1
|
Zhang S, Li J, Zhang Y, Li X, Zhang Y, Li Y, Zhou L, Hu X. Efficacy of nonpharmacological interventions for severe radiation-induced oral mucositis among head and neck cancer patients: A network meta-analysis of randomised controlled trials. J Clin Nurs 2024; 33:2030-2049. [PMID: 38454556 DOI: 10.1111/jocn.17087] [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: 04/10/2023] [Revised: 12/08/2023] [Accepted: 02/19/2024] [Indexed: 03/09/2024]
Abstract
AIMS AND OBJECTIVES To assess the effectiveness of different nonpharmacological treatments for severe radiation-induced oral mucositis in patients with head and neck cancer. BACKGROUND Radiation-induced oral mucositis is highly prevalent in patients with head and neck cancer. Current medications for radiation-induced oral mucositis are limited in effectiveness and susceptible to side effects, and while there is an increasing adoption of nonpharmacological interventions, the optimal one remains unclear. DESIGN Systematic review and network meta-analysis based on the PRISMA-NMA guidelines. METHODS Six databases were searched. Two authors independently performed the literature screening, data extraction and methodological quality assessment of the included studies. Traditional pairwise meta-analysis was performed by R Studio. A network meta-analysis was then conducted to assess the effects of nonpharmacological interventions for severe radiation-induced oral mucositis in patients with head and neck cancer. RESULTS Fifty-two studies involving seven types of nonpharmacological interventions were enrolled. The network meta-analysis indicated that natural plant-based therapies might be the most effective, health education interventions might be the second most effective, and honey might be the third most effective interventions for reducing the incidence of severe radiation-induced oral mucositis. For reducing the incidence of severe oral mucositis-related pain, the pairwise meta-analysis showed that only natural plant-based therapies and health education interventions were effective. CONCLUSIONS Nonpharmacological interventions are effective in the management of severe radiation-induced oral mucositis among patients with head and neck cancer. RELEVANCE TO CLINICAL PRACTICE Nonpharmacological interventions are a category of safe and effective adjunctive therapies that should be encouraged in clinical practice. TRIAL REGISTRATION DETAILS CRD42023400745.
Collapse
Affiliation(s)
- Shu Zhang
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Juejin Li
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Yun Zhang
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Xia Li
- Department of General Practice, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yalin Zhang
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Yunhuan Li
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Lin Zhou
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Xiaolin Hu
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- Tianfu Jincheng Laboratory, City of Future Medicine, Chengdu, Sichuan, China
| |
Collapse
|
2
|
Ng ML, Majid AMSA, Yee SM, Natesan V, Basheer MKA, Gnanasekaran A, Al-Suede FSR, Parish C, Dalal M, Ming LC, Nazari V M, Khan SS, Stn Hameed Sultan SB, Babu KG, Majid ASA, Abdul Aziz MAS. A phase II randomized, double-blind, placebo-controlled study of Nuvastatic (C50SEW505OESA), a standardized rosmarinic acid-rich polymolecular botanical extract formulation to reduce cancer-related fatigue in patients with solid tumors. Support Care Cancer 2024; 32:331. [PMID: 38710920 DOI: 10.1007/s00520-024-08536-w] [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: 03/12/2023] [Accepted: 04/30/2024] [Indexed: 05/08/2024]
Abstract
AIM We evaluated the efficacy and safety of Nuvastatic™ (C5OSEW5050ESA) in improving cancer-related fatigue (CRF) among cancer patients. METHODS This multicenter randomized double-blind placebo-controlled phase 2 trial included 110 solid malignant tumor patients (stage II-IV) undergoing chemotherapy. They were randomly selected and provided oral Nuvastatic™ 1000 mg (N = 56) or placebo (N = 54) thrice daily for 9 weeks. The primary outcomes were fatigue (Brief Fatigue Inventory (BFI)) and Visual Analog Scale for Fatigue (VAS-F)) scores measured before and after intervention at baseline and weeks 3, 6, and 9. The secondary outcomes were mean group difference