Feasibility and acceptability of cognitive behavioral therapy for insomnia (CBT-I) or acupuncture for insomnia and related distress among cancer caregivers.

OBJECTIVE: Insomnia is a common, distressing, and impairing psychological outcome experienced by informal caregivers (ICs) of patients with cancer. Cognitive behavioral therapy for insomnia (CBT-I) and acupuncture both have known benefits for patients with cancer, but such benefits have yet to be evaluated among ICs. The purpose of the present study was to evaluate the feasibility, acceptability and preliminary effects of CBT-I and acupuncture among ICs with moderate or greater levels of insomnia. METHOD: Participants were randomized to eight sessions of CBT-I or ten sessions of acupuncture. RESULTS: Results highlighted challenges of identifying interested and eligible ICs and the impact of perception of intervention on retention and likely ultimately outcome. SIGNIFICANCE OF THE RESULTS: Findings suggest preliminary support for non-pharmacological interventions to treat insomnia in ICs and emphasize the importance of matching treatment modality to the preferences and needs of ICs.

[Acupuncture and smoking cessation, a review of the literature]. / Acupuncture et arrêt de la consommation tabagique, une revue de la littérature.

INTRODUCTION: Tobacco smoking represents the main cause of death in industrialised countries. Acupuncture is proposed as an aid to stopping smoking. What are the current studies? BACKGROUND: We found 23 controlled randomised studies with differing protocols in terms of intensity of treatment and methodology. The meta-analyses undertaken were contradictory. The short-term effect of acupuncture is well documented but the medium term effect is more uncertain. OUTLOOK: The undertaking of well-standardised, high-intensity protocols is necessary to produce evidence of a medium term effect. CONCLUSION: Acupuncture can be offered to patients wishing to stop smoking within the framework of a global management programme. The association of acupuncture with classical aids increases the chances of the patient stopping. The conditions of intervention should be defined precisely within the framework of a randomised controlled trial.

Real-world experiences with acupuncture among breast cancer survivors: a cross-sectional survey study.

PURPOSE: The purpose of this study was to evaluate acupuncture use among breast cancer survivors, including perceived symptom improvements and referral patterns. METHODS: Breast cancer survivors who had used acupuncture for cancer- or treatment-related symptoms were identified using an ongoing prospective Mayo Clinic Breast Disease Registry (MCBDR). Additionally, Mayo Clinic electronic health records (MCEHR) were queried to identify eligible participants. All received a mailed consent form and survey including acupuncture-related questions about acupuncture referrals, delivery, and costs. Respondents were also asked to recall symptom severity before and after acupuncture treatment and time to benefit on Likert scales. RESULTS: Acupuncture use was reported among 415 participants (12.3%) of the MCBDR. Among MCBDR and MCEHR eligible participants, 241 women returned surveys. A total of 193 (82.1%) participants reported a symptomatic benefit from acupuncture, and 57 (24.1% of participants) reported a "substantial benefit" or "totally resolved my symptoms" (corresponding to 4 and 5 on the 5-point Likert scale). The mean symptom severity decreased by at least 1 point of the 5-point scale for each symptom; the percentage of patients who reported an improvement in symptoms ranged from 56% (lymphedema) to 79% (headache). The majority of patients reported time to benefit as "immediate" (34%) or "after a few treatments" (40.4%). Over half of the participants self-referred for treatment; 24.1% were referred by their oncologist. Acupuncture delivery was more frequent in private offices (61.0%) than in hospital or medical settings (42.3%). Twelve participants (5.1%) reported negative side effects, such as discomfort. CONCLUSIONS: Acupuncture is commonly utilized by patients for a variety of breast cancer-related symptoms. However, patients frequently self-refer for acupuncture treatments, and most acupuncture care is completed at private offices, rather than medical clinic or hospital settings.

Group Acupuncture Model in a Cancer Institute: Improved Access and Affordability.

Cancer patients may experience significant symptom mitigation from acupuncture. However, this service may not be easily accessible or affordable at all cancer institutions. The development of a group acupuncture program provided one institution with improved availability, lower cost to patients, and a foundation for oncology acupuncture research. This care delivery model was deployed at a large southeastern cancer institution within a multistate academic-community hybrid hospital system. The cancer institute serves >15,000 patients annually. Acupuncture is provided through the institute's Integrative Medicine section of the Department of Supportive Oncology. The purpose of this commentary is to describe the successful transition from an individual to group acupuncture model at this cancer institute. With the implementation of group acupuncture, patient visits increased 275% from individual care delivery. Although successful implementation of a group acupuncture model may be affordable and clinically positive, the authors also share unique challenges learned through the development and expansion of this program.

