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Schad F, Thronicke A, Hofheinz RD, Matthes H, Grah C. Patients with Advanced or Metastasised Non-Small-Cell Lung Cancer with Viscum album L. Therapy in Addition to PD-1/PD-L1 Blockade: A Real-World Data Study. Cancers (Basel) 2024; 16:1609. [PMID: 38672690 PMCID: PMC11049173 DOI: 10.3390/cancers16081609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/09/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Immunotherapy with PD-1/PD-L1 inhibitors has significantly improved the survival rates of patients with metastatic non-small-cell lung cancer (NSCLC). Results of a real-world data study investigating add-on VA (Viscum album L.) to chemotherapy have shown an association with the improved overall survival of patients with NSCLC. We sought to investigate whether the addition of VA to PD-1/PD-L1 inhibitors in patients with advanced or metastasised NSCLC would have an additional survival benefit. In the present real-world data study, we enrolled patients from the accredited national registry, Network Oncology, with advanced or metastasised NSCLC. The reporting of data was performed in accordance with the ESMO-GROW criteria for the optimal reporting of oncological real-world evidence (RWE) studies. Overall survival was compared between patients receiving PD-1/PD-L1 inhibitor therapy (control, CTRL group) versus the combination of anti-PD-1/PD-L1 therapy and VA (combination, COMB group). An adjusted multivariate Cox proportional hazard analysis was performed to investigate variables associated with survival. From 31 July 2015 to 9 May 2023, 415 patients with a median age of 68 years and a male/female ratio of 1.2 were treated with anti-PD-1/PD-L1 therapy with or without add-on VA. Survival analyses included 222 (53.5%) patients within the CRTL group and 193 (46.5%) in the COMB group. Patients in the COMB group revealed a median survival of 13.8 months and patients in the CRTL group a median survival of 6.8 months (adjusted hazard ratio, aHR: 0.60, 95% CI: 0.43-0.85, p = 0.004) after adjustment for age, gender, tumour stage, BMI, ECOG status, oncological treatment, and PD-L1 tumour proportion score. A reduction in the adjusted hazard of death by 56% was seen with the addition of VA (aHR 0.44, 95% CI: 0.26-0.74, p = 0.002) in patients with PD-L1-positive tumours (tumour proportion score > 1%) treated with first-line anti-PD-1/PD-L1 therapy. Our findings suggest that add-on VA correlates with improved survival in patients with advanced or metastasised NSCLC who were treated with PD-1/PD-L1 inhibitors irrespective of age, gender, tumour stage, or oncological treatment. The underlying mechanisms may include the synergistic modulation of the immune response. A limitation of this study is the observational non-randomised study design, which only allows limited conclusions to be drawn and prospective randomised trials are warranted.
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Affiliation(s)
- Friedemann Schad
- Research Institute Havelhöhe, Network Oncology Registry, Kladower Damm 221, 14089 Berlin, Germany
- Hospital Gemeinschaftskrankenhaus Havelhöhe, Interdisciplinary Oncological Centre, Kladower Damm 221, 14089 Berlin, Germany
| | - Anja Thronicke
- Research Institute Havelhöhe, Network Oncology Registry, Kladower Damm 221, 14089 Berlin, Germany
| | - Ralf-Dieter Hofheinz
- Mannheim University Hospital, Mannheim Cancer Center, Theodor-Kutzer Ufer 1-3, 68167 Mannheim, Germany
| | - Harald Matthes
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Gastroenterology, Hindenburgdamm 30, 12203 Berlin, Germany
- Hospital Gemeinschaftskrankenhaus Havelhöhe, Daycare Clinic, Kladower Damm 221, 14089 Berlin, Germany
| | - Christian Grah
- Hospital Gemeinschaftskrankenhaus Havelhöhe, Lung Cancer Center, Kladower Damm 221, 14089 Berlin, Germany;
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Thronicke A, Oei SL, Grieb G, Grabowski P, Roos J, Schad F. Self-Reported Baseline Quality of Life Mirrors Treatment-Specific Characteristics of Cancer Patients. Cancers (Basel) 2023; 15:5763. [PMID: 38136309 PMCID: PMC10742018 DOI: 10.3390/cancers15245763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Baseline quality of life (bQL) has been shown to be a predictor of the clinical outcome of oncological patients. The primary objective of the present study was to examine the role of bQL as a treatment predictor in oncological patients. METHODS In this prospective study, all-stage cancer patients registered in the Network Oncology registry were enrolled, and their bQL at diagnosis was evaluated. RESULTS Five hundred and thirty-eight oncological patients were eligible (median age 64 years). We show that survival-predicting bQL variables such as pain, low physical functioning or financial burden at tumor diagnosis were linked to lower systemic treatment (p = 0.03), reduced surgery (p = 0.007) or reduced oncological treatment compliance (0.01), respectively. Lastly, female gender and older cancer patients exhibited a tempered bQL. CONCLUSION Our study is one of the first to reveal that bQL at tumor diagnosis is significantly associated with the prediction of oncological treatment with distinctive age- and gender-related patterns. Our results emphasize the need to address the physical, psychosocial, and financial burden of cancer patients prior to their oncological treatment with respect to age and gender. The associations found here pave the way for early integration of patient-reported outcomes into oncological supportive concepts.
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Affiliation(s)
- Anja Thronicke
- Research Institute Havelhöhe gGmbH, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany; (A.T.)
| | - Shiao Li Oei
- Research Institute Havelhöhe gGmbH, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany; (A.T.)
| | - Gerrit Grieb
- Department of Plastic Surgery and Hand Surgery, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany
| | - Patricia Grabowski
- Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany
| | - Juliane Roos
- Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany
| | - Friedemann Schad
- Research Institute Havelhöhe gGmbH, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany; (A.T.)
- Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany
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Oei SL, Thronicke A, Grieb G, Schad F, Groß J. Evaluation of quality of life in breast cancer patients who underwent breast-conserving surgery or mastectomy using real-world data. Breast Cancer 2023; 30:1008-1017. [PMID: 37587322 DOI: 10.1007/s12282-023-01494-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/09/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Due to advances in the fight against breast cancer, aesthetic aspects and the prevention of breast deformities are playing an important role in surgical procedures. Currently the main form of breast cancer surgery is breast-conserving surgery (BCS), and even if mastectomy (MAS) is required, oncoplastic surgery and reconstruction options can improve outcomes, including health-related quality of life (QoL) of cancer patients. The purpose of this study was to assess whether surgery options induce different outcomes in self-reported QoL in guide-line treated breast cancer patients of the Network Oncology (NO). METHODS This prospective Real-World-Data (RWD) study was conducted using data from the NO-clinical registry. QoL was assessed by evaluation of the European Organization of Research and Treatment Health-Related Quality of Life Core Questionnaire scale (EORTC QLQ-C30). Association factors between type of surgery options, without or with immediate breast reconstructions the EORTC QLQ-C30-scales at baseline after surgery, 6, 12, and 24 months later were analyzed with adjusted multivariate regression analysis, considering age, cancer stage, and treatment regimens, using software R. RESULTS A total of 623 primary breast cancer patients (all tumor stages, median age 58 (ICR: 50-68) diagnosed and guide-line treated between 2013 and 2021), 524 BCS and 99 MAS, 24 of whom received immediate breast reconstruction (MBR), were eligible for analyses. Compared with BCS patients, MBR patients self-reported considerably lower global health, physical and social functioning, and higher burden of pain and financial difficulties at baseline. In later follow-up surveys, functional scales increased and symptoms decreased in all patients, and the differences between MAS and BCS equalized. Longitudinal analyses after 24 months were obtained from 258 patients and revealed that compared to 224 BCS, the 34 MAS patients reported increased social functioning (p = 0.04). CONCLUSIONS At 24 months after MAS, breast cancer patients' QoL improved compared with BCS, although impairments in QoL were reported immediately after MAS. A growing expertise in surgical procedures as well as supportive care is critical to optimizing patients' well-being. These findings may be considered when counseling breast cancer patients pre- and post-surgery. TRIAL REGISTRATION NUMBER DRKS00013335 on 27/11/2017 retrospectively registered.
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Affiliation(s)
- Shiao Li Oei
- Research Institut Havelhöhe gGmbH at, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.
| | - Anja Thronicke
- Research Institut Havelhöhe gGmbH at, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Gerrit Grieb
- Department of Plastic Surgery and Hand Surgery, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Friedemann Schad
- Research Institut Havelhöhe gGmbH at, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
- Interdisciplinary Oncology and Supportive Cancer Medicine, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Jessica Groß
- Breast Cancer Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
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Schad F, Rieser T, Becker S, Groß J, Matthes H, Oei SL, Thronicke A. Efficacy of Tango Argentino for Cancer-Associated Fatigue and Quality of Life in Breast Cancer Survivors: A Randomized Controlled Trial. Cancers (Basel) 2023; 15:cancers15112920. [PMID: 37296883 DOI: 10.3390/cancers15112920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Persistent impairments of quality of life-in particular, cancer-associated fatigue-are a major limitation for breast cancer survivors. As physical activity and mindfulness interventions have been shown to be effective in reducing fatigue symptoms, we investigated the efficacy of a six-week Argentine tango program. METHODS A randomized controlled trial was conducted with 60 breast cancer survivors diagnosed with stage I-III tumors 12-48 months prior to study enrollment and who had increased symptoms of fatigue. The participants were randomly assigned with a 1:1 allocation to either the tango or the waiting group. The treatment consisted of six weeks of supervised weekly one-hour tango group-sessions. Self-reported fatigue and further quality of life parameters were assessed at baseline and six weeks post-baseline. Longitudinal changes, correlations, Cohen's D (d) effect sizes, and association factors were also calculated. RESULTS Superiority of the tango intervention over the waiting list control was found in terms of improvement in fatigue (d = -0.64; 95%CI, -1.2 to -0.08; p = 0.03), especially cognitive fatigue. In addition, a superiority of the tango intervention over the waiting list was found in the improvement of diarrhea (d = -0.69; 95%CI, -1.25 to -0.13; p = 0.02). A pooled pre-post analysis of the 50 participants completing the six-week tango program revealed a close to 10% improvement of fatigue (p = 0.0003), insomnia (p = 0.008) and further quality of life outcomes. Adjusted multivariate linear regression analyses revealed the greatest improvements for participants who were more active in sports. In particular, survivors who received endocrine therapies, were obese, or had no prior dance experience seemed to especially benefit from the tango program. CONCLUSIONS This randomized controlled trial demonstrated that a six-week Argentine tango program improves fatigue in breast cancer survivors. Further trials are warranted to determine whether such improvements lead to better long-term clinical outcomes. TRIAL REGISTRATION trial registration number DRKS00021601. Retrospectively registered on 21 August 2020.
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Affiliation(s)
- Friedemann Schad
- Research Institute Havelhöhe, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany
- Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany
| | - Thomas Rieser
- Research Institute Havelhöhe, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Sarah Becker
- Breast Cancer Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany
| | - Jessica Groß
- Breast Cancer Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany
| | - Harald Matthes
- Research Institute Havelhöhe, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
- Institute for Gastroenterology, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany
| | - Shiao Li Oei
- Research Institute Havelhöhe, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany
| | - Anja Thronicke
- Research Institute Havelhöhe, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany
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Schad F, Steinmann D, Oei SL, Thronicke A, Grah C. Evaluation of quality of life in lung cancer patients receiving radiation and Viscum album L.: a real-world data study. Radiat Oncol 2023; 18:47. [PMID: 36879290 PMCID: PMC9990362 DOI: 10.1186/s13014-023-02234-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 02/20/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Lung cancer (LC) is associated with high mortality and poor quality of life (QoL). The disease as well as oncological treatments such as radiation and chemotherapy with adverse effects can impair the QoL of patients. Add-on treatment with extracts of Viscum album L. (white-berry European mistletoe, VA) has been shown to be feasible and safe and to improve the QoL of cancer patients. The aim of this study was to analyze the changes in QoL of LC patients being treated with radiation according to oncological guidelines and add-on VA treatment in a real-world setting. METHODS A real-world data study was conducted using registry data. Self-reported QoL was assessed by the evaluation of the European Organization of Research and Treatment Health-Related Quality of Life Core Questionnaire scale (EORTC QLQ-C30). Adjusted multivariate linear regression analyses were performed to analyze factors associated with changes in QoL at 12 months. RESULTS A total of 112 primary LC patients (all stages, 92% non-small-cell lung cancer, median age 70 (ICR: 63-75)), answered the questionnaires at first diagnosis and 12 months later. Assessment of 12 months changes in QoL revealed significant improvement of 27 points for pain (p = 0.006) and 17 points for nausea/vomiting (p = 0.005) in patients who received combined radiation and VA. In addition, significant improvements of 15 to 21 points for role (p = 0.03), physical (p = 0.02), cognitive (p = 0.04), and social functioning (p = 0.04) were observed in guideline treated patients receiving no radiation but add-on VA. CONCLUSIONS Add-on VA therapy reveals supportive effects for the QoL of LC patients. Particularly in combination with radiation a significant reduction in pain and nausea/ vomiting has been observed. Trial registration The study received ethics approval and was retrospectively registered (DRKS00013335 on 27/11/2017).
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Affiliation(s)
- Friedemann Schad
- Hospital Gemeinschaftskrankenhaus Havelhöhe, Research Institute Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany. .,Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany.
| | - Diana Steinmann
- Department of Radiotherapy and Special Oncology, Hannover Medical School, Hannover, Germany
| | - Shiao Li Oei
- Hospital Gemeinschaftskrankenhaus Havelhöhe, Research Institute Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Anja Thronicke
- Hospital Gemeinschaftskrankenhaus Havelhöhe, Research Institute Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Christian Grah
- Lung Cancer Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
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Schad F, Thronicke A. Safety of Combined Targeted and Helixor ®Viscum album L. Therapy in Breast and Gynecological Cancer Patients, a Real-World Data Study. Int J Environ Res Public Health 2023; 20:ijerph20032565. [PMID: 36767928 PMCID: PMC9916034 DOI: 10.3390/ijerph20032565] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Newer personalized medicines including targeted therapies such as PARP inhibitors and CDK 4/6 inhibitors have been shown to improve the survival of breast and gynaecological cancer patients. However, efficacy outcomes may be ham5pered by treatment discontinuation due to targeted therapy-related adverse drug reactions or resistance. Studies have suggested that add-on mistletoe (Viscum album L., VA) improves the quality of life and ameliorates the cytotoxic side effects of standard oncological therapy in cancer patients. The primary objective of this real-world data study was to determine the safety profile of targeted therapy in combination with add-on Helixor® VA therapy compared to targeted therapy alone in breast and gynecological cancer patients. METHODS The present study is a real-world data observational cohort study utilizing demographic and treatment data from the accredited national Network Oncology (NO) registry. The study has received ethics approval. The safety profile of targeted therapies with or without Helixor® VA therapy and safety-associated variables were evaluated by univariate and adjusted multivariable regression analyses. RESULTS All stages of breast and gynecological cancer patients (n = 242) were on average 54.5 ± 14.2 years old. One hundred and sixty patients (66.1%) were in the control (CTRL, targeted therapy) and 82 patients (33.9%) were in the combinational (COMB, targeted plus Helixor® VA therapy) group. The addition of Helixor® VA did not hamper the safety profile (χ2 = 0.107, p-value = 0.99) of targeted therapy. Furthermore, no adverse events and a trend towards an improved targeted therapy adherence were observed in the COMB group. CONCLUSIONS The present study is the first of its kind showing the applicability of Helixor® VA in combination with targeted therapies. The results indicate that add-on Helixor® VA does not negatively alter the safety profile of targeted therapies in breast and gynaecological cancer patients.
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Affiliation(s)
- Friedemann Schad
- Network Oncology, Research Institute Havelhöhe, Kladower Damm 221, 14089 Berlin, Germany
- Oncological Center, Department of Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089 Berlin, Germany
- Correspondence:
| | - Anja Thronicke
- Network Oncology, Research Institute Havelhöhe, Kladower Damm 221, 14089 Berlin, Germany
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Schad F, Thronicke A. Real-World Evidence-Current Developments and Perspectives. Int J Environ Res Public Health 2022; 19:ijerph191610159. [PMID: 36011793 PMCID: PMC9408280 DOI: 10.3390/ijerph191610159] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 06/06/2023]
Abstract
Real-world evidence (RWE) is increasingly involved in the early benefit assessment of medicinal drugs. It is expected that RWE will help to speed up approval processes comparable to RWE developments in vaccine research during the COVID-19 pandemic. Definitions of RWE are diverse, marking the highly fluid status in this field. So far, RWE comprises information produced from data routinely collected on patient's health status and/or delivery of health care from various sources other than traditional clinical trials. These sources can include electronic health records, claims, patient-generated data including in home-use settings, data from mobile devices, as well as patient, product, and disease registries. The aim of the present update was to review current RWE developments and guidelines, mainly in the U.S. and Europe over the last decade. RWE has already been included in various approval procedures of regulatory authorities, reflecting its actual acceptance and growing importance in evaluating and accelerating new therapies. However, since RWE research is still in a transition process, and since a number of gaps in this field have been explored, more guidance and a consented definition are necessary to increase the implementation of real-world data.