in the vitality subscale of the Medical Outcome Scale Short Form-36 (SF-36) and urinary F2-isoprostane concentration (an oxidative stress biomarker), Eastern Cooperative Oncology Group scores, adverse events, and biochemical and hematologic parameters. Analysis was performed by intention-to-treat (ITT). Primary and secondary outcomes were assessed by two-way repeated-measures analysis of variance (mixed ANOVA). RESULTS The Nuvastatic™ group exhibited an overall decreased fatigue score compared with the placebo group. Compared with the placebo group, the Nuvastatic™ group significantly reduced BFI-fatigue (BFI fatigue score, F (1.4, 147) = 16.554, p < 0.001, partial η2 = 0.333). The Nuvastatic™ group significantly reduced VAS-F fatigue (F (2, 210) = 9.534, p < 0.001, partial η2 = 0.083), improved quality of life (QoL) (F (1.2, 127.48) = 34.07, p < 0.001, partial η2 = 0.243), and lowered urinary F2-IsoP concentrations (mean difference (95% CI) = 55.57 (24.84, 86.30)), t (55) = 3.624, p < 0.001, Cohen's d (95% CI) = 0.48 (0.20, 0.75)). Reported adverse events were vomiting (0.9%), fever (5.4%), and headache (2.7%). CONCLUSION Nuvastatic™ is potentially an effective adjuvant for CRF management in solid tumor patients and worthy of further investigation in larger trials. TRIAL REGISTRATION ClinicalTrial.gov ID: NCT04546607. Study registration date (first submitted): 11-05-2020.
Collapse
Grants
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
Collapse
Affiliation(s)
- Mei Ling Ng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Amin Malik Shah Abdul Majid
- EMAN Research Ltd, Symonston, Australia
- College of Health & Medicine, Australian National University, Canberra, Australia
| | - Siew Mei Yee
- Faculty of Pharmacy, SEGi University, Petaling Jaya, Malaysia
| | - V Natesan
- EMAN Research Ltd, Symonston, Australia
| | | | - Ashok Gnanasekaran
- Department of Pharmacology, Faculty of Medicine, Quest International University, Ipoh, Malaysia
| | | | - Christopher Parish
- College of Health & Medicine, Australian National University, Canberra, Australia
| | - Meena Dalal
- Notrox Research Private Limited, Hospital & Health Care Bangalore, Bangalore, Karnataka, India
| | - Long Chiau Ming
- School of Medical and Life Sciences, Sunway University, Sunway City, Malaysia
| | - Mansoureh Nazari V
- EMAN Biodiscoveries Sdn. Bhd, Sungai Petani, Malaysia
- School of Pharmacy, Universitas 17 Agustus 1945 Jakarta, Jakarta, Indonesia
| | | | - Siti Balkees Stn Hameed Sultan
- EMAN Biodiscoveries Sdn. Bhd, Sungai Petani, Malaysia
- Integrative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Penang, Malaysia
| | - K Govind Babu
- HCG Cancer Centre-Double Road, Bengaluru, Karnataka, India
| | - Aman Shah Abdul Majid
- Department of Pharmacology, Faculty of Medicine, Quest International University, Ipoh, Malaysia.
- EMAN Biodiscoveries Sdn. Bhd, Sungai Petani, Malaysia.
| | | |
Collapse
|
3
|
Extract of Pogostemon cablin Possesses Potent Anticancer Activity against Colorectal Cancer Cells In Vitro and In Vivo. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:9758156. [PMID: 32963578 PMCID: PMC7499317 DOI: 10.1155/2020/9758156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/10/2020] [Accepted: 08/25/2020] [Indexed: 12/13/2022]
Abstract
Pogostemon cablin (PCa), an herb used in traditional Chinese medicine, is routinely used in the amelioration of different types of gastrointestinal discomfort. However, the mechanisms underlying the cancer suppression activity of PCa in colorectal cancer (CRC) cells have yet to be clarified. The aim of this study was to investigate the anticancer effects of PCa, specifically the induction of apoptosis in CRC cells. The growth inhibition curve of CRC cells following exposure to PCa was detected by an MTT assay. Moreover, PCa combined with 5-FU revealed a synergic effect of decreased cell viability. PCa inhibited cell proliferation and induced cell cycle arrest at the G0/G1 phase and cell apoptosis through regulation of associated protein expression. An in vivo study showed that PCa suppressed the growth of CRC via induction of cell apoptosis with no significant change in body weight or organ histology. Our results demonstrated that PCa inhibits the growth of CRC cells and induces apoptosis in vitro and in vivo, which suggests the potential applicability of PCa as an anticancer agent.