Acupuncture Versus Cognitive Behavioral Therapy for Insomnia in Cancer Survivors: A Randomized Clinical Trial.

BACKGROUND: Insomnia is a common and debilitating disorder experienced by cancer survivors. Although cancer survivors express a preference for using nonpharmacological treatment to manage insomnia, the comparative effectiveness between acupuncture and Cognitive Behavioral Therapy for Insomnia (CBT-I) for this disorder is unknown. METHODS: This randomized trial compared 8 weeks of acupuncture (n = 80) and CBT-I (n = 80) in cancer survivors. Acupuncture involved stimulating specific points on the body with needles. CBT-I included sleep restriction, stimulus control, cognitive restructuring, relaxation training, and education. We measured insomnia severity (primary outcome), pain, fatigue, mood, and quality of life posttreatment (8 weeks) with follow-up until 20 weeks. We used linear mixed-effects models for analyses. All statistical tests were two-sided. RESULTS: The mean age was 61.5 years and 56.9% were women. CBT-I was more effective than acupuncture posttreatment (P < .001); however, both acupuncture and CBT-I produced clinically meaningful reductions in insomnia severity (acupuncture: -8.31 points, 95% confidence interval = -9.36 to -7.26; CBT-I: -10.91 points, 95% confidence interval = -11.97 to -9.85) and maintained improvements up to 20 weeks. Acupuncture was more effective for pain at the end of treatment; both groups had similar improvements in fatigue, mood, and quality of life and reduced prescription hypnotic medication use. CBT-I was more effective for those who were male (P < .001), white (P = .003), highly educated (P < .001), and had no pain at baseline (P < .001). CONCLUSIONS: Although both treatments produced meaningful and durable improvements, CBT-I was more effective and should be the first line of therapy. The relative differences in the comparative effectiveness between the two interventions for specific groups should be confirmed in future adequately powered trials to guide more tailored interventions for insomnia.

Clinical Effectiveness of Traditional and Complementary Medicine Interventions in Combination with Nicotine Replacement Therapy on Smoking Cessation: A Randomized Controlled Pilot Trial.

Background: Smoking is associated with many preventable diseases and deaths. Globally, more than 6 million deaths per year are related to smoking. This study aimed to evaluate the pragmatic effectiveness of traditional and complementary medicine (T&CM) interventions for the smoking cessation treatment and to calculate the incremental cost-effectiveness ratio (ICER) of these interventions. Methods: The study design was a pragmatic, open-label randomized trial. The hypothesis of this trial was that the smoking cessation success rate increases with the addition of T&CM methods. The intervention group was provided T&CM interventions in addition to nicotine replacement therapy (NRT) and counseling, whereas the control group was treated with only NRT and counseling. Individuals received treatment for 4 weeks, then follow-up care for 20 weeks. Results: Forty-one participants were enrolled and assigned to either an intervention group or a control group at a ratio of 1:1. The odds ratio values at 4 weeks were 1.96 (0.51-8.51) in intention-to-treat analysis and 3.27 (0.75-17.75) in per-protocol analysis. The amount of smoking (cigarettes) decreased in both groups: from 17.2 ± 10.31 (baseline) to 1.7 ± 3.02 (4 weeks) in the intervention group and from 12.9 ± 5.47 (baseline) to 3.3 ± 5.96 (4 weeks) in the control group. The total medical costs per patient were $212.20 USD in the intervention group and $170.80 in the control group. The adjusted ICER of T&CM interventions was $13,355. Conclusions: This pilot study evaluated the clinical feasibility of T&CM used in conjunction with NRT and counseling for the smoking cessation treatment. However, there was no statistically significant effectiveness of T&CM interventions to raise cessation success rate. This study demonstrates the necessity for further studies based on large-scale randomized controlled trials.

