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Sont O, Rombouts M, Crul M. Attitude of healthcare professionals toward the use of complementary and alternative medication during anti-cancer therapy. J Oncol Pharm Pract 2024; 30:628-635. [PMID: 37259518 PMCID: PMC11118789 DOI: 10.1177/10781552231179899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Patients with cancer often use complementary and alternative medication (CAM). This research aims to study the current attitude of healthcare professionals toward the use of CAM to improve current care. METHODS A questionnaire on both the current practice and opinions about CAM use was sent to healthcare professionals in Amsterdam UMC, who work for the department of hematology or oncology. Oncologists, hematologists, residents, (specialized) nurses, dieticians, (hospital)pharmacists, and pharmacy technicians were asked to participate in this study. RESULTS Among eligible healthcare professionals, 77 responded to the questionnaire (34%). Overall, 87% of healthcare professionals indicate it is important to be aware of their patient's CAM use, and all find the potential of drug-herb interactions important. However, more than half of the healthcare professionals inquire about the patient's CAM use infrequently. In addition, only 15% of the healthcare professionals stated they had sufficient knowledge of CAM to advise patients on their use of CAM. CONCLUSIONS Healthcare professionals are aware of the potential risks of CAM use in combination with anti-cancer treatment. However, CAM use is not yet discussed with every patient. This may be due to healthcare professionals' lack of knowledge about CAM.
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Affiliation(s)
- O.M. Sont
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - M.D. Rombouts
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - M Crul
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
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2
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Malifarge L, Deppenweiler M, Italiano A, Lortal B. Impact of Medication Reconciliation in Oncology Early Phase Studies: A Drug-Drug Interaction Retrospective Study. JCO Oncol Pract 2024; 20:386-392. [PMID: 37944082 DOI: 10.1200/op.22.00281] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/20/2023] [Accepted: 08/29/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE This study aims to investigate the impact of medication reconciliation (MR) conducted by pharmacists before patient enrollment and the initiation of investigational treatments. By implementing MR, the primary objective is to evaluate the extent to which the inclusion of patients with prohibited or not recommended concomitant medications in clinical trials can be significantly reduced. MATERIALS AND METHODS The study included all patients who participated in clinical trials and underwent MR between September 1, 2015, and September 1, 2020. To identify prohibited or monitored drugs, protocols and investigator's brochures provided by the sponsor were meticulously reviewed and taken into consideration. RESULTS MR was performed for 501 patients, uncovering 35% of the medications they were currently taking. Through the pharmaceutical analysis, a total of 346 drug-drug interactions (DDIs) were identified, of which 188 required monitoring and 158 were strictly prohibited. More than half of the prohibited medications were herbal drugs. A significant portion of these prohibited drugs were discontinued, with only 6% being replaced by suitable alternatives. The implementation of MR played a crucial role in the identification of 51% of the prohibited or monitored drugs that were initially overlooked by oncologists. CONCLUSION MR is a highly effective measure aimed at reducing the risk of DDIs with investigational drugs, thereby minimizing protocol deviations and enhancing patient care. Sponsors of clinical trials value its implementation and recognize the substantial benefits it brings to the entire trial process. Consequently, many sponsors willingly provide funding to investigational sites that adopt MR as part of their standard practice, acknowledging its critical role in ensuring patient safety and maintaining data integrity throughout the course of clinical research studies.
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Affiliation(s)
- Laura Malifarge
- Department of Pharmacy, Bergonié Institute, Bordeaux, France
| | | | - Antoine Italiano
- Early Phase Trials Unit, Bergonié Institute, Bordeaux, France
- University of Bordeaux, Bordeaux, France
| | - Barbara Lortal
- Department of Pharmacy, Bergonié Institute, Bordeaux, France
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Lacey J, Huston A, Lopez G, Vozmediano JR, Lam CS, Narayanan S, Lu W, Wolf U, Subbiah IM, Richard P, Lopez AM, Rao S, Frenkel M. Establishing an Integrative Oncology Service: Essential Aspects of Program Development. Curr Oncol Rep 2024; 26:200-211. [PMID: 38358637 DOI: 10.1007/s11912-024-01504-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE OF REVIEW Over the last 2 decades, integrative oncology (IO) has seen exponential growth within cancer care. It aims to combine evidence-based complementary therapies with conventional treatments to improve the well-being and quality of life for individuals dealing with cancer. The proliferation of integrative medicine programs in major cancer centers globally reflects varying approaches shaped by cultural, demographic, and resource-based factors. RECENT FINDINGS Drawing upon the expertise of leaders in IO from the Society for Integrative Oncology (SIO) Clinical Practice Committee, this manuscript serves as a practical guide for establishing an IO practice. Collating insights from diverse professionals, including oncologists, integrative oncologists, supportive care physicians, researchers, and clinicians, the paper aims to provide a comprehensive roadmap for initiating and advancing IO services. The primary objective is to bridge the gap between conventional cancer care and complementary therapies, fostering a patient-centric approach to address the multifaceted challenges encountered by individuals with cancer. This paper delineates several key sections elucidating different aspects of IO practice. It delves into the core components necessary for an IO service's foundation, outlines the initial medical consultation process, and presents crucial tools essential for successful consultations. By consolidating insights and expertise, this manuscript seeks to facilitate the integration of IO into mainstream cancer care, ultimately enhancing patient outcomes and experiences.
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Affiliation(s)
- Judith Lacey
- Supportive Care and Integrative Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Alissa Huston
- Pluta Integrative Oncology & Wellness Center, Wilmot Cancer Institute University of Rochester, Rochester, NY, USA
| | - Gabriel Lopez
- Integrative Medicine Center, Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Chun Sing Lam
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Santhosshi Narayanan
- Integrative Medicine Center, Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Weidong Lu
- Zakim Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Ursula Wolf
- Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland
| | - Ishwaria M Subbiah
- Cancer Care Equity and Professional Wellness, Sarah Cannon Research Institute, Nashville, TN, USA
| | - Patrick Richard
- Radiation Oncology, Rocky Mountain Cancer Centers, Boulder, CO, USA
| | - Ana Maria Lopez
- Integrative Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Cherry Hill, Cherry Hill, NJ, USA
| | - Santosh Rao
- Integrative Oncology, University Hospitals Connor Whole Health. Beachwood, Beachwood, OH, USA
| | - Moshe Frenkel
- Complementary and Integrative Medicine Service, Oncology Division, Rambam Health Care Campus, Haifa, Israel.
- Department of Family Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.
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4
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Ammar A, Soua A, Ezzi O, Chelly S, Ammar N, Ezzairi F, Khenissi N, Chabchoub I, Ben Ahmed S, Mahjoub M, Njah M. Complementary and alternative medicine in oncology: knowledge, attitude and practice among Tunisian healthcare workers. J Cancer Res Clin Oncol 2023; 149:11585-11594. [PMID: 37401941 DOI: 10.1007/s00432-023-05040-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/28/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE Over the past years, there has been a considerable increase in complementary and alternative medicine (CAM) use among cancer patients. However, guidance from health care workers (HCWs) is not always provided. We aimed to determine the knowledge, attitude and practice of Tunisian HCWs regarding the use of CAM in cancer patients. METHODS We conducted a multicenter cross-sectional study over 5 months from February to June 2022 among HCWs caring for cancer patients in the Tunisian center region. Data were collected using a self-administered questionnaire developed by our investigators. RESULTS The level of knowledge about CAM was declared limited by 78.4% of our population. The best known CAM therapies were herbal medicine and homeopathy while chiropractic and hypnosis where the least. HCWs who had sought information on CAM represented 54.3% of our sample and the main source of information was the Internet (37.1%). A positive attitude towards the use of CAM was found in 56% of HCWs. The integration of CAM into supportive care in oncology was approved by 78% of HCWs. Concerning training on CAM, 78% declared its necessity for HCWs and 73.3% expressed a desire to have it. A personal use of CAM was found in 53% of HCWs while 38.8% had previously used CAM in the treatment of their cancer patients. CONCLUSION The majority of HCWs had a positive attitude towards the use of CAM in oncology despite their poor knowledge about it. Our study emphasizes the need to train HCWs dealing with cancer patients on CAM.
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Affiliation(s)
- Asma Ammar
- Department of Hospital Hygiene, Farhat Hached University Hospital, Sousse, Tunisia
| | - Asma Soua
- Department of Hospital Hygiene, Farhat Hached University Hospital, Sousse, Tunisia.
| | - Olfa Ezzi
- Department of Hospital Hygiene, Farhat Hached University Hospital, Sousse, Tunisia
| | - Souhir Chelly
- Department of Hospital Hygiene, Farhat Hached University Hospital, Sousse, Tunisia
| | - Nouha Ammar
- Department of Medical Oncology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Faten Ezzairi
- Department of Medical Oncology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Nouha Khenissi
- Higher Institute of Nursing Sciences of Sousse, Sousse, Tunisia
| | - Imene Chabchoub
- Department of Medical Oncology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Slim Ben Ahmed
- Department of Medical Oncology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Mohamed Mahjoub
- Department of Hospital Hygiene, Farhat Hached University Hospital, Sousse, Tunisia
| | - Mansour Njah
- Department of Hospital Hygiene, Farhat Hached University Hospital, Sousse, Tunisia
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Zwart NRK, Franken MD, Tissing WJE, Lubberman FJE, McKay JA, Kampman E, Kok DE. Folate, folic acid, and chemotherapy-induced toxicities: a systematic literature review. Crit Rev Oncol Hematol 2023:104061. [PMID: 37353179 DOI: 10.1016/j.critrevonc.2023.104061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 06/25/2023] Open
Abstract
Folate metabolism is a target for various chemotherapeutic drugs. Folate and its synthetic variant folic acid are B-vitamins. To what extent these vitamins impact treatment tolerance in patients with cancer remains unclear. A systematic literature review was conducted on intake and status of folate and folic acid in relation to chemotherapy-induced toxicities in children and adults with cancer. A total of 6,231 publications were identified, of which 40 publications met the inclusion criteria. In 12 out of 22 studies focusing on antifolates, a deficient folate status and lower folate and folic acid intake were associated with a higher risk of toxicities. In 8 out of 14 studies focusing on fluoropyrimidine treatments, a higher folate status and intake were associated with a higher risk of toxicities. These findings might explain interindividual differences in treatment tolerance and highlight the importance of evaluating nutritional status in oncology care.
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Affiliation(s)
- Nienke R K Zwart
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Mira D Franken
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Wim J E Tissing
- Prinses Máxima Centre for Pediatric Oncology, Utrecht, the Netherlands
| | - Floor J E Lubberman
- Department of Clinical Pharmacy, Hospital Gelderse Vallei, Ede, the Netherlands
| | - Jill A McKay
- Department of Applied Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands.
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6
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Semeniuk G, Bahadini B, Ahn E, Zain J, Cheng J, Govindarajan A, Rose J, Lee RT. Integrative Oncology and the Clinical Care Network: Challenges and Opportunities. J Clin Med 2023; 12:3946. [PMID: 37373639 DOI: 10.3390/jcm12123946] [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: 04/14/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Integrative oncology is a new and growing field of cancer care. Integrative oncology is a patient-centered, evidence-based field of comprehensive cancer care that utilizes integrative therapies such as mind-body practices, acupuncture, massage, music therapy, nutrition, and exercise in collaboration with conventional cancer treatments. Patient interest and utilization has been growing over the past two decades. Clinical research has shown the benefits of these approaches to improving symptom management and quality of life, and is now being incorporated into national guidelines from the National Comprehensive Cancer Network (NCCN) and American Society for Clinical Oncology (ASCO). The availability of these services at cancer centers is growing, although the structure and implementation of integrative oncology remains highly variable. This article discusses the benefits of integrative oncology and provides an overview of the current state of integrative oncology programs nationwide. Current challenges and opportunities for cancer centers to provide integrative services is reviewed in the areas of programmatic structure, clinical service, education, and research.
