Mapping the clinical practice of traditional, complementary and integrative medicine in oncology in Western countries: A multinational cross-sectional survey.

BACKGROUND: Many cancer patients seek adjunctive therapies to biomedical cancer treatments at some point of their disease trajectory. While acupuncture is increasingly recommended by leading oncological associations, limited evidence exists concerning the evidence-informed practice and adherence to current guidelines of traditional complementary and integrative medicine (TCIM) practitioners treating cancer patients. METHODS: An international online-survey assessed the demographical data, clinical practice, and sources of information used by TCIM practitioners in Austria, Germany, United States of America, Australia, and New Zealand. RESULTS: In total, 404 respondents completed the survey, of which 254 (62.9%) treated cancer patients. Most practitioners were acupuncturists and herbalists (57.1%), had (16.8 ± 9.9) years of clinical experience and see a median of 2 (1, 4) cancer patients per week. Breast cancer (61.8%) is the most common cancer type seen in TCIM clinics. Adjunctive TCIM treatments are frequently concurrent with the patient's cancer specific treatment (39.9%), which is also reflected by the main goal of a TCIM treatment to alleviate side effects (52.4%). However, only 28.0% of the respondents are in contact with the treating oncologist. According to the respondents, pain is most effectively treated using acupuncture, while herbal medicine is best for cancer-related fatigue. TCIM practitioners mostly use certified courses (33.1%) or online databases (28.3%) but often believe that experts are more reliable to inform their practice (37.0%) than research publications (32.7%). CONCLUSION: Acupuncturists and herbalists commonly treat cancer patients. Most practitioners use TCIM as an adjunct to biomedicine as supportive care and use it largely in accordance with current oncological guidelines. PLEASE CITE THIS ARTICLE AS: Huemer M, Graca S, Bitsche S, Hofmann G, Armour M, Pichler M. Mapping the clinical practice of traditional, complementary and integrative medicine in oncology in Western countries: A multinational cross-sectional survey. J Integr Med. 2024; 22(1): 64-71.

IL-7, IL-18, MCP-1, MIP1-ß, and OPG as biomarkers for pain treatment response in patients with cancer.

BACKGROUND: Pain is one of the most common symptoms in patients suffering from advanced cancer and receiving palliative care and is often responsible for a poor quality of life. To date, there exists no published correlation between biological, measurable biomarkers and pain intensity. OBJECTIVES: The primary objective was to search and identify pain-associated cytokines (biomarkers) correlating with changes in numeric rating scale (NRS) pain scores in patients with cancer before and after pain treatment. The secondary objectives were to assess cytokine serum level differences between patients and healthy controls and to evaluate possible relationships between pain entities, pain intensity (in NRS), gender, location of primary tumor, and the patients' cytokine baseline concentrations. STUDY DESIGN: Controlled, prospective study. SETTING: University medical center. METHODS: Eligible patients with exacerbated cancer-related pain (NRS = 5) and healthy controls with no pain were included. Serum level changes of 19 cytokines were analyzed before and during opioid treatment. RESULTS: Of 19 analyzed biomarkers, 5 (IL-7, IL-18, MCP-1, MIP-1α, MIP-1ß and OPG) turned out to correlate significantly with pain relief. In healthy controls, all analyzed cytokines showed no significant differences. In the secondary analysis, only one significant correlation was detected between OPG and pain entities. Furthermore, IL-4, IL-7, IFN-γ and OPG appeared to account for the ability to predict a patient's gender. LIMITATIONS: Our findings should be considered as preliminary and need to be confirmed in further studies. CONCLUSION: Our results provide preliminary evidence of a significant correlation of pain relief in patients with cancer and at least 5 cytokines. These biomarkers may serve as the basis for development of diagnostic tools for pain assessment and could serve as potential new targets for pain control.