1
|
Ng JY, Kochhar J, Cramer H. Oncology researchers' and clinicians' perceptions of complementary, alternative, and integrative medicine: an international, cross-sectional survey. Support Care Cancer 2024; 32:615. [PMID: 39196463 PMCID: PMC11358342 DOI: 10.1007/s00520-024-08785-9] [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: 03/03/2024] [Accepted: 08/02/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Complementary, alternative, and integrative medicine (CAIM) has become an increasingly popular supportive therapy option for patients with cancer. The objective of this study was to investigate how researchers and clinicians in the oncology field perceive CAIM. METHODS We conducted an online, anonymous, cross-sectional survey for researchers and clinicians who have published their work in oncology journals that are indexed in MEDLINE. The link to the survey was sent to 47, 991 researchers and clinicians whose contact information was extracted from their publications. The survey included various multiple-choice questions, and one open-ended question at the end to allow for any additional comments. RESULTS 751 respondents completed the survey, and they mostly identified themselves as researchers (n = 329, 45.13%), or as both researchers and clinicians (n = 332, 45.45%) in the field of oncology. Over half of the respondents perceive mind-body therapies (n = 354, 54.97%) to be the most promising CAIM category with regards to the prevention, treatment, and/or management of diseases related to oncology, and many respondents agreed that most CAIM therapies are safe (n = 218, 37.39%), and that clinicians should receive training on CAIM therapies via formal (n = 225, 38.59%) and supplemental education (n = 290, 49.83%). However, many respondents were unsure when asked if most CAIM therapies are effective (n = 202, 34.77%). CONCLUSIONS The findings from this study demonstrated great current interest in the use of CAIM in oncology. This information can serve as a foundation for conducting additional research and creating customized educational materials for researchers and clinicians in oncology.
Collapse
Affiliation(s)
- Jeremy Y Ng
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany.
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany.
| | - Jassimar Kochhar
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
| | - Holger Cramer
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
| |
Collapse
|
2
|
Smorodin E, Chuzmarov V, Veidebaum T. The Potential of Integrative Cancer Treatment Using Melatonin and the Challenge of Heterogeneity in Population-Based Studies: A Case Report of Colon Cancer and a Literature Review. Curr Oncol 2024; 31:1994-2023. [PMID: 38668052 PMCID: PMC11049198 DOI: 10.3390/curroncol31040149] [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: 01/28/2024] [Revised: 03/19/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
Melatonin is a multifunctional hormone regulator that maintains homeostasis through circadian rhythms, and desynchronization of these rhythms can lead to gastrointestinal disorders and increase the risk of cancer. Preliminary clinical studies have shown that exogenous melatonin alleviates the harmful effects of anticancer therapy and improves quality of life, but the results are still inconclusive due to the heterogeneity of the studies. A personalized approach to testing clinical parameters and response to integrative treatment with nontoxic and bioavailable melatonin in patient-centered N-of-1 studies deserves greater attention. This clinical case of colon cancer analyzes and discusses the tumor pathology, the adverse effects of chemotherapy, and the dynamics of markers of inflammation (NLR, LMR, and PLR ratios), tumors (CEA, CA 19-9, and PSA), and hemostasis (D-dimer and activated partial thromboplastin time). The patient took melatonin during and after chemotherapy, nutrients (zinc, selenium, vitamin D, green tea, and taxifolin), and aspirin after chemotherapy. The patient's PSA levels decreased during CT combined with melatonin (19 mg/day), and melatonin normalized inflammatory markers and alleviated symptoms of polyneuropathy but did not help with thrombocytopenia. The results are analyzed and discussed in the context of the literature on oncostatic and systemic effects, alleviating therapy-mediated adverse effects, association with survival, and N-of-1 studies.