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Affiliation(s)
- George Semeniuk
- City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | | | - Eugene Ahn
- City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
- City of Hope Chicago, Zion, IL 60099, USA
| | - Jasmine Zain
- City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Jessica Cheng
- City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | | | - Judy Rose
- City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Richard T Lee
- City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
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Conway K, Ferstl C, Kumar M. Dietary supplement adulteration - knowledge, attitudes, and practices of California health care professionals: A cross-sectional survey study. PATIENT EDUCATION AND COUNSELING 2023; 114:107824. [PMID: 37290282 DOI: 10.1016/j.pec.2023.107824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/08/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess knowledge, attitudes, and practices surrounding dietary supplements (DS) among California health care professionals (HCPs) and assess factors contributing to the frequency with which HCPs discuss DS with patients. METHODS In this cross-sectional study, an online questionnaire was distributed to HCPs in California from December 2021-April 2022 via professional membership email listservs. RESULTS Among 514 HCPs, overall knowledge of DS did not vary significantly by professional group, and 90% had received little to no DS education. Pharmacists (OR = 0.328, p = 0.0001) and those with less reported DS education (OR = 0.58, p = 0.0045; OR = 0.075, p = 0.0097) had a decreased likelihood of initiating conversations about DS more frequently. Females (OR = 2.5, p < 0.0001) and those with a higher knowledge score (OR = 1.2, p = 0.0297) had an increased likelihood of initiating conversations about DS more frequently. CONCLUSIONS HCPs acknowledge the clinical significance of DS adulteration and would benefit from additional informational resources to reduce the adverse effects associated with adulterated supplements. PRACTICE IMPLICATIONS HCPs initiate more conversations about DS use when they are more informed and will gain from staying up to date on DS-related information to encourage more patient communication.
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Affiliation(s)
- Kimberly Conway
- California Department of Public Health, Sacramento, USA; California Epidemiologic Investigation Service (Cal-EIS) Fellowship, Sacramento, USA.
| | - Carrie Ferstl
- California Department of Public Health, Sacramento, USA.
| | - Madhur Kumar
- California Department of Public Health, Sacramento, USA.
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8
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Dores AR, Peixoto M, Castro M, Sá C, Carvalho IP, Martins A, Maia E, Praça I, Marques A. Knowledge and Beliefs about Herb/Supplement Consumption and Herb/Supplement-Drug Interactions among the General Population, including Healthcare Professionals and Pharmacists: A Systematic Review and Guidelines for a Smart Decision System. Nutrients 2023; 15:nu15102298. [PMID: 37242184 DOI: 10.3390/nu15102298] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/03/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
The increased consumption of a variety of herbs/supplements has been raising serious health concerns. Owing to an inadequate understanding of herb/supplement-drug interactions, the simultaneous consumption of these products may result in deleterious effects and, in extreme cases, even fatal outcomes. This systematic review is aimed at understanding the knowledge and beliefs about the consumption of herbs/supplements and herb/drug-supplement interactions (HDIs). The study follows the PRISMA guidelines. Four online databases (Web of Science; PubMed; Cochrane; and EBSCOhost) were searched, and a total of 44 studies were included, encompassing 16,929 participants. Herb and supplement consumption is explained mostly by the reported benefits across multiple conditions and ease of use. Regarding HDIs, most people take both herbs/supplements and prescription drugs simultaneously. Only a small percentage of participants have knowledge about their interaction effects, and many reported adverse interactions or side effects. Nevertheless, the main reason for stopping the prescribed drug intake is the perceived lack of its effect, and not due to interactions. Therefore, it is important to increase the knowledge about supplement use so that further strategies can be elaborated to better detect or be alert for whenever a potentially dangerous reaction and/or interaction may occur. This paper raises awareness regarding the need for developing a decision support system and ends with some considerations about the development of a technological solution capable of detecting HDIs and, thereby, aiding in the improvement of pharmacy services.
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Affiliation(s)
- Artemisa R Dores
- Laboratório de Reabilitação Psicossocial, Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto (ESS-IPP), 4200-072 Porto, Portugal
| | - Miguel Peixoto
- Laboratório de Reabilitação Psicossocial, Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto (ESS-IPP), 4200-072 Porto, Portugal
| | - Maria Castro
- Laboratório de Reabilitação Psicossocial, Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto (ESS-IPP), 4200-072 Porto, Portugal
| | - Catarina Sá
- Laboratório de Reabilitação Psicossocial, Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto (ESS-IPP), 4200-072 Porto, Portugal
| | - Irene P Carvalho
- Clinical Neurosciences and Mental Health Department, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Andreia Martins
- Research Group on Intelligent Engineering and Computing for Advanced Innovation and Development (GECAD), School of Engineering, Polytechnic of Porto (ISEP/IPP), 4249-015 Porto, Portugal
| | - Eva Maia
- Research Group on Intelligent Engineering and Computing for Advanced Innovation and Development (GECAD), School of Engineering, Polytechnic of Porto (ISEP/IPP), 4249-015 Porto, Portugal
| | - Isabel Praça
- Research Group on Intelligent Engineering and Computing for Advanced Innovation and Development (GECAD), School of Engineering, Polytechnic of Porto (ISEP/IPP), 4249-015 Porto, Portugal
| | - António Marques
- Laboratório de Reabilitação Psicossocial, Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto (ESS-IPP), 4200-072 Porto, Portugal
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Bao T, Greenlee H, Lopez AM, Kadro ZO, Lopez G, Carlson LE. How to Make Evidence-Based Integrative Medicine a Part of Everyday Oncology Practice. Am Soc Clin Oncol Educ Book 2023; 43:e389830. [PMID: 37200595 DOI: 10.1200/edbk_389830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Integrativety oncology (IO) is a "patient-centered, evidence-informed field of comprehensive cancer care that utilizes mind-body practices, natural products, and lifestyle modifications from different traditions alongside conventional cancer treatments." There is an urgent need to educate oncology health care providers on the fundamentals of evidence-based IO to meet the needs of people with cancer. In this chapter, we aim to provide oncology professionals with actionable guidance on the basis of the Society for Integrative Oncology (SIO)-American Society of Clinical Oncology (ASCO) guidelines on integrative medicine use during oncology visits to help alleviate symptoms and side effects in people with cancer during and after treatment.
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Affiliation(s)
- Ting Bao
- Memorial Sloan Kettering Cancer Center, Integrative and Breast Medicine Services, New York, NY
| | | | - Ana Maria Lopez
- Sidney Kimmel Cancer Center-Jefferson Health-New Jersey, Philadelphia, PA
| | | | - Gabriel Lopez
- Department of Palliative, Rehabilitation, & Integrative Medicine, MD Anderson Cancer Center, Houston, TX
| | - Linda E Carlson
- Psychosocial Resources at the Tom Baker Cancer Centre, University of Calgary, Calgary, Canada
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Deleemans J, MacLeod J, Fuentes E, Glenn L, Glosik E, Leyh J, Ryan S, Sarcich M, Pole L. Exploring the Roles of Patient Advocates in Integrative Oncology. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:134-138. [PMID: 36763611 DOI: 10.1089/jicm.2023.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Julie Deleemans
- University of Calgary Cumming School of Medicine, Society for Integrative OncologyAYA CAN Canadian Support Community, Calgary, Alberta, Canada. ®, AYA CAN Canadian Support Community, Calgary, Alberta, Canada
| | - Jodi MacLeod
- Society for Integrative Oncology, Memorial Sloan Kettering Cancer Center, National Coalition of Cancer Survivorship, Breinigsville, PA, USA
| | - Eileen Fuentes
- Memorial Sloan Kettering Cancer Center, Society for Integrative Oncology, SWOG, New York, NY, USA
| | - Lesley Glenn
- Project Life, Society for Integrative Oncology, Metastatic Breast Cancer Alliance, National Coalition of Cancer Survivorship, Central Point, OR, USA
| | - Elizabeth Glosik
- Society for Integrative Oncology, Escape to Thrive, National Coalition of Cancer Survivorship, Brecksville, OH, USA
| | - Jenny Leyh
- Samueli Foundation's Integrative Health Programs, Society for Integrative Oncology, Integrative Oncology Leadership Collaborative, Haddon Heights, NJ, USA
| | - Susan Ryan
- Society for Integrative Oncology, Living Beyond Breast Cancer, Unite for Her, Collegeville, PA, USA
| | - Marianne Sarcich
- Society for Integrative Oncology, National Coalition of Cancer Survivorship, Wilmington, DE, USA
| | - Laura Pole
- Smith Center for Healing and the Arts, CancerChoices, Society for Integrative Oncology, Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative, Washington, DC, USA
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11
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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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12
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Integrating herbal medicine into oncology care delivery: development, implementation, and evaluation of a novel program. Support Care Cancer 2023; 31:128. [PMID: 36680628 PMCID: PMC9860233 DOI: 10.1007/s00520-023-07577-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/05/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the feasibility of a novel program facilitating patient-provider communication about appropriate use of herbal medicine at a large academic cancer center and its impact on patient wellbeing. METHODS In the Herbal Oncology Program (HOP), integrative medicine providers counseled patients about unmet symptom needs and prescribed traditional Chinese medicine (TCM) herbs when indicated, taking into consideration the clinical context, patient preference, and research evidence. To evaluate the feasibility and outcomes, we performed a retrospective analysis using medical record data (symptoms and other concerns that motivated patients to seek herbal products, types and numbers of dispensed TCM herbs, and demographic characteristics). We also conducted a survey to assess patient experience and satisfaction. RESULTS All 851 participants were outpatients, with 712 (84%) in active treatment. HOP dispensed 1266 herbal prescriptions for a range of symptoms, most commonly GI symptoms (467, 37%); pain (353, 28%); and treatment-related fatigue, sleep, and mood disorders (346, 27%). Of 269 patients invited to the survey, 107 (40%) completed it. A majority of respondents 70.9% (73/103) were satisfied with the effectiveness of dispensed herbs in relieving their symptoms, and few 6.7% (7/104) had experienced mild adverse events that resolved after discontinuing herbal use. CONCLUSIONS The study's findings support the feasibility of integrating herbal medicine into an academic oncology setting. Patient satisfaction with HOP was high, with limited adverse events. The patterns of herbal prescriptions in HOP suggest future areas for clinical research to strengthen the evidence base around safe and effective use.
