This study focused on herbalists, herbal shops and people currently using traditional Arabic medicine. Informants were asked to list plants and methods for obtaining plant herbal extracts used to manage a range of illnesses. A total of 109 plants were identified, of these, principle plant elements included, leaves (47.3%), fruits (18.5%) and seeds (18.0%) were most commonly utilized. Extraction methods included decoction (boiling) 51%, and infusion 17% and prepared as creams, powders, syrups, food or cooked. Many plant species are used by herbalists for treating a range of ailments. This study suggests that a lack of methodological standardization during herbal extraction could compromise herbal stability. There is also a need to monitor for potential adverse drug interactions when used concurrently with prescribed medications.

Bridging cross-cultural gaps: monitoring herbal use during chemotherapy in patients referred to integrative medicine consultation in Israel

INTRODUCTION

The high prevalence of the use of traditional herbs among patients with cancer is a cause for concern with regard to potentially adverse interactions with conventional oncology treatments. In this study, we explore herbal use among patients with cancer in northern Israel who are referred by their health care providers to complementary and traditional medicine (CTM) consultations provided to them within the conventional oncology department. The study's objectives were to identify which herbs patients use and to examine the scope of current research on the efficacy and safety regarding the identified herbs.

PATIENTS AND METHODS

Herbal use by patients receiving oncology care was assessed prospectively from July 2009 to July 2012 by integrative physicians (IPs) trained in herbal medicine. Historical, ethnobotanical, basic research, and clinical data regarding the identified herbs were explored by using a keyword search in PubMed and Middle Eastern ethnohistorical literature.

RESULTS

Disclosure of herbal use was reported by 154 of the 305 patients (50.5 %) interviewed by IPs. The use of 85 single herbs and 30 different herbal formulas was documented during the initial or follow-up IP assessments. Patients reported 14 quality of life-associated indications for herbal use. The ten most prevalent herbs displaying in vitro/in vivo anticancer activity and nine other herbs were preliminarily assessed concerning potential risks, safety, and interaction with chemotherapy.

CONCLUSIONS

Herbal use by patients with cancer in northern Israel is widespread and calls for further study in order to address issues of safety and effectiveness. We recommend constructing a multinational and multidisciplinary team of researchers with ethnopharmacological and clinical expertise that will explore the use of herbs among patients with cancer in a cross-cultural perspective attuned with patients' affinity to traditional herbal medicine.

Integrative health care in Israel and traditional arab herbal medicine: when health care interfaces with culture and politics

This article contributes to contemporary critical debate in medical anthropology concerning medical pluralism and integrative medicine by highlighting the issue of exclusion of traditional medicine (TM) and presenting attempts at border crossing. Although complementary medicine (CM) modalities are integrated into most Israeli mainstream health care organizations, local indigenous TM modalities are not. Ethnographic fieldwork focused on a group of Israeli dual-trained integrative physicians that has recently begun to integrate traditional herbal medicine preferred by the Arab minority, using it as a boundary object to bridge professional gaps between biomedicine, CM, and TM. This article highlights the relevance of political tensions, ethnicity, and medical inequality to the field of integrative health care. It shows that using herbal medicine as a boundary object can overcome barriers and provide opportunities for dialog and reciprocal learning.

The protective and therapeutic effects of alpha-solanine on mice breast cancer

Alpha-solanine, a naturally steroidal glycoalkaloid, is found in leaves and fruits of plants as a defensive agent against fungi, bacteria and insects. Herein, we investigated solanine toxicity in vitro and in vivo, and assessed its protective and the therapeutic effects on a typical animal model of breast cancer. The study conducted in three series of experiments to obtain (i) solanine effects on cell viability of mammary carcinoma cells, (ii) in vivo toxicity of solanine, and (iv) the protective and therapeutic effects of solanine on animal model of breast cancer. Alpha-solanine significantly suppressed proliferation of mouse mammary carcinoma cells both in vitro and in vivo (P<0.05). Under the dosing procedure, 5 mg/kg solanine has been chosen for assessing its protective and therapeutic effects in mice breast cancer. Tumor take rate in the solanine-treated group was zero compared with a 75% rate in its respective control group (P<0.05). The average tumor size and weight were significantly lower in solanine-treated animals than its respective control ones (P<0.05). Proapoptotic Bax protein expression increased in breast tumor by solanine compared with its respective control group (P<0.05). Antiapoptotic Bcl-2 protein expression found to be lower in solanine-treated animals (P<0.05). Proliferative and angiogenic parameters greatly decreased in solanine-treated mice (P<0.05). Data provide evidence that solanine exerts a significant chemoprotective and chemotherapeutic effects on an animal model of breast cancer through apoptosis induction, cell proliferation and angiogenesis inhibition. These findings reveal a new therapeutic potential for solanine in cancer.

We and they in the house of healing: debate among Arab complementary medicine practitioners on an integrative versus alternative approach to supportive cancer care

PURPOSE

Complementary and traditional medicine (CTM) plays an important role in culture-centered care for cancer patients in the Middle East. In this article, we have studied the attitudes of Arab CTM therapists concerning integration of complementary medicine within the conventional supportive cancer care of Arab patients in northern Israel.

