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Akeeb AA, King SM, Olaku O, White JD. Communication Between Cancer Patients and Physicians About Complementary and Alternative Medicine: A Systematic Review. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:80-98. [PMID: 36149678 PMCID: PMC10081707 DOI: 10.1089/jicm.2022.0516] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: Complementary and alternative medicine (CAM) has become increasingly popular among cancer patients and is often used concomitantly with standard cancer therapies. Nonetheless, disclosure of CAM utilization by cancer patients to physicians, along with the provision of information on CAM therapies by physicians, is poor. This review explores the literature to synthesize existing information on communication about CAM usage, reasons for nondisclosure, and the clinical implications thereof. Methods: A search of medical literature published between December 1, 2009, and October 1, 2021 (last searched on April 18, 2022), on communications between physicians and cancer patients about CAM treatments was conducted through MEDLINE and EMBASE. Results were screened for inclusion, dually reviewed, and assessed using the QualSyst quality appraisal instrument. Findings were categorized and synthesized for review. Results: A total of 30 articles were located (n = 8721 total participants), which discussed elements related to patient disclosure of CAM use (n = 16), provider experiences or perceptions related to communication about CAM (n = 3), patterns of this communication (n = 6), and recommendations for effectively discussing CAM with cancer patients (n = 5). Reports indicate that nondisclosure is common throughout the cancer care spectrum. Factors influencing nondisclosure range from patient beliefs and attitudes about their provider, demographic characteristics, disease progression, physician-patient relationship, physician noninquiry, and type of CAM used; ultimately creating a gap in care that may have serious medical implications. Discussion: Many of the studies identified are small and confined to a single-center, hospital-network, or geographic setting, thereby limiting the applicability of findings and recommendations. Nonetheless, improving patient-physician communication is essential in delivering evidence-informed, patient-centered care and crucial for achieving patient satisfaction and positive health outcomes. The lack of adequate CAM dialogue about CAM use increases the risk of adverse interactions with conventional cancer treatments and results in missed opportunities for providers and patients to engage in vital information exchange. Future research and education are necessary to further identify barriers surrounding patient-provider communication about CAM treatments.
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Affiliation(s)
- Ameenat A. Akeeb
- Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Sophia M. King
- Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Oluwadamilola Olaku
- Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Jeffrey D. White
- Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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Yeom J, Lee JM. Use of Complementary and Alternative Medicine (CAM) in Patients With Colorectal Cancer. Clin Nutr Res 2022; 11:255-263. [PMID: 36381470 PMCID: PMC9633969 DOI: 10.7762/cnr.2022.11.4.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 10/14/2022] [Accepted: 10/16/2022] [Indexed: 11/07/2022] Open
Abstract
This study was conducted to analyze the relationship between cancer-related stress and the types of complementary and alternative medicine (CAM) used by subjects diagnosed with colorectal cancer. The number of study subjects was 142, and for data analysis, descriptive statistics, t-test, χ2 test, logistic regression procedures were performed. Of the subjects, 114 were CAM users, who accounted for 79.6%. When it came to using CAM, 82 (72.6%) said they did "to prevent cancer recurrence." The most popular reason for not using CAM was "to focus on treatment as instructed by the doctor," with 22 (75.8%) respondents selecting the answer. Of those who used CAM, 79 (55.6%) said they took "dietary supplements," followed by 65 (45.8%) who picked "vitamins and minerals." Regarding CAM usage, ginger, aloe, swimming, and walking had the highest satisfaction (4.25 ± 0.71). The cancer-related stress of subjects who use CAM (18.21 ± 15.37) was higher than that of subjects who did not use CAM (10.11 ± 12.08). Logistic regression analysis determined that cancer-related stress were factors significantly associated with CAM use. Patients using CAM had higher cancer-related stress, suggesting that stress on cancer increased CAM interest. Safe and reliable CAM information and standardized recommendations should be provided to cancer survivors. We propose the development of training programs for CAM to improve communication between medical staff and patients and to protect patients.