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Narayanan S, Liu W, Lopez G, Fellman B, Reddy A, Subbiah IM, Cohen L, Bruera E. Practice Patterns on the Incorporation of Integrative Medicine Into the Oncologic Care of Patients With Cancer. Integr Cancer Ther 2023; 22:15347354231213045. [PMID: 37978821 PMCID: PMC10657516 DOI: 10.1177/15347354231213045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/08/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND With rising interest in complementary approaches to symptom management, awareness of real-world practice patterns in the incorporation of integrative oncology (IO) into cancer care is limited. Therefore, we examined the reasons for referral, symptom burdens, and clinical outcomes for cancer patients who underwent initial IO consultations. METHODS The records of adult patients with cancer who underwent initial outpatient IO consultations at our cancer center for a representative 10-day period at the start of each month for 12 months starting January 1, 2017, were reviewed retrospectively. Patient demographic and medical characteristics and outpatient IO consultation details, including patient-reported outcome measures of symptom burden, were extracted. Descriptive summary statistics and logistic regression were used to analyze the data. RESULTS Among the 473 study patients, 71% were women, breast cancer (42%) was the most common cancer type, and 31% had metastatic cancer. Referring clinicians listed an integrative approach (57%) as the most common reason for referral, followed by diet (26%), pain (19%), discussion of herbs and supplements (18%), and stress (18%). In comparison, patients listed their primary concerns as diet (16%), pain (15%), and an integrative approach to overall health (11%). After the IO consultations, the highest likelihood of subsequent recommendations were acupuncture for hot flashes (odds ratio [OR], P = .002) or peripheral neuropathy (OR = 6.59, P < .001), oncology massage for pain (OR = 3.04, P < .001), psychology referral for patient's self-reported anxiety (OR = 2.35, P < .001), and mind-body therapies for stress (OR = 2.57, P < .001). CONCLUSION Cancer patients' top concerns regarding IO consultation may not always match providers' reasons for referral. Longitudinal data analysis is needed to determine the effect of integrative interventions on symptom burden.
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Affiliation(s)
| | - Wenli Liu
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gabriel Lopez
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bryan Fellman
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Akhila Reddy
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Lorenzo Cohen
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Mao JJ, Ismaila N, Bao T, Barton D, Ben-Arye E, Garland EL, Greenlee H, Leblanc T, Lee RT, Lopez AM, Loprinzi C, Lyman GH, MacLeod J, Master VA, Ramchandran K, Wagner LI, Walker EM, Bruner DW, Witt CM, Bruera E. Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline. J Clin Oncol 2022; 40:3998-4024. [PMID: 36122322 DOI: 10.1200/jco.22.01357] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The aim of this joint guideline is to provide evidence-based recommendations to practicing physicians and other health care providers on integrative approaches to managing pain in patients with cancer. METHODS The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2021. Outcomes of interest included pain intensity, symptom relief, and adverse events. Expert panel members used this evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 227 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Among adult patients, acupuncture should be recommended for aromatase inhibitor-related joint pain. Acupuncture or reflexology or acupressure may be recommended for general cancer pain or musculoskeletal pain. Hypnosis may be recommended to patients who experience procedural pain. Massage may be recommended to patients experiencing pain during palliative or hospice care. These recommendations are based on an intermediate level of evidence, benefit outweighing risk, and with moderate strength of recommendation. The quality of evidence for other mind-body interventions or natural products for pain is either low or inconclusive. There is insufficient or inconclusive evidence to make recommendations for pediatric patients. More research is needed to better characterize the role of integrative medicine interventions in the care of patients with cancer.Additional information is available at https://integrativeonc.org/practice-guidelines/guidelines and www.asco.org/survivorship-guidelines.
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Affiliation(s)
- Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Ting Bao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Debra Barton
- University of Michigan School of Nursing, Ann Arbor, MI
| | - Eran Ben-Arye
- Lin & Carmel Medical Centers, Clalit Health Services; Technion Faculty of Medicine, Haifa, Israel
| | - Eric L Garland
- College of Social Work, University of Utah, Salt Lake City, UT
| | | | | | - Richard T Lee
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Ana Maria Lopez
- Thomas Jefferson. Sidney Kimmel Cancer Center, Philadelphia, PA
| | | | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jodi MacLeod
- Patient Representative, Memorial Sloan Kettering Integrative Medicine Service, New York, NY
| | - Viraj A Master
- Winship Cancer Institute of Emory University, Atlanta, GA
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Keene MR, Heslop IM, Sabesan SS, Glass BD. Knowledge, attitudes, and practices of Australian oncology health professionals on complementary medicines. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2022. [DOI: 10.1002/jppr.1838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Martin R. Keene
- College of Medicine and Dentistry James Cook University Townsville Australia
- Albury Base Hospital East Albury Australia
| | - Ian M. Heslop
- College of Medicine and Dentistry James Cook University Townsville Australia
| | - Sabe S. Sabesan
- College of Medicine and Dentistry James Cook University Townsville Australia
| | - Beverley D. Glass
- College of Medicine and Dentistry James Cook University Townsville Australia
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Mentink MDC, van Vliet LM, Timmer-Bonte JANH, Noordman J, van Dulmen S. How is complementary medicine discussed in oncology? Observing real-life communication between clinicians and patients with advanced cancer. PATIENT EDUCATION AND COUNSELING 2022; 105:3235-3241. [PMID: 35989202 DOI: 10.1016/j.pec.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study aims to examine the structure of communication about complementary medicine (CM) between patients with cancer and clinicians during oncology consultations. METHODS Previously, consultations between 29 clinicians and 80 patients with advanced cancer were recorded in six hospitals in the Netherlands. The present study considers a secondary analysis. References to CM during the consultation were coded using a self-developed observational coding scheme. RESULTS At least one reference to CM was observed in 35 out of 80 consultations (44 %), with a total of 73 references. In most cases, CM was initially referred to by patients. Clinicians often did not elaborate on the subject of CM. Relevant aspects related to CM (e.g., safety, effectiveness) were infrequently discussed. Both patients and clinicians showed predominantly neutral to positive attitudes towards CM. CONCLUSIONS This study shows that patients are still the main initiators of discussions about CM and the topic is not consistently discussed in daily oncology practice. PRACTICE IMPLICATIONS If exploration of patients' interest in CM or its use became routine in oncology practice, it may relieve patients of the burden of introducing the topic, decrease potential risks of CM use and increase access to evidence-based CM for all patients with cancer.
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Affiliation(s)
- Marit D C Mentink
- Nivel, Netherlands Institute for Health Services Research, Department of Communication in Healthcare, Utrecht, Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, Netherlands.
| | - Liesbeth M van Vliet
- Leiden University, Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden, Netherlands; Leiden University, Leiden Institute for Brain and Cognition, Leiden, Netherlands
| | | | - Janneke Noordman
- Nivel, Netherlands Institute for Health Services Research, Department of Communication in Healthcare, Utrecht, Netherlands
| | - Sandra van Dulmen
- Nivel, Netherlands Institute for Health Services Research, Department of Communication in Healthcare, Utrecht, Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, Netherlands
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Womack DM, Kennedy R, Chamberlin SR, Rademacher AL, Sliney CD. Patients' lived experiences and recommendations for enhanced awareness and use of integrative oncology services in cancer care. PATIENT EDUCATION AND COUNSELING 2022; 105:2557-2561. [PMID: 34865887 PMCID: PMC9888321 DOI: 10.1016/j.pec.2021.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/25/2021] [Accepted: 11/19/2021] [Indexed: 05/27/2023]
Abstract
BACKGROUND Consuming educational content, adhering to treatment plans and managing symptoms and side-effects can be overwhelming to new oncology patients. OBJECTIVE The purpose of this study is to engage patients in conceptualization of enhanced clinic processes and digital health tools to support awareness and use of integrative oncology services. PATIENT INVOLVEMENT We engaged patients in participatory design to understand lived experiences surrounding use of integrative oncology services during and after conventional cancer treatment. METHODS Ten participatory design sessions were held with individual participants. Sessions began with patient story telling regarding diagnosis and paths to awareness and use of integrative oncology services. We then reviewed prototype mobile app screens to solicit feedback regarding digital health functionality to support patient navigation of symptom-alleviating options. RESULTS Oncology patients are active participants in the management of symptoms and side effects. Patients who utilize yoga, acupuncture, and massage report a need for earlier patient education about these services. Patients express interest in digital health tools to match symptoms to options for relief, provide access to searchable information, and facilitate streamlined access to in-person and remote services. DISCUSSION Patients co-produce wellbeing by seeking solutions to daily challenges and consuming educational content. Clinics can collaborate with patients to identify high priority needs and challenges. PRACTICAL VALUE Active collaboration with patients is needed to identify unmet needs and guide development of clinic processes and digital health tools to enhance awareness and use of IO services in conventional cancer care. FUNDING The principal investigator was supported by the U.S. Agency for Healthcare Research and Quality (AHRQ K12HS026370). The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of AHRQ. The sponsor had no role in the study design, data collection, analysis, report writing, or decision to submit for publication.
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Affiliation(s)
- Dana M Womack
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, USA.
| | | | - Steven R Chamberlin
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, USA
| | | | - Carolyn D Sliney
- Office of Visitors and Volunteers, Oregon Health & Science University, Portland, USA
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18
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Green J, Wright H, Seely D, Legacy M, Anderson M, Armstrong H, Martell C, Soles S, Balneaves LG. A survey of multidisciplinary healthcare providers utilizing the KNOWintegrativeoncology.org educational platform. BMC Complement Med Ther 2022; 22:118. [PMID: 35484545 PMCID: PMC9047465 DOI: 10.1186/s12906-022-03601-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/13/2022] [Indexed: 12/03/2022] Open
Abstract
Background Although the vast majority of cancer patients use natural health products (NHPs), 59% of oncology healthcare providers (HCP) report not receiving any education on NHPs. KNOWintegrativeoncology.org (KNOW) is a web-based educational platform that provides up-to-date evidence on NHPs used in cancer care with a user-friendly interface. KNOW is a database of human studies systematically gathered from MEDLINE and EMBASE. We surveyed HCPs before and after accessing KNOW to identify their information needs regarding NHPs in cancer care, their preferred way to receive information, barriers they face accessing NHP information, and to obtain feedback on the website. Methods Recruitment was done through Beaumont Health Systems, the Society for Integrative Oncology, and the Andrew Weil Centre for Integrative Medicine, University of Arizona. HCPs who consented completed an initial survey and then a follow-up survey after being given access to KNOW for 4–6 weeks. Participants were required to access KNOW at least three times before completion of the follow-up survey. Results A total of 65 participants completed the initial survey, with 60% (n = 39) from the conventional medical community, 33% (n = 21) from the integrative medicine community, and 7% (n = 5) from the research community. The majority of participants (82%; n = 53) preferred educational websites to email updates, podcasts/webinars, in-house experts, PubMed searches and smartphone apps. The most common barriers identified to accessing information on NHPs were time, accessibility at point-of-care, and credibility of sources. A high number of participants were lost to follow up, with 18 participants demographically representative of the initial sample of 65 completing the follow-up survey. Half (n = 9) of participants stated accessing the KNOW website changed their clinical practice. Close to 90% (n = 16) reported they would recommend KNOW to a colleague. Conclusion Oncology HCPs reported preferring to use, and already relying on, numerous web-based educational platforms to gather information on NHPs, with time, accessibility, and credibility being common barriers to obtaining information. Our study findings highlight the promise of the KNOW web-based educational platform in reducing barriers to accessing up-to-date information on NHPs in busy cancer care settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-022-03601-5.
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Affiliation(s)
- Jen Green
- Emcura Integrative Clinic, Bloomfield Twp, Bloomfield Hills, MI, USA
| | | | - Dugald Seely
- Patterson Institute for Integrative Oncology Research, CCNM, Toronto, ON, Canada.,The Centre for Health Innovation, Ottawa, ON, Canada
| | - Mark Legacy
- Patterson Institute for Integrative Oncology Research, CCNM, Toronto, ON, Canada.,The Centre for Health Innovation, Ottawa, ON, Canada
| | | | | | | | - Sarah Soles
- Integrated Health Clinic, Fort Langley, Langley, BC, Canada
| | - Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada.