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Affiliation(s)
- Friedemann Schad
- Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany
- Research Institute Havelhöhe, Hospital Havelhöhe, 14089 Berlin, Germany
| | - Anja Thronicke
- Research Institute Havelhöhe, Hospital Havelhöhe, 14089 Berlin, Germany
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Schad F, Thronicke A, Steele ML, Merkle A, Matthes B, Grah C, Matthes H. Correction: Overall survival of stage IV non-small cell lung cancer patients treated with Viscum album L. in addition to chemotherapy, a real-world observational multicenter analysis. PLoS One 2022; 17:e0273387. [PMID: 35972953 PMCID: PMC9380908 DOI: 10.1371/journal.pone.0273387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Thronicke A, Schad F, Debus M, Grabowski J, Soldner G. Viscum album L. Therapy in Oncology: An Update on Current Evidence. Complement Med Res 2022; 29:362-368. [PMID: 35325897 DOI: 10.1159/000524184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 03/18/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND A majority of oncological patients apply add-on white-berry European mistletoe (Viscum album L., VA) extracts to reduce disease- and treatment-related symptoms and to improve health-related quality of life (HRQL). VA extracts exert various antitumor, pro-apoptotic, anti-proliferative, and immunomodulatory effects. Two current meta-analyses attribute life-prolonging and HRQL-improving properties to additive VA therapy. The aim of the present update was to review the current knowledge on VA extracts in clinical oncology. Hereby, we concentrated on studies with the highest clinical relevance in the field of lung, gastric, colorectal and pancreatic, gynaecological, as well as breast cancer applying the anthroposophical mistletoe preparations. SUMMARY The present update provides a brief overview regarding the use of VA preparations in clinical oncology reviewing current guidelines, systematic reviews, randomized controlled and real-world data studies. We have searched the pubmed.gov database of the National Library of Medicine with the search terms "mistletoe" and "cancer." We found good evidence of add-on VA therapy to improve the HRQL of patients with breast cancer (American Society of Clinical Oncology - endorsed Society for Integrative Oncology guideline) and of HRQL-improving and survival-prolonging properties of VA therapy in pancreatic cancer. In the field of gastrointestinal, gynaecological, and lung cancer, new or updating integrative and/or oncological guidelines should consider clear recommendations on integrative therapies including VA therapy. Nevertheless, further clinical and real-world data trials need to be performed in this field. KEY MESSAGES Evidence for add-on VA treatment for the improved management of cancer and cancer-related side effects is accumulating. Patients with breast cancer: good evidence for add-on VA therapy to improve the HRQL of oncological patients. Patients with pancreatic cancer: good evidence for add-on VA to improve HRQL and prolong survival. Patients with gastrointestinal, gynaecological, and lung cancer: update of guidelines is recommended with regards to integrative oncological therapies including add-on VA.
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Affiliation(s)
- Anja Thronicke
- Research Institute Havelhöhe at the Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Friedemann Schad
- Research Institute Havelhöhe at the Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
- Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | | | | | - Georg Soldner
- School of Spiritual Science, Medical Section at the Goetheanum, Dornach, Switzerland
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Oei SL, Rieser T, Becker S, Groß J, Matthes H, Schad F, Thronicke A. TANGO: effect of tango Argentino on cancer-associated fatigue in breast cancer patients-study protocol for a randomized controlled trial. Trials 2021; 22:866. [PMID: 34857031 PMCID: PMC8637025 DOI: 10.1186/s13063-021-05869-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/23/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The majority of breast cancer patients suffer from persistent impairments after completion of their primary oncological therapy. Cancer-related fatigue (CRF) in particular is a multidimensional syndrome having a profound negative impact on the quality of life. To counter CRF symptoms, physical activities are suggested as first-line interventions, mind-body therapies have been shown to be effective, and music therapy can also reduce anxiety and stress in breast cancer patients. Tango therapy that combines various elements can have an impact on physical, psychological, and cognitive abilities and could therefore have a beneficial effect on breast cancer patients. The purpose of this study is to investigate whether a 6-week tango module is suited as a therapeutic approach for people after primary breast cancer therapy to favorably influence their quality of life, especially CRF levels. METHODS Sixty patients with a diagnosis for stage I-III breast cancer 12-48 months before enrollment and with CRF (age > 18) will be recruited and randomized 1:1 to a tango or a waiting-list group. Movement concepts using elements of Argentine tango (self-awareness, musical and spatial perception, self-perception, playfulness, shared experience) will be examined with the participants during six consecutive weekly 1-h tango sessions. The primary outcome will be the improvement of CRF (German version of the Cancer Fatigue Scale), and the secondary outcomes will be the improvement in sleep quality (Pittsburgh Sleep Quality Index) and quality of life (EORTC-QLQ-C30). Patient-reported outcomes will be measured at baseline and 6 weeks later; follow-up will be performed 6, 12, and 24 months after baseline. An evaluation will be performed by means of descriptive data analyses. DISCUSSION Argentine tango, as a music-based movement therapy, can influence different skills and may improve several outcomes. The therapeutic use of Argentine tango in the care of breast cancer patients has not yet been reported. It is anticipated that participants receiving the tango module will have improved CRF, sleep, and quality of life scores compared to a waitlist control. TRIAL REGISTRATION German Clinical Trials Registry (DRKS) DRKS00021601 . Retrospectively registered on 21 August 2020.
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Affiliation(s)
- Shiao Li Oei
- Research Institute Havelhöhe at the Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Thomas Rieser
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Sarah Becker
- Breast Cancer Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Jessica Groß
- Breast Cancer Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Harald Matthes
- Research Institute Havelhöhe at the Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Medical Clinic for Gastroenterology, Infectiology and Rheumatology CBF Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Friedemann Schad
- Research Institute Havelhöhe at the Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
- Institute for Gastroenterology, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Anja Thronicke
- Research Institute Havelhöhe at the Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany.
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
- Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany.
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11
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Thronicke A, Oei SL, Schad F. Patients’ oncological therapy depends on their pre-treatment quality of life. Eur J Integr Med 2021. [DOI: 10.1016/j.eujim.2021.102043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Weinert S, Thronicke A, Hinse M, Schad F, Matthes H. School Teachers' Self-Reported Fear and Risk Perception during the COVID-19 Pandemic-A Nationwide Survey in Germany. Int J Environ Res Public Health 2021; 18:9218. [PMID: 34501807 PMCID: PMC8430488 DOI: 10.3390/ijerph18179218] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 12/24/2022]
Abstract
With the coronavirus disease 2019 (COVID-19) cases peaking and health systems reaching their limits in winter 2020/21, schools remained closed in many countries. To better understand teachers' risk perception, we conducted a survey in Germany. Participants were recruited through various associations and invited to take part in a cross-sectional COVID-19-specific online survey. Descriptive statistical analysis was performed. Factors associated with teachers' fears of contracting the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) were evaluated with an adjusted multivariable regression analysis. The median age of the 6753 participating teachers was 43 years, and 77% were female. Most teachers worked in high schools (29%) and elementary schools (26%). The majority of participants (73%) feared contracting SARS-CoV-2 at school, while 77% intended to receive their COVID-19 vaccination. Ninety-eight percent considered students to pose the greatest risk. Female and younger teachers were significantly more anxious to get infected and teachers who opposed the re-opening of schools had significantly higher odds of being more anxious (p < 0.001). To the authors' knowledge, this is the first study to describe teachers' risk perception of COVID-19 and their attitudes towards vaccinations in a nationwide survey. The anxiety correlates with the COVID-19 protection measures demanded and appears to be a driving factor rather than rational logic.
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Affiliation(s)
- Stefanie Weinert
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; (A.T.); (M.H.); (H.M.)
| | - Anja Thronicke
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; (A.T.); (M.H.); (H.M.)
- Research Institute Havelhöhe (FIH), Department Network Oncology, Kladower Damm 221, Berlin, Germany;
| | - Maximilian Hinse
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; (A.T.); (M.H.); (H.M.)
| | - Friedemann Schad
- Research Institute Havelhöhe (FIH), Department Network Oncology, Kladower Damm 221, Berlin, Germany;
- Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Harald Matthes
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; (A.T.); (M.H.); (H.M.)
- Research Institute Havelhöhe (FIH), Department Network Oncology, Kladower Damm 221, Berlin, Germany;
- Medical Clinic for Gastroenterology, Infectiology and Rheumatology CBF, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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13
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Oei SL, Thronicke A, Kröz M, von Trott P, Schad F, Matthes H. Impact of Oncological Therapy and Viscum album L Treatment on Cancer-Related Fatigue and Internal Coherence in Nonmetastasized Breast Cancer Patients. Integr Cancer Ther 2021; 19:1534735420917211. [PMID: 32478590 PMCID: PMC7273755 DOI: 10.1177/1534735420917211] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction:Viscum album L extracts (VA) are frequently used in integrative
oncology. Aim of this study was to evaluate the impact of add-on VA applications
on various patient-reported outcome measures. Methods: A
longitudinal real-world study was conducted, using data from the Network
Oncology clinical registry. Primary, nonmetastasized breast cancer patients
treated with oncological standard therapy partly combined with VA applications
were included. Internal Coherence Cancer-related Fatigue, and EORTC QLQ-C30
questionnaires were assessed at baseline and 6, 12, and 24 months later.
Results: A total of 319 patients received standard oncological
therapy and 40% of them additionally VA applications. After 6 and 12 months for
patients treated with chemotherapy (Ctx) only a significant decline of the
thermo-coherence, and worsening of fatigue was observed. For patients receiving
VA applications but no Ctx, significant beneficial effects on thermo-coherence,
fatigue, and seven EORTC QLQ-C30 scales were observed 24 months later. Adjusted
multivariable long-term subgroup (n = 106) regression analysis
revealed that Ctx, immuno-, and endocrine therapies had a worsening of 17, 17,
and 6 point changes, respectively, for EORTC QLQ-C30 fatigue (P
= .0004), while VA applications showed an improvement of 12 point change. A
similar impact of improvement (add-on VA) and worsening (standard oncological
treatment regimens) on EORTC QLQ-C30 insomnia (P = .009) and
physical functioning (P = .005) were observed.
Conclusions: In the present real-world study, add-on VA
applications had a supportive effect on cancer-related fatigue, insomnia,
physical functioning, and thermo-coherence. Thus, VA applications might be
suited to alleviate symptom burden during anticancer therapy in breast cancer
patients.
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Affiliation(s)
| | | | - Matthias Kröz
- Research Institute Havelhöhe, Berlin, Germany.,Institute for Integrative Medicine, Witten/Herdecke, Germany
| | - Philipp von Trott
- Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Friedemann Schad
- Research Institute Havelhöhe, Berlin, Germany.,Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Harald Matthes
- Research Institute Havelhöhe, Berlin, Germany.,Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany.,Medical Clinic for Gastroenterology, CBF, Charité Universitätsmedizin Berlin, Berlin, Germany
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14
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Breidenbach C, Wesselmann S, Sibert NT, Ortmann O, Blankenburg K, Stoklossa C, Gebauer G, Dos Santos Guilherme M, Lindner C, Peschel S, Schad F, Strecker P, Rieger L, Ferencz J, Dieng S, Kowalski C. Use of social service counseling by cancer patients: an analysis of quality assurance data of 6339 breast cancer patients from 13 certified centers in Germany treated between 2015 and 2017. BMC Cancer 2021; 21:671. [PMID: 34090379 PMCID: PMC8180094 DOI: 10.1186/s12885-021-08396-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/23/2021] [Indexed: 11/28/2022] Open
Abstract
Background Integrated social care may help to mitigate social risk factors in order to achieve more equitable health outcomes. In cancer centers certified according to the criteria set out by the German Cancer Society, every patient must be given low-threshold access to qualified social workers at the center for in-house social service counseling (SSC). Previous analyses have demonstrated large variation in the utilization of these services across individual centers. Therefore, this research aims at investigating whether SSC utilization varies regarding breast cancer patient characteristics and center characteristics presenting a unique approach of using routine data. Methods Multilevel modeling was performed using quality assurance data based on 6339 patients treated in 13 certified breast cancer centers in Germany in order to investigate whether SSC utilization varies with patient sex, age, and disease characteristics as well as over time and across centers. Results In the sample, 80.3% of the patients used SSC. SSC use varies substantially between centers for the unadjusted model (ICC = 0.24). Use was statistically significantly (P < .001) more likely in women, patients with invasive (in comparison to tumor in situ/ductal carcinoma in situ) diseases (P < .001), patients with both breasts affected (P = .03), patients who received a surgery (P < .001), patients who were diagnosed in 2015 or 2017 compared to 2016 (P < .001) and patients older than 84 years as compared to patients between 55 and 64 years old (P = .002). Conclusion The analysis approach allows a unique insight into the reality of cancer care. Sociodemographic and disease-related patient characteristics were identified to explain SSC use to some extent. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08396-1.
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Affiliation(s)
| | | | | | - Olaf Ortmann
- Caritas-Krankenhaus St. Josef, Regensburg, Germany
| | - Katrin Blankenburg
- Deutsche Vereinigung für Soziale Arbeit im Gesundheitswesen e.V., Berlin, Germany
| | - Cindy Stoklossa
- Deutsche Vereinigung für Soziale Arbeit im Gesundheitswesen e.V., Berlin, Germany
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15
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Sibert NT, Wesselmann S, Breidenbach C, Blohmer J, Brückner B, Gebauer G, Dos Santos Guilherme M, Hartkopf A, Lindner C, Peschel S, Rieger L, Schad F, Strecker P, Ferencz J, Dieng S, Inwald EC, Kowalski C, Ortmann O. Trastuzumab treatment of patients with early, HER2-positive breast cancer in 17 certified German breast cancer centers. J Cancer Res Clin Oncol 2021; 148:719-726. [PMID: 33914125 DOI: 10.1007/s00432-021-03651-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/22/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Since 2008, guidelines recommend that patients with HER2-positive early breast cancer (BC) should receive adjuvant chemotherapy in combination with trastuzumab in Germany. However, recent studies highlight that a substantial share of patients do not receive trastuzumab. We investigate which patient characteristics are associated with a tumor board recommendation for trastuzumab in Breast Cancer Centers (BCC) certified by the German Cancer Society (DKG) and the German Society for Senology, and if the recommendation differs between BCCs. MATERIALS AND METHODS Multi-level modeling was performed using quality assurance data based on 3052 HER2-positive, operated patients with a first diagnosis of early BC treated between 2006 and 2019 in 17 BCCs in Germany to investigate whether trastuzumab recommendation varies with patient sex, age, and disease characteristics, as well as over time and across BCCs. RESULTS Tumor board recommendations for trastuzumab differ substantially between BCCs (intraclass correlation coefficient [ICC] null model: 0.11). Our final model (ICC 0.17, Akaike Information Criterion [AIC], 1328.0, R2 0.69) shows that physicians in BCCs more often recommend trastuzumab to patients who are younger than 60 years and those with a recommendation for any additional therapy (chemotherapy, radiation or endocrine therapy) (all p < 0.05). Furthermore, there is a significant time-dependent increase of trastuzumab recommendations (odds ratio [OR] = 1.38, 95% confidence interval [CI] = 1.31-1.46, p < 0.05). CONCLUSION In certified BCCs in Germany, guideline concordant trastuzumab recommendation is increasing since 2006 (positive cohort effect). Recommendation of trastuzumab for HER2-positive BC patients in BCCs is significantly associated with patients' age and the recommendations for other additional therapy strategies, apart from surgery. The quality assurance data analyzed do not include potentially relevant confounders, such as socioeconomic status or comorbidities.
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Affiliation(s)
- Nora Tabea Sibert
- German Cancer Society, Kuno-Fischer-Straße 8, 14057, Berlin, Germany.
| | - Simone Wesselmann
- German Cancer Society, Kuno-Fischer-Straße 8, 14057, Berlin, Germany
| | - Clara Breidenbach
- German Cancer Society, Kuno-Fischer-Straße 8, 14057, Berlin, Germany
| | - Jens Blohmer
- Department of Gynaecology Incl. Breast Center (CCM), Charité Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Barbara Brückner
- Krankenhaus Waldfriede, Argentinische Allee 40, 14163, Berlin, Germany
| | - Gerhard Gebauer
- Askplepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Germany
| | | | - Andreas Hartkopf
- Department of Obstetrics and Gynecology, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Christoph Lindner
- Agaplesion Diakonieklinikum Hamburg, Hohe Weide 17, 20259, Hamburg, Germany
| | - Susanne Peschel
- St. Bernward Krankenhaus, Treiberstraße 9, 31134, Hildesheim, Germany
| | - Lorenz Rieger
- Krankenhaus Landshut-Achdorf, Achdorfer Weg 3, 84036, Landshut, Germany
| | - Friedemann Schad
- Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Paul Strecker
- Helios Klinikum Erfurt, Nordhäuser Straße 74, 99089, Erfurt, Germany
| | - Julia Ferencz
- OnkoZert GmbH, Gartenstraße 24, 89231, Neu-Ulm, Germany
| | | | - Elisabeth C Inwald
- Department of Gynaecology, Caritas-Krankenhaus St. Josef, Landshuter Straße 65, 93053, Regensburg, Germany
| | | | - Olaf Ortmann
- Department of Gynaecology, Caritas-Krankenhaus St. Josef, Landshuter Straße 65, 93053, Regensburg, Germany
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16
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Megas IF, Tolzmann DS, Bastiaanse J, Fuchs PC, Kim BS, Kröz M, Schad F, Matthes H, Grieb G. Integrative Medicine and Plastic Surgery: A Synergy-Not an Antonym. ACTA ACUST UNITED AC 2021; 57:medicina57040326. [PMID: 33915729 PMCID: PMC8066838 DOI: 10.3390/medicina57040326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/09/2021] [Accepted: 03/25/2021] [Indexed: 01/25/2023]
Abstract
Background: Integrative medicine focuses on the human being as a whole—on the body, mind, and spirit—to achieve optimal health and healing. As a synthesis of conventional and complementary treatment options, integrative medicine combines the pathological with the salutogenetic approach of therapy. The aim is to create a holistic system of medicine for the individual. So far, little is known about its role in plastic surgery. Hypothesis: We hypothesize that integrative medicine based on a conventional therapy with additional anthroposophic therapies is very potent and beneficial for plastic surgery patients. Evaluation and consequence of the hypothesis: Additional anthroposophic pharmacological and non-pharmacological treatments are promising for all areas of plastic surgery. We are convinced that our specific approach will induce further clinical trials to underline its therapeutic potential.
