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Ben-Arye E, Lavie O, Heyl W, Ramondetta L, Berman T, Samuels N. Integrative Medicine for Ovarian Cancer. Curr Oncol Rep 2023; 25:559-568. [PMID: 36939963 DOI: 10.1007/s11912-023-01359-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 03/21/2023]
Abstract
PURPOSE OF REVIEW Integrative oncology (IO) services provide a wide range of complementary medicine therapies, many of which can augment the beneficial effects of conventional supportive and palliative care for patients with ovarian cancer. This study aims to assess the current state of integrative oncology research in ovarian cancer care. RECENT FINDINGS We review the clinical research both supporting the effectiveness of leading IO modalities in ovarian cancer care as well as addressing potential safety-related concerns. There is growing amount of clinical research supporting the use of IO and implementation of integrative gynecological oncology models of care within the conventional supportive cancer care setting. Additional research is still needed in order to create clinical guidelines for IO interventions for the treatment of female patients with ovarian cancer. These guidelines need to address both effectiveness and safety-related issues, providing oncology healthcare professionals with indications for which these patients can be referred to the IO treatment program.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin, Carmel & Zebulun Medical Centers, Clalit Health Services, Haifa, Western Galilee District, Israel. .,Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel and Clalit Health Services, Haifa, Western Galilee District, Israel.
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Gynecologic Oncology Service, Carmel Medical Center, Haifa, Israel
| | - Wolfgang Heyl
- Department of Obstetrics and Gynecology, Cancer Center North Wurttemberg, Ludwigsburg, Germany
| | - Lois Ramondetta
- Department of Gynecologic Oncology and Reproductive Medicine And Department of Palliative, Rehabilitation, & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tara Berman
- Department of Medical Oncology, Inova Schar Cancer Institute, Fairfax, VA, USA
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Faculty of Medicine, Shaarei Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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Ben-Arye E, Elly M, Gressel O, Reshef A, Shani Md M, Stein N, Saliba W, Samuels N. Exploring the effectiveness of a patient-tailored integrative oncology program on emotional distress during chemotherapy for localized cancer. Psychooncology 2021; 31:207-218. [PMID: 34435403 DOI: 10.1002/pon.5794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/25/2021] [Accepted: 08/11/2021] [Indexed: 01/06/2023]
Abstract
STUDY OBJECTIVE There is a need to explore how patient-tailored integrative oncology (IO) programs reduce emotional distress. This study set out to bridge the IO research gap between non-specific, quality of life-related and specific emotional-related concerns in chemotherapy-treated patients. METHODS This pragmatic, prospective and preference-controlled study examined patients attending an integrative-physician consultation and weekly IO treatments during adjuvant/neo-adjuvant chemotherapy for localized cancer. Patients choosing to attend ≥4 IO sessions (highly adherent to integrative care, AIC) were compared to low AIC patients using the ESAS (Edmonton Symptom Assessment Scale) anxiety, depression and sleep; and the EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) emotional functioning scale, at baseline, 6 and 12 weeks. Emotional distress was assessed by ESAS anxiety and depression, considered as the primary study outcomes. RESULTS Of 439 participants, 260 (59%) were high-AIC and 179 low-AIC, both with similar baseline demographic and cancer-related characteristics. At 6 weeks, high-AIC patients reported greater improvement on ESAS sleep (p = 0.044); within-group improvement on ESAS anxiety and; and EORTC emotional functioning. Compared with low-AIC, high-AIC patients showed greater improvement on ESAS depression (p = 0.022) and sleep (p = 0.015) in those with high baseline ESAS anxiety scores (≥7); and ESAS anxiety (p = 0.049) for patients moderately anxious (4-6) at baseline. CONCLUSIONS High-AIC was associated with significantly reduced anxiety, depression and sleep severity at 6 weeks, especially those with high-to-moderate baseline anxiety levels. These findings reduce the research gap, suggesting specific emotional-related effects of IO.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, Haifa, Israel.,Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Maya Elly
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Orit Gressel
- Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, Haifa, Israel.,Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Alon Reshef
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Psychiatry Department, Ha'Emek Medical Center, Haifa, Israel
| | - Michal Shani Md
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Clalit Health Service, Rehovot, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nili Stein
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Walid Saliba