Collapse
Affiliation(s)
- Eugeniy Smorodin
- Department of Chronic Diseases, National Institute for Health Development, Paldiski mnt 80, 10617 Tallinn, Estonia;
| | - Valentin Chuzmarov
- 2nd Surgery Department, General Surgery and Oncology Surgery Centre, North Estonia Medical Centre, J. Sütiste Str. 19, 13419 Tallinn, Estonia
| | - Toomas Veidebaum
- Department of Chronic Diseases, National Institute for Health Development, Paldiski mnt 80, 10617 Tallinn, Estonia;
| |
Collapse
|
3
|
Kadro ZO, Snyder S, Benn R, Fouladbakhsh JM, Greenlee H, Harris RE, Henry NL, Klein KC, Mayhew S, Spratke L, Walker EM, Zebrack B, Zick SM. Impact of the Integrative Oncology Scholars Program on Oncology Providers' Key Knowledge of Dietary Supplements and Antioxidants for Providing Evidence-based Oncology Care. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1871-1878. [PMID: 37526910 DOI: 10.1007/s13187-023-02348-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/02/2023]
Abstract
Dietary supplements are commonly used among cancer survivors. Oncology providers rarely receive training about dietary supplements. We evaluated whether e-learning modules could improve oncology providers' dietary supplement knowledge. Oncology providers participated in the National Cancer Institute funded Integrative Oncology Scholars (IOS) program. We used posttest readiness assurance tests (RAT) to measure knowledge acquisition from modules. One cohort completed a pre and posttest RAT to assess change in knowledge. Multivariate linear regression models adjusted for gender, race, profession, and years in practice were used to determine if these characteristics were associated with posttest RAT performance and change in pre to posttest RAT scores. Scholars (N = 101) included 86% (N = 87) females; age 44 ± 10 years; 72% (N = 73) Non-Hispanic White; years in practice mean range 11-15 ± 10. There were 37 physicians, 11 physician assistants, 23 nurses, 21 social workers, 2 psychologists, 4 pharmacists, and 2 physical therapists. The posttest dietary supplement and antioxidant RAT scores for all Scholars were 67 ± 18% and 71 ± 14%. In adjusted models there were no significant associations between dietary supplement and antioxidant posttest RAT scores with Scholar characteristics. Change in RAT scores for dietary supplement and antioxidants were 25% ± 23 and 26% ± 27 (P < 0.0001). In adjusted models, there were no significant predictors of change in dietary supplement RATs. For antioxidant RATs, profession was associated with change in scores (P = 0.021). Improvement in Scholar's test scores demonstrate the IOS program can significantly increase oncology providers' knowledge of dietary supplements and antioxidants.
Collapse
Affiliation(s)
- Zachary O Kadro
- Integrative Medicine Program, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Medical Oncology, University of Washington School of Medicine, Seattle, WA, USA
- Department of Physical Medicine and Rehabilitation, Program On Integrative Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sara Snyder
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Nutritional Sciences, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48105, USA
| | - Rita Benn
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Heather Greenlee
- Integrative Medicine Program, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Medical Oncology, University of Washington School of Medicine, Seattle, WA, USA
- Public Health Sciences & Clinical Research Divisions, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Richard E Harris
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - N Lynn Henry
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kristin C Klein
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Sabrina Mayhew
- College of Nursing, Wayne State University, Detroit, MI, USA
| | - Lisa Spratke
- Division of Gynecologic Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Eleanor M Walker
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI, USA
| | - Bradley Zebrack
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Suzanna M Zick
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.
- Department of Nutritional Sciences, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48105, USA.