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Affiliation(s)
- Ioannis-Fivos Megas
- Department of Plastic Surgery and Hand Surgery, Gemeinschaftskrankenhaus Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany; (I.-F.M.); (D.S.T.); (J.B.)
| | - Dascha Sophie Tolzmann
- Department of Plastic Surgery and Hand Surgery, Gemeinschaftskrankenhaus Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany; (I.-F.M.); (D.S.T.); (J.B.)
| | - Jacqueline Bastiaanse
- Department of Plastic Surgery and Hand Surgery, Gemeinschaftskrankenhaus Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany; (I.-F.M.); (D.S.T.); (J.B.)
| | - Paul Christian Fuchs
- Department of Plastic Surgery and Hand Surgery, Burn Center, University of Witten/Herdecke, Kliniken der Stadt Köln, Ostmerheimer Str. 200, 51109 Köln, Germany;
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland;
| | - Matthias Kröz
- Institute of Integrative Medicine, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany;
- Research Department Klinik Arlesheim, Pfeffingerweg 1, 4144 Arlesheim, Switzerland
- Research Institute Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany; (F.S.); (H.M.)
| | - Friedemann Schad
- Research Institute Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany; (F.S.); (H.M.)
| | - Harald Matthes
- Research Institute Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany; (F.S.); (H.M.)
- Institute of Social Medicine, Epidemiology and Health Economics CCM, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Gerrit Grieb
- Department of Plastic Surgery and Hand Surgery, Gemeinschaftskrankenhaus Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany; (I.-F.M.); (D.S.T.); (J.B.)
- Department of Plastic Surgery and Hand Surgery, Burn Center, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
- Correspondence:
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17
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Oei SL, Thronicke A, Matthes H, Schad F. Assessment of integrative non-pharmacological interventions and quality of life in breast cancer patients using real-world data. Breast Cancer 2021; 28:608-617. [PMID: 33393018 DOI: 10.1007/s12282-020-01193-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/19/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Treatments with non-pharmacological interventions (NPIs), comprising art and exercise therapies, nursing interventions, and educational components, are considered to improve quality of life of cancer patients. The aim of this study was to assess the longitudinal changes in self-reported quality of life of breast cancer patients receiving an integrative medicine program consisting of hospital-based NPIs and standard oncological treatments. METHODS This real-world data study was conducted using data from the Network Oncology clinical registry of the Gemeinschaftskrankenhaus Havelhöhe. Primary breast cancer patients of all tumor stages, who answered the European Organization of Research and Treatment Health-Related Quality of Life Core Questionnaire scale (EORTC QLQ-C30) at first diagnosis and 12 months later, were included. Association factors between received NPIs and longitudinal EORTC QLQ-C30-changes were analyzed with additive non-parametric regression tests, considering treatment regimens and demographic variables, using the software R. RESULTS A total of 231 primary breast cancer patients were enrolled and separate regression analyses were carried out. Significant associations between the received NPIs elaborate consultations and life review, nursing compresses, music and eurythmy therapy and improvements of 8-13 points for global health, all five functional EORTC-scales, and symptoms fatigue, dyspnea, insomnia, and financial difficulties were observed. CONCLUSION Our findings support the beneficial impact of NPIs for breast cancer patients. Further research could be directed towards synergistic effects of multimodal applied NPIs. TRIAL REGISTRATION Trial registration number DRKS00013335 on 27/11/2017 retrospectively registered.
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Affiliation(s)
- Shiao Li Oei
- Research Institute Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.
| | - Anja Thronicke
- Research Institute Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.,Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Harald Matthes
- Research Institute Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.,Medical Clinic for Gastroenterology, Infectiology and Rheumatology CBF, Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Friedemann Schad
- Research Institute Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.,Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
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18
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Schad F, Thronicke A, von Trott P, Oei SL. Analysis of Changes in Cancer-Related Fatigue of Breast Cancer Patients Receiving an Integrative Medicine Program. Integr Cancer Ther 2020; 19:1534735420963780. [PMID: 33040629 PMCID: PMC7585890 DOI: 10.1177/1534735420963780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction: Cancer-related fatigue (CRF) occurs frequently in breast cancer patients. The
aim of this real-world study was to analyze the longitudinal changes of CRF
in breast cancer patients receiving an integrative medicine program, which
includes the application of non-pharmacological interventions (NPIs) and
Viscum album L. (VA) extracts. Methods: All data were collected from the clinical register of the Network Oncology of
a German certified breast cancer center of the Gemeinschaftskrankenhaus
Havelhöhe (GKH). Primary breast cancer patients, treated upon initial
diagnosis with integrated NPIs, comprising art and exercise therapy, nursing
interventions, and educational components, during their hospital stay, and
who had answered the German Cancer-Fatigue Scale (CFS-D) questionnaire at
first diagnosis and 12 months later, were included. The associations between
NPIs and CFS-D changes were analyzed with adjusted multivariable regression
analyses, considering received treatment regimens and demographic variables,
using the software R. Results: 231 female breast cancer patients of all tumor stages were evaluated. While
chemotherapy exhibited significant severe deterioration, add-on VA
applications seem to partially mitigate this impairment on CRF. 36 separate
multivariable regression analyses for all NPIs showed that in particular
significant associations between CFS-D improvements and the interventions
nursing compresses (6 point change; P = .0002;
R² = 28%) or elaborate consultations and life review
(ECLR) (4 point change; P = .0002;
R² = 25%) were observed. Conclusions: Breast cancer patients benefit from a hospital-based integrative medicine
program. To alleviate fatigue symptoms during oncological therapy, an
expansion of this concept should be developed in the future.
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Affiliation(s)
- Friedemann Schad
- Research Institute Havelhöhe, Berlin, Germany.,Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | | | - Phillipp von Trott
- Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
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19
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Thronicke A, Matthes B, von Trott P, Schad F, Grah C. Overall Survival of Nonmetastasized NSCLC Patients Treated With Add-On Viscum album L: A Multicenter Real-World Study. Integr Cancer Ther 2020; 19:1534735420940384. [PMID: 32856476 PMCID: PMC7457695 DOI: 10.1177/1534735420940384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Recent data suggest a beneficial effect of add-on treatment with Viscum album L (VA) on the survival in cancer patients. The objective of this study was to compare the impact of standard oncological therapy plus add-on VA treatment (S+VA) versus standard oncological therapy alone (S) on the overall survival (OS) of patients with nonmetastasized non–small cell lung carcinoma (NSCLC). Methods: The multicenter real-world data study was conducted using data from the Network Oncology Clinical Registry. The primary end point was OS. OS and impact on hazard in both treatment groups were compared. Results: A total of 275 patients with stages I to IIIA NSCLC were enrolled (mean age = 67.6 years, 57.2% male patients). No significant difference of OS was observed between both groups. Even though not significant, for a subgroup of unresected patients with stage I NSCLC, adenocarcinoma or squamous cell carcinoma, a medium effect size OS improvement was observed for S+VA compared to S. Conclusions: Our findings support the importance of surgery as the most effective intervention in nonmetastasized NSCLC patients. Add-on VA therapy shows here no additional effect in resected patients. However, a small subgroup analysis suggests a possible role of add-on VA for nonresected subgroups. Our results complement existing knowledge on the clinical impact of add-on VA therapy in NSCLC patients and may serve as hypothesis-generating data for further examinations in this cohort. Further research could be directed towards the role of combined therapy for nonresected early-stage NSCLC.
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Affiliation(s)
| | - Burkhard Matthes
- Research Institute Havelhöhe, Berlin, Germany.,Interdisciplinary Oncology and Palliative Care, Hospital Havelhöhe, Berlin, Germany
| | - Philipp von Trott
- Interdisciplinary Oncology and Palliative Care, Hospital Havelhöhe, Berlin, Germany
| | - Friedemann Schad
- Research Institute Havelhöhe, Berlin, Germany.,Interdisciplinary Oncology and Palliative Care, Hospital Havelhöhe, Berlin, Germany
| | - Christian Grah
- Research Institute Havelhöhe, Berlin, Germany.,Lung Cancer Center and Department of Pneumology, Hospital Havelhöhe, Berlin, Germany
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20
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Thronicke A, Reinhold T, von Trott P, Grah C, Matthes B, Matthes H, Schad F. Cost-effectiveness of real-world administration of chemotherapy and add-on Viscum album L. therapy compared to chemotherapy in the treatment of stage IV NSCLC patients. PLoS One 2020; 15:e0236426. [PMID: 32716969 PMCID: PMC7384610 DOI: 10.1371/journal.pone.0236426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 07/06/2020] [Indexed: 12/29/2022] Open
Abstract
Background For stage IV lung cancer patients receiving add-on Viscum album L. (VA) treatment an improved overall survival was detected. Information regarding cost-effectiveness (CE) for comparisons between chemotherapy (CTx) and CTx plus additive VA in stage IV lung cancer treatment is limited. The present study assessed the costs and cost-effectiveness of CTx plus VA (V) compared to CTx alone (C) for stage IV non-small cell lung cancer (NSCLC) patients treatment in a hospital in Germany. Methods In the observational real-world data study, data from the Network Oncology clinical registry were utilized. Enrolled stage IV lung cancer patients received the respective therapy (C or V) in a certified German Cancer Center. Cost and cost-effectiveness analyses from the hospital’s perspective were investigated on the basis of overall survival (OS) and routine financial controlling data. In addition, the incremental cost-effectiveness ratio (ICER) was calculated. The primary result of the analysis was tested for robustness in a bootstrap-based sensitivity analysis. Results 118 patients (C: n = 86, V: n = 32) were included in the analysis, mean age 63.8 years, the proportion of male patients was 55.1%. Adjusted hospital’s total mean costs for patients from the C and V group were €16,289, 95%CI: 13,834€-18,744€ (over an adjusted mean OS time of 13.4 months) and €17,992, 95%CI: 13,658–22,326 (over an adjusted mean OS time of 19.1 months), respectively. The costs per additional OS year gained (ICER) with the V-therapy compared to C therapy were €3,586. Conclusion The findings of the present study suggest that the combined use of chemotherapy and VA was clinically effective and comparably cost-effective to chemotherapy alone in our analysed patient sample from the hospital’s perspective. Further randomized and prospective cost-effectiveness studies are necessary to complement our findings.
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Affiliation(s)
- Anja Thronicke
- Research Institute Havelhöhe at the Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Thomas Reinhold
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Philipp von Trott
- Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Christian Grah
- Lung Cancer Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Burkhard Matthes
- Lung Cancer Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Harald Matthes
- Research Institute Havelhöhe at the Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
- Medical Clinic for Gastroenterology, Infectiology and Rheumatology CBF and Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friedemann Schad
- Research Institute Havelhöhe at the Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
- Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
- * E-mail:
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Oei SL, Thronicke A, Matthes H, Schad F. Evaluation of the effects of integrative non-pharmacological interventions on the internal coherence and resilience of breast cancer patients. Support Care Cancer 2020; 29:1413-1421. [PMID: 32671562 DOI: 10.1007/s00520-020-05617-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/07/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE In the breast cancer center at the Gemeinschaftskrankenhaus Havelhöhe (GKH), integrative strategies are implemented in the routine care of breast cancer patients. The aim of this breast cancer real-world study was to systematically evaluate changes in patients' internal coherence and resilience, associated with the use of non-pharmacological interventions (NPIs). METHODS This study included 231 primary breast cancer patients treated with standard oncological therapy and NPIs, which comprise art and movement therapies, nursing interventions, and educational components, and had answered the internal coherence scale (ICS) questionnaire at first diagnosis and 12 months later. Data were collected from the Network Oncology clinical registry of the GKH, and effects of NPIs on ICS changes were analyzed with adjusted linear multivariable regression analyses, using the software R. RESULTS Two hundred twenty breast cancer patients of all tumor stages were eligible for a total of 27 separate adjusted multivariable linear regression analyses. The NPIs elaborate consultations and life review (ECLR); nursing compresses, music therapy, and rhythmic massages were significantly associated with increases of about 2-point changes in inner resilience and coherence (p < 0.05). Furthermore, a significant association with an elevation of the thermo coherence was observed for the application of nursing compresses. CONCLUSIONS The evaluation of real-world data carried out here shows that the application of the multimodal treatment concept can lead to an enhancement of the internal coherence and resilience in breast cancer patients. To improve the care of cancer patients, this multimodal program should be further expanded into routine clinical practices. TRIAL REGISTRATION Trial registration number DRKS00013335 on 27/11/2017 retrospectively registered.
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Affiliation(s)
- Shiao Li Oei
- Research Institute Havelhöhe, Forschungsinstitut Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.
| | - Anja Thronicke
- Research Institute Havelhöhe, Forschungsinstitut Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Harald Matthes
- Research Institute Havelhöhe, Forschungsinstitut Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.,Institute of Social Medicine, Epidemiology and Health Economics and Medical Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Friedemann Schad
- Research Institute Havelhöhe, Forschungsinstitut Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.,Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
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Matthes H, Thronicke A, Hofheinz RD, Baars E, Martin D, Huber R, Breitkreuz T, Bar-Sela G, Galun D, Schad F. Statement to an Insufficient Systematic Review on Viscum album L. Therapy. Evid Based Complement Alternat Med 2020; 2020:7091039. [PMID: 32148549 PMCID: PMC7049420 DOI: 10.1155/2020/7091039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/24/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Up to 88% of oncological patients apply complementary therapies and up to 77% apply complementary mistletoe therapy in the context of integrative oncological approaches. An evidence-based consultation of oncological health professionals regarding complementary therapies used in Germany is missing. Therefore, a new S3-Guideline for Complementary Medicine in the Treatment of Oncological Patients is under development and is anticipated to be finalized in November 2020. It will be based on evidence-based publications and systematic reviews on complementary therapies in oncology. A recently published two-part systematic review on mistletoe treatment in oncology has been reevaluated. METHODS The latest published systematic two-part review on mistletoe has been systematically proofread and checked in compliance with the Cochrane Handbook for Systematic Reviews of Intervention and the AMSTAR 2 (A MeaSurement Tool to Assess Systematic Reviews) tool. RESULTS The here discussed two-part review is incomplete, lacks sound accuracy including insufficient assessment of the risk of bias, and contains imprecise statements. In addition, it does not sufficiently comply with the Cochrane Handbook for Systematic Reviews of Intervention and the AMSTAR 2 tool. CONCLUSION In view of the approaching release of a new guideline in the field of complementary therapies in oncology, the present statement draws attention to a lack of profound methodology of conductance of a recently released systematic review on mistletoe. In consequence, a comprehensive overview of published mistletoe studies, i.e., a meta-analysis with a sound methodology of conductance, is necessary.