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Noah Samuels
- The Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Ben-Arye E, Yakubov Y, Samuels N, Gressel O, Yosipovich A, Schiff E, Ophir M, Saliba W, Dagash J. Impact of a combined integrative oncology and palliative care program on quality of life of patients with advanced cancer. Med Oncol 2021; 38:93. [PMID: 34241706 DOI: 10.1007/s12032-021-01544-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Abstract
Many oncology centers provide integrative oncology (IO) care, many within palliative care settings. The primary study objective was to examine the impact of IO-palliative patient-tailored program on quality of life (QoL) among patients with advanced cancer. In this pragmatic prospective controlled study, patients with advanced cancer undergoing chemotherapy/palliative care were referred by their oncology healthcare providers to an integrative physician (IP) consultation and weekly IO treatments. Patients with high adherence to integrative care (AIC; ≥ 4 IO sessions/6 weeks) were compared with moderate (2-3 sessions) or low AIC patients (regarded as control group). Outcomes were assessed at 6- and 12-week follow-up with Edmonton Symptom Assessment Scale (ESAS) and EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) tools. Change in QoL scores (ESAS fatigue in particular) was considered a primary study outcome. Of 225 eligible patients, 153 underwent baseline and 6-week optimal assessment (high AIC, 100; moderate AIC, 22; low AIC, 31). High AIC patients reported greater improvement on ESAS scores for fatigue (vs. low-moderate AIC, P < 0.001), depression (vs. moderate AIC, P = 0.01) at 6 weeks, and sleep (P = 0.007) at 12 weeks. High AIC patients had significantly improved EORTC global health status/QoL at 6 weeks (vs. moderate-low AIC, P = 0.01), cognitive functioning (vs. moderate AIC, P = 0.043), and social functioning (vs. moderate AIC, P = 0.032). High AIC patients had lower rates of hospitalizations at 12 weeks (19% vs. 35% in low AIC, P = 0.02; 44% in moderate AIC, P = 0.003), hospitalization days (vs. low AIC, P = 0.003), and opioid use (vs. low AIC, P < 0.001). High adherence to integrative care was associated with a significant effect on fatigue, depression, global QoL at 6 weeks, and need for hospitalizations at 12 weeks.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, 35 Rothschild St., Haifa, Israel. .,Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Yonatan Yakubov
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Orit Gressel
- Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, 35 Rothschild St., Haifa, Israel.,Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Elad Schiff
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Internal Medicine & Integrative Medicine Service, Bnai-Zion Hospital, Haifa, Israel
| | - Mattan Ophir
- Palliative Care Service, Carmel Medical Center, Haifa, Israel
| | - Walid Saliba
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Jamal Dagash
- Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, 35 Rothschild St., Haifa, Israel.,Palliative Care - Home Care Hospice, Clalit Health Services, Haifa and Western Galilee District, Haifa, Israel
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Ben-Arye E, Elly D, Samuels N, Gressel O, Shulman K, Schiff E, Lavie O, Minerbi A. Effects of a patient-tailored integrative oncology intervention in the relief of pain in palliative and supportive cancer care. J Cancer Res Clin Oncol 2021; 147:2361-2372. [PMID: 33433656 DOI: 10.1007/s00432-020-03506-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/14/2020] [Indexed: 12/29/2022]
Abstract
CONTEXT AND OBJECTIVES The present study examined the impact of an integrative oncology treatment program in the relief of pain in patients undergoing chemotherapy and/or palliative care. METHODS In this pragmatic prospective controlled study, patients undergoing chemotherapy and/or palliative care were referred by their oncology healthcare providers to an integrative physician (IP) consultation, followed by weekly integrative treatments. Patients attending ≥ 4 sessions during the first 6 weeks of the study were considered to be highly adherent to integrative care (AIC). Pain was assessed at baseline and at 6 and 12 weeks using the ESAS (Edmonton Symptom Assessment Scale) and EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) tools. RESULTS Of 815 eligible patients, 484 (59.4%) were high-AIC and 331 low-AIC. Mean pain scores decreased significantly from baseline to 6 and 12 weeks in both groups. However, ESAS and EORTC pain scores improved significantly more in the high-AIC group at 6 weeks (p= 0.008), though not at 12 weeks. Between-group analysis of participants undergoing adjuvant/neo-adjuvant chemotherapy showed higher pain reduction in the high-AIC group at 6 weeks (ESAS, p = 0.006; EORTC, p = 0.046), as was the case with patients receiving palliative care (ESAS p = 0.04; EORTC p = 0.056). CONCLUSIONS High adherence to integrative care was found to be associated with a greater effect on pain relief at 6 weeks but not at 12 weeks in patients undergoing chemotherapy and/or palliative care.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, 35 Rothschild St, Haifa, Israel.