A craniopuntura japonesa como instrumento para o tratamento da dor não específica em profissionais de saúde / The japanese scalp acupuncture as an instrument for non- specific pain treatment in health professionals / La craniopuntura japonesa como instrumento para el tratamiento del dolor no específico en profesionales de salud

Objetivo: Caracterizar a técnica de craniopuntura japonesa como instrumento para o tratamento da dor não específica em profissionais de saúde. Método: Estudo do tipo antes e depois. O cenário foi uma instituição pública de saúde, de assistência em nível primário. O processo de coleta dos dados ocorreu por um período de 4 semanas, totalizando 8 sessões. Foi utilizada a Escala Visual/verbal Numérica antes e após a sessão. Os dados foram analisados com auxílio do programa Bioestat 5.3. Resultados: Foi composto por 7 sujeitos, aproximadamente 41% do total dos profissionais da equipe que compõem o cenário do estudo. A técnica de craniopuntura japonesa auxiliou na redução da dor (p=0,009) em 100% dos participantes deste estudo. Conclusão: A craniopuntura japonesa foi eficaz em todas as sessões, na redução da dor não específica dos sujeitos do estudo

Objective: The study's goal has been to characterize the Japanese scalp acupuncture technique as an instrument for non-specific pain treatment in health professionals. Methods: It is a controlled before-and-after study. The scenario was a public health institution, which performs health assistance at the primary level. The data collection process was carried out over a period of 4 weeks, totaling 8 sessions. The Visual/Verbal Numeric Scale was used both before and after each session. Data were analyzed using the Bioestat 5.3 program. Results: It was encompassed by 7 subjects, approximately 41% of the total of the professionals of the team that comprises the studied scenario. The Japanese scalp acupuncture technique helped reduce pain (p=0.009) in 100% of the participants of this study. Conclusion: Japanese scalp acupuncture was effective in all sessions, therefore, reducing non-specific pain events in the participants under study

Objetivo: Caracterizar la técnica de craneofaringe japonés como instrumento para el tratamiento del dolor no específico en los profesionales de la salud. Método: Estudio del tipo antes y después. El escenario fue una institución pública de salud, de asistencia a nivel primario. El proceso de recolección de datos ocurrió por un período de 4 semanas, totalizando 8 sesiones. Se utilizó la Escala Visual / verbal Numérica antes y después de la sesión. Los datos se analizaron con ayuda del programa Bioestat 5.3. Resultados: Fue compuesto por 7 sujetos, aproximadamente el 41% del total de los profesionales del equipo que componen el escenario del estudio. La técnica de craneoparatil japonesa ayudó en la reducción del dolor (p = 0,009) en el 100% de los participantes de este estudio. Conclusión: La cranealuntura japonesa fue eficaz en todas las sesiones, en la reducción del dolor no específico de los sujetos del estudio

Utilization of integrative medicine differs by age among pediatric oncology patients.

PURPOSE: Coping with symptoms related to cancer treatment is challenging for pediatric patients with cancer and their caregivers. Additionally, caring for pediatric patients requires specialized expertise to incorporate age-appropriate interventions to improve outcomes. Despite the increase in pediatric inpatient integrative medicine (IM) therapies, there is a paucity of knowledge about whether the utilization of IM therapies differs by patient age. METHODS: We conducted a retrospective analysis on IM utilization among pediatric inpatients between 2008 and 2016 in a tertiary urban cancer center using electronic medical records. Multivariable logistic regression models examined the relationship between age and specific type of IM utilization, adjusting for specific demographic factors. RESULTS: Between 2008 and 2016, the pediatric inpatient IM service had 20 686 visits and treated 1877 unique patients. A significant age difference (P < 0.001) by modality was noted: dance therapy (mean age ± standard deviation: 5.9 ± 5.3 years), music therapy (8.0±7.0 years), mind-body therapies (13.0 ± 7.7 years), massage (14.5 ± 7.8 years), and acupuncture (20.0 ± 7.9 years). In multivariable analysis, the association between age and use of specific IM therapies remained significant (P < 0.001 for all). CONCLUSION: Specific types of inpatient IM therapy usage significantly differed by the age of pediatric patients with cancer; therefore, designing and providing age-appropriate IM interventions with consideration for developmental stage are needed to ensure that the most appropriate and effective therapies are provided to children with cancer.

Understanding the Use of Acupuncture for Insomnia Among Cancer Survivors: A Qualitative Study.

