Inverse relationship between reduced fatigue and severity of anemia in oncology patients treated with integrative medicine: understanding the paradox.

OBJECTIVE: To assess the impact of integrative medicine (IM) on cancer-related fatigue in patients undergoing chemotherapy for early and advanced breast and gynecological (ovarian, endometrial, and cervical) cancer. METHODS: Patients reporting significant levels of fatigue (on the Edmonton Symptom Assessment Scale (ESAS), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), or Measure Yourself Concerns and Wellbeing questionnaire (MYCAW)) were offered complementary and integrative medicine (CIM) treatments in addition to standard supportive care. Patients who did not undergo IM treatments were designated as controls. Attending at least five CIM treatments less than 30 days between each session was considered as high adherence to integrative care (AIC). RESULTS: Of 258 eligible patients reporting significant fatigue, follow-up assessment at 6 and 12 weeks was considered optimal for 120 patients in the intervention group and for 64 controls; 88 of treated patients found to be adherent to the IM intervention. At 12 weeks, ESAS (P < 0.001) and EORTC (p = 0.001) scores for fatigue improved more significantly in treated patients, with a higher percent with optimal relative dose intensity in the AIC subgroup, both at 6 weeks (P = 0.002) and at 12 weeks (P < 0.001). IM treatment was paradoxically associated with a greater decrease in hemoglobin levels at 12 weeks (P = 0.016), more so in the AIC subgroup (P = 0.024). CONCLUSION: Integrative medicine program may alleviate cancer-related fatigue in patients with breast and gynecological cancer undergoing chemotherapy.

Impact of a complementary/integrative medicine program on the need for supportive cancer care-related medications.

OBJECTIVE: Despite the growing evidence supporting the use of complementary/integrative medicine (CIM) in the treatment of chemotherapy-induced toxicities, little is known on CIM impact of these therapies regarding the use of medications for supportive cancer care. In this study, we examined the impact of CIM on the need for supportive cancer care-related medications. PATIENTS AND METHODS: Patients with breast or gynecological cancer referred to and attending an integrative physician (IP) consultation for gastrointestinal (GI) concerns were designated as the treatment group; those not attending as controls. Adherence to the integrative care program (AIC) was defined as attending ≥4 CIM interventions. The need for conventional supportive care-related medications and doses was determined from patients' medical files, as well as the implications on the potential for cost reduction. RESULTS: Of the 205 patients diagnosed with GI concerns, 116 attended the IP consultation and weekly CIM treatments (56.6%; treatment group), of which 85 (73.3%) were adherent to the program (AIC subgroup); 89 did not undergo an IP consultation (43.4%; controls). Within-group analysis found a greater decrease in the use of non-opioid analgesics (NOAs) at 6 weeks in the treatment group (P = 0.01), more so in the AIC subgroup (P = 0.02). A cost analysis suggests that reduced NOA use in the treatment group reduced the cost of supportive care, covering 27.1% of the overall expense of CIM treatments. Controls were less likely to require anti-emetics (P = 0.007). Between-group analysis showed a trend for reduced use of anxiolytics (P = 0.06) and NOAs (P = 0.08) among treated patients, with lower dose equivalents for NOAs than controls (P < 0.001). CONCLUSION: CIM treatments may reduce the need for NOAs among patients with breast or gynecological cancer.

Integrative oncology for palliative care nurses: pre-post training evaluation.

OBJECTIVES: Integrative oncology (IO) is increasingly being incorporated in supportive and palliative cancer care. This study examined an IO-palliative care training programme for nurses from community and hospital settings. METHODS: A 120-hour course, attended by 24 palliative care nurses without IO training, included precourse/postcourse questionnaires examining knowledge, attitudes and level of IO-palliative care skills. Qualitative analysis examined precourse and postcourse narratives. RESULTS: Most (18; 75%) completed study questionnaires, with knowledge and attitudes towards IO changing only modestly and IO-related skills significantly for guidance on herbal medicine and lifestyle changes, manual-movement and mind-body modalities. Greater consultation skills were reported for fatigue, stomatitis, nausea, appetite, constipation/diarrhoea, insomnia, peripheral neuropathy and hot flashes. Trainees reported improved skills for pain (p=0.003), emotional (p<0.001) and informal caregiver-related concerns (p<0.001), with no change in palliative care-related skills. Qualitative analysis found both personal and professional attitude changes, with enhanced mindfulness and an expressed intent to implement the learnt skills in daily practice. CONCLUSIONS: The IO-palliative care nurse training programme increased IO-related and palliative care-related consultation skills for a wide range of quality of life-related concerns. Further research is needed to explore both short-term and long-term effects and the implementation of the learnt skills in clinical practice. TRIAL REGISTRATION NUMBER: NCT03676153.