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Dana Elly
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Shaarei Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Orit Gressel
- Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, 35 Rothschild St, Haifa, Israel
| | - Katerina Shulman
- The Oncology Service, Lin and Zebulun Medical Centers, Clalit Health Services, Haifa, Israel
| | - Elad Schiff
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Internal Medicine and Integrative Medicine Service, Bnai-Zion, Hospital, Haifa, Israel
| | - Ofer Lavie
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Obstetrics and Gynecology Carmel Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Amir Minerbi
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Institute for Pain Medicine, Rambam Health Campus, Haifa, Israel
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Belloumi N, Maalej Bellaj S, Bachouche I, Chermiti Ben Abdallah F, Fenniche S. Comparison of Sleep Quality before and after Chemotherapy in Locally Advanced Nonsmall Cell Lung Cancer Patients: A Prospective Study. SLEEP DISORDERS 2020; 2020:8235238. [PMID: 32765910 PMCID: PMC7387987 DOI: 10.1155/2020/8235238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/20/2020] [Accepted: 05/04/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Preservation of sleep quality is a modifiable and treatable factor, which may enhance the patient's adherence to other supportive and palliative care procedures. The outcome of sleep disturbances in lung cancer patients before and after treatment aren't reported. The aim of this study was to investigate changes in sleep quality before and after chemotherapy in locally advanced or metastatic NSCLC patients. METHODS It was a prospective study including 64 patients with stage III or IV nonsmall-cell lung cancer. Patients answered the Tunisian dialectal version of the following questionnaires: PSQI and QLQ-C30 in order to evaluate, respectively, the sleep quality and the quality of life. The assessments took place before chemotherapy and then repeated after the chemotherapy course was over. RESULTS The mean age was 62.9 years. All patients were active smokers. Before chemotherapy, there were 10 patients (15%) with poor sleep quality. The most frequent complaints were daytime sleepiness (70%) and nocturnal arousals (100%). After chemotherapy, the mean PSQI score increased from 2.9 to 5.4, and 45% of all patients had poor sleep quality. Most frequent complaints were the extension of sleep latency (69%), daytime sleepiness (98%), and nocturnal arousals (100%). Predicting factors of sleep disturbance according to statistical univariate analysis were delayed diagnosis confirmation (p = 0.05), delayed treatment onset (p < 10-3), depressive mood (p = 0.001), and anxious mood (p = 0.001). Multivariate analysis had shown a significant and independent correlation between sleep quality and shortened diagnosis and treatment delays. Sociodemographic parameters, clinical parameters, and factors related to treatment procedure had no correlation with sleep quality. CONCLUSIONS Our study demonstrates the persistence and potential intensity worsening of sleep disturbances in advanced stage nonsmall-cell lung cancer patients. We, hereby, reported a statistical correlation between sleep quality and quality of life in our patients.
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Affiliation(s)
- N. Belloumi
- Pulmonology Department Pavilion 4 Abderrahman Mami Hospital Ariana, Tunisia
| | - S. Maalej Bellaj
- Pulmonology Department Pavilion D Abderrahman Mami Hospital Ariana, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - I. Bachouche
- Pulmonology Department Pavilion 4 Abderrahman Mami Hospital Ariana, Tunisia
| | - F. Chermiti Ben Abdallah
- Pulmonology Department Pavilion 4 Abderrahman Mami Hospital Ariana, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - S. Fenniche
- Pulmonology Department Pavilion 4 Abderrahman Mami Hospital Ariana, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
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Ben-Arye E, Samuels N, Lavie O. Integrative Medicine for Female Patients with Gynecologic Cancer. J Altern Complement Med 2018; 24:881-889. [DOI: 10.1089/acm.2018.0163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin and Carmel Medical Centers, Clalit Health Services, Haifa, Israel
- Complementary and Traditional Medicine Unit, Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Clalit Health Services, Haifa, Israel
| | - Noah Samuels
- Tal Center for Integrative Medicine, Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Gynecologic Oncology Service, Carmel Medical Center, Haifa, Israel
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Providing integrative care in the pre-chemotherapy setting: a pragmatic controlled patient-centered trial with implications for supportive cancer care. J Cancer Res Clin Oncol 2018; 144:1825-1833. [DOI: 10.1007/s00432-018-2700-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
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