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Affiliation(s)
- Harald Matthes
- Oncological Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
- Institute of Social Medicine, Epidemiology and Health Economics and Medical Department of Gastroenterology, Infectiology and Rheumatology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Research Institute Havelhöhe, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Anja Thronicke
- Research Institute Havelhöhe, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Ralf-Dieter Hofheinz
- Interdisciplinary Tumour Centre Mannheim, University Medicine of Mannheim, Mannheim, Germany
| | - Erik Baars
- Louis Bolk Institute, Bunnik, Netherlands
| | - David Martin
- Gerhard Kienle Chair for Medical Theory, Integrative and Anthroposophical Medicine, Department of Human Medicine, Faculty of Health, University of Witten/Herdecke, Witten/Herdecke, Germany
| | - Roman Huber
- Center for Complementary Medicine, Institute for Infection, Prevention and Hospital Epidemiology, University Freiburg, Freiburg, Germany
| | - Thomas Breitkreuz
- Hospital Filderklinik, Stuttgart, Germany
- Hospital Paracelsus Krankenhaus, Bad Liebenzell, Germany
| | | | - Daniel Galun
- Clinical Center of Serbia, Belgrade and Medical School, University of Belgrade, Belgrade, Serbia
| | - Friedemann Schad
- Oncological Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
- Research Institute Havelhöhe, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
- Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
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Matthes H, Hofheinz RD, Bar-Sela G, Galun D, Martin D, Huber R, Langhorts J, Matthiessen PF, Schad F. Letter to the editors of the Journal of Cancer Research and Clinical Oncology. J Cancer Res Clin Oncol 2019; 145:2405-2407. [PMID: 31115671 DOI: 10.1007/s00432-019-02926-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/22/2019] [Indexed: 11/28/2022]
Affiliation(s)
- H Matthes
- Institute for Social Medicine, Epidemiology and Health Economics and Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Charité CCM and CBF, Berlin, Germany.
| | - R-D Hofheinz
- Interdisciplinary Tumour Centre Mannheim, University Medicine of Mannheim, Mannheim, Germany
| | | | - D Galun
- Clinical Center of Serbia, Belgrade and Medical School, University of Belgrade, Belgrade, Serbia
| | - D Martin
- Gerhard Kienle Chair for Medical Theory, Integrative and Anthroposophical Medicine, Department of Human Medicine, Faculty of Health, University of Witten/Herdecke, Witten/Herdecke, Germany
| | - R Huber
- Center for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, University of Freiburg, Freiburg, Germany
| | - J Langhorts
- Clinic for Integrative Medicine and Naturopathy, Social Foundation Bamberg, Klinikum am Bruderwald, Bamberg, Germany
| | - P F Matthiessen
- Institute for Integrative Medicine at the University of Witten/Herdecke, Witten/Herdecke, Germany
| | - F Schad
- Department of Oncology, Hospital Havelhöhe, Berlin, Germany
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Oei SL, Thronicke A, Kröz M, Matthes H, Schad F. Use and Safety of Viscum album L Applications in Cancer Patients With Preexisting Autoimmune Diseases: Findings From the Network Oncology Study. Integr Cancer Ther 2019; 18:1534735419832367. [PMID: 30808274 PMCID: PMC6432670 DOI: 10.1177/1534735419832367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Viscum album L (VA, mistletoe) extracts are commonly used in integrative oncology. Here the clinical safety profile of additional VA-treatments to standard care in cancer patients with preexisting autoimmune diseases was analyzed. METHODS In this observational cohort study medical data and recorded adverse events (AEs) of treated patients were retrieved from the Network Oncology registry and a safety analysis was performed. RESULTS A total of 106 patients (median age 63 years) treated with add-on VA-extracts were analyzed. Most frequent autoimmune diseases were Hashimoto's thyroiditis (27%), psoriasis (19%), and ulcerative colitis (15%). Seventeen patients (16%) experienced VA-related AEs, but neither long-term side effects nor VA-therapy discontinuations were recorded. In a subgroup of 30 patients receiving long-term VA-therapy no exacerbations or flares of underlying autoimmune diseases were recorded. Additionally, a significant halving of overall AE-rates was observed during VA-treatment periods (p= 0.019). CONCLUSIONS Our findings suggest that add-on VA-therapy in cancer patients with preexisting autoimmune diseases as Hashimoto's thyroiditis, psoriasis, ulcerative colitis, Grave's disease, and some rheumatic diseases is safe. No higher rates of VA-associated AEs were observed and the overall AE-rates were significantly lowered in VA-therapy periods. However, results should be interpreted with caution in light of the study's observational character.
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Affiliation(s)
| | | | - Matthias Kröz
- 1 Research Institute Havelhöhe, Berlin, Germany.,3 Institute for Social Medicine, Charité, Berlin, Germany.,4 Institute for Integrative Medicine, Witten/Herdecke, Germany
| | - Harald Matthes
- 1 Research Institute Havelhöhe, Berlin, Germany.,3 Institute for Social Medicine, Charité, Berlin, Germany.,5 Medical Clinic for Gastroenterology, CBF, Charité, Berlin, Germany
| | - Friedemann Schad
- 1 Research Institute Havelhöhe, Berlin, Germany.,2 Oncological Centre, Hospital Havelhöhe, Berlin, Germany
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Thronicke A, Oei SL, Merkle A, Matthes H, Schad F. Clinical Safety of Combined Targeted and Viscum album L. Therapy in Oncological Patients. Medicines (Basel) 2018; 5:medicines5030100. [PMID: 30200590 PMCID: PMC6164814 DOI: 10.3390/medicines5030100] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 12/14/2022]
Abstract
Background: Despite improvement of tumor response rates, targeted therapy may induce toxicities in cancer patients. Recent studies indicate amelioration of adverse events (AEs) by add-on mistletoe (Viscum album L., VA) in standard oncological treatment. The primary objective of this multicenter observational study was to determine the safety profile of targeted and add-on VA therapy compared to targeted therapy alone. Methods: Demographic and medical data were retrieved from the Network Oncology registry. Allocation to either control (targeted therapy) or combinational group (targeted/add-on VA) was performed. Safety-associated variables were evaluated by adjusted multivariable analyses. Results: The median age of the study population (n = 310) at first diagnosis was 59 years; 67.4% were female. In total, 126 patients (40.6%) were in the control and 184 patients (59.4%) in the combination group. Significant differences were observed between both groups with respect to overall AE frequency (χ2 = 4.1, p = 0.04) and to discontinuation of standard oncological treatment (χ2 = 4.8, p = 0.03) with lower rates in the combinational group (20.1%, 35% respectively) compared to control (30.2%, 60.5%, respectively). Addition of VA to targeted therapy significantly reduced the probability of oncological treatment discontinuation by 70% (Odds ratio (OR) 0.30, p = 0.02). Conclusions: Our results indicate a highly significant reduction of AE-induced treatment discontinuation in all-stage cancer patients when treated with VA in addition to targeted therapy.
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Affiliation(s)
- Anja Thronicke
- Network Oncology, Research Institute Havelhöhe, Kladower Damm 221, 14089 Berlin, Germany.
| | - Shiao Li Oei
- Network Oncology, Research Institute Havelhöhe, Kladower Damm 221, 14089 Berlin, Germany.
| | - Antje Merkle
- Network Oncology, Research Institute Havelhöhe, Kladower Damm 221, 14089 Berlin, Germany.
- Oncological Centre, Hospital Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany.
| | - Harald Matthes
- Network Oncology, Research Institute Havelhöhe, Kladower Damm 221, 14089 Berlin, Germany.
- Medical Clinic for Gastroenterology, Infectiology and Rheumatology CBF and Institute of Social Medicine, Epidemiology and Health Economics CCM, Charité University Hospital Berlin, 10117 Berlin, Germany.
| | - Friedemann Schad
- Network Oncology, Research Institute Havelhöhe, Kladower Damm 221, 14089 Berlin, Germany.
- Oncological Centre, Hospital Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany.
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Schad F, Thronicke A, Steele ML, Merkle A, Matthes B, Grah C, Matthes H. Overall survival of stage IV non-small cell lung cancer patients treated with Viscum album L. in addition to chemotherapy, a real-world observational multicenter analysis. PLoS One 2018; 13:e0203058. [PMID: 30148853 PMCID: PMC6110500 DOI: 10.1371/journal.pone.0203058] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 08/14/2018] [Indexed: 12/15/2022] Open
Abstract
Background Stage IV non-small cell lung cancer (NSCLC) is associated with a five-year survival rate of around 1%. Treatment with Viscum album L. (VA) extracts has been shown to reduce chemotherapy (CTx)-related adverse events, decrease CTx dose reductions and improve quality of life in a number of cancers. Recent data suggest a beneficial effect of add-on treatment with Viscum album L. (VA, European mistletoe) on survival in cancer patients. The objective of this study was to evaluate the effect of VA in addition to chemotherapy on survival in stage IV NSCLC patients. Methods The observational study was conducted using data from the Network Oncology clinical registry which is an accredited conjoint clinical registry of German oncological hospitals, practitioners and out-patient centers.Patients were included if they had stage IV NSCLC at diagnosis, lived at least for four weeks post-diagnosis and received chemotherapeutic treatment. Patients with EGFR mutations as well as patients receiving tyrosine kinase inhibitors or immune checkpoint inhibitors were not included. Overall survival and impact on hazard in patients with chemotherapy (CTx) to patients receiving CTx plus VA were compared. To identify factors associated with survival and to address potential sources of bias a multivariate analyses using Cox proportional hazard model was performed. Results The median age of the population was 64.1 years with 55.7% male patients. The highest proportion of patients had adenocarcinoma (72.2%) and most of the patients were current or past smokers (70.9%). Of 158 stage IV NSCLC patients, 108 received CTx only and 50 additional VA. Median survival was 17.0 months in the CTx plus VA group (95%CI: 11.0–40.0) and was 8.0 months (95%CI: 7.0–11.0) in the CTx only group (χ2 = 7.2, p = .007). Overall survival was significantly prolonged in the VA group (HR 0.44, 95%CI: 0.26–0.74, p = .002). One-year and three-year overall survival rates were greater with CTx plus VA compared to CTX alone (1y: 60.2% vs. 35.5%; 3y: 25.7% vs. 14.2%). Conclusion Our findings suggest that concomitant VA is positively associated with survival in stage IV NSCLC patients treated with standard CTx. These findings complement pre-existing knowldedge of add-on VA’s clinical impact, however, results should be interpreted with caution in light of the study’s observational character.
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Affiliation(s)
- Friedemann Schad
- Research Institute Havelhöhe, Hospital Havelhöhe, Berlin, Germany
- Interdisciplinary Oncology and Palliative Care, Hospital Havelhöhe, Berlin, Germany
- * E-mail:
| | - Anja Thronicke
- Research Institute Havelhöhe, Hospital Havelhöhe, Berlin, Germany
| | - Megan L. Steele
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Antje Merkle
- Research Institute Havelhöhe, Hospital Havelhöhe, Berlin, Germany
- Interdisciplinary Oncology and Palliative Care, Hospital Havelhöhe, Berlin, Germany
| | - Burkhard Matthes
- Research Institute Havelhöhe, Hospital Havelhöhe, Berlin, Germany
- Interdisciplinary Oncology and Palliative Care, Hospital Havelhöhe, Berlin, Germany
| | - Christian Grah
- Research Institute Havelhöhe, Hospital Havelhöhe, Berlin, Germany
- Lung Cancer Center and Department of Pneumology, Hospital Havelhöhe, Berlin, Germany
| | - Harald Matthes
- Research Institute Havelhöhe, Hospital Havelhöhe, Berlin, Germany
- Medical Clinic for Gastroenterology, Infectiology and Rheumatology CBF and Institute of Social Medicine, Epidemiology and Health Economics CCM, Charité University Medicine Berlin, Berlin, Germany
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Thronicke A, Kröz M, Merkle A, Matthes H, Herbstreit C, Schad F. Psychosocial, Cognitive, and Physical Impact of Elaborate Consultations and Life Review in Female Patients with Non-Metastasized Breast Cancer. Complement Med Res 2018; 25:92-101. [DOI: 10.1159/000486672] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Elaborate consultations and life review (ECLR) has been regularly applied in patients of various cancer entities and stages within Anthroposophic-integrative oncology concepts. However, a lack of systematic research in this field has been detected. To close this gap of knowledge, we evaluated the impact of ECLR in patients with non-metastasized breast cancer before, during, and after primary oncological treatment. Methods: Patient-reported outcome measures were evaluated by analyzing European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ-C30) in patients with non-metastasized breast cancer who had received either oncological standard therapy alone or in combination with ECLR. Results: 95 female patients were eligible for questionnaire analysis (median age 58 years). Adjusted multivariable linear regression analysis revealed that ECLR was associated with significant improvements in medium-term global health/quality of life and emotional, social, and cognitive functioning. Furthermore, ECLR was associated with significant reductions of short-term appetite loss burden, pain, and short- and medium-term financial difficulties. Subgroup analyses revealed significant improvements in pivotal quality-of-life aspects including fatigue (p = 0.002) in chemotherapy-treated patients after ECLR. Conclusions: 12 months of surveillance of breast cancer patients reveals medium-term recovery of the global health status/quality of life and cognitive and psychosocial well-being associated with ECLR. In addition, our data indicate a possible association between ECLR and reduced short-term fatigue burden, which has to be re-confirmed prospectively in a larger study cohort. As long-term cancer survivors develop psychological symptoms similar to patients with chronic diseases, prospective studies should evaluate the impact of ECLR on the psychosocial well-being in these patients.
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Thronicke A, Oei SL, Merkle A, Herbstreit C, Lemmens HP, Grah C, Kröz M, Matthes H, Schad F. Integrative cancer care in a certified Cancer Centre of a German Anthroposophic hospital. Complement Ther Med 2018; 40:151-157. [PMID: 30219441 DOI: 10.1016/j.ctim.2018.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/19/2018] [Accepted: 03/31/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The concept of integrative oncology (IO) comprising guideline-oriented standard and add-on complementary medicine has gained growing importance. The Anthroposophic-integrative Cancer Centre (CC) at the hospital Gemeinschaftskrankenhaus (GKH) in Berlin has been implementing IO concepts during recent years. Furthermore, it is a certified CC and has been annually audited by national cancer authorities since 2012. The objective of the present study was to evaluate IO concepts of the certified CC GKH. METHODS Clinical, demographic, integrative treatment and follow-up data were analyzed between 2011 and 2016. In addition, CC GKH quality measures were compared with those of nationwide benchmarking CCs. RESULTS Between 2011 and 2016, 2.382 primary cancer patients, median age 66 years, were treated at the CC GKH. 70.1% of the patients showed either Union for International Cancer Control (UICC) stage 0, I, II or III and 25.6% were in UICC stage IV. IO therapies included surgery (64.4% of patients), radiation (41.2%), and application of cytostatic drugs (53.9%), add-on mistletoe therapy (30.5%), and non-pharmacological interventions (87.3%). Regarding psycho-oncological support and quota of patient's enrollment in studies the CC GKH performs above nationwide benchmarks. Research outcomes including safety issues, clinical impact as well as patient's health-related quality of life are continuously evaluated and integrated into hospital's decision-management. CONCLUSION This analysis reveals that IO concepts are applied to a high proportion of male and female primary cancer patients of all age groups, indicating a successful implementation at the certified CC GKH. Ongoing clinical evaluations have been initiated and cost-effectiveness comparisons are under analyses.
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Affiliation(s)
| | - Shiao Li Oei
- Research Institute Havelhöhe, 14089 Berlin, Germany.
| | - Antje Merkle
- Research Institute Havelhöhe, 14089 Berlin, Germany; Oncological Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany.
| | - Cornelia Herbstreit
- Oncological Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany; Breast Cancer Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany.
| | - Hans-Peter Lemmens
- Oncological Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany; Colon and Rectum Cancer Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany.
| | - Christian Grah
- Oncological Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany; Lung Cancer Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany.
| | - Matthias Kröz
- Research Institute Havelhöhe, 14089 Berlin, Germany; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, 10098 Berlin, Germany; Institute for Integrative Medicine, University of Witten/Herdecke, 58313 Witten, Herdecke, Germany.
| | - Harald Matthes
- Oncological Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany; Medical Department, Division of Gastroenterology, Infectiology and Rheumatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany.
| | - Friedemann Schad
- Research Institute Havelhöhe, 14089 Berlin, Germany; Oncological Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany.
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Schad F, Thronicke A, Merkle A, Steele ML, Kröz M, Herbstreit C, Matthes H. Implementation of an Integrative Oncological Concept in the Daily Care of a German Certified Breast Cancer Center. Complement Med Res 2018; 25:85-91. [PMID: 29510405 DOI: 10.1159/000478655] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND In recent decades the concept of integrative medicine has attracted growing interest in patients and professionals. At the Gemeinschaftskrankenhaus Havelhöhe (GKH), a hospital specialized in anthroposophical medicine, a breast cancer center (BCC) has been successfully certified for more than 5 years. The objective of the present study was to analyze how integrative strategies were implemented in the daily care of primary breast cancer patients. METHODS Clinical, demographic, and follow-up data as well as information on non-pharmacological interventions were analyzed. In addition, BCC quality measures were compared with data of the National Breast Cancer Benchmarking Report 2016. RESULTS Between 2011 and 2016, 741 primary breast cancer patients (median age 57.4 years) were treated at the GKH BCC. 91.5% of the patients showed Union for International Cancer Control (UICC) stage 0, I, II, or III and 8.2% were in UICC stage IV. 97% of the patients underwent surgery, 53% radiation, 38% had hormone therapy, and 25% received cytostatic drugs. 96% of the patients received non-pharmacological interventions and 32% received Viscum album L. THERAPY Follow-up was performed in up to 93% of the patients 2 years after first diagnosis. Compared to nationwide benchmarking BCCs, the GKH BCC met the requirements in central items. CONCLUSIONS The results of the present study show that integrative therapies offered by the concept of anthroposophical medicine can be implemented in the daily care and treatment of a certified BCC. However, as national guidelines on integrative concepts in oncology are missing, further studies are needed for a systematic evaluation of integrative treatment and care concepts in this field.