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19
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Goel AR, Henderson CR, Reid MC. Do Palliative Care Providers Use Complementary and Integrative Medicine? A Nationwide Survey. J Pain Symptom Manage 2022; 63:599-609. [PMID: 34788656 PMCID: PMC9121789 DOI: 10.1016/j.jpainsymman.2021.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/03/2021] [Accepted: 11/07/2021] [Indexed: 11/20/2022]
Abstract
CONTEXT Given the high prevalence of burdensome symptoms in palliative care (PC) and increasing use of complementary and integrative medicine (CIM) therapies, research is needed to determine how often and what types of CIM therapies providers recommend to manage symptoms in PC. OBJECTIVES To document recommendation rates of CIM for target symptoms and assess if, CIM use varies by provider characteristics. METHODS Nationwide survey's of physicians (MD and DO), physician assistants, and nurse practitioners in PC. RESULTS Participants (N = 404) were mostly female (71.3%), physicians (74.9%), and cared for adults (90.4%). Providers recommended CIM an average of 6.82 times per-month (95% CI: 6.04-7.60) and used an average of 5.13 (95% CI: 4.90-5.36) out of 10 CIM modalities. Respondents recommended mind-body medicines (e.g., meditation, biofeedback) most, followed by massage, and acupuncture and/or acupressure. The most targeted symptoms included pain; followed by anxiety, mood disturbance, and distress. Recommendation frequencies for specific modality-for-symptom combinations ranged from little use (e.g., aromatherapy for constipation) to occasional use (e.g., mind-body interventions for psychiatric symptoms). Finally, recommendation rates increased as a function of pediatric practice, noninpatient practice setting, provider age, and proportion of effort spent delivering palliative care. CONCLUSION To the best of our knowledge, this is the first national survey to characterize PC providers' CIM recommendation behaviors and assess specific therapies and common target symptoms. Providers recommended a broad range of CIM but do so less frequently than patients report using CIM. These findings should be of interest to any provider caring for patients with serious illness.
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Affiliation(s)
- Anurag Ratan Goel
- Departments of Medicine and Pediatrics (A.R.G.), Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Charles R Henderson
- Department of Human Development (C.R.H.), Cornell University, Ithaca, New York, USA
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20
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Lubián López DM. Management of genitourinary syndrome of menopause in breast cancer survivors: An update. World J Clin Oncol 2022; 13:71-100. [PMID: 35316932 PMCID: PMC8894268 DOI: 10.5306/wjco.v13.i2.71] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/19/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
There is increasing attention about managing the adverse effects of adjuvant therapy (Chemotherapy and anti-estrogen treatment) for breast cancer survivors (BCSs). Vulvovaginal atrophy (VVA), caused by decreased levels of circulating estrogen to urogenital receptors, is commonly experienced by this patients. Women receiving antiestrogen therapy, specifically aromatase inhibitors, often suffer from vaginal dryness, itching, irritation, dyspareunia, and dysuria, collectively known as genitourinary syndrome of menopause (GSM), that it can in turn lead to pain, discomfort, impairment of sexual function and negatively impact on multiple domains of quality of life (QoL). The worsening of QoL in these patients due to GSM symptoms can lead to discontinuation of hormone adjuvant therapies and therefore must be addressed properly. The diagnosis of VVA is confirmed through patient-reported symptoms and gynecological examination of external structures, introitus, and vaginal mucosa. Systemic estrogen treatment is contraindicated in BCSs. In these patients, GSM may be prevented, reduced and managed in most cases but this requires early recognition and appropriate treatment, but it is normally undertreated by oncologists because of fear of cancer recurrence, specifically when considering treatment with vaginal estrogen therapy (VET) because of unknown levels of systemic absorption of estradiol. Lifestyle modifications and nonhormonal treatments (vaginal moisturizers, lubricants, and gels) are the first-line treatment for GSM both in healthy women as BCSs, but when these are not effective for symptom relief, other options can be considered, such as VET, ospemifene, local androgens, intravaginal dehydroepiandrosterone (prasterone), or laser therapy (erbium or CO2 Laser). The present data suggest that these therapies are effective for VVA in BCSs; however, safety remains controversial and a there is a major concern with all of these treatments. We review current evidence for various nonpharmacologic and pharmacologic therapeutic modalities for GSM in BCSs and highlight the substantial gaps in the evidence for safe and effective therapies and the need for future research. We include recommendations for an approach to the management of GSM in women at high risk for breast cancer, women with estrogen-receptor positive breast cancers, women with triple-negative breast cancers, and women with metastatic disease.
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Affiliation(s)
- Daniel María Lubián López
- Department of Mother and Child Health and Radiology, Faculty of Medicine, University of Cadiz, Cádiz 11100, Spain
- Department of Obstetrics and Gynecology Service, University Hospital of Jerez de la Frontera, Jerez de la Frontera 11407, Spain
- Department of Obstetrics and Gynecology, Hospital Viamed Bahía de Cádiz, Chiclana de la Frontera 11130, Cádiz, a Spain
- Department of Obstetrics and Gynecology, Hospital Quirónsalud Campo de Gibraltar, Los Barrios 11379, Cádiz, Spain
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21
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Balneaves LG, Watling CZ. "Part of the Conversation": A Qualitative Study of Oncology Healthcare Professionals' Experiences of Integrating Standardized Assessment and Documentation of Complementary Medicine. Integr Cancer Ther 2022; 21:15347354221077229. [PMID: 35130735 PMCID: PMC8829709 DOI: 10.1177/15347354221077229] [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] [Indexed: 12/04/2022] Open
Abstract
Introduction: The use of complementary medicine (CM) among individuals with cancer is common, however, it is infrequently assessed or documented by oncology healthcare professionals (HCPs). A study implementing standardized assessment and documentation of CM was conducted at a provincial cancer agency. The purpose of this study was to understand the perspectives and experience of oncology HCPs who took part in the study, as well as withdrew, regarding the feasibility and the challenges associated with assessment and documentation of CM use. Methods: An interpretive descriptive study methodology was used. A total of 20 HCPs who participated, managed staff, or withdrew from the study were interviewed. Interviews were recorded and transcribed verbatim. Thematic, inductive analysis was used to code and analyse themes from the data. Results: Oncology HCPs who participated in the study felt that CM use was common among patients and recognized it went underreported and was poorly documented. Facilitating factors for the implementation of standardized assessment and documentation of CM use included having a standard assessment form, embedding assessment within existing screening processes, and leveraging self-report by patients. Barriers included limited time, perceived lack of knowledge regarding CM, hesitancy to engage patients in discussion about CM, and lack of institutional support and resources. Recommendations for future implementation included having explicit policies related to addressing CM at point-of-care, leveraging existing electronic patient reporting systems, including the electronic health record, and developing information resources and training for HCPs. Conclusions: With the high prevalence of CM use among individuals with cancer, oncology HCPs perceive addressing CM use to be feasible and an essential part of high-quality, person-centered cancer care. Institutional and professional challenges, however, must be overcome to support the assessment, documentation and discussion of CM in patient-HCP consultations.
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Affiliation(s)
- Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Cody Z Watling
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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22
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Mascaro JS, Catic A, Srivastava M, Diller M, Rana S, Escoffery C, Master V. Examination of Provider and Patient Knowledge, Beliefs, and Preferences in Integrative Oncology at a National Cancer Institute-Designated Comprehensive Cancer Center. INTEGRATIVE MEDICINE REPORTS 2022; 1:66-75. [PMID: 35966884 PMCID: PMC9372903 DOI: 10.1089/imr.2021.0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 11/13/2022]
Abstract
Purpose The use of integrative approaches for symptom management is highly prevalent among patients undergoing cancer treatment and among cancer survivors and is increasingly endorsed by clinical practice guidelines. However, access to and implementation of integrative oncology (IO) approaches are hindered by barriers at multiple levels, including logistic, geographic, financial, organizational, and cultural barriers. The goal of this mixed-method study was to examine oncology provider and patient knowledge, beliefs, and preferences in IO to identify facilitators, barriers, and recommendations for implementation of IO modalities. Materials and Methods Data sources included patient surveys and provider semistructured interviews. Patients were in active treatment (n = 100) and survivors (n = 100) of heterogeneous cancer types. Patient and survivor surveys interrogated: (1) interest in types of IO approaches; and (2) preferences for delivery modality, frequency, and location. Providers (n = 18) were oncologists and nurse navigators working with diverse cancer types. Interviews queried their knowledge of and attitudes about IO, about their patients' needs for symptom management, and for recommendations for implementation of IO approaches in their clinic. We used the Consolidated Framework for Implementation Research framework to systematically analyze provider interviews. Results The primary interests reported among actively treated patients and survivors were massage therapy, acupuncture, and wellness/exercise. Most patients expressed interest in both group and individual sessions and in telehealth or virtual reality options. Emergent themes from provider interviews identified barriers and facilitators to implementing IO approaches in both the internal and external settings, as well as for the implementation process. Conclusion The emphasis on mind-body interventions as integrative rather than alternative highlights the importance of interventions as evidence-based, comprehensive, and integrated into health care. Gaining simultaneous perspectives from both patients and physicians generated insights for the implementation of IO care into complex clinical systems within a comprehensive cancer center.
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Affiliation(s)
- Jennifer S Mascaro
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Almira Catic
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Meha Srivastava
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Maggie Diller
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Shaheen Rana
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Cam Escoffery
- Winship Cancer Institute, Emory University, Atlanta, GA, USA.,Department of Behavioral, Social, Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Viraj Master
- Department of Urology, Emory University, Atlanta, GA, USA
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23
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Dietary Supplement Use and Interactions with Tamoxifen and Aromatase Inhibitors in Breast Cancer Survivors Enrolled in Lifestyle Interventions. Nutrients 2021; 13:nu13113730. [PMID: 34835986 PMCID: PMC8621720 DOI: 10.3390/nu13113730] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 11/20/2022] Open
Abstract
The use of dietary supplements is common in the general population and even more prevalent among cancer survivors. The World Cancer Research Fund/American Institute for Cancer Research specifies that dietary supplements should not be used for cancer prevention. Several dietary supplements have potential pharmacokinetic and pharmacodynamic interactions that may change their clinical efficacy or potentiate adverse effects of the adjuvant endocrine therapy prescribed for breast cancer treatment. This analysis examined the prevalence of self-reported dietary supplement use and the potential interactions with tamoxifen and aromatase inhibitors (AIs) among breast cancer survivors enrolled in three randomized controlled trials of lifestyle interventions conducted between 2010 and 2017. The potential interactions with tamoxifen and AIs were identified using the Natural Medicine Database. Among 475 breast cancer survivors (2.9 (mean) or 2.5 (standard deviation) years from diagnosis), 393 (83%) reported using dietary supplements. A total of 108 different types of dietary supplements were reported and 36 potential adverse interactions with tamoxifen or AIs were identified. Among the 353 women taking tamoxifen or AIs, 38% were taking dietary supplements with a potential risk of interactions. We observed a high prevalence of dietary supplement use among breast cancer survivors and the potential for adverse interactions between the prescribed endocrine therapy and dietary supplements was common.