OBJECTIVE: To understand cancer survivors' perceptions regarding the use of acupuncture for the treatment of cancer-related insomnia. DESIGN: Semistructured interviews with cancer survivors participating in a randomized controlled trial comparing the effectiveness of Cognitive Behavioral Therapy for Insomnia (CBT-I) and acupuncture for the treatment of insomnia. Interviews were conducted before randomization into either treatment option, and structured to elicit participants' experiences with insomnia as well as their beliefs and understanding surrounding acupuncture for the treatment of insomnia. An integrated approach was used for data analysis. SUBJECTS: Sixty-three cancer survivors with DSM-V diagnosed insomnia. RESULTS: Participants shared a broad lack of understanding regarding acupuncture for the treatment of insomnia. Specifically, individuals in this study expressed confusion surrounding what symptoms or medical conditions acupuncture could be used to treat, how acupuncture works, and how long the effects of acupuncture last. CONCLUSIONS: This study identified three specific gaps in knowledge, including treatment target, mechanism, and durability, surrounding the use of acupuncture for insomnia in cancer survivors. Addressing these gaps by providing appropriate and timely education surrounding the use of acupuncture to treat insomnia is essential to increase the evidence-informed utilization of acupuncture and to better meet patients' needs among cancer survivors.

Placebo by proxy expectations toward acupuncture change over time: a survey comparing parental expectations to acupuncture pre- and postoperatively.

BACKGROUND: Patients entering a treatment have expectancy to outcome based on their previous experience, the information received, and the credibility of the treatment. Once the treatment has started, patients may detect and interpret contextual cues and somatic state. Influenced and conditioned by positive or negative interpretations, their reappraisal may improve or worsen the treatment outcome. The aims were to investigate whether parental pre-treatment expectancies towards acupuncture differ compared to post-treatment expectancies, and assess predictors for possible change of parental expectancy. Further, we wanted to explore whether the change correlates with the treatment outcome, i.e. postoperative vomiting in children. METHODS: Two hundred and eighty-two parents completed per- and 24 h postoperatively a survey on their expectancy to acupuncture treatment for alleviation of postoperative vomiting in children. The survey was embedded in a randomised controlled trial. RESULTS: Parental expectancy to acupuncture treatment changed over time. The changes were predicted by several variables such as children's gender, parents' age and education, previous experiences, and assignment to treatment group. The strongest predictor was parental anxiety to their child undergoing surgery. Further, the change of parental expectancy was correlated with postoperative vomiting. CONCLUSIONS: Anxious parents are prone to change their expectancy in a positive direction during the treatment period, which in turn may improve treatment outcome. Acupuncture therapists in clinical practice should pay a special attention to the potential that lies here, and acknowledge parental anxiety as a possible facilitator, and not a barrier, to elicit placebo by proxy effects. Further research to expand the findings of the present study into other treatments is in order. Future research should also provide more knowledge about how parental expectancy changes over time, and how different factors predict and produce change of parental expectancy. TRIAL REGISTRATION: ClinicalTrials.gov NCT01729052 . Registered November 20, 2012.

Barriers to Acupuncture Use Among Breast Cancer Survivors: A Cross-Sectional Analysis.

INTRODUCTION: Increasing evidence suggests that acupuncture may be helpful to manage common symptoms and treatment side effects among breast cancer (BC) survivors. Acupuncture usage among BC survivors remains low with little known about the barriers to its utilization. We evaluated perceived barriers to acupuncture use among BC survivors and explored the sociodemographic variations of such barriers. METHODS: We conducted a cross-sectional analysis at an urban academic cancer center on 593 postmenopausal women with a history of stage I-III hormone receptor-positive BC who were taking or had taken an aromatase inhibitor. We used the modified Attitudes and Beliefs about Complementary and Alternative Medicine instrument to evaluate patients' perceived barriers to acupuncture. Multiple linear regression analysis was performed to determine sociodemographic factors associated with perceived barrier scores. RESULTS: The most common barriers were lack of knowledge about acupuncture (41.6%), concern for lack of insurance coverage (25.0%), cost (22.3%), and difficulty finding qualified acupuncturists (18.6%). Compared with whites, minority patients had higher perceived barriers to use acupuncture (ß coefficient = 1.63, 95% confidence interval = 0.3-2.9, P = .013). Patients with lower education had higher barriers to use acupuncture (ß coefficient = 4.23, 95% confidence interval = 3.0-5.4, P < .001) compared with patients with college education or above. CONCLUSION: Lack of knowledge and concerns for insurance coverage and cost are the common barriers to acupuncture use among BC survivors, especially among minority patients with lower education. Addressing these barriers may lead to more equitable access to acupuncture treatment for BC survivors from diverse backgrounds.