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Thronicke A, Steele ML, Grah C, Matthes B, Schad F. Clinical safety of combined therapy of immune checkpoint inhibitors and Viscum album L. therapy in patients with advanced or metastatic cancer. BMC Complement Altern Med 2017; 17:534. [PMID: 29237435 PMCID: PMC5729272 DOI: 10.1186/s12906-017-2045-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 12/05/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite improvement of tumour response rates in patients with progressive and metastatic cancer, immune checkpoint inhibitors (ICM) induce toxicities in cancer patients. Viscum album L. (VA, mistletoe) extracts are applied as add-on cancer therapy especially in German speaking countries and within integrative and anthroposophical concepts with the goal to improve quality of life. The primary objective of this pilot observational cohort study was to determine the rate of adverse events (AE) related to ICM therapy with and without VA in patients with advanced or metastatic cancer in a certified Cancer Center. METHODS ICM or combined ICM/VA therapies were applied in patients with progressive or metastatic cancer. AE rates of both therapy groups were compared. RESULTS A total of sixteen cancer patients were treated with ICM: nivolumab (75%), ipilimumab (19%) or pembrolizumab (6%). The median age of the study population was 64 years (IQR 57.8; 69.3); 44% were male. Of the sixteen patients receiving ICM, nine patients received additional VA (56%; ICM/VA group) and seven did not (44%; ICM group). No statistically significant differences were seen between groups with respect to AE-rates (67% ICM/VA versus 71% ICM). Adjusted multivariate regression analysis revealed that concomitant application of VA did not alter the AE rate in ICM treated patients. 85% of AEs were expected ICM reactions. No AEs of grade 3 or greater were documented for the total study cohort. CONCLUSIONS This is the first study evaluating the clinical safety profile of ICM in combination with VA in patients with advanced or metastatic cancer. The overall AE rate of the study cohort is comparable to AE rates of ICM treatment in the literature. Our data indicate a first impression that concomitant VA application may not alter ICM-induced AE rates. However, the nature of this study does not allow excluding possible immunological interactions between ICM and VA. Further prospective trials in larger study cohorts should focus on the assessment of safety aspects, clinical efficacy and health related quality of life in patients with combined ICM/VA therapy. TRIAL REGISTRATION DRKS00013335 , retrospectively registered (November 27th, 2017) at the German Clinical Trials Register ( www.drks.de ).
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Schad F, Thronicke A, Merkle A, Matthes H, Steele ML. Immune-related and adverse drug reactions to low versus high initial doses of Viscum album L. in cancer patients. Phytomedicine 2017; 36:54-58. [PMID: 29157828 DOI: 10.1016/j.phymed.2017.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 07/18/2017] [Accepted: 09/19/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Immune-related adverse drug reactions (ADRs) to immunotherapy agents have been associated with beneficial clinical outcomes in oncology. Viscum album L. (VA, European mistletoe) is frequently used as an immunomodulatory agent alongside conventional cancer treatment in Europe. VA has been associated with improved quality of life and a reduction in chemotherapy-related ADRs. Beneficial effects of VA are believed to be related to its immunomodulatory properties. Current guidelines recommend commencing with a low dose and increasing slowly overtime, however, off-label prescribing of high initial doses is common. PURPOSE We investigated ADR profiles related to subcutaneous VA therapy commencing with low, recommended doses versus higher than recommended doses. STUDY DESIGN Retrospective cohort study. METHODS Medical records of 1361 cancer patients treated between 2003 and 2013 were assessed. Patients were divided into two groups based on whether the dose of their first VA injection adhered to current guidelines. Patient characteristics and suspected VA-related ADRs were compared between dose groups. RESULTS Of 1361 cancer patients, 516 (38%) started with a recommended, low dose of VA(≤0.02 mg) and 845 (62%) started with a higher dose(>0.02 mg). Groups did not differ by age or gender, but significant differences were observed for type (p < 0.001) and stage of cancer (p = 0.05). Starting with a high dose of VA was significantly associated with a higher incidence of VA-related ADRs compared to starting with a low dose (20.7% versus 0.8%, p < 0.001). Adjusting for age, gender, tumour type and stage of disease, produced an odds ratio of 37.5 (95% CI = 15.7-122.8, p < .001). Almost all ADRs, irrespective of the initial VA dose, were of mild or moderate intensity. Most ADRs were immune-related, general disorders and administration site conditions, many of which are desired reactions, such as pyrexia and local reactions. Overall, no serious ADRs occurred. CONCLUSIONS Starting VA therapy with a higher than recommended dose was associated with a high frequency of ADRs, however, nearly all ADRs were expected, of mild to moderate intensity and most were desired reactions. Future research is necessary to investigate whether higher incidences of immune-related events are indicators of beneficial immunomodulation and better clinical outcomes.
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Affiliation(s)
- Friedemann Schad
- Research Institute Havelhoehe, Berlin, Germany; Department of Oncology, Hospital Havelhoehe, Berlin, Germany
| | | | | | - Harald Matthes
- Research Institute Havelhoehe, Berlin, Germany; Department of Oncology, Hospital Havelhoehe, Berlin, Germany
| | - Megan L Steele
- Research Institute Havelhoehe, Berlin, Germany; Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
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Ortiz M, Schnabel K, Teut M, Rotter G, Binting S, Cree M, Lotz F, Suhr R, Brinkhaus B, Parvizi MM, Handjani F, Zarshenas MM, Moein MR, Nimrouzi M, Hatam G, Hasanzadeh J, Hamidizadeh N, Parvizi MM, Heydari M, Namazi MR, Parvizi Z, Pasalar M, Mosaffa-Jahromi M, Bagheri-Lankarani K, Afsharypuor S, Tamaddon AM, Ostovar M, Peloni G, Bolliger I, Faria RMDC, Quadri P, Sanzeni W, Zemp D, Risvoll H, Giverhaug T, Halvorsen KH, Waaseth M, Musial F, Rossi E, Baccetti S, Picchi M, Conti T, Firenzuoli F, Guido C, Bosco F, Guido C, Rossi E, Panozzo M, Picchi M, Cervino C, Nurra L, Rossi E, Picchi M, Firenzuoli F, Traversi A, Vuono K, Sabatini F, Bellandi T, Rutert B, Eggert A, Seifert G, Stritter W, Holmberg C, Längler A, Salamonsen A, Wiesener S, Schad F, Steele M, Kröz M, Matthes H, Herbstreit C, Thronicke A, Schlingensiepen I, von Schoen-Angerer T, Schneider R, Waeber L, Vagedes J, Kaczala G, Pharisa C, Wildhaber J, Huber B, Sidorov P, Sovershaeva E, Simões-Wüst AP, Nietlispach A, Mennet M, Schnelle M, von Mandach U, Wang X, Woo HL, Lee JM, Wu Y, Cho Y, Yun Y, Kim H, Jung W, Jang BH, Ziea E, Hui H, Li M, Tsui D, Lam C, Hsieh J, Chan E, Balneaves L, Burnside S, Doyle E, Dorazio S, Chan PK, Bhagra A, Chen PH, Chung VCH, Wu JCY, Lin ZX, Wong W, Wu XY, Ho RST, Wong CHL, Chan L, Ziea ETC, Elder W, Cardarelli R, Kaspar C, Kempenich R, Kopferschmitt J, Marinko Z, Damir S, Vcev A, Monezi R, Ruggerini EM, Fuchigami IM, Mazini ACM, Monezi R, Oliveira MW, Papuga P, Schloss J, Steel A, Jacobsen MDS, Monezi R, Jacobsen MR, Mangini MT, Trapani G, Di Giampietro T, Zanino L, Ciullo L, Lanaro D, Cerritelli F, Macrì F, Tsai A, Lin C, Wu TH, D’Alessandro E, Watts S, Zhang Y, Wu X, Li X, Fei Y, Liu J, Zhao N, Jia L, Yan X, Zhen F, Liu Z, Liu J, Ahn J, Yun Y, AlEidi S, Mohamed AG, Al-Beda AM, Abutalib RA, Khalil MKM, Amri H, Badekila S, Behmanesh E, Mozaffarpour S, Behmanesh E, Mozaffarpour S, Behmanesh E, Shirooye P, Meybodi RN, Mokaberinejad R, Tansaz M, Mozaffarpour S, Chung VCH, Wu XY, Wu JCY, Daneshfard B, Hosseinkhani A, Tafazoli V, Jaladat AM, Jaladat AM, Sadeghi H, Jia L, Zhao N, Yan X, Zhou L, Zhao M, Li W, Liu J, Liu Z, Jia L, Zhao N, Yan X, Zhou L, Zhao M, Li W, Liu J, Liu Z, Larsen AL, Salamonsen A, Kristoffersen AE, Hamran T, Evjen B, Stub T, Li M, Cai J, Lu T, Yin L, Wu D, Wang L, Liew SM, Liu T, Bai C, Zheng Z, Wan Y, Xu J, Wang X, Yu H, Gu X, Liu Z, Yan X, Jia L, Zhao N, Yang G, Liu J, Mozaffarpour S, Behmanesh E, Nimrouzi M, Tafazoli V, Daneshfard B, Ostrowski D, Fox K, Pasalar M, Tabatabei F, Amini F, Sathasivampillai S, Rajamanoharan P, Munday M, Heinrich M, Scherrer YM, Heinrich M, Szuter C, Amini F, Tabatabaei F, Tavakoli A, Tavakoli F, Pasalar M, rostami M, Torri MC, Szuter C, Walach H, Warner F, Majumdar A, Serasingh P, Yan X, Jia L, Zhao N, Liu Z, Liu J, Zhao N, Zhen F, Jia L, Yan X, Liu Z, Liu J, Abbing A, Ponstein A, Baars E, Croke S, Hanser S, Heckel V, Krüerke D, Simões-Wüst AP, Weiss S, Metzner S, Lee JW, Hyun MK, Masetti M, Oepen R, Gruber H, Heusser P, Pelz H, Perlitz V, Ponstein A, Abbing A, Baars E, Robinson N, Ronan P, Mian A, Madge S, Lorenc A, Agent P, Carr S, Ronan P, Robinson N, Carr S, Mian A, Lorenc A, Agent P, Madge S, Winnubst ME, Monezi R, Abolghasemi J, Heydari M, Baccetti S, Rossi E, Fedi P, Di Stefano M, Belvedere K, Baccetti S, Rossi E, Firenzuoli F, Di Stefano M, Belvedere K, Beaven K, Rose A, Florschutz G, Phil NB, Parsons H, Stewart-Brown S, Burke K, Busch M, Heyning F, Smit J, Jeekel H, de Goeij H, Guido PC, Barraza N, Balbarrey Z, Ribas A, Jimenez B, Iachino C, Quattrone F, Gaioli M, Dell’Orso M, Villanueva S, Rocha C, Macchi A, Cai J, Chen L, Wu D, Wang S, Choi E, Go N, Lee Y, Dahal G, Frauenknecht X, Gerhardt H, Galanti M, Cerda CJ, Galanti M, Galanti M, Heckersdorf DN, Jorquera H, Saldivia MLA, Jakubonienė D, McEwen B, Melo F, Fontana FM, Valle ACV, Neres MTB, Mohagheghzadeh A, Zohalinezhad ME, Njaradi O, Dunjic M, Njaradi O, Dunjic M, Ostrowski D, Fox K, Pokladnikova J, Selke-Krulichova I, Seo J, Jang H, Simões-Wüst AP, Moltó-Puigmartí C, van Dongen M, Dagnelie P, Thijs C, Tihanyi E, Hegyi G, Zhang Y, Li X, Fei Y, Liu J, Zhang Y, Liu J, Tong X. World Congress Integrative Medicine & Health 2017: part three. Altern Ther Health Med 2017. [PMCID: PMC5499100 DOI: 10.1186/s12906-017-1784-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Ee C, Thuraisingam S, Pirotta M, French S, Xue C, Teede H, Kristoffersen AE, Sirois F, Stub T, Engler J, Joos S, Güthlin C, Felenda J, Beckmann C, Stintzing F, Evans R, Bronfort G, Keefe D, Taberko A, Hanson L, Haley A, Ma H, Jolton J, Yarosh L, Keefe F, Nam J, Evans R, Ojala L, Kreitzer MJ, Hanson L, Fink C, Kraft K, Flower A, Lewith G, Harman K, Stuart B, Bishop FL, Frawley J, Füleki L, Kiss E, Vancsik T, Krenacs T, Funabashi M, Pohlman KA, Mior S, Thiel H, Hill MD, Cassidy DJ, Westaway M, Yager J, Hurwitz E, Kawchuk GN, O’Beirne M, Vohra S, Gaboury I, Morin C, Gaertner K, Torchetti L, Frei-Erb M, Kundi M, Frass M, Gallo E, Maggini V, Comite M, Sofi F, Baccetti S, Vannacci A, Di Stefano M, Monechi MV, Gori L, Rossi E, Firenzuoli F, Mediati RD, Ballerini G, Gardiner P, Lestoquoy AS, Negash L, Stillman S, Shah P, Liebschutz J, Adelstein P, Farrell-Riley C, Brackup I, Penti B, Saper R, Sampedro IG, Carvajal G, Gleiss A, Gross MM, Brendlin D, Röttger J, Stritter W, Seifert G, Grzanna N, Stange R, Guendling PW, Gu W, Lu Y, Wang J, Zhang C, Hajimonfarednejad M, Hannan N, Hellsing R, Wode K, Nordberg JH, Nordberg JH, Andermo S, Arman M, von Hörsten I, Torrielo PV, Bai H, Vilaró CLA, Cabrera FC, Huber R, Hui H, Ziea E, Tsui D, Hsieh J, Lam C, Chan E, Jensen MP, He Y, Battalio SL, Chan J, Edwards KA, Gertz KJ, Day MA, Sherlin LH, Ehde DM, Kim KH, Jang S, Jang BH, Zhang X, Go HY, Park S, Ko SG, Kraft K, Janik H, Börner A, Lee J, Lee B, Chang GT, Menassa A, Zhang Z, Motoo Y, Müller J, Rabini S, Vinson B, Kelber O, Storr M, Kraft K, Niemeijer M, Baars E, Hoekman J, Wang D, Ruijssenaaars W, Njoku FC, Klose P, Brinkhaus B, Michalsen A, Dobos G, Cramer H, Norheim AJ, Alræk T, Okumus F, Meng F, Oncu-Celik H, Hagel A, Albrecht H, Vollbracht C, Dauth W, Hagel W, Vitali F, Ganzleben I, Schultis H, Konturek P, Stein J, Neurath M, Raithel M, Hagel A, Vollbracht C, Raithel M, Konturek P, Krick B, Haller H, Klose P, Dobos G, Kümmel S, Cramer H, Haller H, Saha FJ, Kowoll A, Ebner B, 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D, Ahmed M, He L, Hwang JH, Kiss E, Vancsik T, Meggyeshazi N, Kovago C, Krenacs T, Klaus AK, Zerm R, Pranga D, Ostermann T, Reif M, von Laue HB, Brinkhaus B, Kröz M, Klaus AK, Zerm R, Pranga D, Recchia DR, Ostermann T, Reif M, von Laue HB, Brinkhaus B, Kröz M, Klein-Laansma CT, Jong M, von Hagens C, Jansen JP, van Wietmarschen H, Jong MC, Ko Y, Sun SH, Go HY, Jeon CY, Song YK, Ko SG, Koch AK, Rabsilber S, Lauche R, Kümmel S, Dobos G, Langhorst J, Cramer H, Koch AK, Trifunovic-Koenig M, Klose P, Cramer H, Dobos G, Langhorst J, Koster E, Baars E, Delnoij D, Kroll L, Weiss K, Kubo A, Hendlish S, Altschuler A, Connolly N, Avins A, Lauche R, Recchia DR, Cramer H, Wardle J, Lee D, Sibbritt D, Adams J, Ostermann T, Lauche R, Sibbritt D, Park C, Mishra G, Adams J, Cramer H, Lechner J, Lee I, Chae Y, Lee J, Cho SH, Choi Y, Lee JY, Ryu HS, Yoon SS, Oh HK, Hyun LK, Kim JO, Yoon SW, Lee JY, Shin SH, Jang M, Müller I, Park SHJ, Lestoquoy AS, Laird L, Negash L, Mitchell S, Gardiner P, Li X, Wang Y, Zhen J, Yu H, Liu T, Gu X, Liu H, Ma W, Zhang C, Shang X, Bai Y, Meng F, Liu W, Rooney C, Smith A, Lopes S, Demarzo M, do Patrocínio Nunes M, Lorenz P, Gründemann C, Heinrich M, Garcia-Käufer M, Grunewald F, Messerschmidt S, Herrick A, Gruber K, Beckmann C, Knödler M, Huber R, Steinborn C, Stintzing F, Lu T, Wang L, Wu D, Luberto CM, Hall DL, Chad-Friedman E, Lechner S, Park ER, Luberto CM, Park E, Goodman J, Luer S, Heri M, von Ammon K, Frei-Erb M, Ma W, Meng F, Maggini V, Gallo E, Landini I, Lapucci A, Nobili S, Mini E, Firenzuoli F, McDermott C, Lewith G, Richards S, Cox D, Frossell S, Leydon G, Eyles C, Raphael H, Rogers R, Selby M, Adler C, Allam J, Meng F, Gu W, Zhang C, Bai H, Zhang Z, Wang D, Bu X, Zhang H, Zhang J, Liu H, Mikolasek M, Berg J, Witt C, Barth J, Miskulin I, Lalic Z, Miskulin M, Dumic A, Sebo D, Vcev A, Mohammed NAA, Han D, Ahmed M, Choi SJ, Im HB, Hwang JH, Mukherjee A, Kandhare A, Bodhankar S, Mukherjee A, Kandhare A, Thakurdesai P, Bodhankar S, Munk N, Evans E, Froman A, Kline M, Bair MJ, Musial F, Kristoffersen AE, Alræk T, Hamre