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El-Khouly FE, Adil SM, Wiese M, Hulleman E, Hendrikse NH, Kaspers GJL, Kramm CM, Veldhuijzen van Zanten SEM, van Vuurden DG. Complementary and alternative medicine in children with diffuse intrinsic pontine glioma-A SIOPE DIPG Network and Registry study. Pediatr Blood Cancer 2021; 68:e29061. [PMID: 33942498 DOI: 10.1002/pbc.29061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/27/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Diffuse intrinsic pontine glioma (DIPG) is a rare and aggressive childhood brainstem malignancy with a 2-year survival rate of <10%. This international survey study aims to evaluate the use of complementary and alternative medicine (CAM) in this patient population. METHODS Parents and physicians of patients with DIPG were asked to participate in a retrospective online survey regarding CAM use during time of illness. RESULTS Between January and May 2020, 120 parents and 75 physicians contributed to the online survey. Most physicians estimated that <50% of their patients used CAM, whereas 69% of the parents reported using CAM to treat their child during time of illness. Cannabis was the most frequently used form of CAM, followed by vitamins and minerals, melatonin, curcumin, and boswellic acid. CAM was mainly used with the intention of direct antitumor effect. Other motivations were to treat side effects of chemotherapy or to increase comfort of the child. Children diagnosed from 2016 onwards were more likely to use CAM (χ2 = 6.08, p = .014). No significant difference was found between CAM users and nonusers based on ethnicity (χ2 = 4.18, p = .382) or country of residence (χ2 = 9.37, p = .154). Almost 50% of the physicians do not frequently ask their patients about possible CAM use. CONCLUSION This survey demonstrates that worldwide, a considerable number of patients with DIPG use CAM. Physicians should be more aware of potential CAM use and actively discuss the topic. In addition, more research is needed to gain knowledge about possible anticancer effects of CAM and (positive/negative) interactions with conventional therapies.
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Affiliation(s)
- Fatma E El-Khouly
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Syed M Adil
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maria Wiese
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Esther Hulleman
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - N Harry Hendrikse
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gertjan J L Kaspers
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Christof M Kramm
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Sophie E M Veldhuijzen van Zanten
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Dannis G van Vuurden
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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A pre-post evaluation of oncology healthcare providers' knowledge, attitudes, and practices following the implementation of a complementary medicine practice guideline. Support Care Cancer 2021; 29:7487-7495. [PMID: 34100136 DOI: 10.1007/s00520-021-06318-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Complementary medicine (CM) use is prevalent among cancer patients, yet it is often not assessed by oncology healthcare providers (HCPs). The purpose of this study was to evaluate oncology HCPs' knowledge, attitudes, and practices surrounding CM use before and after the implementation of a practice guideline focusing on standardizing assessment and documentation of CM. METHODS Oncology HCPs across a provincial cancer agency were invited to participate in the study. The implementation strategy included an initial education session for HCPs and standardized CM assessment forms. Pre-post surveys assessing knowledge, attitudes, and practices related to CM were completed by HCPs prior to attending the education session and following the 4-month implementation period. Paired t-tests were conducted to determine differences between baseline and follow-up surveys. RESULTS A total of 31 oncology HCPs completed both baseline and follow-up surveys, with over 3700 patient CM assessment forms being completed during the 4-month study period. At the end of the study, HCPs reported greater CM knowledge (p < 0.001), readiness to support cancer patients' CM decisions (p = 0.002), and willingness to consult with another HCP about CM (p = 0.004). No significant change in HCPs' reported attitudes towards CM, or other clinical practices related to CM were observed. CONCLUSION Implementing a practice guideline, including a CM education session and a standardized assessment form, was found to improve oncology HCPs' self-reported CM knowledge and readiness to answer cancer patients' questions about CM. The findings provide support for future knowledge translation research aimed at standardizing how CM is addressed within cancer care settings.
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26
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Karim S, Benn R, Carlson LE, Fouladbakhsh J, Greenlee H, Harris R, Henry NL, Jolly S, Mayhew S, Spratke L, Walker EM, Zebrack B, Zick SM. Integrative Oncology Education: An Emerging Competency for Oncology Providers. Curr Oncol 2021; 28:853-862. [PMID: 33578660 PMCID: PMC7985783 DOI: 10.3390/curroncol28010084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/22/2021] [Accepted: 02/03/2021] [Indexed: 11/24/2022] Open
Abstract
A growing number of cancer patients use complementary and alternative therapies during and after conventional cancer treatment. Patients are often reluctant to discuss these therapies with their oncologist, and oncologists may have limited knowledge and confidence on how to advise patients on the appropriate use. Integrative oncology is a patient-centered, evidence-informed field that utilizes mind-body practices, lifestyle modifications and/or natural products interwoven with conventional cancer treatment. It prioritizes safety and best available evidence to offer appropriate interventions alongside conventional care. There are few opportunities for oncologists to learn about integrative oncology. In this commentary, we highlight the Integrative Oncology Scholars (IOS) program as a means to increase competency in this growing field. We provide an overview of several integrative oncology modalities that are taught through this program, including lifestyle modifications, physical activity, and mind-body interventions. We conclude that as more evidence is generated in this field, it will be essential that oncology healthcare providers are aware of the prevalent use of these modalities by their patients and cancer centers include Integrative Oncology trained physicians and other healthcare professionals in their team to discuss and recommend evidence-based integrative oncology therapies alongside conventional cancer treatments to their patients.
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Affiliation(s)
- Safiya Karim
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Rita Benn
- Department of Family Medicine, University of Michigan, Ann Arbor, MI 48109, USA; (R.B.); (S.M.Z.)
| | - Linda E. Carlson
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | | | - Heather Greenlee
- Public Health Sciences & Clinical Research Divisions, Fred Hutchison Cancer Research Centre, Seattle, WA 98109, USA;
- Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
- Seattle Cancer Care Alliance, Seattle, WA 98109, USA
| | - Rick Harris
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, USA;
| | - N. Lynn Henry
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Sabrina Mayhew
- College of Nursing, Wayne State University, Detroit, MI 48202, USA;
| | - Lisa Spratke
- Division of Gynecologic Oncology, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Eleanor M. Walker
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI 48202, USA;
| | - Bradley Zebrack
- School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Suzanna M. Zick
- Department of Family Medicine, University of Michigan, Ann Arbor, MI 48109, USA; (R.B.); (S.M.Z.)
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI 48109, USA
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27
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Exploring Herbal Medicine Use during Palliative Cancer Care: The Integrative Physician as a Facilitator of Pharmacist-Patient-Oncologist Communication. Pharmaceuticals (Basel) 2020; 13:ph13120455. [PMID: 33322582 PMCID: PMC7763590 DOI: 10.3390/ph13120455] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 12/13/2022] Open
Abstract
Oncology patients frequently use herbal and other forms of complementary medicine, often without the knowledge of oncologists, pharmacists, and other healthcare professionals responsible for their care. Oncology healthcare professionals may lack the knowledge needed to guide their patients on the safe and effective use of herbal medicinal products, a number of which have potentially harmful effects, which include direct toxicity and negative herb–drug interactions. The current review addresses the prevalence and expectations of oncology patients from herbal medicine, as well as evidence for the beneficial or harmful effects of this practice (potential and actual), especially when the herbal products are used in conjunction with anticancer agents. Models of integrative oncology care are described, in which open and effective communication among oncologists, pharmacists, and integrative physicians on the use of herbal medicine by their patients occurs. This collaboration provides patients with a nonjudgmental and multidisciplinary approach to integrative medicine, echoing their own health-belief models of care during conventional cancer treatments. The role of the integrative physician is to facilitate this process, working with oncologists and pharmacists in the fostering of patient-centered palliative care, while ensuring a safe and effective treatment environment. Case scenario: W. is a 56 year old female artist who was recently diagnosed with localized hormone receptor-positive breast cancer. Following lumpectomy and sentinel node dissection, she is scheduled to begin adjuvant chemotherapy with a regimen which will include adriamycin, cyclophosphamide, and paclitaxel (AC-T protocol). She is worried about developing peripheral neuropathy and its impact on her ability to paint, and she asks about a number of dietary supplements which she heard could prevent this from happening: omega-3, vitamin E, alpha-lipoic acid, and acetyl-l-carnithine. She is concerned, however, that the supplements may negatively interact with her chemotherapy regimen.
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Gerber DE, Sheffield TY, Beg MS, Williams EL, Clark VL, Xie Y, Holbein MEB, Skinner CS, Lee SJC. Experience, Perceptions, and Recommendations Concerning COVID-19-Related Clinical Research Adjustments. J Natl Compr Canc Netw 2020; 19:505-512. [PMID: 33027755 DOI: 10.6004/jnccn.2020.7643] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/19/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND During the COVID-19 public health emergency, the FDA and NIH altered clinical trial requirements to protect participants and manage study conduct. Given their detailed knowledge of research protocols and regular contact with patients, clinicians, and sponsors, clinical research professionals offer important perspectives on these changes. METHODS We developed and distributed an anonymous survey assessing COVID-19-related clinical trial adjustment experiences, perceptions, and recommendations to Clinical Research Office personnel at the Harold C. Simmons Comprehensive Cancer Center. Responses were compared using the Fisher exact test. RESULTS A total of 94 of 109 contacted research personnel (87%) responded. Among these individuals, 58% had >5 years' professional experience in clinical research, and 56% had personal experience with a COVID-19-related change. Respondents perceived that these changes had a positive impact on patient safety; treatment efficacy; patient and staff experience; and communication with patients, investigators, and sponsors. More than 90% felt that positive changes should be continued after COVID-19. For remote consent, telehealth, therapy shipment, off-site diagnostics, and remote monitoring, individuals with personal experience with the specific change and individuals with >5 years' professional experience were numerically more likely to recommend continuing the adjustment, and these differences were significant for telehealth (P=.04) and therapy shipment (P=.02). CONCLUSIONS Clinical research professionals perceive that COVID-19-related clinical trial adjustments positively impact multiple aspects of study conduct. Those with greatest experience-both specific to COVID-19-related changes and more generally-are more likely to recommend that these adjustments continue in the future.