Collapse
|
4
|
Abstract
Cancer-related fatigue (CRF) is a common symptom for which cancer patients often use integrative and integrative therapies; however, evidence supporting these therapies is limited. The aim of this review is to provide evidence-based recommendations for integrative interventions during and after cancer treatment for CRF. These recommendations are based on a systematic literature review from 1990 through 2019. Cognitive behavior therapy plus hypnosis and American ginseng can be considered during active treatment, and acupressure, mindfulness-based cognitive therapy, and qigong/tai chi easy can be considered during posttreatment. Coenzyme Q10 and L-carnitine are not recommended during active-treatment. All other integrative therapies for CRF had insufficient evidence to make a recommendation. While there is increasing evidence for integrative therapies for CRF, because of lack of rigorous trials and replication, no therapies could be definitively recommended. Further rigorously designed integrative therapy research is needed and should consider implementation and dissemination.
Collapse
|
5
|
De Oliveira Andrade F, Yu W, Zhang X, Carney E, Hu R, Clarke R, FitzGerald K, Hilakivi-Clarke L. Effects of Jaeumkanghwa-tang on tamoxifen responsiveness in preclinical ER+ breast cancer model. Endocr Relat Cancer 2019; 26:339-353. [PMID: 30640711 PMCID: PMC6365679 DOI: 10.1530/erc-18-0393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 01/14/2019] [Indexed: 12/14/2022]
Abstract
Resistance to endocrine therapy remains a clinical challenge in the treatment of estrogen receptor-positive (ER+) breast cancer. We investigated if adding a traditional Asian herbal mixture consisting of 12 herbs, called Jaeumkanghwa-tang (JEKHT), to tamoxifen (TAM) therapy might prevent resistance and recurrence in the ER+ breast cancer model of 7,12-dimethylbenz[a]anthracene (DMBA)-exposed Sprague-Dawley rats. Rats were divided into four groups treated as follows: 15 mg/kg TAM administered via diet as TAM citrate (TAM only); 500 mg/kg JEKHT administered via drinking water (JEKHT only group); TAM + JEKHT and no treatment control group. The study was replicated using two different batches of JEKHT. In both studies, a significantly higher proportion of ER+ mammary tumors responded to TAM if animals also were treated with JEKHT (experiment 1: 47% vs 65%, P = 0.015; experiment 2: 43% vs 77%, P < 0.001). The risk of local recurrence also was reduced (31% vs 12%, P = 0.002). JEKHT alone was mostly ineffective. In addition, JEKHT prevented the development of premalignant endometrial lesions in TAM-treated rats (20% in TAM only vs 0% in TAM + JEKHT). Co-treatment of antiestrogen-resistant LCC9 human breast cancer cells with 1.6 mg/mL JEKHT reversed their TAM resistance in dose-response studies in vitro. Several traditional herbal medicine preparations can exhibit anti-inflammatory properties and may increase anti-tumor immune activities in the tumor microenvironment. In the tumors of rats treated with both JEKHT and TAM, expression of Il-6 (P = 0.03), Foxp3/T regulatory cell (Treg) marker (P = 0.033) and Tgfβ1 that activates Tregs (P < 0.001) were significantly downregulated compared with TAM only group. These findings indicate that JEKHT may prevent TAM-induced evasion of tumor immune responses.