HJ, Stub T, Björkman L, Fønnebø VM, Pang B, Lian FM, Ni Q, Tong XL, Li XL, Liu WK, Feng S, Zhao XY, Zheng YJ, Zhao XM, Lin YQ, Pang B, Lian FM, Tong XL, Zhao TY, Zhao XY, Phd HC, Zhang C, Pang B, Liu F, Tong XL, Zhao LH, Zhao XM, Ye R, Gu CJ, Pang B, Ni Q, Tong XL, Lian FM, Zhao XY, Jin D, Zhao XM, Zheng YJ, Lin YQ, Peng W, Lauche R, Sibbritt D, Adams J, Peng W, Wardle J, Cramer H, Mishra G, Lauche R, Pohlman KA, Mior S, Funabashi M, De Carvalho D, El-Bayoumi M, Haig B, Kelly K, Wade DJ, O’Beirne M, Vohra S, Portalupi E, Gobo G, Bellavita L, Guglielmetti C, Raak C, Teuber M, Molsberger F, von Rath U, Reichelt U, Schwanebeck U, Zeil S, Vogelberg C, Veintimilla DR, Vollbracht C, Mery GT, Villavicencio MM, Moran SH, Sachse C, Gündlin PW, Stange R, Sahebkarkhorasani M, Azizi H, Schumann D, Lauche R, Sundberg T, Leach MJ, Cramer H, Seca S, Greten H, Selliah S, Shakya A, Han D, Kim HY, Choi DI, Im HB, Choi SJ, Sherbakova A, Ulrich-Merzenich G, Kelber O, Abdel-Aziz H, Sibinga E, Webb L, Ellen J, Skrautvol K, Nåden D, Song R, Grabowska W, Osypiuk K, Diaz GV, Bonato P, Park M, Hausdorff J, Fox M, Sudarsky LR, Tarsy D, Novakowski J, Macklin EA, Wayne PM, Song R, Hwang I, Ahn S, Lee MA, Wayne PM, Sohn MK, Sorokin O, Steckhan N, Heydeck D, Borchert A, Hohmann CD, Kühn H, Michalsen A, Kessler C, Steckhan N, Hohmann CD, Cramer H, Michalsen A, Dobos G, von Scheidt C, Kirschbaum C, Stalder T, Stöckigt B, Teut M, Suhr R, Sulmann D, Brinkhaus B, Streeter C, Gerbarg P, Silveri M, Brown R, Jensen J, Stritter W, Rutert B, Eggert A, Längler A, Seifert G, Holmberg C, Sun J, Deng X, Li WY, Wen B, Robinson N, Liu JP, Sung HK, Yang N, Go HY, Shin SM, Jung H, Kim YJ, Jung WS, Park TY, Suzuki K, Ito T, Uchida S, Kamohara S, Ono N, Takamura M, Yokochi A, Maruyama K, Tapia P, Thabaut K, Brinkhaus B, Stöckigt B, Thronicke A, Kröz M, Steele M, Matthes H, Herbstreit C, Schad F, Tian J, Lian F, Yang L, Tong X, Tian T, Zhang H, Tian X, Wang C, Chai QY, Zhang L, Xia R, Huang N, Fei Y, Liu J, Trent N, Miraglia M, Dusek J, Pasalis E, Khalsa SB, Trifunovic-König M, Klose P, Cramer H, Lauche R, Koch A, Dobos G, Langhorst J, Uebelacker L, Tremont G, Gillette L, Epstein-Lubow G, Strong D, Abrantes A, Tyrka A, Tran T, Gaudiano B, Miller I, Ullmann G, Ullmann G, Li Y, Vaidya S, Marathe V, Vale AC, Motta J, Donadão F, Valente AC, Valente LCC, Ghelman R, Vesovic D, Jevdic D, Jevdic A, Jevdic K, Djacic M, Letic D, Bozic D, Markovic M, Dunjic S, Vesovic D, Jevdic D, Jevdic A, Jevdic K, Djacic M, Letic D, Bozic D, Markovic M, Ruscuklic G, Baksa D, Dunjic S, Vesovic D, Jevdic D, Jevdic A, Jevdic K, Djacic M, Letic D, Bozic D, Markovic M, Ruscuklic G, Baksa D, Dunjic S, Vesovic D, Jevdic D, Jevdic A, Jevdic K, Djacic M, Letic D, Bozic D, Markovic M, Ruscuklic G, Baksa D, Dunjic S, Vesovic D, Jevdic D, Jevdic A, Jevdic K, Djacic M, Letic D, Bozic D, Markovic M, Vrca K, Dunjic S, Vincent A, Wahner-Roedler D, Whipple M, Vogelius MM, Vollbracht C, Friesecke I, Gündling PW, Wahner-Roedler D, Mahapatra S, Hynes R, Van Rooy K, Looker S, Ghosh A, Bauer B, Cutshall S, Walach H, Flores AB, Walach H, Ofner M, Kastner A, Schwarzl G, Schwameder H, Alexander N, Strutzenberger G, Wang J, Lu Y, Gu W, Zhang C, Bu X, Zhang H, Zhang J, He Y, Zhang X, Meng F, Wang S, Yu H, Shi J, Hao Y, Liu T, Wu J, Qiu Z, Gu X, Wang YH, Lou CJ, Watts S, Wayne P, Osypiuk K, Vergara-Diaz G, Bonato P, Gow B, Hausdorff J, Miranda J, Sudarsky L, Tarsy D, Fox M, Macklin E, Wode K, Bergqvist J, Bernhardsson BM, Nordberg JH, Kienle G, Sharp L, Henriksson R, Woo Y, Hyun MK, Wu H, Wang TF, Zhao Y, Wei Y, Tian L, He L, Wang X, Wu R, Feng S, Han M, Caldwell PHY, Liu S, Zhang J, Liu J, Xia R, Chai Q, Fei Y, Guo Z, Wang C, Liu Z, Li X, Zhang Y, Liu J, Yang IJ, Lincha VR, Ahn SH, Lee DU, Shin HM, Yang L, Sibbritt D, Peng W, Adams J, Yang N, Sung H, Shin SM, Go HY, Jung H, Kim Y, Park TY, Yap A, Kwan YH, Tan CS, Ibrahim S, Ang SB, Yayi A, Han D, Im HB, Hwang JH, Choi SJ, Yoo JE, Yoo HR, Jang SB, Lee HL, Youssef A, Ezzat S, Motaal AA, El-Askary H, Yu X, Cui Y, Zhang Y, Lian F, Yun Y, Ko Y, Ahn JH, Jang BH, Kim KS, Ko SG, Choi I, Zerm R, Glinz A, Pranga D, Berger B, ten Brink F, Reif M, Büssing A, Gutenbrunner C, Kröz M, Zerm R, Helbrecht B, Pranga D, Brinkhaus B, Michalsen A, Kröz M, Zhang H, Fang T, Wang J, Zhang C, He Y, Zhang X, Zhang Z, Wang D, Meng F, Zhang J, Zhang C, Bai H, Shen Z, Ma W, Liu H, Bai Y, Shang X, Meng F, Zhang R, Wu F, Li M, Xuan X, Shen X, Ren K, Berman B, Zhen J, Li X, Gu X, Yu H, Zheng Z, Wan Y, Wang Y, Ma X, Dong F, Liu T, Zhen J, Li X, Gu X, Yu H, Zheng Z, Wan Y, Wang Y, Ma X, Dong F, Liu T, Zick S, Harris R, Bae GE, Kwon JN, Lee HY, Nam JK, Lee SD, Lee DH, Han JY, Yun YJ, Lee JH, Park HL, Park SH, Bocci C, Ivaldi GB, Vietti I, Meaglia I, Guffi M, Ruggiero R, Gualea M, Longa E, Bonucci M, Croke S, Rodriguez LD, Caracuel-Martínez JC, Fajardo-Rodríguez MF, Ariza-García A, la Fuente FGD, Arroyo-Morales M, Estrems MS, Gómez VG, Estrems MS, Sabater MV, Ferreri R, Bernardini S, Pulcri R, Cracolici F, Rinaldi M, Porciani C, Firenzuoli F, Baccetti S, Di Stefano M, Monechi MV, Gallo E, Maggini V, Gori L, Rossi E, Fisher P, Hughes J, Mendoza A, MacPherson H, Witt C, Filshie J, Lewith G, Di Francesco A, Bernardini A, Messe M, Primitivo V, Iasella PA, Ghelman R, Taminato M, Alcantara JDC, De Oliveira KR, Rodrigues DCDA, Mumme JRC, Sunakozawa OKM, Filho VO, Seifert G, Goldenberg J, Day A, Sasagawa M, Ward L, Cooley K, Gunnarsdottir T, Hjaltadottir I. World Congress Integrative Medicine & Health 2017: part two. BMC Complement Altern Med 2017. [PMCID: PMC5498867 DOI: 10.1186/s12906-017-1783-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Brinkhaus B, Falkenberg T, Haramati A, Willich SN, Briggs JP, Willcox M, Linde K, Theorell T, Wong LM, Dusek J, Wu D, Eisenberg D, Haramati A, Berger B, Kemper K, Stock-Schröer B, Sützl-Klein H, Ferreri R, Kaplan G, Matthes H, Rotter G, Schiff E, Arnon Z, Hahn E, Luberto CM, Martin D, Schwarz S, Tauschel D, Flower A, Gramminger H, Gupta HH, Gupta SN, Kerckhoff A, Kessler CS, Michalsen A, Kessler CS, Kim ES, Jang EH, Kim R, Jan SB, Mittwede M, Mohme W, Ben-Arye E, Bonucci M, Saad B, Breitkreuz T, Rossi E, Kebudi R, Daher M, Razaq S, Gafer N, Nimri O, Hablas M, Kienle GS, Samuels N, Silbermann M, Bandelin L, Lang AL, Wartner E, Holtermann C, Binstock M, Riebau R, Mujkanovic E, Cramer H, Lauche R, Michalsen A, Ward L, Cramer H, Irnich D, Stör W, Burnstock G, Schaible HG, Ots T, Langhorst J, Lauche R, Sundberg T, Falkenberg T, Amarell C, Amarell C, Anheyer M, Eckert M, Eckert M, Ogal M, Eckert M, Amarell C, Schönauer A, Reisenberger B, Brand B, Anheyer D, Dobos G, Kroez M, Martin D, Matthes H, Ammendola A, Mao JJ, Witt C, Yang Y, Dobos G, Oritz M, Horneber M, Voiß P, Reisenberger B, von Rosenstiel A, Eckert M, Ogal M, Amarell C, Anheyer M, Schad F, Schläppi M, Kröz M, Büssing A, Bar-Sela G, Matthes H, Schiff E, Ben-Arye E, Arnon Z, Avshalomov D, Attias S, Schönauer A, Haramati A, Witt C, Brinkhaus B, Cotton S, Jong M, Jong M, Scheffer C, Haramati A, Tauschel D, Edelhäuser F, AlBedah A, Lee MS, Khalil M, Ogawa K, Motoo Y, Arimitsu J, Ogawa M, Shimizu G, Stange R, Kraft K, Kuchta K, Watanabe K, Bonin D, Büssing A, Gruber H, Koch S, Gruber H, Pohlmann U, Caldwell C, Krantz B, Kortum R, Martin L, Wieland LS, Kligler B, Gould-Fogerite S, Zhang Y, Wieland LS, Riva JJ, Lumpkin M, Ratner E, Ping L, Jian P, Hamme GM, Mao X, Chouping H, Schröder S, Hummelsberger J, Wullinger M, Brodzky M, Zalpour C, Langley J, Weber W, Mudd LM, Wayne P, Witt C, Weidenhammer W, Fønnebø V, Boon H, Steel A, Bugarcic A, Rangitakatu M, Steel A, Adams J, Sibbritt D, Wardle J, Leach M, Schloss J, Dieze H, Boon H, Ijaz N, Willcox M, Heinrich M, Lewith G, Flower A, Graz B, Adam D, Grabenhenrich L, Ortiz M, Binting S, Reinhold T, Brinkhaus B, Andermo S, Sundberg T, Falkenberg T, Nordberg JH, Arman M, Bhasin M, Fan X, Libermann T, Fricchione G, Denninger J, Benson H, Berger B, Stange R, Michalsen A, Martin DD, Boers I, Vlieger A, Jong M, Brinkhaus B, Teut M, Ullmann A, Ortiz M, Rotter G, Binting S, Lotz F, Roll S, Canella C, Mikolasek M, Rostock M, Beyer J, Guckenberger M, Jenewein J, Linka E, Six C, Stoll S, Stupp R, Witt CM, Chuang E, Kligler B, McKee MD, Cramer H, Lauche R, Klose P, Lange S, Langhorst J, Dobos G, Chung VCH, Wong HLC, Wu XY, Wen GYG, Ho RST, Ching JYL, Wu JCY, Coakley A, Flanagan J, Annese C, Empoliti J, Gao Z, Liu X, Yu S, Yan X, Liang F, Hohmann CD, Steckhan N, Ostermann T, Paetow A, Hoff E, Michalsen A, Hu XY, Wu RH, Logue M, Blonde C, Lai LY, Stuart B, Flower A, Fei YT, Moore M, Liu JP, Lewith G, Hu XY, Wu RH, Logue M, Blonde C, Lai LY, Stuart B, Flower A, Fei YT, Moore M, Liu JP, Lewith G, Jeitler M, Zillgen H, Högl M, Steckhan N, Stöckigt B, Seifert G, Michalsen A, Kessler C, Khadivzadeh T, Bashtian MH, Aval SB, Esmaily H, Kim J, Kim KH, Klocke C, Joos S, Koshak A, Wie L, Koshak E, Wali S, Alamoudi O, Demerdash A, Qutub M, Pushparaj P, Heinrich M, Kruse S, Fischer I, Tremel N, Rosenecker J, Leung B, Takeda W, Liang N, Feng X, Liu JP, Cao HJ, Luberto CM, Shinday N, Philpotts L, Park E, Fricchione GL, Yeh G, Munk N, Zakeresfahani A, Foote TR, Ralston R, Boulanger K, Özbe D, Gräßel E, Luttenberger K, Pendergrass A, Pach D, Bellmann-Strobl J, Chang Y, Pasura L, Liu B, Jäger SF, Loerch R, Jin L, Brinkhaus B, Ortiz M, Reinhold T, Roll S, Binting S, Icke K, Shi X, Paul F, Witt CM, Rütz M, Lynen A, Schömitz M, Vahle M, Salomon N, Lang A, Lahat A, Kopylov U, Ben-Horin S, Har-Noi O, Avidan B, Elyakim R, Gamus D, NG S, Chang J, Wu J, Kaimiklotis J, Schumann D, Buttó L, Langhorst J, Dobos G, Haller D, Cramer H, Smith C, de Lacey S, Chapman M, Ratcliffe J, Johnson N, Lyttleton J, Boothroyd C, Fahey P, Tjaden B, van Vliet M, van Wietmarschen H, Jong M, Tröger W, Vuolanto P, Aarva P, Sorsa M, Helin K, Wenzel C, Zoderer I, Pammer P, Simon P, Tucek G, Wode K, Henriksson R, Sharp L, Stoltenberg A, Nordberg JH, Xiao-ying Y, Wang LQ, Li JG, Liang N, Wang Y, Liu JP, Balneaves L, Capler R, Bocci C, Guffi M, Paolini M, Meaglia I, Porcu P, Ivaldi GB, Dragan S, Bucuras P, Pah AM, Badalica-Petrescu M, Buleu F, Hogea-Stoichescu G, Christodorescu R, Kao L, Cho Y, Klafke N, Mahler C, von Hagens C, Uhlmann L, Bentner M, Schneeweiss A, Mueller A, Szecsenyi J, Joos S, Neri I, Ortiz M, Schnabel K, Teut M, Rotter G, Binting S, Cree M, Lotz F, Suhr R, Brinkhaus B, Rossi E, Baccetti S, Firenzuoli F, Monechi MV, Di Stefano M, Amunni G, Wong W, Chen B, Wu J, Amri H, Haramati A, Kotlyanskaya L, Anderson B, Evans R, Kligler B, Marantz P, Bradley R, Booth-LaForce C, Zwickey H, Kligler B, Brooks A, Kreitzer MJ, Lebensohn P, Goldblatt E, Esmel-Esmel N, Jiménez-Herrera M, Ijaz N, Boon H, Jocham A, Stock-Schröer B, Berberat PO, Schneider A, Linde K, Masetti M, Murakozy H, Van Vliet M, Jong M, Jong M, Agdal R, Atarzadeh F, Jaladat AM, Hoseini L, Amini F, Bai C, Liu T, Zheng Z, Wan Y, Xu J, Wang X, Yu H, Gu X, Daneshfard B, Nimrouzi M, Tafazoli V, Alorizi SME, Saghebi SA, Fattahi MR, Salehi A, Rezaeizadeh H, Zarshenas MM, Nimrouzi M, Fox K, Hughes J, Kostanjsek N, Espinosa S, Lewith G, Fisher P, Latif A, Lefeber D, Paske W, Öztürk AÖ, Öztürk G, Boers I, Tissing W, Naafs M, Busch M, Jong M, Daneshfard B, Sanaye MR, Dräger K, Fisher P, Kreitzer MJ, Evans R, Leininger B, Shafto K, Breen J, Sanaye MR, Daneshfard B, Simões-Wüst AP, Moltó-Puigmartí C, van Dongen M, Dagnelie P, Thijs C, White S, Wiesener S, Salamonsen A, Stub T, Fønnebø V, Abanades S, Blanco M, Masllorens L, Sala R, Al-Ahnoumy S, Han D, He L, Kim HY, In Choi D, Alræk T, Stub T, Kristoffersen A, von Sceidt C, Michalsen A, Bruset S, Musial F, Anheyer D, Cramer H, Lauche R, Saha FJ, Dobos G, Anheyer D, Haller H, Lauche R, Dobos G, Cramer H, Azizi H, Khadem N, Hassanzadeh M, Estiri N, Azizi H, Tavassoli F, Lotfalizadeh M, Zabihi R, Esmaily H, Azizi H, Shabestari MM, Paeizi R, Azari MA, Bahrami-Taghanaki H, Zabihi R, Azizi H, Esmaily H, Baars E, De Bruin A, Ponstein A, Baccetti S, Di Stefano M, Rossi E, Firenzuoli F, Segantini S, Monechi MV, Voller F, Barth J, Kern A, Lüthi S, Witt C, Barth J, Zieger A, Otto F, Witt C, Beccia A, Dunlap C, Courneene B, Bedregal P, Passi A, Rodríguez A, Chang M, Gutiérrez S, Beissner F, Beissner F, Preibisch C, Schweizer-Arau A, Popovici R, Meissner K, Beljanski S, Belland L, Rivera-Reyes L, Hwang U, Berger B, Sethe D, Hilgard D, Heusser P, Bishop F, Al-Abbadey M, Bradbury K, Carnes D, Dimitrov B, Fawkes C, Foster J, MacPherson H, Roberts L, Yardley L, Lewith G, Bishop F, Al-Abbadey M, Bradbury K, Carnes D, Dimitrov B, Fawkes C, Foster J, MacPherson H, Roberts L, Yardley L, Lewith G, Bishop F, Holmes M, Lewith G, Yardley L, Little P, Cooper C, Bogani P, Maggini V, Gallo E, Miceli E, Biffi S, Mengoni A, Fani R, Firenzuoli F, Brands-Guendling N, Guendling PW, Bronfort G, Evans R, Haas M, Leininger B, Schulz C, Bu X, Wang J, Fang T, Shen Z, He Y, Zhang X, Zhang Z, Wang D, Meng F, Büssing A, Baumann K, Frick E, Jacobs C, Büssing A, Grünther RA, Lötzke D, Büssing A, Jung S, Lötzke D, Recchia DR, Robens S, Ostermann T, Berger B, Stankewitz J, Kröz M, Jeitler M, Kessler C, Michalsen A, Cheon C, Jang BH, Ko SG, Huang CW, Sasaki Y, Ko Y, Cheshire A, Ridge D, Hughes J, Peters D, Panagioti M, Simon C, Lewith G, Cho HJ, Han D, Choi SJ, Jung YS, Im HB, Cooley K, Tummon-Simmons L, Cotton S, Luberto CM, Wasson R, Kraemer K, Sears R, Hueber C, Derk G, Lill JR, An R, Steinberg L, Rodriguez LD, la Fuente FGD, De la Vega M, Vargas-Román K, Fernández-Ruiz J, Cantarero-Villanueva I, Rodriguez LD, García-De la Fuente F, Jiménez-Guerrero F, Vargas-Román K, Fernández-Ruiz J, Galiano-Castillo N, Diaz-Saez G, Torres-Jimenez JI, Garcia-Gomez O, Hortal-Muñoz L, Diaz-Diez C, Dicen D, Diezel H, Adams J, Steel A, Wardle J, Diezel H, Steel A, Frawley J, Wardle J, Broom A, Adams J, Dong F, Yu H, Liu T, Ma X, Yan L, Wan Y, Zheng Z, Gu X, Dong F, Yu H, Wu L, Liu T, Ma X, Ma J, Yan L, Wan Y, Zheng Z, Zhen J, Gu X, Dubois J, Rodondi PY, Edelhäuser F, Schwartze S, Trapp B, Cysarz D. World Congress Integrative Medicine & Health 2017: Part one. Altern Ther Health Med 2017. [PMCID: PMC5498855 DOI: 10.1186/s12906-017-1782-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Thronicke A, Steele M, Grah C, Matthes B, Schad F. P3.02c-037 Clinical Safety of Combinational Therapy of Immune Checkpoint Inhibitors and Viscum Album L. in Patients with Advanced or Metastasized Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Combination strategies involving chemotherapy and monoclonal antibodies (mAb) are