Integrative Oncology in Supportive Cancer Care in Israel.

PURPOSE: Integrative oncology (IO) services provide complementary/integrative medicine (CIM) therapies to patients as part of their supportive cancer care. In this study, we examine and compare the structural, operational, financial and academic/research-related aspects of IO services in Israeli oncology centers. METHODS: The medical directors of seven Israeli IO programs completed questionnaires which explored the objectives and organizational features of their service within the context of supportive cancer care. RESULTS: All participating IO services addressed patient-reported concerns related to quality of life and function, within the context of conventional supportive cancer care. The centers shared similar characteristics regarding the procedure of referral to their service and emphasized research and teaching initiatives within an academic framework, as part of their clinical practice. A number of obstacles to integration were identified, primarily those related to financial considerations, such as the need for patients to carry the cost of the CIM treatments. CONCLUSIONS: IO services situated within conventional oncology departments in Israel share a number of characteristics, as well as obstacles to their incorporation into standard care. All participating centers described both clinical and academic activities, including research initiatives and the promotion of CIM in an academic setting. Further research is needed in order to better understand the place of CIM in the oncology setting and prioritize the allocation of resources in order to advance the inclusion of CIM in standard supportive cancer care.

Effect of a 12-week integrative oncology intervention on gastro-intestinal concerns in patients with gynecological and breast cancer undergoing chemotherapy.

Research on the long-term effects of complementary and integrative medicine (CIM) is limited. In this study, we explore the impact of a CIM intervention on gastro-intestinal (GI)-related concerns in patients with breast/gynecological cancer undergoing chemotherapy. Patients reporting chemotherapy-related GI concerns were referred by their cancer care providers to a CIM consultation and treatments and assessed at baseline and at 12 weeks. The following tools were used: Edmonton Symptom Assessment Scale (ESAS), Measure Yourself Concerns and Wellbeing (MYCAW) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). The intervention group was subdivided according to adherence to the integrative care program (AIC), defined as attending ≥4 CIM treatments with ≤30 days between each session. Controls chose not to undergo the CIM consultation or treatments. Of 289 patients reporting GI-related concerns, 42 were treated with CIM and optimally assessed (intervention arm; AIC = 33), as were 32 of controls. ESAS scores for appetite and nausea improved more significantly in the intervention group, more so in the AIC subgroup (appetite, p = 0.025; nausea, p = 0.033). MYCAW scores for GI-related concerns also improved in the intervention group, again more so in the adherent subgroup. EORTC scores improved more significantly with respect to global health (p = 0.021) and cognitive functioning (p = 0.031) in the intervention group, when compared to controls. The integration of a 12-week CIM intervention in conventional supportive cancer care may reduce nausea and improve appetite in patients with breast/gynecological cancer undergoing chemotherapy.

Can complementary medicine increase adherence to chemotherapy dosing protocol? A controlled study in an integrative oncology setting.