Collapse
MESH Headings
- 9,10-Dimethyl-1,2-benzanthracene/toxicity
- Animals
- Antineoplastic Agents, Hormonal/administration & dosage
- Breast Neoplasms/chemically induced
- Breast Neoplasms/drug therapy
- Breast Neoplasms/pathology
- Cell Line, Tumor
- Cell Proliferation/drug effects
- Cytokines/blood
- Drug Resistance, Neoplasm/drug effects
- Endometrium/drug effects
- Endometrium/pathology
- Estrogen Antagonists/administration & dosage
- Female
- Forkhead Transcription Factors/genetics
- Humans
- Mammary Neoplasms, Experimental
- Medicine, East Asian Traditional
- Neoplasm Recurrence, Local/prevention & control
- Plant Extracts/administration & dosage
- Plant Extracts/pharmacology
- Rats
- Rats, Sprague-Dawley
- Receptors, Estrogen/metabolism
- Tamoxifen/administration & dosage
- Transforming Growth Factor beta1/genetics
- Tumor Microenvironment/drug effects
- Tumor Microenvironment/immunology
Collapse
Affiliation(s)
| | - Wei Yu
- Department of Oncology, Georgetown University, Washington, District of Columbia, USA
| | - Xiyuan Zhang
- Department of Oncology, Georgetown University, Washington, District of Columbia, USA
| | - Elissa Carney
- Department of Oncology, Georgetown University, Washington, District of Columbia, USA
| | - Rong Hu
- Department of Oncology, Georgetown University, Washington, District of Columbia, USA
| | - Robert Clarke
- Department of Oncology, Georgetown University, Washington, District of Columbia, USA
| | - Kevin FitzGerald
- Department of Oncology, Georgetown University, Washington, District of Columbia, USA
| | - Leena Hilakivi-Clarke
- Department of Oncology, Georgetown University, Washington, District of Columbia, USA
- Correspondence should be addressed to L Hilakivi-Clarke:
| |
Collapse
|
6
|
Buckner CA, Lafrenie RM, Dénommée JA, Caswell JM, Want DA. Complementary and alternative medicine use in patients before and after a cancer diagnosis. ACTA ACUST UNITED AC 2018; 25:e275-e281. [PMID: 30111972 DOI: 10.3747/co.25.3884] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Cancer patients are increasingly seeking out complementary and alternative medicine (cam) and might be reluctant to disclose its use to their oncology treatment team. Often, cam agents are not well studied, and little is known about their potential interactions with chemotherapy, radiation therapy, or biologic therapies, and their correlations with outcomes. In the present study, we set out to determine the rate of cam use in patients receiving treatment at a Northern Ontario cancer centre. Methods Patients reporting for treatment at the Northeast Cancer Centre (necc) in Sudbury, Ontario, were asked to complete an anonymous questionnaire to assess cam use. Changes in cam use before, compared with after, diagnosis were also assessed. Results Patients in Northern Ontario reported significant cam use both before and after diagnosis. However, as a function of the cam type, cam use was greatly enhanced after cancer diagnosis. For example, the number of patients who reported use of biologic products increased to 51.8% after a cancer diagnosis from 15.6% before a cancer diagnosis. Patients reported much smaller changes in the use of alternative medical systems or spiritual therapy after diagnosis. Vitamin use was reported by 66% of respondents, and the number of different cams used correlated significantly with the reported number of vitamins used. Conclusions Use of cam, particularly biologic products, increased significantly after a cancer diagnosis. Further studies are required to examine the effect of cam use on the efficacy and safety of cancer therapies.