commonly used in attempts to produce better clinical outcomes. This practice has
led to new and ongoing toxicities that may lead to reductions in dose or
noncompliance, limiting the effectiveness of treatment. Viscum
album L (VA) preparations are widely used in Europe as additive
therapy and have been associated with reduced chemotherapy-related adverse
reactions and increased health-related quality of life. Concomitant VA therapy
might also reduce toxicity related to mAb. This retrospective study investigated
the safety of combined treatment with VA and mAb in cancer patients. A total of
43 patients had combined therapy (474 exposures); 12 had VA without mAb (129
exposures), and 8 had mAb without VA (68 exposures). Most patients (89.3%)
received concomitant chemotherapy or supportive therapies. A total of 34
patients (60.7%) experienced 142 adverse events (AEs). Leucopenia (14.1% of all
events), acneiform rash (8.5%), and stomatitis (6.3%) occurred most frequently.
Longitudinal logistic regression analysis suggested a nearly 5 times higher odds
of experiencing an AE following treatment with mAb compared with mAb plus VA
(95% CI = 1.53-16.14). Our results, together with theoretical consideration of
potential botanical-drug interactions, suggest that combined treatment with VA
and mAb is safe.
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Affiliation(s)
- Friedemann Schad
- 1 Research Institute Havelhoehe, Berlin, Germany.,2 Hospital Havelhoehe, Berlin, Germany
| | - Jan Axtner
- 1 Research Institute Havelhoehe, Berlin, Germany
| | - Matthias Kröz
- 1 Research Institute Havelhoehe, Berlin, Germany.,2 Hospital Havelhoehe, Berlin, Germany.,3 Charité University Medical Center, Berlin, Germany.,4 University of Witten/Herdecke, Herdecke, Germany
| | - Harald Matthes
- 1 Research Institute Havelhoehe, Berlin, Germany.,2 Hospital Havelhoehe, Berlin, Germany
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Steele M, Schad F. Immune-related and adverse events following low versus high initial dose of Viscum album L. in cancer patients. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw390.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kröz M, Reif M, Pranga D, Zerm R, Schad F, Baars EW, Girke M. The questionnaire on autonomic regulation: a useful concept for integrative medicine? J Integr Med 2016; 14:315-21. [PMID: 27641604 DOI: 10.1016/s2095-4964(16)60264-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The concept of autonomic regulation (aR) reflects the relevance of the function of different autonomic systems for health. aR can be captured by questionnaires. We differentiate between a trait or constitutional aR questionnaire version including 12 (short-version) or 18 items, respectively, with three subscales (orthostatic-circulatory, rest/activity and digestive regulation), and an 18-item state aR questionnaire on the preceding week with four subscales (rest/activity, orthostatic-circulatory, thermo- and digestive regulation). The validated questionnaires show satisfying to good reliability and robust validity with clear construct validity. In this article, we summarized the actually available literature on aR and the use of aR questionnaires in clinical and observational studies. We described the relationship of high aR with health and in case of low aR or loss of regulation with disease and functional disorder in the three (four) different subscales and functional systems, such as rest/activity, orthostatic-circulatory or digestive regulation (thermoregulation) with the consecutive therapeutic need. Finally, we gave perspectives of its further application in clinical research.
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Affiliation(s)
- Matthias Kröz
- Research Institute Havelhöhe, D-14089 Berlin, Germany
- Department of Internal Medicine, Havelhöhe Hospital, D-14089 Berlin, Germany
- Institute for Social Medicine, Epidemiology and Health Economics, D-10117 Berlin, Germany
- Institute for Integrative Medicine, University of Witten/Herdecke, D-58313 Witten/Herdecke, Germany
| | - Marcus Reif
- Society for Clinical Research, D-10623 Berlin, Germany
| | - Danilo Pranga
- Research Institute Havelhöhe, D-14089 Berlin, Germany
| | - Roland Zerm
- Research Institute Havelhöhe, D-14089 Berlin, Germany
- Department of Internal Medicine, Havelhöhe Hospital, D-14089 Berlin, Germany
| | - Friedemann Schad
- Research Institute Havelhöhe, D-14089 Berlin, Germany
- Department of Internal Medicine, Havelhöhe Hospital, D-14089 Berlin, Germany
| | - Erik Wim Baars
- Professorship Anthroposophic Healthcare, University of Applied Sciences Leiden, NL-2300 AJ Leiden, the Netherlands
| | - Matthias Girke
- Research Institute Havelhöhe, D-14089 Berlin, Germany
- Department of Internal Medicine, Havelhöhe Hospital, D-14089 Berlin, Germany
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Axtner J, Steele M, Kröz M, Spahn G, Matthes H, Schad F. Health services research of integrative oncology in palliative care of patients with advanced pancreatic cancer. BMC Cancer 2016; 16:579. [PMID: 27485618 PMCID: PMC4971628 DOI: 10.1186/s12885-016-2594-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 07/21/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Pancreatic cancer has a dire prognosis and is associated with a high mortality. Palliative patients have special needs and often seek help in integrative oncological concepts (IO) that combine conventional and complementary therapies. Nevertheless there are few recommendations regarding IO in current cancer guidelines. The aims of this study were to report on implementation of IO in everyday palliative care and to analyze patient survival in advanced pancreatic cancer. METHODS This multicenter observational study investigates the implementation of IO and length of survival of patients suffering from advanced pancreatic cancer (stage IV). We analyzed patient's survival by employing multivariable proportional hazard models using different parametric distribution functions and compared patients receiving chemotherapy only, a combination of chemotherapy and Viscum album (VA) treatment, and VA treatment only. RESULTS Records of 240 patients were analyzed. Complementary therapy showed high acceptance (93 %). Most frequent therapy was VA treatment (74 %) that was often administered concomitantly to chemotherapy (64 %). Both therapies had positive effects on patient survival as they had significant negative effects on the hazard in our log-normal model. A second analysis showed that patients with combined chemotherapy and VA therapy performed significantly better than patients receiving only chemotherapy (12.1 to 7.3 month). Patients receiving only VA therapy showed longer survival than those receiving neither chemotherapy nor VA therapy (5.4 to 2.5 months). Our data demonstrates that IO can be implemented in the everyday care of patients without disregarding conventional treatment. Patients combining VA with chemotherapy showed longest survival. CONCLUSIONS Our data demonstrate the importance and potential of health services research showing that IO treatment can be successfully implemented in the every-day care of patients suffering from advanced pancreatic cancer. Patients combining VA with chemotherapy showed longest survival. To address patients' needs adequately, future cancer guidelines might increasingly include comments on complementary treatment options in addition to conventional therapies. Further studies should investigate the effect of complementary treatments on survival and quality of life in more detail.
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Affiliation(s)
- Jan Axtner
- Forschungsinstitut Havelhöhe gGmbH, Kladower Damm 221, 14089, Berlin, Germany
| | - Megan Steele
- Forschungsinstitut Havelhöhe gGmbH, Kladower Damm 221, 14089, Berlin, Germany.,ihop Research Group, Queensland University of Technology, School of Public Health and Social Work, Victoria Park Road, 4059, Brisbane, Australia
| | - Matthias Kröz
- Forschungsinstitut Havelhöhe gGmbH, Kladower Damm 221, 14089, Berlin, Germany.,Krankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Günther Spahn
- Institut für Integrative Krebstherapie, Hans-Böckler-Str. 7, 55128, Mainz, Germany
| | - Harald Matthes
- Forschungsinstitut Havelhöhe gGmbH, Kladower Damm 221, 14089, Berlin, Germany.,Krankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Friedemann Schad
- Forschungsinstitut Havelhöhe gGmbH, Kladower Damm 221, 14089, Berlin, Germany. .,Krankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.
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Kröz M, Pranga D, Zerm R, Friemel D, Reif M, Schad F, Matthes H, Girke M. Hat die Selbstregulation eine Bedeutung in der Behandlung von onkologischen Patienten? ACTA ACUST UNITED AC 2016. [DOI: 10.1055/s-0042-103522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kröz M, Reif M, Zerm R, Winter K, Schad F, Gutenbrunner C, Girke M, Bartsch C. Do we have predictors of therapy responsiveness for a multimodal therapy concept and aerobic training in breast cancer survivors with chronic cancer-related fatigue? Eur J Cancer Care (Engl) 2015; 24:707-17. [PMID: 25602030 DOI: 10.1111/ecc.12278] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2014] [Indexed: 11/29/2022]
Abstract
Cancer-related fatigue (CRF) is a burdensome symptom for breast cancer (BC) patients. In this pilot study, we tested several questionnaires as predictors for treatment responsiveness, along with the implementation of a multimodal therapy concept consisting of sleep, psycho-education, eurythmy, painting therapy and standard aerobic training. At the Community Hospital Havelhöhe and the Hannover Medical School, 31 BC patients suffering from CRF could be evaluated in a 10-week intervention study. CRF was assessed by the Cancer Fatigue Scale (CFS-D). Further questionnaires were the Pittsburgh Sleep Quality Index, the autonomic regulation scale, Self-Regulation Scale (SRS), the Internal Coherence Scale (ICS) and the European Organization of Research and Treatment Health-Related Quality of Life Core Questionnaire scale. We estimated the regression coefficients of all scales on CFS-D by simple and multiple linear regression analyses and compared regression slopes and variances between the different questionnaires on CFS-D at the end of treatment. We found a significant impact of SRS and ICS at baseline on CFS-D at the end of the intervention [absolute standardised multiple regression coefficient values ranging from 0.319 (SRS) to 0.269 (ICS)] but not for the other questionnaires. In conclusion, this study supports the hypothesis that the SRS or ICS measuring adaptive capacities could be more appropriate as outcome predictors than classical questionnaire measures in complex interventions studies.
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Affiliation(s)
- M Kröz
- Research Institute Havelhöhe (FIH), Berlin, Germany.,Department of Internal Medicine, Community Hospital Havelhöhe, Berlin, Germany.,Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin, Germany.,Institute of Integrative Medicine, Witten, Germany
| | - M Reif
- Institute for Clinical Research (IKF), Berlin, Germany
| | - R Zerm
- Research Institute Havelhöhe (FIH), Berlin, Germany.,Department of Internal Medicine, Community Hospital Havelhöhe, Berlin, Germany
| | - K Winter
- Clinic for Rehabilitative Medicine, Hannover Medical School, Hannover, Germany
| | - F Schad
- Research Institute Havelhöhe (FIH), Berlin, Germany.,Department of Internal Medicine, Community Hospital Havelhöhe, Berlin, Germany
| | - C Gutenbrunner
- Clinic for Rehabilitative Medicine, Hannover Medical School, Hannover, Germany
| | - M Girke
- Research Institute Havelhöhe (FIH), Berlin, Germany.,Department of Internal Medicine, Community Hospital Havelhöhe, Berlin, Germany
| | - C Bartsch
- Center for Research in Medical and Natural Sciences, University of Tübingen, Tübingen, Germany
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Steele ML, Axtner J, Happe A, Kröz M, Matthes H, Schad F. Use and Safety of Intratumoral Application of European Mistletoe (Viscum album L) Preparations in Oncology. Integr Cancer Ther 2014; 14:140-8. [DOI: 10.1177/1534735414563977] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background. Intratumoral (IT) injection of European mistletoe ( Viscum album L) preparations might induce local tumor response through combined cytotoxic and immunomodulatory actions of the preparations. Although promising in vitro and in vivo data, along with clinical case studies suggest the need for validation of this hypothesis in prospective trials, the safety of IT mistletoe injections has yet to be thoroughly assessed. Methods. The present study summarizes the practice and safety of off-label IT mistletoe therapy within the Network Oncology, a conjoint clinical registry of German hospitals and outpatients specialized in anthroposophic and integrative medicine. Demographic, diagnosis and treatment data of cancer patients who received IT mistletoe applications between 2007 and 2013 were assessed. Suspected adverse drug reactions (ADRs) were analyzed in terms of type, frequency, severity, seriousness and potential risk factors. Results. A total of 123 cancer patients received 862 IT mistletoe injections (preparations from Abnoba, Helixor and Iscucin). The most commonly applied preparations were Abnoba viscum Fraxini (71 patients) and Helixor Mali (54 patients). Of the total patients, 26 patients (21.1%) experienced 74 ADRs. All ADRs were in response to either Abnoba viscum Fraxini (25.4% of exposed patients) or Helixor Mali (18.5% of exposed patients). ADRs were mostly body temperature or immune related and of mild (83.8%) or moderate (14.9%) intensity. Only one possible ADR was described as severe (hypertension) and no serious ADRs occurred. The frequency of ADRs to IT mistletoe injections was 3 times and 5 times higher than has previously been found for subcutaneous and intravenous applications of mistletoe, respectively. Conclusion. IT injection of mistletoe preparations resulted in a relatively high frequency of ADRs. Nearly all ADRs were mild to moderate however, and no serious ADRs occurred. Furthermore, it is possible that immune-related ADRs such as pyrexia and local inflammatory reactions might be critical for tumor response. In light of these results, IT mistletoe therapy seems to be safe and prospective trials are recommended.