CONTEXT AND OBJECTIVES: The impact of complementary and integrative medicine (CIM) on adherence to chemotherapy regimens is unclear. We explored the effect of patient-tailored CIM treatments on the relative dose intensity (RDI) of chemotherapy among patients with breast and gynecological cancer. METHODS: Chemotherapy-treated patients with breast or gynecological cancer were referred by their oncology healthcare professional to a CIM treatment program. Adherence to integrative care (AIC) was defined as ≥4 CIM treatments, with ≤30 days between each treatment. Relative dose intensity (RDI) of chemotherapy was compared between CIM-treated patients and controls, and among adherence sub-groups. RESULTS: RDI was calculated for 106-treated patients (62 AIC) and 75 controls. Baseline-to-6-week RDI values were similar in both study arms, with a lower % RDI <1.0 among controls at 12 weeks (47 vs. 57.5%; P = 0.036). Adherence sub-groups had similar RDI values, though at 6 weeks, the AIC group had lower % RDI <1.0 (33.9 vs. 54.5%, P = 0.046). Total administered medication dose/planned dose was higher in the AIC group at 6 weeks for paclitaxel (82%/50%, P = 0.025) and carboplatin (87%/67%, P = 0.028), with no difference in cytoxan/adriamycin dosages. CONCLUSION: A patient-tailored CIM program for patients with breast or gynecological cancer may be associated with a lower percentage of reduced RDI at 6 weeks, this in a sub-group of patients with higher adherence to CIM, and for specific chemotherapy agents, though this benefit did not persist after 12 weeks. Further research is needed to better understand the impact of CIM in cancer care.

Effect of a patient-tailored integrative medicine program on gastro-intestinal concerns and quality of life in patients with breast and gynecologic cancer.

CONTEXT AND OBJECTIVES: This study was conducted to assess the impact of a patient-tailored complementary/integrative medicine (CIM) program on gastro-intestinal (GI) symptoms and other concerns in female patients with breast/gynecological cancer undergoing chemotherapy. METHODS: Patients with breast/gynecological cancer reporting GI-related concerns were referred to an integrative physician (IP) consultation. The treatment group included patients agreeing to attend the consultation; controls those who did not. The Edmonton Symptom Assessment Scale (ESAS) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were administered at baseline and at 6 weeks. Adherence to integrative care (AIC) was defined as attending ≥4 CIM treatments, with ≤30 days between each session. RESULTS: Of 496 patients approached, 289 reported GI-related concerns. Optimal assessment at baseline and 6 weeks was achieved in 117 patients in the treatment arm, with 86 adhering to the CIM program (AIC subgroup); and in 89 of controls. EORTC scores improved more significantly in the treatment arm for appetite (P = 0.018), fatigue (P = 0.026), cognitive functioning (P < 0.001) and emotional functioning (P = 0.002); and ESAS scores for pain (P = 0.038), anxiety (P = 0.016), and sleep (P = 0.001). EORTC scores improved more significantly in the AIC group for global health status/QOL (P = 0.041), physical functioning (P = 0.004), role functioning (P = 0.011), appetite (P = 0.019), and fatigue (P = 0.001); and ESAS scores for pain (P = 0.048), fatigue (P = 0.011), drowsiness (P = 0.035), and appetite (P = 0.002). CONCLUSION: The integration of CIM may improve chemotherapy-related GI and other QOL-related concerns in patients with breast and gynecological cancer, with greater benefit observed in adherent patients.

Attitudes Among Nurses Toward the Integration of Complementary Medicine Into Supportive Cancer Care.

PURPOSE/OBJECTIVES: To explore the attitudes of nurses treating patients with cancer regarding the use of complementary and integrative medicine (CIM) therapies to reduce symptoms and improve quality of life (QOL). 
. DESIGN: Prospective and descriptive.
 
. SETTING: 12 hospital and community care settings in Israel. 
. SAMPLE: 973 nurses working in oncology and non-oncology departments.
. METHODS: A 26-item questionnaire was administered to a convenience sample of nurses treating patients with cancer. 
. MAIN RESEARCH VARIABLES: Interest in CIM integration and training in supportive cancer care.
. FINDINGS: Of the 973 nurses who completed the questionnaire, 934 expressed interest in integrating CIM into supportive cancer care. A logistic regression model indicated that nurses with a greater interest in integration tended to be older, believed that CIM improved patients' QOL, and had no structured postgraduate oncology training. Nurses who believed CIM to be beneficial for QOL-related outcomes were more likely to express interest in related training. The goals of such training include improving QOL-related outcomes, such as anxiety, insomnia, gastrointestinal symptoms, and pain. 
. CONCLUSIONS: Most nurses working with patients with cancer are interested in the integration of CIM into supportive cancer care. 
. IMPLICATIONS FOR NURSING: Most nurses would like to undergo training in CIM to supplement conventional care. CIM-trained integrative nurses can help promote the integration of patient-centered CIM therapies in supportive cancer care settings.