A Survey of Licensed Acupuncturists in the San Francisco Bay Area: Prevalence of Treating Oncology Patients.

BACKGROUND: Many cancer patients seek traditional Chinese medicine (TCM), the prevalence varying with diagnosis, comorbidities, and demographics. Interventions sought include acupuncture, massage, herbs, diet, and exercise, usually combined with conventional therapies. It is not known what proportion of TCM practitioners care for cancer patients, their cancer specific training or caseload, what interventions they employ, their outcomes, and their communication patterns with conventional oncologists. METHODS: A survey was mailed to all 2213 licensed acupuncturists in the 9-county San Francisco Bay Area gathering descriptive statistics. RESULTS: A total of 472 (21%) responded by mail or web-based Research Electronic Data Capture (REDCap) tool. Most respondents (77%) reported caring for patients with cancer, with 29% reporting having 6 to 10 years of practice experience, and 44.2% having 0 to 20 hours of training specific to the needs of patients with cancer. Improving quality of life was reported by 94% as what their treatment offered cancer patients as well as the area where treatment was felt to have the greatest impact. The most useful TCM modalities were acupuncture (98%), herbs (79%), diet (72%), moxibustion (46%), and meditation instruction (44%). Absence of adverse reactions was noted by 95%. Ninety-one percent reported "never" or "hardly ever" having been contacted by patients' oncologists to discuss treatment. CONCLUSIONS: Many acupuncturists seeing cancer patients have significant clinical experience and have sought specialized training. Improved communication is needed between TCM practitioners and oncologists sharing care of cancer patients.

Effect of Acupuncture and Clomiphene in Chinese Women With Polycystic Ovary Syndrome: A Randomized Clinical Trial.

Importance: Acupuncture is used to induce ovulation in some women with polycystic ovary syndrome, without supporting clinical evidence. Objective: To assess whether active acupuncture, either alone or combined with clomiphene, increases the likelihood of live births among women with polycystic ovary syndrome. Design, Setting, and Participants: A double-blind (clomiphene vs placebo), single-blind (active vs control acupuncture) factorial trial was conducted at 21 sites (27 hospitals) in mainland China between July 6, 2012, and November 18, 2014, with 10 months of pregnancy follow-up until October 7, 2015. Chinese women with polycystic ovary syndrome were randomized in a 1:1:1:1 ratio to 4 groups. Interventions: Active or control acupuncture administered twice a week for 30 minutes per treatment and clomiphene or placebo administered for 5 days per cycle, for up to 4 cycles. The active acupuncture group received deep needle insertion with combined manual and low-frequency electrical stimulation; the control acupuncture group received superficial needle insertion, no manual stimulation, and mock electricity. Main Outcomes and Measures: The primary outcome was live birth. Secondary outcomes included adverse events. Results: Among the 1000 randomized women (mean [SD] age, 27.9 [3.3] years; mean [SD] body mass index, 24.2 [4.3]), 250 were randomized to each group; a total of 926 women (92.6%) completed the trial. Live births occurred in 69 of 235 women (29.4%) in the active acupuncture plus clomiphene group, 66 of 236 (28.0%) in the control acupuncture plus clomiphene group, 31 of 223 (13.9%) in the active acupuncture plus placebo group, and 39 of 232 (16.8%) in the control acupuncture plus placebo group. There was no significant interaction between active acupuncture and clomiphene (P = .39), so main effects were evaluated. The live birth rate was significantly higher in the women treated with clomiphene than with placebo (135 of 471 [28.7%] vs 70 of 455 [15.4%], respectively; difference, 13.3%; 95% CI, 8.0% to 18.5%) and not significantly different between women treated with active vs control acupuncture (100 of 458 [21.8%] vs 105 of 468 [22.4%], respectively; difference, -0.6%; 95% CI, -5.9% to 4.7%). Diarrhea and bruising were more common in patients receiving active acupuncture than control acupuncture (diarrhea: 25 of 500 [5.0%] vs 8 of 500 [1.6%], respectively; difference, 3.4%; 95% CI, 1.2% to 5.6%; bruising: 37 of 500 [7.4%] vs 9 of 500 [1.8%], respectively; difference, 5.6%; 95% CI, 3.0% to 8.2%). Conclusions and Relevance: Among Chinese women with polycystic ovary syndrome, the use of acupuncture with or without clomiphene, compared with control acupuncture and placebo, did not increase live births. This finding does not support acupuncture as an infertility treatment in such women. Trial Registration: clinicaltrials.gov Identifier: NCT01573858.