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Affiliation(s)
| | - Jan Axtner
- Research Institute Havelhoehe, Berlin, Germany
| | - Antje Happe
- Research Institute Havelhoehe, Berlin, Germany
| | - Matthias Kröz
- Research Institute Havelhoehe, Berlin, Germany
- Witten/Herdecke University, Herdecke, Germany
| | - Harald Matthes
- Research Institute Havelhoehe, Berlin, Germany
- Hospital Havelhoehe, Berlin, Germany
| | - Friedemann Schad
- Research Institute Havelhoehe, Berlin, Germany
- Hospital Havelhoehe, Berlin, Germany
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Heckenbach K, Ostermann T, Schad F, Kröz M, Matthes H. Medication and falls in elderly outpatients: an epidemiological study from a German Pharmacovigilance Network. Springerplus 2014; 3:483. [PMID: 25207204 PMCID: PMC4158008 DOI: 10.1186/2193-1801-3-483] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 08/12/2014] [Indexed: 01/07/2023]
Abstract
The aim of this study was to investigate the relationship between fall risk increasing drugs (FRIDS) and the risk of falls in regard to fall-related chronic diseases. In total, 39 primary care physicians in Germany participated in the EvaMed Pharmacovigilance Network. Antihypertensives, non-steroidal anti-inflammatory drugs, hypnotics and sedatives, antidepressants and psycholeptics were labelled as FRIDS. A fall was defined according to a diagnosis in the chapter Injury or poisoning (S00-T14 in International Statistical Classification of Diseases 10th Revision (ICD-10)). Patients older than or equal to 65 years with at least two doctor’s visits were included. FRIDS were prescribed for 1768 patients from a total of 5124 patients included in the analysis. FRIDS and seven chronic diseases were statistically significant associated with a higher risk of experiencing a fall. The risk was highest for patients with a diagnosis abnormalities of gait and mobility, vertigo, visual -impairment and weight loss, and increased by 50-90% with arthritis, diseases of arteries, arterioles and capillaries and heart failure. From patients (N = 425) with at least one diagnosis of fall, 219 patients were prescribed FRIDS. In 100 (45.7%) of cases the diagnoses for fall were made before and in 105 (47.9%) of cases at least a month after the prescription of FRIDS. 14 (6.4%) patients had a prescription of FRIDS and a diagnosis of fall within one month. Perceptual disorders, low walking speed and pain are prominent predictors for falls in the elderly. A prescription of FRIDS selects more vulnerable patients having a higher risk of falls. However, experiencing a fall is mainly due to the disease followed by treatment. Thus, not prescribing FRIDS will avoid only a small number of falls.
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Affiliation(s)
| | - Thomas Ostermann
- Institute of Integrated medicine, University of Witten/Herdecke, Gerhard-Kienle-Weg 4, D-58313 Herdecke, Germany
| | - Friedemann Schad
- Havelhoehe Research Institute, Kladower Damm 221, 14089 Berlin, Germany
| | - Matthias Kröz
- Havelhoehe Research Institute, Kladower Damm 221, 14089 Berlin, Germany
| | - Harald Matthes
- Havelhoehe Research Institute, Kladower Damm 221, 14089 Berlin, Germany
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Grah C, McCutcheon A, Axtner J, Thieme C, Schad F. Basisdaten Versorgungsforschung für nicht pharmakotherapeutische Interventionen in der Therapie vom Lungenkarzinom. Pneumologie 2014. [DOI: 10.1055/s-0034-1367954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Schad F, Atxner J, Buchwald D, Happe A, Popp S, Kröz M, Matthes H. Intratumoral Mistletoe (Viscum album L) Therapy in Patients With Unresectable Pancreas Carcinoma: A Retrospective Analysis. Integr Cancer Ther 2013; 13:332-40. [PMID: 24363283 DOI: 10.1177/1534735413513637] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Pancreatic carcinoma remains one of the main causes for cancer-related death. Intratumoral application of anticancer agents is discussed as a promising method for solid tumors such as pancreatic cancer. Endoscopic ultrasound provides a good tool to examine and treat the pancreas. European mistletoe (Viscum album L) is a phytotherapeutic commonly used in integrative oncology in Central Europe. Its complementary use seeks to induce immunostimulation and antitumoral effects as well as alleviate chemotherapeutic side effects. Intratumoral mistletoe application has induced local tumor response in various cancer entities. This off-label use needs to be validated carefully in terms of safety and benefits. Here we report on 39 patients with advanced, inoperable pancreatic cancer, who received in total 223 intratumoral applications of mistletoe, endoscopic ultrasound guided or under transabdominal ultrasound control. No severe procedure-related events were reported. Adverse drug reactions were mainly increased body temperature or fever in 14% and 11% of the applications, respectively. Other adverse drug reactions, such as pain or nausea, occurred in less than 7% of the procedures. No severe adverse drug reaction was recorded. Patients received standard first- and second-line chemotherapy and underwent adequate palliative surgical interventions as well as additive subcutaneous and partly intravenous mistletoe application. A median survival of 11 months was observed for all patients, or 11.8 and 8.3 months for stages III and IV, respectively. Due to the multimodal therapeutic setting and the lack of a control group, the effect of intratumoral mistletoe administration alone remains unclear. This retrospective analysis suggests that intratumoral-applicated mistletoe might contribute to improve survival of patients with pancreatic cancer. In conclusion, the application is feasible and safe, and its efficacy should be evaluated in a randomized controlled trial.
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Affiliation(s)
- Friedemann Schad
- Hospital Havelhoehe, Berlin, Germany Research Institute Havelhoehe, Berlin, Germany
| | - Jan Atxner
- Research Institute Havelhoehe, Berlin, Germany
| | | | - Antje Happe
- Research Institute Havelhoehe, Berlin, Germany
| | | | - Matthias Kröz
- Hospital Havelhoehe, Berlin, Germany Research Institute Havelhoehe, Berlin, Germany
| | - Harald Matthes
- Hospital Havelhoehe, Berlin, Germany Research Institute Havelhoehe, Berlin, Germany
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Kröz M, Reif M, Bartsch C, Heckmann C, Zerm R, Schad F, Girke M. Impact of autonomic and self-regulation on cancer-related fatigue and distress in breast cancer patients--a prospective observational study. J Cancer Surviv 2013; 8:319-28. [PMID: 24253954 DOI: 10.1007/s11764-013-0314-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 09/26/2013] [Indexed: 01/06/2023]
Abstract
PURPOSE Cancer-related fatigue (CRF) has a major impact on the quality of life in breast cancer patients (BC). So far, only a few prospective studies have investigated the effect of adaptive salutogenic mechanisms on CRF. The aim of our study was to evaluate the possible prospective influence of autonomic Regulation (aR) and self-regulation (SR) on CRF and distress in long-term survivors. METHODS 95 BC and 80 healthy female controls (C) had been included in the observational study between 2000 and 2001 and completed the questionnaires on aR, SR and Hospital Anxiety and Depression Scale (HADS). Of these, 62 BC, and 58 C participated in the re-evaluation 6.6 years later: 16 participants were deceased (14 BC and 2 C). During follow-up, participants were requested to answer questions involving (Cancer Fatigue Scales) CFS-D, aR, SR and HADS. Multiple regression analysis was used to evaluate the influence of aR, SR, age, Charlson co-morbidity-index and diagnosis on CFS-D and HADS, and to select further potentially relevant factors. RESULTS High aR values showed significant effects, namely inverse relationships with CFS-D, cognitive fatigue, anxiety and depression. SR showed a reduced influence on anxiety and depression (all p < 0.05). CONCLUSIONS Autonomic regulation might have an independent, reductive influence on global fatigue, cognitive fatigue and--together with self-regulation--it seems to have a protective influence on anxiety and depression. The connection between these parameters is still unclear and awaits further evaluation. IMPLICATION FOR CANCER SURVIVORS AR seems to be a prognostic factor in breast cancer survivors, capable of reducing cancer-related fatigue and self-regulation distress as well. Further research is necessary in order to show how aR can be improved by therapeutic interventions.
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Affiliation(s)
- M Kröz
- Research Institute Havelhöhe (FIH), Berlin, Germany,
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Schad F, Axtner J, Happe A, Breitkreuz T, Paxino C, Gutsch J, Matthes B, Debus M, Kröz M, Spahn G, Riess H, von Laue HB, Matthes H. Network Oncology (NO)--a clinical cancer register for health services research and the evaluation of integrative therapeutic interventions in anthroposophic medicine. ACTA ACUST UNITED AC 2013; 20:353-60. [PMID: 24200825 DOI: 10.1159/000356204] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Concepts of integrative oncology (IO), as have been offered by anthroposophic medicine (AM) for decades, are gaining increasing interest and acceptance. Central aspects are multimodal therapeutic interventions, health-related quality of live, and patients' preference as well as therapeutic relationship and clinical outcome. Despite its broad application, IO lacks evaluation in clinical practice and complementary therapies are not monitored by any cancer registries. METHODS To close this gap we established 'Network Oncology' (NO), a conjoint registry of German outpatient AM practitioners and AM hospitals. In this paper we present the project and a first data overview and compare it to epidemiological registers and current literature. RESULTS NO has collected 10,405 cancer patients' records in 6 years. Compared to epidemiological registers our data show minor differences in disease entity distribution, age, and gender. There is an overproportional amount of young breast cancer patients in NO institutions indicating a demand for integrative therapies in this group. There is no difference between the UICC (Union for International Cancer Control) stages at first diagnosis and at admission to a NO facility. According to our data conventional therapies were less frequently administered after admission to a NO facility. Nevertheless, one third of the patients received their first conventional therapy in a NO facility. 80% of the patients received mistletoe preparations and 63% had nonpharmacotherapeutic, complementary interventions. CONCLUSION Integrative oncological approaches attract a great number of patients visiting AM institutions. The NO provides an infrastructure to evaluate integrative interventions in AM, allows comparison to other clinical registers, and thus can contribute to health service research in this field.
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Schad F, Axtner J, Happe A, Kroez M, Matthes B, Grah C, Spahn G, Matthes H. Palliative care in patients with advanced lung cancer in a network of health service research in integrative oncology. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e20710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20710 Background: Early palliative care was demonstrated to result in a superior survival and improvement of health related quality of live (HRQL) in patients with advanced lung cancer. Concepts of integrative oncology (IO) offer multimodal therapy strategies aiming to enhance patients’ salutogenic resources in addition to standard care. In the present study we analyzed patients with advanced lung cancer from a clinical registry in Germany. Methods: Data were collected by the Network Oncology, a clinical registry of hospitals and outpatients care specialized in Anthroposophic Medicine and integrative oncology. We analyzed 441 C34 patients of UICC stage IV that had at least one of the following additional therapies: Viscum album, embrocation, therapeutic unction’s, rhythmical massages, lymph drainage, physiotherapy, eurythmy therapy, music or drawing therapy, modeling, speech-, breathing and hyperthermia therapy. We calculated Kaplan-Meier survival based on right censored data and using Greenwoods 95% confidence intervals. Results: 43% of the patients were female and median age was 64 yr (min 32/ max 92). 84% received chemotherapy, 55% radiation and 40% surgery. Most frequent additional therapies were Viscum album (72%), embrocation (43%), therapeutic unction (42%), eurythmy therapy and physiotherapy (both 27%). Patients used combinations up to 9 different additional therapies (median ♀=3, median ♂=2) with significant difference between genders (Fisher’s exact test, < p=0.001). Median length of VA therapy was 6.4 months. Median OS was 1.05yr (95% CI: 0.83 - 1.32), 2 and 3 year survival was 31% and 20%, respectively. Conclusions: Integrative therapy concepts are of growing interest in cancer care. In this observational study patients received conventional and complementary interventions. A relevant number of lung cancer patient use IO when offered in palliative oncology. Median OS seems to be comparable to the palliative care group of Temel et al. 2010 (median OS=0.97yr, 95% CI: 0.53 – 1.41). Health service research in multimodal IO settings needs further evaluation in terms of HRQL measurement and effectiveness.
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Affiliation(s)
| | - Jan Axtner
- Forschungsinstitut Havelhoehe gGmbH, Berlin, Germany
| | - Antje Happe
- Forschungsinstitut Havelhoehe gGmbH, Berlin, Germany
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Jeschke E, Ostermann T, Vollmar HC, Tabali M, Schad F, Matthes H. Prescribing patterns in dementia: a multicentre observational study in a German network of CAM physicians. BMC Neurol 2011; 11:99. [PMID: 21824429 PMCID: PMC3178479 DOI: 10.1186/1471-2377-11-99] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 08/08/2011] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Dementia is a major and increasing health problem worldwide. This study aims to investigate dementia treatment strategies among physicians specialised in complementary and alternative medicine (CAM) by analysing prescribing patterns and comparing them to current treatment guidelines in Germany. METHODS Twenty-two primary care physicians in Germany participated in this prospective, multicentre observational study. Prescriptions and diagnoses were reported for each consecutive patient. Data were included if patients had at least one diagnosis of dementia according to the 10th revision of the International Classification of Diseases during the study period. Multiple logistic regression was used to determine factors associated with a prescription of any anti-dementia drug including Ginkgo biloba. RESULTS During the 5-year study period (2004-2008), 577 patients with dementia were included (median age: 81 years (IQR: 74-87); 69% female). Dementia was classified as unspecified dementia (57.2%), vascular dementia (25.1%), dementia in Alzheimer's disease (10.4%), and dementia in Parkinson's disease (7.3%). The prevalence of anti-dementia drugs was 25.6%. The phytopharmaceutical Ginkgo biloba was the most frequently prescribed anti-dementia drug overall (67.6% of all) followed by cholinesterase inhibitors (17.6%). The adjusted odds ratio (AOR) for receiving any anti-dementia drug was greater than 1 for neurologists (AOR = 2.34; CI: 1.59-3.47), the diagnosis of Alzheimer's disease (AOR = 3.28; CI: 1.96-5.50), neuroleptic therapy (AOR = 1.87; CI: 1.22-2.88), co-morbidities hypertension (AOR = 2.03; CI: 1.41-2.90), and heart failure (AOR = 4.85; CI: 3.42-6.88). The chance for a prescription of any anti-dementia drug decreased with the diagnosis of vascular dementia (AOR = 0.64; CI: 0.43-0.95) and diabetes mellitus (AOR = 0.55; CI: 0.36-0.86). The prescription of Ginkgo biloba was associated with sex (female: AOR = 0.41; CI: 0.19-0.89), patient age (AOR = 1.06; CI: 1.02-1.10), treatment by a neurologist (AOR = 0.09; CI: 0.03-0.23), and the diagnosis of Alzheimer's disease (AOR = 0.07; CI: 0.04-0.16). CONCLUSIONS This study provides a comprehensive analysis of everyday practice for treatment of dementia in primary care in physicians with a focus on CAM. The prescribing frequency for anti-dementia drugs is equivalent to those found in other German studies, while the administration of Ginkgo biloba is significantly higher.
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Affiliation(s)
- Elke Jeschke
- Havelhoehe Research Institute, Kladower Damm 221, 14089 Berlin, Germany
| | - Thomas Ostermann
- Center for Integrative Medicine, University of Witten/Herdecke, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany
| | - Horst C Vollmar
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 58453 Witten, Germany
- Institute for General Practice and Family Medicine, University of Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448 Witten, Germany
| | - Manuela Tabali
- Havelhoehe Research Institute, Kladower Damm 221, 14089 Berlin, Germany
| | - Friedemann Schad
- Havelhoehe Research Institute, Kladower Damm 221, 14089 Berlin, Germany
| | - Harald Matthes
- Havelhoehe Research Institute, Kladower Damm 221, 14089 Berlin, Germany
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