METHODS

Semistructured interviews were held with 27 Arab therapists who use medicinal herbs, the Quran, and various CTM modalities, with the aim of characterizing their treatment practices and learning about their perspectives regarding conventional cancer care.

RESULTS

We first summarized the different characteristics of the various CTM therapists, including training, typical practice, and so on. Thematic analysis revealed that folk healers and complementary medicine therapists describe their role as supportive and secondary to that of physicians. Their goal was not to cure patients with cancer but rather to enhance their quality of life by reducing the severity of both the disease symptoms and the side effects of cancer treatment. Religious healers, by contrast, purport to cure the disease. While folk healers opt for parallel alternative care and complementary therapists support integrative care, religious healers claimed that they offer an alternative to conventional medicine in terms of both etiology and practice.

CONCLUSIONS

The majority of Arab CTM therapists support integration of their treatments with the conventional system, but in practice, they are not sure how to bring about this change or create a parallel model in which 2 different systems are active, but not integrated. Our findings emphasized the need to promote doctor-CTM practitioner communication based on structured referral and bidirectional consultation. Moreover, we recommend intensifying research on the efficacy and safety of CTM in the Middle East and the potential role in promoting culture-based supportive care.

I will always be with you: traditional and complementary therapists' perspectives on patient-therapist-doctor communication regarding treatment of Arab patients with cancer in Israel

OBJECTIVE

In 2008, an Integrative Oncology Program was implemented at the Clalit Oncology Service in Haifa, Israel, to promote patients' well-being during chemotherapy and advanced stages of disease. We hypothesized that studying the perceptions of Arab complementary and alternative medicine (CAM) therapists would facilitate development of a cross-culturally integrative oncology approach.

METHODS

Semi-structured interviews were held with 27 Arab therapists who use medicinal herbs, the Quran and various CAM modalities, with the aim of characterizing their treatment practices and learning about their perspectives regarding conventional cancer care.

RESULTS

Thematic analysis revealed that therapists act as go-betweens, mediating between patients and conventional physicians. Therapists translate diagnoses into Arabic and elucidate key concepts. They tend to perceive their role as gatekeepers accompanying patients through the conventional health system, referring them for further examinations, and providing CAM-based supportive care consultation.

CONCLUSIONS

CAM therapists have an essential role in supportive care of Arab patients with cancer. Triangular patient-therapist-oncologist communication may have an impact on patients' experience and treatment quality.

PRACTICE IMPLICATIONS

Recognition of CAM therapists as mediators between patients' health beliefs and conventional perceptions of care may improve doctor-patient dialogue and facilitate supportive care provision in a cross-cultural context.

Integrative oncology for breast cancer patients: introduction of an expert-based model

Background

Malignant breast neoplasms are among the most frequent forms of cancer in the Western world. Conventional treatment of breast cancer may include surgery, hormonal therapy, chemotherapy, radiation and/or immunotherapy, all of which are often accompanied by severe side effects. Complementary and alternative medicine (CAM) treatments have been shown to be effective in alleviating those symptoms. Furthermore, with patient survival rates increasing, oncologists, psychologists and other therapists have to become more sensitive to the needs of cancer survivors that go beyond than the mere alleviation of symptoms. Many CAM methods are geared to treat the patient in a holistic manner and thus are also concerned with the patient’s psychological and spiritual needs.

Discussion

The use of certain CAM methods may become problematic when, as frequently occurs, patients use them indiscriminately and without informing their oncologists. Herbal medicines and dietary supplements, especially, may interfere with primary cancer treatments or have other detrimental effects. Thus, expertise in this highly specialized field of integrative medicine should be available to patients so that they can be advised about the benefits and negative effects of such preparations and practices.

Being a beneficial combination of conventional and CAM care, integrative oncology makes possible the holistic approach to cancer care. The concept of integrative oncology for breast cancer is jointly practiced by the Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, academic teaching hospital of the University of Duisburg-Essen, and the Breast Center at Kliniken Essen-Mitte in Germany. This model is introduced here; its scope is reviewed, and its possible implications for the practice of integrative medicine are discussed.

Summary

Evidence-based integrative care is crucial to the field of oncology in establishing state-of-the-art care for breast cancer patients.

Barriers to integration of traditional and complementary medicine in supportive cancer care of arab patients in northern Israel

In 2008, an Integrative Oncology Program (IOP), aiming to improve patients' quality of life during chemotherapy and advanced cancer, was launched within the Clalit Health Organization's oncology service at the Lin Medical Center, Haifa, Israel. The IOP clinical activity is documented using a research-based registry protocol. In this study, we present an analysis of the registry protocol of 15 Arab patients with cancer who were referred to the IOP. Analysis of patients' reported outcomes using the Edmonton Symptom Assessment Scale suggests that integrative medicine care improves fatigue (P = 0.024), nausea (P = 0.043), depression (P = 0.012), anxiety (P = 0.044), appetite (P = 0.012), and general well-being (P = 0.031). Barriers to integration of traditional and complementary medicine in supportive care of Arab patients are discussed followed by six practical recommendations aimed at improving accessibility of patients to integrative supportive care, as well as compliance with treatments.