Collapse
Affiliation(s)
- C A Buckner
- Health Sciences North Research Institute.,Departments of Biology, Biomolecular Sciences, and Psychology, Laurentian University, and
| | - R M Lafrenie
- Health Sciences North Research Institute.,Departments of Biology, Biomolecular Sciences, and Psychology, Laurentian University, and
| | - J A Dénommée
- Departments of Biology, Biomolecular Sciences, and Psychology, Laurentian University, and
| | | | - D A Want
- Northeast Cancer Centre, Sudbury, ON
| |
Collapse
|
7
|
Tsai CC, Chang YH, Chang CC, Cheng YM, Ou YC, Chien CCC, Hsu YC. Induction of Apoptosis in Endometrial Cancer (Ishikawa) Cells by Pogostemon cablin Aqueous Extract (PCAE). Int J Mol Sci 2015; 16:12424-35. [PMID: 26042464 PMCID: PMC4490452 DOI: 10.3390/ijms160612424] [Citation(s) in RCA: 7] [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: 03/26/2015] [Revised: 05/13/2015] [Accepted: 05/28/2015] [Indexed: 12/16/2022] Open
Abstract
Pogostemon cablin (PC) is a traditional herbal medicine used in the treatment of the common cold, nausea, diarrhea, and even for headaches and fever. However, the mechanisms underlying the anti-proliferative activity of PC in endometrial cancer (EC) cells have yet to be fully elucidated. This study investigated the anticancer effects of an aqueous extract of Pogostemon cablin (PCAE), specifically induced apoptosis in EC (Ishikawa) cells. Proliferation of EC cells following exposure to PCAE was assessed by an MTT assay. DNA content and the induction of cell cycle apoptosis were analyzed by flow cytometry (FACS Calibur). Protein caspase-3 and, -9 as well as AIF were investigated using Western blot. Our results demonstrate growth inhibition of Ishikawa cells by PCAE. Furthermore, caspase-3 activity caused PCAE-treated cell lines to accumulate in apoptosis. Gene expression profiling (GEP) results further suggest that, in addition to its known effects with regard to EC prevention, PCAE may also exert antitumor activity on established EC cells. Many previous studies have identified the chemo-preventive effects of natural plant materials and the potential role of these materials in chemotherapy. This current study used human EC Ishikawa cells to investigate the anti-tumor effects of PCAE in EC cells. Our results demonstrate that PCAE inhibits the growth of cancer cells and induces apoptosis, which suggests the potential applicability of PCAE as an antitumor agent.
Collapse
Affiliation(s)
- Ching-Chou Tsai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan.
| | - Ya-Huei Chang
- Innovative Research Center of Medicine, College of Health Sciences, Chang Jung Christian University, Tainan 71101, Taiwan.
- Graduate Institute of Medical Science, College of Health Sciences, Chang Jung Christian University, Tainan 71101, Taiwan.
| | - Chi-Chang Chang
- Department of Obstetrics and Gynecology, E-Da Hospital, E-Da Hospital/I-Shou University, Kaohsiung 82445, Taiwan.
| | - Ya-Min Cheng
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 71701, Taiwan.
| | - Yu-Che Ou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan.
| | - Chan-Chao Chang Chien
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan.
| | - Yi-Chiang Hsu
- Innovative Research Center of Medicine, College of Health Sciences, Chang Jung Christian University, Tainan 71101, Taiwan.
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 71701, Taiwan.
| |
Collapse
|
8
|
Truant TL, Balneaves LG, Fitch MI. Integrating complementary and alternative medicine into cancer care: Canadian oncology nurses' perspectives. Asia Pac J Oncol Nurs 2015; 2:205-214. [PMID: 27981116 PMCID: PMC5123512 DOI: 10.4103/2347-5625.167233] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The integration of complementary and alternative medicine (CAM) and conventional cancer care in Canada is in its nascent stages. While most patients use CAM during their cancer experience, the majority does not receive adequate support from their oncology health care professionals (HCPs) to integrate CAM safely and effectively into their treatment and care. A variety of factors influence this lack of integration in Canada, such as health care professional(HCP) education and attitudes about CAM; variable licensure, credentialing of CAM practitioners, and reimbursement issues across the country; an emerging CAM evidence base; and models of cancer care that privilege diseased-focused care at the expense of whole person care. Oncology nurses are optimally aligned to be leaders in the integration of CAM into cancer care in Canada. Beyond the respect afforded to oncology nurses by patients and family members that support them in broaching the topic of CAM, policies, and position statements exist that allow oncology nurses to include CAM as part of their scope. Oncology nurses have also taken on leadership roles in clinical innovation, research, education, and advocacy that are integral to the safe and informed integration of evidence-based CAM therapies into cancer care settings in Canada.
Collapse
Affiliation(s)
- Tracy L Truant
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Lynda G Balneaves
- Centre for Integrative Medicine, Faculty of Medicine and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| |
Collapse
|