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Affiliation(s)
- David E Gerber
- 1Department of Internal Medicine, Division of Hematology-Oncology.,2Harold C. Simmons Comprehensive Cancer Center, and.,3Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Thomas Y Sheffield
- 3Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - M Shaalan Beg
- 1Department of Internal Medicine, Division of Hematology-Oncology.,2Harold C. Simmons Comprehensive Cancer Center, and
| | | | | | - Yang Xie
- 2Harold C. Simmons Comprehensive Cancer Center, and.,3Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - M E Blair Holbein
- 3Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Celette Sugg Skinner
- 2Harold C. Simmons Comprehensive Cancer Center, and.,3Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Simon J Craddock Lee
- 2Harold C. Simmons Comprehensive Cancer Center, and.,3Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
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Powers-James C, Alvarez A, Milbury K, Barbo A, Daunov K, Lopez G, Cohen L, Delgado-Guay MO, Olopade OI, Lee RT. The Influence of Spirituality and Religiosity on US Oncologists' Personal Use of and Clinical Practices Regarding Complementary and Alternative Medicine. Integr Cancer Ther 2020; 19:1534735420945769. [PMID: 32830556 PMCID: PMC7448258 DOI: 10.1177/1534735420945769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Cancer patients frequently use complementary and alternative medicine (CAM), and spirituality has been associated with CAM use among patients. We evaluated how oncologists’ spirituality and religiosity are associated with personal use and patient recommendations for CAM. Methods: A survey was mailed to 1000 medical oncologists in the United States. The questionnaire asked about oncologists’ approaches to CAM use by patients, focusing on the use of herbs and supplement (HS), and about religiosity and spirituality. Results: Of 937 deliverable questionnaires, 392 were returned (response rate 42%). Respondents were mostly men (71%) and Caucasian (76%), with a median age of 48. Approximately 16% reported no religion, 19% Jewish, 24% Catholic, 28% Christian, and 13% other religions. Eighteen percent reported attending religious services at least once a week, including 15% who attend several times per week. Twenty-eight percent reported high theological pluralism (skepticism regarding whether one religion is comprehensively and uniquely true); 58% described themselves as moderately or very spiritual. Self-reported spirituality and religious service attendance were associated with using CAM personally and recommending HS to patients. In multivariate analyses, moderate-high spirituality and attending religious services less than monthly was positively associated with personal use of CAM: odds ratio (OR) = 3.10 (confidence interval [CI] = 1.5-6.5) and OR = 3.04 (CI = 1.5-6.6), respectively. Physicians with moderate to high spirituality were more likely to report recommending CAM in general (OR = 3.07, CI = 1.3-7.1), but less likely to report recommending HS (OR = 0.33, CI = 0.14-0.75). Conclusion: Self-reported spirituality is a significant factor among US oncologists’ decision to use CAM and recommend CAM to patients.
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Affiliation(s)
| | | | - Kathrin Milbury
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Gabriel Lopez
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lorenzo Cohen
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Richard T Lee
- University Hospitals, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
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30
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Lee RT, Greenlee H. Don't ask, don't tell: It's time to talk about complementary, alternative, and integrative medicine with our patients. Cancer 2020; 126:2968-2970. [PMID: 32286684 DOI: 10.1002/cncr.32844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Richard T Lee
- Division of Hematology and Oncology, Department of Medicine, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, Ohio.,Supportive and Integrative Oncology Program, University Hospitals Seidman Cancer Center, Cleveland, Ohio.,Case Center for Integrative Oncology, Case Western Reserve University Comprehensive Cancer Center, Cleveland, Ohio
| | - Heather Greenlee
- Cancer Prevention Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington.,Integrative Medicine Program, Seattle Cancer Care Alliance, Seattle, Washington
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31
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Nissen N, Laursen SS, Rossau HK. Communication about Complementary and Alternative Medicine in Danish Oncological Settings: An Intervention Study. Complement Med Res 2020; 27:392-400. [PMID: 32541148 DOI: 10.1159/000507565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/27/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE Communication about complementary and alternative medicine (CAM) between cancer patients and health professionals rarely takes place. This article reports on an intervention study that aimed to support communication about the use and effects of CAM between cancer patients and care providers. METHODS The intervention consisted of the use of evidence-based information material (website; leaflet) about the effects of CAM for cancer. Focus groups with cancer patients, relatives, nurses and doctors (n = 50) determined the preferred content and format of materials and evaluated the intervention. The information material was informed by a related systematic metareview of literature. A survey identified patient participants' CAM use, information sources, and the extent of communication about CAM before and after the intervention. RESULTS No significant impact of the intervention on communication about CAM for cancer patients, patients' CAM use or sources of information was identified. Health professionals disseminated the leaflet only in response to patients raising the topic; the website was not accessed during consultations. The intervention and information materials were well received. CONCLUSION Cancer patients and care providers wish to improve communication about CAM. Nevertheless, patients and professionals wait for the other to broach the subject of CAM. This reflects a "culture of waiting."
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Affiliation(s)
- Nina Nissen
- REHPA, Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark,
| | - Sara Seerup Laursen
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Henriette Knold Rossau
- REHPA, Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark
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Murphy CC, Craddock Lee SJ, Geiger AM, Cox JV, Ahn C, Nair R, Gerber DE, Halm EA, McCallister K, Skinner CS. A randomized trial of mail and email recruitment strategies for a physician survey on clinical trial accrual. BMC Med Res Methodol 2020; 20:123. [PMID: 32429848 PMCID: PMC7236338 DOI: 10.1186/s12874-020-01014-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 05/11/2020] [Indexed: 11/21/2022] Open
Abstract
Background Patient participation in cancer clinical trials is suboptimal. A challenge to capturing physicians’ insights about trials has been low response to surveys. We conducted a study using varying combinations of mail and email to recruit a nationally representative sample of medical, surgical, and radiation oncologists to complete a survey on trial accrual. Methods We randomly assigned eligible physicians identified from the American Medical Association MasterFile (n = 13,251) to mail- or email-based recruitment strategies. Mail-based recruitment included a survey packet with: (1) cover letter describing the survey and inviting participation; (2) paper copy of the survey and postage-paid return envelope; and (3) a web link for completing the survey online. Email-based recruitment included an e-mail describing the survey and inviting participation, along with the web link to the survey, and a reminder postcard 2 weeks later. Results Response was higher for mail-based (11.8, 95% CI 11.0–12.6%) vs. email-based (4.5, 95% CI 4.0–5.0%) recruitment. In email-based recruitment, only one-quarter of recipients opened the email, and even fewer clicked on the link to complete the survey. Most physicians in mail-based recruitment responded after the first invitation (362 of 770 responders, 47.0%). A higher proportion of responders vs. non-responders were young (ages 25–44 years), men, and radiation or surgical (vs. medical) oncologists. Conclusions Most physicians assigned to mail-based recruitment actually completed the survey online via the link provided in the cover letter, and those in email-based recruitment did not respond until they received a reminder postcard by mail. Providing the option to return a paper survey or complete it online may have further increased participation in the mail-based group, and future studies should examine how combinations of delivery mode and return options affect physicians’ response to surveys.
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Affiliation(s)
- Caitlin C Murphy
- Division of Epidemiology, Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA. .,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA. .,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.
| | - Simon J Craddock Lee
- Division of Epidemiology, Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Ann M Geiger
- Healthcare Delivery Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - John V Cox
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Chul Ahn
- Division of Epidemiology, Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Rasmi Nair
- Division of Epidemiology, Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - David E Gerber
- Division of Epidemiology, Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Ethan A Halm
- Division of Epidemiology, Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Katharine McCallister
- Division of Epidemiology, Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Celette Sugg Skinner
- Division of Epidemiology, Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
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Keene MR, Heslop IM, Sabesan SS, Glass BD. Knowledge, attitudes and practices of health professionals toward complementary and alternative medicine in cancer care – a systematic review. ACTA ACUST UNITED AC 2020. [DOI: 10.1080/17538068.2020.1755202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Martin R. Keene
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Ian M. Heslop
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Sabe S. Sabesan
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Beverley D. Glass
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
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34
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McLennan A, Kerba M, Subnis U, Campbell T, Carlson LE. Health care provider preferences for, and barriers to, cannabis use in cancer care. ACTA ACUST UNITED AC 2020; 27:e199-e205. [PMID: 32489269 DOI: 10.3747/co.27.5615] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Limited research has been conducted about the perspectives of oncology health care providers (hcps) concerning the use of cannabis in cancer care and their potential role in advising patients. We sought to determine the barriers encountered by hcps with respect to medical cannabis and their preferred practices in this area. Methods An anonymous survey about cannabis was distributed to oncology hcps at the Tom Baker Cancer Centre in Calgary, Alberta. The 45-question survey measured the opinions of hcps about cannabis use and authorization in oncology. Results Of 103 oncology hcps who participated in the study, 75% were women. By hcp type, the most commonly reported professional groups were oncology nurse (40%), radiation therapist (9%), and pharmacist (6%). Of respondents, 75% reported providing direct care to cancer patients. More than half (69%) had spoken to a patient about cannabis in the preceding month, and 84% believed that they lacked sufficient knowledge about cannabis to make recommendations. Barriers such as monitoring the patient's use of cannabis (54%), prescribing an accurate dose (61%) or strain (53%), and having insufficient research (50%) were most commonly reported. More than half of hcps (53%) would be interested in receiving more information or training about the use of cannabis in oncology. Conclusions The survey indicated that this group of oncology hcps believed that they lacked sufficient knowledge about cannabis to make recommendations to patients. In addition to that lack of knowledge, a number of notable barriers were reported, and more than half the hcps indicated interest in learning more about cannabis in the future.
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Affiliation(s)
- A McLennan
- Department of Psychosocial Oncology, Holy Cross Cancer Centre, University of Calgary, Calgary, AB
| | - M Kerba
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB
| | - U Subnis
- Department of Psychosocial Oncology, Holy Cross Cancer Centre, University of Calgary, Calgary, AB
| | - T Campbell
- Department of Psychosocial Oncology, Holy Cross Cancer Centre, University of Calgary, Calgary, AB
| | - L E Carlson
- Department of Psychosocial Oncology, Holy Cross Cancer Centre, University of Calgary, Calgary, AB
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35
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Witt CM, Helmer SM, Schofield P, Wastell M, Canella C, Thomae AV, Rogge AA. Training oncology physicians to advise their patients on complementary and integrative medicine: An implementation study for a manual‐guided consultation. Cancer 2020; 126:3031-3041. [DOI: 10.1002/cncr.32823] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/12/2019] [Accepted: 11/28/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Claudia M. Witt
- Institute for Complementary and Integrative Medicine University of Zurich, University Hospital Zurich Zurich Switzerland
- Institute for Social Medicine, Epidemiology, and Health Economics Charite ‐ University Medicine Berlin, Humboldt University Berlin, and Berlin Institute of Health Berlin Germany
| | - Stefanie M. Helmer
- Institute for Social Medicine, Epidemiology, and Health Economics Charite ‐ University Medicine Berlin, Humboldt University Berlin, and Berlin Institute of Health Berlin Germany
| | - Penelope Schofield
- Department of Psychology and Iverson Health Innovation Research Institute Swinburne University Melbourne Victoria Australia
- Behavioral Sciences Unit, Department of Cancer Experiences Research Peter MacCallum Cancer Center Melbourne Victoria Australia
- Sir Peter MacCallum Department of Oncology The University of Melbourne Parkville Victoria Australia
| | - Marisa Wastell
- Faculty of Behavioral and Social Sciences Institute of Sociology University of Technology Chemnitz Germany
| | - Claudia Canella
- Institute for Complementary and Integrative Medicine University of Zurich, University Hospital Zurich Zurich Switzerland
| | - Anita V. Thomae
- Institute for Complementary and Integrative Medicine University of Zurich, University Hospital Zurich Zurich Switzerland
| | - Alizé A. Rogge
- Institute for Social Medicine, Epidemiology, and Health Economics Charite ‐ University Medicine Berlin, Humboldt University Berlin, and Berlin Institute of Health Berlin Germany
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Li S, Odedina S, Agwai I, Ojengbede O, Huo D, Olopade OI. Traditional medicine usage among adult women in Ibadan, Nigeria: a cross-sectional study. BMC Complement Med Ther 2020; 20:93. [PMID: 32192455 PMCID: PMC7083039 DOI: 10.1186/s12906-020-02881-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 03/05/2020] [Indexed: 12/24/2022] Open
Abstract
Background Previous research has revealed high rates of traditional medicine usage in Nigeria. Reports of widespread contamination of herbal medicine products and higher rates of noncompliance with Western medications among traditional medicine users have raised concerns about the safety of traditional medicine use. Few studies have explored how demographic factors predict rates of traditional medicine use in the general population. Methods We conducted interviews of 748 adult women recruited from the communities in the city of Ibadan, Nigeria from 2013 to 2015. A structured questionnaire was created to collect data on rates of traditional medicine use and demographic factors such as age, education, ethnicity, and occupation. Multivariate logistic regressions were run to examine factors related to traditional medicine use, and the effects were measured with odds ratios (OR) along with 95% confidence interval (95%CI). Results The overall proportion of traditional medicine use was 81.6%. Women from the Ibo and Hausa ethnic groups were significantly less likely to use traditional medicine than the majority Yoruba group (OR 0.25, 95%CI 0.10–0.63;, OR 0.43, 95%CI 0.24–0.76) respectively). In addition, educated women were less likely than their non-educated counterparts to have used traditional medicine, with the biggest effect seen in women with a secondary education (OR 0.42, 95%CI 0.21–0.85). Conclusions We found a high rate of traditional medicine usage, consistent with that found in prior research. A novel finding was the significance of ethnicity as a predictor for usage rates.