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Affiliation(s)
- Jeongwon Yeom
- Department of Nursing, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea
| | - Jung Mi Lee
- Department of Nursing, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea
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Valentini J, Fröhlich D, Stolz R, Mahler C, Martus P, Klafke N, Horneber M, Frasch J, Kramer K, Bertz H, Grün B, Tomaschko-Ubeländer K, Joos S. Interprofessional evidence-based counselling programme for complementary and integrative healthcare in patients with cancer: study protocol for the controlled implementation study CCC-Integrativ. BMJ Open 2022; 12:e055076. [PMID: 35149568 PMCID: PMC8845169 DOI: 10.1136/bmjopen-2021-055076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION According to international literature, patients with cancer wish to have information on complementary and integrative healthcare (CIH). Medical guidelines recommend actively approaching patients with cancer discussing potential benefits and risks of individual CIH methods. While some CIH methods, for example, acupuncture and yoga, have been proven effective in high-quality studies, other CIH methods lack studies or bear the risk of interactions with chemotherapeutics, for example, herbal drugs. Therefore, an evidence-based interprofessional counselling programme on CIH will be implemented at four Comprehensive Cancer Centres in the federal state of Baden-Wuerttemberg, Germany. METHODS AND ANALYSIS A complex intervention consisting of elements on patient, provider and system levels will be developed and evaluated within a multilayer evaluation design with confirmatory evaluation on patient level. Patients with a cancer diagnosis within the last 6 months will receive three individual counselling sessions on CIH within 3 months (=intervention on patient level). The counselling will be provided by an interprofessional team of medical and nursing staff. For this purpose, an intensive online training programme, a CIH knowledge database and an interprofessional team-building process were developed and implemented (=intervention on provider level). Moreover, training events on the basics of CIH are offered in the outpatient setting (=intervention on system level). Primary outcome of the evaluation at the patient level is patient activation measured (PAM) with the PAM-13 after 3 months. Secondary outcomes, for example, quality of life, self-efficacy and clinical parameters, will be assessed at baseline, after 3 months and at 6 months follow-up. The intervention group (n=1000) will be compared with a control group (n=500, treatment as usual, no CIH counselling. The outcomes and follow-up times in the control group are the same as in the intervention group. Moreover, the use of health services will be analysed in both groups using routine data. A qualitative-quantitative process evaluation as well as a health economic evaluation will identify relevant barriers and enabling factors for later roll-out. ETHICS AND DISSEMINATION The study has been approved by the appropriate Institutional Ethical Committee of the University of Tuebingen, No. 658/2019BO1. The results of these studies will be disseminated to academic audiences and in the community. TRIAL REGISTRATION NUMBER DRKS00021779; Pre-results.
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Affiliation(s)
- Jan Valentini
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Daniela Fröhlich
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Regina Stolz
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Cornelia Mahler
- Institute for Health Sciences, Department of Nursing Science, University Hospital Tübingen, Tübingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biostatistics, University Hospital Tübingen, Tübingen, Germany
| | - Nadja Klafke
- Department of General Practice and Health Services Reseach, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus Horneber
- Department of Internal Medicine, Division of Pneumology, Paracelsus Medical University, Klinikum Nurnberg, Nurnberg, Germany
| | - Jona Frasch
- aQua Institute for Applied Quality Improvement and Research in Health Care, Goettingen, Germany
| | - Klaus Kramer
- Department of Integrative Medicine, Faculty of Medicine, University Hospital Ulm, Ulm, Germany
| | - Hartmut Bertz
- Department of Medicine I, Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Barbara Grün
- Department of Medical Oncology, National Centre for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Stefanie Joos
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
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Tangkiatkumjai M, Boardman H, Walker DM. Potential factors that influence usage of complementary and alternative medicine worldwide: a systematic review. BMC Complement Med Ther 2020; 20:363. [PMID: 33228697 PMCID: PMC7686746 DOI: 10.1186/s12906-020-03157-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To determine similarities and differences in the reasons for using or not using complementary and alternative medicine (CAM) amongst general and condition-specific populations, and amongst populations in each region of the globe. METHODS A literature search was performed on Pubmed, ScienceDirect and EMBASE. KEYWORDS 'herbal medicine' OR 'herbal and dietary supplement' OR 'complementary and alternative medicine' AND 'reason' OR 'attitude'. Quantitative or qualitative original articles in English, published between 2003 and 2018 were reviewed. Conference proceedings, pilot studies, protocols, letters, and reviews were excluded. Papers were appraised using valid tools and a 'risk of bias' assessment was also performed. Thematic analysis was conducted. Reasons were coded in each paper, then codes were grouped into categories. If several categories reported similar reasons, these were combined into a theme. Themes were then analysed using χ2 tests to identify the main factors related to reasons for CAM usage. RESULTS 231 publications were included. Reasons for CAM use amongst general and condition-specific populations were similar. The top three reasons for CAM use were: (1) having an expectation of benefits of CAM (84% of publications), (2) dissatisfaction with conventional medicine (37%) and (3) the perceived safety of CAM (37%). Internal health locus of control as an influencing factor was more likely to be reported in Western populations, whereas the social networks was a common factor amongst Asian populations (p < 0.05). Affordability, easy access to CAM and tradition were significant factors amongst African populations (p < 0.05). Negative attitudes towards CAM and satisfaction with conventional medicine (CM) were the main reasons for non-use (p < 0.05). CONCLUSIONS Dissatisfaction with CM and positive attitudes toward CAM, motivate people to use CAM. In contrast, satisfaction with CM and negative attitudes towards CAM are the main reasons for non-use.