| |
Collapse
|
4
|
Grant SJ, Gonzalez M, Heller G, Soliman S, Spiegel G, Lacey J. Knowledge and attitudes towards medicinal cannabis and complementary and integrative medicine (CIM): a survey of healthcare professionals working in a cancer hospital in Australia. Support Care Cancer 2023; 31:623. [PMID: 37819556 PMCID: PMC10567955 DOI: 10.1007/s00520-023-08080-z] [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: 05/25/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE We investigated attitudes and practices of healthcare professionals (HCPs) to medicinal cannabis (MC) and complementary and integrative medicine (CIM), including individual therapies, such as acupuncture, massage, herbs, dietary supplements, nutrition and exercise. We explored whether healthcare occupation influenced attitudes to CIM and MC; referral pathways for advice on CIM; and interest in a pharmacy service to evaluate herbs and supplements. METHODS Cross-sectional survey. All clinical staff at a comprehensive cancer hospital were invited to complete an anonymous questionnaire about CIM and MC. We used descriptive analysis to describe the respondent's knowledge and attitudes, and Fisher's exact test to test for differences by occupation, length of time at the hospital and age. RESULTS Most of the 116 HCPs respondents supported integrating CIM into cancer care (94.8%) and wanted to learn more (90%) and to understand benefits and contraindications. Most respondents believed that CIM (87.9%) could benefit patients with cancer, and MC could benefit those with advanced cancer (49-51%). Whilst just over half (52.6%) felt confident discussing CIM with patients, only 10% felt they had sufficient knowledge to discuss MC. Most felt they did not have sufficient knowledge to specifically discuss mind and body practices (63.8%) or herbs and supplements (79%). HCPs (63%) would be more inclined to allow use of herbs and supplements with cancer treatment if a pharmacy service was available to evaluate interactions. Occupation, length of time at hospital and age influenced confidence and knowledge about CIM. CONCLUSIONS The integration of evidence-based CIM and MC into cancer care is hampered by a lack of knowledge of benefits and contraindications, and gaps in education. Effective and safe integration may require targeted development of services such as pharmacy to evaluate the safety of herbs and supplements, and inclusion of cancer specialists who have received training in individual CIM therapies and MC.
Collapse
Affiliation(s)
- Suzanne J Grant
- Supportive Care and Integrative Oncology Department, Chris O'Brien Lifehouse Comprehensive Cancer Centre, Missenden Road, Camperdown, Sydney, NSW, Australia.
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia.
| | - Maria Gonzalez
- Supportive Care and Integrative Oncology Department, Chris O'Brien Lifehouse Comprehensive Cancer Centre, Missenden Road, Camperdown, Sydney, NSW, Australia
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Gillian Heller
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Sarah Soliman
- School of Science, Western Sydney University, Sydney, NSW, Australia
| | - Gretel Spiegel
- Supportive Care and Integrative Oncology Department, Chris O'Brien Lifehouse Comprehensive Cancer Centre, Missenden Road, Camperdown, Sydney, NSW, Australia
| | - Judith Lacey
- Supportive Care and Integrative Oncology Department, Chris O'Brien Lifehouse Comprehensive Cancer Centre, Missenden Road, Camperdown, Sydney, NSW, Australia
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- School of Medicine, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
5
|
Liou KT, Ashare R, Worster B, Jones KF, Yeager KA, Acevedo AM, Ferrer R, Meghani SH. SIO-ASCO guideline on integrative medicine for cancer pain management: implications for racial and ethnic pain disparities. JNCI Cancer Spectr 2023; 7:pkad042. [PMID: 37307074 PMCID: PMC10336300 DOI: 10.1093/jncics/pkad042] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/02/2023] [Indexed: 06/13/2023] Open
Abstract
Racial and ethnic disparities in pain management pose major challenges to equitable cancer care delivery. These disparities are driven by complex interactions between patient-, provider-, and system-related factors that resist reductionistic solutions and require innovative, holistic approaches. On September 19, 2022, the Society for Integrative Oncology and the American Society of Clinical Oncology published a joint guideline to provide evidence-based recommendations on integrative medicine for cancer pain management. Integrative medicine, which combines conventional treatments with complementary modalities from cultures and traditions around the world, are uniquely equipped to resonate with diverse cancer populations and fill existing gaps in pain management. Although some complementary modalities, such as music therapy and yoga, lack sufficient evidence to make a specific recommendation, other modalities, such as acupuncture, massage, and hypnosis, demonstrated an intermediate level of evidence, resulting in moderate strength recommendations for their use in cancer pain management. However, several factors may hinder real-world implementation of the Society for Integrative Oncology and the American Society of Clinical Oncology guideline and must be addressed to ensure equitable pain management for all communities. These barriers include, but are not limited to, the lack of insurance coverage for many complementary therapies, the limited diversity and availability of complementary therapy providers, the negative social norms surrounding complementary therapies, the underrepresentation of racial and ethnic subgroups in the clinical research of complementary therapies, and the paucity of culturally attuned interventions tailored to diverse individuals. This commentary examines both the challenges and the opportunities for addressing racial and ethnic disparities in cancer pain management through integrative medicine.
