Survey of cancer researchers regarding complementary and alternative medicine.

The primary purpose of this survey was to assess the interest and concerns of a group of cancer researchers regarding complementary and alternative medicine (CAM) research issues. These issues include cancer researchers' perceptions of the most promising areas of cancer CAM research, their needs for support, the perceived obstacles to carrying out research objectives in the emerging field of cancer CAM research, and their level of interest in research collaboration with CAM practitioners. A cross-sectional survey of a convenience sample of cancer researchers interested in CAM was conducted. Three hundred twenty-one respondents completed the survey, and 298 of them had participated in cancer research. About 85% of the respondents had participated in cancer CAM research. For all CAM categories, the percentage of respondents who would like to conduct research was greater than the percentage of those who have already done so. About two-thirds of the respondents rated research in pharmacologic and biologic treatments and nutritional therapeutics for cancer treatment and symptom/side-effect management as high-priority areas. The obstacle considered to be the most significant by the greatest percentage of the respondents (26.7%) was the lack of success in receiving research funds. This was also the most frequently encountered obstacle. The assistance that was considered to be very useful by the greatest percentage of respondents was support for developmental research or pilot projects, indicated by more than four-fifths (85.4%) of the respondents. More than 83% of respondents expressed some interest in or willingness to establish research collaboration with a CAM practitioner. The results from this survey indicate that many cancer CAM researchers have shared interests, needs, perceived obstacles, and desired research opportunities. These factors and other forces are likely to lead to further growth in the numbers and activity of cancer CAM researchers. If this occurs, then it will become even more important for the National Cancer Institute and other organizations to study the development and changes in this emerging research field.

The role of complementary and alternative medicine in the management of early breast cancer: recommendations of the European Society of Mastology (EUSOMA).

Patients diagnosed with breast cancer have many needs that for a start include the expectation of cure. Where cure is unlikely there is always a place for hope and spiritual support. Furthermore whether dealing with the early stages or with the advanced disease patients require symptomatic control that encompasses pain relief, control of nausea and vomiting and psychological distress. To achieve all of these goals there is a need that goes beyond the role of scientific medicine. This position papers describes the guidelines for the use of complimentary and alternative medicine (CAM) developed by a workshop on behalf of the European Society of Mastology (EUSOMA).

Research-design issues in cancer-symptom-management trials using complementary and alternative medicine: lessons from the National Cancer Institute Community Clinical Oncology Program experience.

PURPOSE: To identify major research-design issues in proposals submitted by investigators in the Community Clinical Oncology Program (CCOP) for clinical trials of complementary and alternative medicine (CAM) for cancer-symptom management. METHODS: We conducted content analysis of all scientific reviews of concepts and protocols submitted by the CCOP to the National Cancer Institute (NCI) to identify research challenges in conducting clinical trials designed to evaluate CAM interventions for cancer-symptom management. RESULTS: Since the inception of the NCI Office of Cancer Complementary and Alternative Medicine in 1998, a total of 46 symptom-management studies using CAM interventions have been proposed by CCOP investigators, with 20 studies now in progress comprising 22% of the current total CCOP symptom-management portfolio. Proposals fell into four categories: complex natural products; nutritional therapeutics; mind-body interventions; and alternative medical systems. The most significant research-design issues arose as a consequence of the lack of preclinical data for CAM interventions and the lack of quality-control standards comparable with those used in regulating new pharmaceutical agents. CONCLUSION: Across the different types of CAM interventions, the most common problems found in proposed research designs are related to unwarranted assumptions about the consistency and standardization of CAM interventions, the need for data-based justifications for the study hypotheses, and the need to implement appropriate quality control and monitoring procedures during the course of the trial. To advance the state of the science, future research must address these critical issues if CAM interventions are to be evaluated rigorously and have a consequent impact on clinical practice and general public awareness.

Research methodology: implications for CAM pain research.

The National Cancer Institute's Office of Cancer Complementary and Alternative Medicine established a series of expert panels to develop the state of the science in research methodologies in CAM cancer research. Panelists from both conventional and CAM research draw on their expertise in their relative fields to apply their knowledge and expertise to specific topic areas within cancer CAM. The first panel is focused on cancer symptom research. The discussion and conclusions raised by this panel primarily address pain research but are applicable to other symptoms as well. This article will focus on the panel presentations that are most applicable to CAM pain research in both cancer and noncareer pain populations, identifying the major challenges and conclusions offered by the panelists.

The meaning of pain: cancer patients' rating and recall of pain intensity and affect.

The present study investigated the influence of an increase in present pain intensity on the rating and recall of the intensity and affective dimensions of clinical pain. Thirty-two cancer patients who reported that movement caused or exacerbated their pain rated their present pain intensity and affect before and after a session of physical therapy. Subjects also rated their usual, highest and lowest pain intensity and pain affect for the previous 3 days, and were randomly assigned to make these ratings either before or after the physical therapy session. Physical therapy increased the intensity (P < 0.01) but not the unpleasantness of the pain (P > 0.05), thus demonstrating a dissociation between pain intensity and pain affect. Beliefs about pain etiology also influenced post-therapy pain ratings. Subjects (N = 11) who believed that their pain was due to cancer, rated their post-therapy pain intensity and pain affect significantly higher than those subjects (N = 21) who did not believe their pain was due to cancer (both P < 0.05). For all subjects, recall of past pain intensity and affect was positively correlated with present levels of pain intensity and pain affect (P < 0.01). Thus, recall was assimilated to present pain levels. The results demonstrate the importance of rating both the intensity and affective dimensions of pain, and suggest that the significance of clinical pain influences pain ratings. These results also suggest that research on the rating and recall of pain, particularly the affective dimension of pain, should use actual patients who are experiencing changes in their naturally occurring pain.