Treatment of Chemotherapy-Induced Peripheral Neuropathy in Integrative Oncology: A Survey of Acupuncture and Oriental Medicine Practitioners.

OBJECTIVES: Complementary and alternative medicine is increasingly integrated into cancer care. We sought detail on the treatment of chemotherapy-induced peripheral neuropathy (CIPN) with acupuncture and oriental medicine (AOM) by surveying practitioners at integrative oncology (IO) sites across the United States. DESIGN: Online survey of licensed acupuncturists. SETTING/LOCATION: IO sites in the United States. SUBJECTS: Fifteen licensed acupuncturists who completed the survey between February 2014 and June 2014. OUTCOME MEASURES: Demographics, IO setting characteristics, AOM treatment characteristics, and practitioner-reported outcomes. RESULTS: Respondents reported an average of 31.3 ± 17.2 patients per week, and one-third (10.1 mean; 7.2 standard deviation [SD]) were treated for CIPN. Medical doctors (86.7%) were the most common providers with whom respondents worked. Traditional Chinese medicine style acupuncture was utilized by a majority of respondents (86.7%), and the most commonly used points were local, typically in the hands and feet, such as Ba Feng, Ba Xie, LV3, and LI4. In addition to acupuncture, nutritional advice was the most frequent auxiliary modality provided by respondents (85.7%). On average, respondents provided 12.75 ± 4.17 treatments for CIPN patients, and a majority (53%) reported treating patients once per week. Timing of the treatments relative to chemotherapy infusion was evenly distributed between "1-2 days after infusion" (60%), "at time of infusion" (53.3%), and "1-2 days before infusion" (46.7%). Sixty percent of respondents rated outcomes as "moderately successful with moderate improvement seen." CONCLUSION: This survey provides detail regarding IO sites using acupuncture for CIPN as well as real-world treatment patterns, including common point combinations, visit characteristics, and practitioner-reported outcomes. This information contributes to the emerging evidence on the use of acupuncture to address unmet needs of CIPN patients, and supports the development of best practice guidelines for the treatment of CIPN with acupuncture in the IO setting.

Implementation of tobacco cessation brief intervention in complementary and alternative medicine practice: qualitative evaluation.

BACKGROUND: This article presents findings from qualitative interviews conducted as part of a research study that trained Acupuncture, Massage, and Chiropractic practitioners' in Arizona, US, to implement evidence-based tobacco cessation brief interventions (BI) in their routine practice. The qualitative phase of the overall study aimed to assess: the impact of tailored training in evidence-based tobacco cessation BI on complementary and alternative medicine (CAM) practitioners' knowledge and willingness to implement BIs in their routine practice; and their patients' responses to cessation intervention in CAM context. METHODS: To evaluate the implementation of skills learned from a tailored training program, we conducted semi-structured qualitative interviews with 54 CAM practitioners in Southern Arizona and 38 of their patients. Interview questions focused on reactions to the implementation of tobacco cessation BIs in CAM practice. RESULTS: After participating in a tailored BI training, CAM practitioners reported increased confidence, knowledge, and motivation to address tobacco in their routine practice. Patients were open to being approached by CAM practitioners about tobacco use and viewed BIs as an expected part of wellness care. CONCLUSIONS: Tailored training motivated CAM practitioners in this study to implement evidence-based tobacco cessation BIs in their routine practice. Results suggest that CAM practitioners can be a valuable point of contact and should be included in tobacco cessation efforts.

Predictors of acupuncture use among children and adolescents with cancer.