Collapse
Affiliation(s)
- Kevin T Liou
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rebecca Ashare
- Department of Psychology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Brooke Worster
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Katie F Jones
- Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, USA
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Amanda M Acevedo
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Rebecca Ferrer
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Salimah H Meghani
- Department of Biobehavioral Health Science, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
6
|
Hammad N, Ndlovu N, Carson LM, Ramogola-Masire D, Mallick I, Berry S, Olapade-Olaopa EO. Competency-Based Workforce Development and Education in Global Oncology. Curr Oncol 2023; 30:1760-1775. [PMID: 36826097 PMCID: PMC9955139 DOI: 10.3390/curroncol30020136] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/14/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
The healthcare workforce plays a pivotal role in cancer care delivery, leadership, policy, education, and research in complex cancer systems. To ensure quality and relevance, health professionals must have the necessary competencies to deliver patient-centered and efficient care, coupled with the ability to work in teams and manage health resources wisely. This paper aims to review the concept of competency-based medical education (CBME) in the context of oncology to provide insights and guidance for those interested in adopting or adapting competency-based education in training programs. The results of a scoping review of CBME in oncology are presented here to describe the current status of CBME in oncology. The literature describing the implementation and evaluation of CBME in oncology training programs for medical professionals internationally is summarized and key themes identified to provide practical guidance for educators. Further, the paper identifies critical competencies for oncology education and training globally and presents recommendations and opportunities for collaboration in competency-based education and training in oncology. The authors argue for increased global collaboration and networking in the realm of CBME to facilitate the establishment of a competent global cancer care workforce.
Collapse
Affiliation(s)
- Nazik Hammad
- Department of Oncology, Queen’s University, Kingston, ON K7L 3N6, Canada
- Correspondence:
| | - Ntokozo Ndlovu
- Department of Oncology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare P.O. Box MP 167, Zimbabwe
- Division of Radiotherapy and Oncology, Parirenyatwa Group of Hospitals, Harare P.O. Box CY 198, Zimbabwe
| | - Laura Mae Carson
- Department of Oncology, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Doreen Ramogola-Masire
- Department of ObGYN, Faculty of Medicine, University of Botswana, Private Bag UB 0022, Gaborone, Botswana
| | - Indranil Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata 700 160, West Bengal, India
| | - Scott Berry
- Department of Oncology, Queen’s University, Kingston, ON K7L 3N6, Canada
| | | |
Collapse
|
7
|
Wen PS, Vora A, Mortera M, Sasson N, Reed WR, Ehsanian R, Galantino ML, Erb M, Hu X, Kim S. Perceptions and use of complementary and integrative health practices among rehabilitation professionals: a survey. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2022.102173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
8
|
Lee JT, Lee YH, Chang YP. Mindfulness Stress Management for Female Cancer Survivors Facing the Uncertainty of Disease Progression: A Randomized Controlled Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4497. [PMID: 35457366 PMCID: PMC9026753 DOI: 10.3390/ijerph19084497] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 02/01/2023]
Abstract
This study aimed to determine the effect of a mindfulness stress management intervention on fear of recurrence and quality of life among female cancer survivors. A longitudinal, randomized design with two groups (60 participants) was used for pretest/posttest comparisons. Twelve weeks of mindfulness stress intervention effectively attenuated fear of recurrence symptoms (T1 p = 0.002, T2 p = 0.047), and quality of life (T1 p = 0.000, T2 p = 0.001) significantly increased. The results were significantly different between the intervention and control groups. Over time, group differences became more significant (T1 p = 0.002), demonstrating the effectiveness of the mindfulness stress management intervention. When female cancer survivors face uncertain disease progression, fear of recurrence affects their quality of life. When these women receive supportive intervention sooner, their improvement is more significant. Healthcare providers should encourage female cancer survivors to engage in mindfulness stress management actions to achieve a better benefit.
Collapse
Affiliation(s)
- Jih-Teng Lee
- Department of Surgery, Fooyin University Hospital, Kaohsiung 928005, Taiwan;
| | - Yi-Hua Lee
- Department of Administration, National Health Research Institutes, Zhunan 350401, Taiwan;
| | - Yuan-Ping Chang
- Department of Nursing, Fooyin University, Kaohsiung 831301, Taiwan
| |
Collapse
|