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Affiliation(s)
- Mayuree Tangkiatkumjai
- Department of Clinical Pharmacy, Faculty of Pharmacy, Srinakharinwirot University, Nakhonnayok, 26120 Thailand
| | - Helen Boardman
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Dawn-Marie Walker
- School of Health Sciences, University of Southampton, Southampton, UK
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Randazzo DM, McSherry F, Herndon JE, Affronti ML, Lipp ES, Flahiff C, Miller E, Woodring S, Boulton S, Desjardins A, Ashley DM, Friedman HS, Peters KB. Complementary and integrative health interventions and their association with health-related quality of life in the primary brain tumor population. Complement Ther Clin Pract 2019; 36:43-48. [PMID: 31383442 DOI: 10.1016/j.ctcp.2019.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Little is known about complementary and integrative health intervention usage in the primary brain tumor population. We aimed to identify the percentage of patients using these practices and explore the impact on quality of life. MATERIALS AND METHODS Clinical records from patients seen in clinic between December 16, 2013 and February 28, 2014 were reviewed retrospectively. The questionnaires used were a modified version of the International Complementary and Alternative Medicine Questionnaire, the Functional Assessment of Cancer Therapy- Brain Cancer and the Functional Assessment of Chronic Illness Therapy- Fatigue. RESULTS 76% of patients utilized a complementary and integrative health modality. The most frequently reported modalities used were vitamins, massage, and spiritual healing, prayer, diet and meditation. CONCLUSION These results confirm the usage of complementary and integrative health practices within the primary brain tumor population; however, there was no evidence of association between use and quality of life.
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Affiliation(s)
- Dina M Randazzo
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, DUMC Box 3624, Durham, NC, 27710, USA.
| | - Frances McSherry
- Duke Cancer Institute Biostatistics, Duke University Medical Center, Durham, NC 27710, USA.
| | - James E Herndon
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, DUMC Box 2717, Durham, NC, 27710, USA.
| | - Mary L Affronti
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, DUMC Box 3624, Durham, NC, 27710, USA; Duke University School of Nursing, DUMC 3624, Durham, NC, 27710, USA.
| | - Eric S Lipp
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, DUMC Box 3624, Durham, NC, 27710, USA.
| | - Charlene Flahiff
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, DUMC Box 3624, Durham, NC, 27710, USA.
| | - Elizabeth Miller
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, DUMC Box 3624, Durham, NC, 27710, USA.
| | - Sarah Woodring
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, DUMC Box 3624, Durham, NC, 27710, USA.
| | - Susan Boulton
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, DUMC Box 3624, Durham, NC, 27710, USA.
| | - Annick Desjardins
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, DUMC Box 3624, Durham, NC, 27710, USA.
| | - David M Ashley
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, DUMC Box 3624, Durham, NC, 27710, USA.
| | - Henry S Friedman
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, DUMC Box 3624, Durham, NC, 27710, USA.
| | - Katherine B Peters
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, DUMC Box 3624, Durham, NC, 27710, USA.