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Affiliation(s)
- Suellen Li
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Stella Odedina
- Center for Population and Reproductive Health, College of Medicine, University of Ibadan, UCH, Ibadan, Nigeria
| | - Imaria Agwai
- Center for Population and Reproductive Health, College of Medicine, University of Ibadan, UCH, Ibadan, Nigeria
| | - Oladosu Ojengbede
- Center for Population and Reproductive Health, College of Medicine, University of Ibadan, UCH, Ibadan, Nigeria
| | - Dezheng Huo
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Olufunmilayo I Olopade
- Center for Clinical Cancer Genetics and Global Health, Department of Medicine, University of Chicago, Chicago, IL, USA
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Ludwick A, Corey K, Meghani S. Racial and Socioeconomic Factors Associated with the Use of Complementary and Alternative Modalities for Pain in Cancer Outpatients: An Integrative Review. Pain Manag Nurs 2020; 21:142-150. [DOI: 10.1016/j.pmn.2019.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/19/2019] [Accepted: 08/23/2019] [Indexed: 11/30/2022]
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Trabulsy P. COMPLEMENTARY AND ALTERNATIVE MEDICINE. Cancer 2019. [DOI: 10.1002/9781119645214.ch27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Farhoudi F, Salehi A, Vojoud M, Molavi Vardanjani H. Assessment of the complementary and integrative medicine utilization among patients with multiple sclerosis using a translated and adapted version of the international questionnaire (I-CAM-QP): A cross-sectional study in Southern Iran. Complement Ther Med 2019; 46:47-53. [PMID: 31519287 DOI: 10.1016/j.ctim.2019.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/07/2019] [Accepted: 07/23/2019] [Indexed: 12/13/2022] Open
Abstract
AIMS To assess the prevalence of and factors related to complementary and integrative medicine (CIM) use among multiple sclerosis (MS) patients, using a translated and adapted version of a standard international questionnaire. METHODS International complementary and alternative medicine questionnaire (I-CAM-Q) was used. A cross-sectional study was done to assess the prevalence of and factors associated with CIM use among MS patients in Southern Iran. Patients who were randomly selected from MS registry center, were interviewed via phone calls. RESULTS Three hundred patients were enrolled in the study; 69% of them were female. Their mean age was 36.6±8.53 years and the mean duration of the disease was 5.6 ± 4.22 years. In all, 99.3% (95% CI) of the patients had used at least one type of CIM. Herbal medicines and dietary supplements were the most commonly used CIM type (97.3%; 95% CI). Praying was the most common modality among all CIM subgroups (81.3%; 95% CI). Long term illness (MS) was selected as the main reason for the last use of all CIM types. Having non-tertiary education and having sequel due to MS were related to visiting a CIM provider (adjusted odds ratio (AOR) = 2.32, 95% confidence interval (CI) = 1.22-4.43), (AOR = 2.67, 95% CI = 1.47-4.83) respectively. Being female was related to the use of self-help practices (AOR = 3.41, 95% CI = 1.5-7.72). CONCLUSION There is a high prevalence of CIM use among MS patients. Therefore, patient- physician communication about CIM use should be emphasized.
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Affiliation(s)
- Farinaz Farhoudi
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Alireza Salehi
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mina Vojoud
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Complementary medicine use during cancer treatment and potential herb-drug interactions from a cross-sectional study in an academic centre. Sci Rep 2019; 9:5078. [PMID: 30911084 PMCID: PMC6434040 DOI: 10.1038/s41598-019-41532-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 03/12/2019] [Indexed: 12/21/2022] Open
Abstract
Complementary medicine (CM) is used by one third to one half of cancer patients throughout the world. The objective of this study was to describe the prevalence of CM use and the potential for interactions with cancer treatments in an academic oncology centre. A cross-sectional study was conducted among patients undergoing current cancer treatment. Among 132 included patients, 56% had used CM since their cancer diagnosis and 45% were using CM during cancer treatment at the time of the survey. The main CM used were green tea (35%), herbal tea (35%), homeopathy (27%), dietary supplements (27%), and herbal medicines (27%). A small majority of patients (58%) spontaneously mentioned the use of CM to their oncologist. Of 42 identified combinations of concomitant use of biologically based CM and anticancer agents among the study patients, the potential for pharmacokinetic interactions of clinical relevance was not expected in 17 combinations (40%), hypothetical and deemed unlikely in 23 (55%), and of probable low clinical relevance in 2 (5%). Considering the high prevalence of CM use, active enquiries should be made by healthcare professionals to detect symptoms that may relate to CM tolerance and effects or that suggest interactions between CM and cancer treatments.
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Aoshima E, Mibu M, Kubota M, Hashida T. Use of Supplements by Japanese Cancer Patients Receiving Outpatient Cancer Chemotherapy. J Altern Complement Med 2018; 24:1003-1006. [PMID: 30247953 DOI: 10.1089/acm.2018.0078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Emi Aoshima
- 1 Department of Human Life and Environment, Nara Women's University , Nara, Japan
| | - Marie Mibu
- 1 Department of Human Life and Environment, Nara Women's University , Nara, Japan
| | - Masaru Kubota
- 1 Department of Human Life and Environment, Nara Women's University , Nara, Japan .,2 Department of Food and Nutrition, Faculty of Agriculture, Ryukoku University , Shiga, Japan
| | - Tohru Hashida
- 3 Department of Pharmacy, Kobe City Medical Center General Hospital , Hyogo, Japan
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Smith CA, Hunter J, Delaney GP, Ussher JM, Templeman K, Grant S, Oyston E. Integrative oncology and complementary medicine cancer services in Australia: findings from a national cross-sectional survey. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 18:289. [PMID: 30373631 PMCID: PMC6206936 DOI: 10.1186/s12906-018-2357-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/19/2018] [Indexed: 01/01/2023]
Abstract
Background Individuals living with and beyond a cancer diagnosis are increasingly using complementary therapies and medicines (CM) to enhance the effectiveness of cancer treatment, manage treatment-related side effects, improve quality-of-life, and promote self-efficacy. In response to the increasing use and demand for CM by cancer patients, interest in the implementation of Integrative Oncology (IO) services that provide CM alongside conventional cancer care in Australia and abroad has developed. The extent that cancer services in Australia are integrating CM is uncertain. Thus, the aim of this study was to identify IO services in Australia and explore barriers and facilitators to IO service provision. Methods A national, cross-sectional survey of healthcare organisations was conducted in 2016. Organisations in the public and private sectors, including not-for-profit organisations that provided cancer care in hospital or community setting, were included. Results A response rate of 93.2% was achieved (n = 275/295). Seventy-one organisations (25.8%) across all states/territories, except the Northern Territory, offered IO albeit in a limited amount by many. Most common IO services included massage, psychological-wellbeing, and movement modalities in hospital outpatient or inpatient settings. There were only a few instances where biological-based complementary medicine (CM) therapies were prescribed. Funding was often mixed, including patient contributions, philanthropy, funding by the organisation, and volunteer practitioners. Of the 204 non-IO providers, 80.9% had never provided any IO service. Overwhelmingly, the most common barrier to IO was a lack of funding, followed by uncertainty about patient demand, choice of services, and establishing such services. Less-common barriers were a lack of evidence, and support from oncologists or management. More funding, education and training, and building the evidence-base for CM were the most commonly suggested solutions. Conclusion IO is increasingly being provided in Australia, although service provision remains limited or non-existent in many areas. Mismatches appear to exist between low IO service provision, CM evidence, and high CM use by cancer patients. Greater strategic planning and policy guidance is indicated to ensure the appropriate provision of, and equitable access to IO services for all Australian cancer survivors. Electronic supplementary material The online version of this article (10.1186/s12906-018-2357-8) contains supplementary material, which is available to authorized users.
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Zick SM, Czuhajewski C, Fouladbakhsh JM, Greenlee H, Harris RE, Henry NL, Jolly S, Khabir T, Perlmutter J, Remington T, Snyder D, Spratke L, Zebrack B, Zettell E, Benn R. Integrative Oncology Scholars Program: A Model for Integrative Oncology Education. J Altern Complement Med 2018; 24:1018-1022. [PMID: 30247974 DOI: 10.1089/acm.2018.0184] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Oncology providers are often confronted by patients who use complementary or alternative therapies, but have limited knowledge or confidence on how to advise patients on appropriate use. Despite this, there are few opportunities for oncology providers to learn about complementary or alternative therapies, while at the same time there is a high demand for integrative oncology (IO) training. To address a gap in IO educational opportunities, and particularly for nonphysicians, we created the Integrative Oncology Scholars (IOS) Program. The program's goal is to train 100 IO leaders and facilitate partnerships between them and complementary practitioners. DESIGN Four iterations of a year-long National Cancer Institute-funded educational program that combines in-person team-based learning and eLearning to teach the evidence, application, and philosophy supporting IO. SETTINGS In-person sessions take place at the University of Michigan, and eLearning is implemented using a Canvas website (Instructure, Inc., Salt Lake City, UT). SUBJECTS Nurses, social workers, physician assistants, psychologists, physicians, pharmacists, and physical/occupational therapists with active oncology practices. Educational intervention: Four cohorts of 25 oncology providers per year will learn the evidence base for complementary and alternative approaches to a wide number of oncology topics, including symptom control, dietary supplements commonly used by cancer patients, diet, and the utility of specific integrative approaches for common oncology side-effects such as fatigue. OUTCOME MEASURES A mixed methods approach will be used to evaluate overall IOS Program progress and individual scholar's impact on IO research, education, and clinical endeavors. RESULTS The first cohort of 25 IOS has been recruited and their education will begin in Summer 2018. Scholars come from 13 states and represent 23 different healthcare systems. CONCLUSIONS The IOS Program has the potential to increase the number of trained IO providers, educators, and researchers in the United States.
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Affiliation(s)
- Suzanna Maria Zick
- 1 Department of Family Medicine, University of Michigan , Ann Arbor, Michigan.,2 Department of Nutritional Sciences, University of Michigan , Ann Arbor, Michigan
| | | | | | - Heather Greenlee
- 4 Department of Medical Oncology, Fred Hutchinson Cancer Research Center , Seattle, Washington
| | | | - Norah Lynn Henry
- 5 Department of Internal Medicine, University of Utah , Salt Lake City, Utah
| | - Shruti Jolly
- 1 Department of Family Medicine, University of Michigan , Ann Arbor, Michigan
| | - Tohfa Khabir
- 1 Department of Family Medicine, University of Michigan , Ann Arbor, Michigan
| | | | - Tami Remington
- 1 Department of Family Medicine, University of Michigan , Ann Arbor, Michigan
| | - Detrick Snyder
- 1 Department of Family Medicine, University of Michigan , Ann Arbor, Michigan
| | - Lisa Spratke
- 1 Department of Family Medicine, University of Michigan , Ann Arbor, Michigan
| | - Brad Zebrack
- 1 Department of Family Medicine, University of Michigan , Ann Arbor, Michigan
| | - Erin Zettell
- 1 Department of Family Medicine, University of Michigan , Ann Arbor, Michigan
| | - Rita Benn
- 1 Department of Family Medicine, University of Michigan , Ann Arbor, Michigan
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Gazzé G. Combination therapy for metastatic melanoma: a pharmacist's role, drug interactions & complementary alternative therapies. Melanoma Manag 2018; 5:MMT07. [PMID: 30459938 PMCID: PMC6240885 DOI: 10.2217/mmt-2017-0026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 04/17/2018] [Indexed: 02/08/2023] Open
Abstract
The incidence of metastatic melanoma has been increasing dramatically over the last decades. Yet, there have been many new innovative therapies, such as targeted therapies and checkpoint inhibitors, which have made progress in survival for these patients. The oncology pharmacist is part of the healthcare team and can help in optimizing these newer therapies. There will be discussion about combination therapies, the oncology pharmacist's role, and issues at the core of his interest, such as drug interactions and complementary and alternative therapies.
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Affiliation(s)
- Gabriel Gazzé
- McGill University Health Center – Royal Victoria Hospital, 1001, boul. Decarie, Montreal, Quebec, H4A 3J1 Canada
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Chugh NA, Bali S, Koul A. Integration of botanicals in contemporary medicine: road blocks, checkpoints and go-ahead signals. Integr Med Res 2018; 7:109-125. [PMID: 29989061 PMCID: PMC6035497 DOI: 10.1016/j.imr.2018.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 03/07/2018] [Accepted: 03/22/2018] [Indexed: 01/14/2023] Open
Abstract
The use of botanicals for maintaining good health and preventing diseases is undisputed. The claimed health benefits of natural health products and herbal medicines are based on traditional claims, positive results obtained in preclinical studies and early phase clinical trials that are not backed by safety and efficacy evidences approved by regulatory agencies. Although, the popularity of botanicals is growing, health care practitioners of modern medicine seldom recommend their use because of ill equipped database of their safety and potency. This review discusses problems that preclude botanicals from integrating into the mainstream contemporary therapeutics and cues that provide impetus for their realisation.
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Affiliation(s)
| | | | - Ashwani Koul
- Department of Biophysics, Panjab University, Chandigarh, India
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Yang G, Zhang H, Gan Z, Fan Y, Gu W, Ling C. Discrepant Views of Oncologists and Cancer Patients on Complementary and Alternative Medicine in a Chinese General Hospital. Integr Cancer Ther 2018; 17:451-457. [PMID: 28870099 PMCID: PMC6041901 DOI: 10.1177/1534735417725579] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/14/2017] [Accepted: 07/03/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Complementary and alternative medicine (CAM) has been widely used by cancer patients but rarely discussed by oncologists. This study was designed to evaluate the communication gap between China's oncologists and cancer patients on CAM. METHODS Two parallel cross-sectional studies assessed 83 oncologists and 402 cancer patients on CAM communication between patients and oncologists, and attitudes toward CAM use and clinical decisions about CAM. RESULTS A majority (75.1%) of the cancer patients (302/402) were identified as CAM users within the most recent three months while 77.6% of the cancer patients (312/402) were identified as CAM users since diagnosis of cancer. Oncologists and patients responded differently ( P < .001) on CAM communications. Both oncologists and patients expected that CAM could improve the immune system. They both agreed that oncologists usually discouraged their patients from using CAM. Regarding the effectiveness of CAM, cancer patients were more likely to believe that CAM was effective while oncologists had more concerns about adverse effects of CAM use. CAM use by patients was predicted by disease duration (≥9 months) in the multivariable logistic regression model. CONCLUSION China's oncologists and cancer patients may hold discrepant views on CAM. China's oncologists are encouraged to improve their knowledge on CAM and to initiate more discussions with their patients regarding effective and the safe use of CAM.
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Affiliation(s)
- Geliang Yang
- Changhai Hospital of Traditional Chinese Medicine, Second Military Medical University, Shanghai, China
| | - Huiqing Zhang
- Changhai Hospital of Traditional Chinese Medicine, Second Military Medical University, Shanghai, China
| | - Zheng Gan
- Changhai Hospital of Traditional Chinese Medicine, Second Military Medical University, Shanghai, China
| | - Yifu Fan
- Changhai Hospital of Traditional Chinese Medicine, Second Military Medical University, Shanghai, China
| | - Wei Gu
- Changhai Hospital of Traditional Chinese Medicine, Second Military Medical University, Shanghai, China
| | - Changquan Ling
- Changhai Hospital of Traditional Chinese Medicine, Second Military Medical University, Shanghai, China
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Smith PJ, Clavarino AM, Long JE, Steadman KJ. The Use of a Brochure to Enable CAM-with-Chemotherapy Patient Education. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:814-819. [PMID: 26932309 DOI: 10.1007/s13187-016-1011-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The majority of cancer patients receiving chemotherapy will consider taking complementary and alternative medicine (CAM) during their treatment. As biologically-active CAM may detrimentally interfere with chemotherapy treatment, cancer patients require evidence-based information on chemotherapy-CAM integration consequences. This study aimed to assess if the availability of a purpose-designed brochure within a cancer service aided doctors' discussions with their patients on CAM use and helped patients understand the effects of CAM during their chemotherapy treatment. Cancer care doctors consulting in an adult day unit completed a structured post-intervention feedback survey form (n = 17), and cancer patients receiving chemotherapy treatment were provided the brochure and completed the local health service consumer testing feedback form (n = 30). All cancer care doctors perceived a need for the brochure and recommended the brochure to their patients. All doctors thought the brochure made it easier for them to discuss CAM with their patients, and 59 % believed that it saved them time during patient consultations. Ninety percent of cancer patients reported the brochure had enough information to answer their CAM questions, and all patients thought the information was easy to read and understand. An evidence-based CAM-with-chemotherapy patient brochure was perceived to have enabled cancer care doctors to discuss CAM with their patients and to have answered patients' CAM questions.
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Affiliation(s)
- Peter J Smith
- School of Pharmacy, The University of Queensland, Brisbane, Qld, 4072, Australia.
- Sunshine Coast Cancer Care Services, Nambour General Hospital, Nambour, Qld, 4560, Australia.
| | | | - Jeremy E Long
- Sunshine Coast Cancer Care Services, Nambour General Hospital, Nambour, Qld, 4560, Australia
| | - Kathryn J Steadman
- School of Pharmacy, The University of Queensland, Brisbane, Qld, 4072, Australia
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Sun L, Yang Y, Vertosick E, Jo S, Sun G, Mao JJ. Do Perceived Needs Affect Willingness to Use Traditional Chinese Medicine for Survivorship Care Among Chinese Cancer Survivors? A Cross-Sectional Survey. J Glob Oncol 2017; 3:692-700. [PMID: 29244994 PMCID: PMC5735974 DOI: 10.1200/jgo.2016.007955] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose We aimed to quantify Chinese cancer survivors' perceived needs for survivorship care and to evaluate whether these needs could impact their willingness to use traditional Chinese medicine (TCM). Methods We conducted a cross-sectional survey with members of the Beijing Anti-Cancer Association in China. We measured perceived needs with the seven-item Brief Chinese Cancer Survivorship Needs Scale that assesses psychological, functional, nutritional, social, body image, pain, and symptom needs. The outcome variable was willingness to use TCM for survivorship care. We performed multivariable logistic regression analyses to evaluate whether perceived needs are associated with willingness. Results A total of 600 patients were invited, with a response rate of 81%. The mean (standard deviation) score of the perceived needs scale (0 to 10) was 4.4 (2.2), with the majority of participants endorsing nutritional (72%), symptom (65%), and psychological (54%) needs. Among survivors, 387 (80%; 95% CI, 76% to 83%) were willing to use TCM for survivorship care. In multivariable analysis, a higher perceived needs score (adjusted odds ratio [OR], 1.33; 95% CI, 1.14 to 1.56; P < .001) was associated with greater willingness to use TCM. Specifically, nutritional (OR, 3.17; 95% CI, 1.79 to 5.62; P < .001) and symptom needs (OR, 3.15; 95% CI, 1.79 to 5.55; P < .001) had the strongest relationship. Conclusion A higher level of perceived needs, especially in the areas of nutrition and symptoms, was associated with greater willingness to use TCM for survivorship care.
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Affiliation(s)
- Lingyun Sun
- Lingyun Sun, Emily Vertosick, and Jun J. Mao, Memorial Sloan Kettering Cancer Center, New York, NY; Lingyun Sun, Yufei Yang, and SungHwa Jo, China Academy of Chinese Medical Science, and Guilan Sun, Beijing Anti-Cancer Association, Beijing, China
| | - Yufei Yang
- Lingyun Sun, Emily Vertosick, and Jun J. Mao, Memorial Sloan Kettering Cancer Center, New York, NY; Lingyun Sun, Yufei Yang, and SungHwa Jo, China Academy of Chinese Medical Science, and Guilan Sun, Beijing Anti-Cancer Association, Beijing, China
| | - Emily Vertosick
- Lingyun Sun, Emily Vertosick, and Jun J. Mao, Memorial Sloan Kettering Cancer Center, New York, NY; Lingyun Sun, Yufei Yang, and SungHwa Jo, China Academy of Chinese Medical Science, and Guilan Sun, Beijing Anti-Cancer Association, Beijing, China
| | - SungHwa Jo
- Lingyun Sun, Emily Vertosick, and Jun J. Mao, Memorial Sloan Kettering Cancer Center, New York, NY; Lingyun Sun, Yufei Yang, and SungHwa Jo, China Academy of Chinese Medical Science, and Guilan Sun, Beijing Anti-Cancer Association, Beijing, China
| | - Guilan Sun
- Lingyun Sun, Emily Vertosick, and Jun J. Mao, Memorial Sloan Kettering Cancer Center, New York, NY; Lingyun Sun, Yufei Yang, and SungHwa Jo, China Academy of Chinese Medical Science, and Guilan Sun, Beijing Anti-Cancer Association, Beijing, China
| | - Jun J. Mao
- Lingyun Sun, Emily Vertosick, and Jun J. Mao, Memorial Sloan Kettering Cancer Center, New York, NY; Lingyun Sun, Yufei Yang, and SungHwa Jo, China Academy of Chinese Medical Science, and Guilan Sun, Beijing Anti-Cancer Association, Beijing, China
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Le TQ, Smith L, Harnett J. A systematic review - Biologically-based complementary medicine use by people living with cancer – is a more clearly defined role for the pharmacist required? Res Social Adm Pharm 2017; 13:1037-1044. [DOI: 10.1016/j.sapharm.2016.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/24/2016] [Accepted: 10/24/2016] [Indexed: 12/20/2022]
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