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Espinoza JL, Kurokawa Y, Takami A. Rationale for assessing the therapeutic potential of resveratrol in hematological malignancies. Blood Rev 2018; 33:43-52. [PMID: 30005817 DOI: 10.1016/j.blre.2018.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 03/27/2018] [Accepted: 07/03/2018] [Indexed: 02/05/2023]
Abstract
Promising results from pre-clinical studies on the naturally-occurring polyphenol resveratrol have generated considerable interest and somewhat excessive expectations regarding the therapeutic potential of this compound for treating or preventing various diseases, including cardiovascular and neurodegenerative disorders and cancer. Resveratrol has potent inhibitory activity in vitro against various tumor types, including cell lines derived from virtually all blood malignancies. Pharmacological studies have shown that resveratrol is safe for humans but has poor bioavailability, due to its extensive hepatic metabolism. Curiously, a substantial proportion of the orally administered resveratrol can reach the bone marrow compartment. Notably, various pathways dysregulated in blood cancers are known to be molecular targets of resveratrol, thus substantiating the potential utility of this agent in blood malignancies. In this review, we primarily focus on the scientific evidence that supports the potential utility of resveratrol for the management of select hematological malignancies. In addition, potential clinical trials with resveratrol are suggested.
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Affiliation(s)
- J Luis Espinoza
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan.
| | - Yu Kurokawa
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan
| | - Akiyoshi Takami
- Department of Internal Medicine, Division of Hematology, School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
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Rojas Rojas T, Bourdy G, Ruiz E, Cerapio JP, Pineau P, Gardon J, Doimi F, Deparis X, Deharo E, Bertani S. Herbal Medicine Practices of Patients With Liver Cancer in Peru: A Comprehensive Study Toward Integrative Cancer Management. Integr Cancer Ther 2016; 17:52-64. [PMID: 28088871 PMCID: PMC5950939 DOI: 10.1177/1534735416681642] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Rationale: The highest burden of liver cancer occurs in developing
countries, where the use of herbal medicine (HM) is still widespread. Despite
this trend, few studies have been conducted to report HM practices of patients
with a hepatic tumor in the developing world. Hence, this study aimed to
document the use of HM among patients with liver cancer in Peru. Study
Design and Methods: A comparative behavioral epidemiological survey
was conducted among liver cancer patients attending the National Cancer
Institute of Peru. Information was obtained by direct interviews based on a
semistructured questionnaire. The use of HM in Peruvian liver cancer patients
was reported, first, regarding general consumption prior to the onset of
disease, and second, after the appearance of symptoms that patients would relate
to their tumor. In parallel, general consumption of HM in noncancerous people
was assessed as a comparative figure. A correspondence analysis was performed to
reveal potential associations between the symptoms of cancer and the specific
use of HM. Results: Eighty-eight patients and 117 noncancerous
individuals participated in the survey. Overall, 68.3% of the people interviewed
claimed to use HM on a regular basis for general health preservation.
Furthermore, 56.8% of the patients turned to plants first to treat the disorders
for which they later came to the cancer care center. When compared with the
number of plant species used routinely (n = 78), a selection of plants was made
by patients in response to the symptoms of cancer (n = 46). At least 2 plant
species, Aloe vera and Morinda citrifolia,
were significantly associated with the treatment of liver cancer–related
symptoms in the patient group. Conclusions: The present study is
the first survey on the HM practices of patients with liver cancer in Latin
America and, more broadly, in the developing world. Our findings confirm that HM
remains one of the principal primary health care resources in Peru, even for a
severe disease like liver cancer. These traditional, complementary and
alternative medicine practices should be taken into consideration in Peruvian
health programs aiming to educate the population in cancer prevention and
treatment, as well as integrative cancer management.
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Affiliation(s)
| | | | - Eloy Ruiz
- 3 Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Juan-Pablo Cerapio
- 4 Sorbonne Universités, UPMC Univ Paris 06, Institut Pasteur, Paris, France
| | - Pascal Pineau
- 5 Institut Pasteur, Paris, France.,6 INSERM, U 993, Paris, France
| | - Jacques Gardon
- 7 Université de Montpellier, IRD, CNRS, UMR 5569, Montpellier, France
| | - Franco Doimi
- 3 Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Xavier Deparis
- 1 Aix-Marseille Université, IRD, INSERM, UMR 912, Marseille, France
| | - Eric Deharo
- 2 Université de Toulouse, IRD, UPS, UMR 152, Toulouse, France
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