BACKGROUND: Evidence for the application of acupuncture in pediatric oncology is limited. We investigated the acceptance of acupuncture and factors associated with its use among children and adolescents with cancer. METHODS: Ninety acupuncture-naïve children receiving cancer treatment at Columbia University Medical Center (CUMC) provided consent/assent for participation. Participants could choose to receive or refuse integrative services offered at CUMC. Symptoms were collected for a 6-month period with the Memorial Symptom Assessment Scale (MSAS). Acute and delayed adverse events among participants who received acupuncture were recorded. RESULTS: Fifty-four percent of the participants elected to receive acupuncture. In total, 252 acupuncture sessions were administered with a median of four sessions per patient (range 1-13 sessions). Pain (56%), nausea (51%), lack of energy (50%), and irritability (43%) were the most frequently reported symptoms in the whole cohort. Determinants of acupuncture use included older age and ethnicity. Acupuncture was more likely than other integrative modalities to be used for gastrointestinal and constitutional symptoms including drowsiness (odds ratio [OR], 3.34; 95% confidence interval [CI], 1.98-5.66; P < 0.0001), lack of energy (OR, 3.23; 95% CI, 1.78-5.87; P = 0.0001), and pain (OR, 2.63; 95% CI, 1.46-4.72; P = 0.001). Adverse events were reported by 3% of the participants. There was no increased incidence of adverse events in children with thrombocytopenia (P = 0.189) or neutropenia (P = 0.497). CONCLUSION: Our results highlight the potential use of acupuncture as a safe, adjunctive therapy for symptom management within existing supportive care regimens in pediatric oncology and potential areas to focus research initiatives.

Acupuncture-Related Quality of Life Changes Using PROMIS Computer Adaptive Tests in a Pragmatic Trial with Oncology and General Integrative Medicine Patients: The Role of Baseline Acupuncture Expectations.

INTRODUCTION: Acupuncture has been shown to alleviate symptoms and increase general well-being in different medical patient samples. A major challenge in acupuncture clinical research is the availability of comparable and standardized patient-reported outcome measurement (PRO) tools. OBJECTIVES: This study used a pragmatic design to examine longitudinal changes in quality of life (QOL) in a medical patient sample following acupuncture using PROs from the National Institutes of Health's Patient Reported Outcomes Measurement Information System (PROMIS) initiative. It also examined the role of acupuncture expectancies, as well as patient and provider perceptions of acupuncture benefit. DESIGN: Following informed consent, patients completed baseline QOL measures (T1) prior to their first acupuncture session. Subsequent assessments (up to 20) were completed immediately following ensuing acupuncture sessions. Patients completed assessments either on a touch-screen computer at the clinic or from their home computer. RESULTS: Compared with acupuncture-naïve participants, those who received prior acupuncture treatment reported significantly higher anxiety, fatigue, sleep disturbance, and lower positive affect at baseline. By the second assessment, however, these differences became nonexistent. Participants who held greater baseline acupuncture expectations (e.g., their situation would improve a lot, they would have improved coping skills, their symptoms would disappear, their energy would increase) reported significantly higher fatigue, pain interference, and problems with physical functioning. Between T1 and T2, all participants reported significant improvements in anxiety, depression, and fatigue. Exploratory longitudinal models demonstrated significant linear improvements over time in anxiety (p = 0.006), depression (p = 0.007), pain interference (p < 0.001), and sleep disturbance (p = 0.004). No linear reduction over time was found with fatigue (p = 0.587), physical function (p = 0.654), or positive affect (p = 0.247). CONCLUSIONS: Overall, PROMIS computer adaptive tests were able to assess domains of QOL briefly. Although pretreatment acupuncture expectations highlighted subgroup differences in outcomes at baseline, linear-growth models demonstrated the positive effects of acupuncture over time on anxiety, depression, pain interference, and sleep disturbance.

Association Between Complementary and Alternative Medicine Use and Breast Cancer Chemotherapy Initiation: The Breast Cancer Quality of Care (BQUAL) Study.

IMPORTANCE: Not all women initiate clinically indicated breast cancer adjuvant treatment. It is important for clinicians to identify women at risk for noninitiation. OBJECTIVE: To determine whether complementary and alternative medicine (CAM) use is associated with decreased breast cancer chemotherapy initiation. DESIGN, SETTING, AND PARTICIPANTS: In this multisite prospective cohort study (the Breast Cancer Quality of Care [BQUAL] study) designed to examine predictors of breast cancer treatment initiation and adherence, 685 women younger than 70 years with nonmetastatic invasive breast cancer were recruited from Columbia University Medical Center, Kaiser Permanente Northern California, and Henry Ford Health System and enrolled between May 2006 and July 31, 2010. Overall, 306 patients (45%) were clinically indicated to receive chemotherapy per National Comprehensive Cancer Network guidelines. Participants were followed for up to 12 months. EXPOSURES: Baseline interviews assessed current use of 5 CAM modalities (vitamins and/or minerals, herbs and/or botanicals, other natural products, mind-body self-practice, mind-body practitioner-based practice). CAM use definitions included any use, dietary supplement use, mind-body use, and a CAM index summing the 5 modalities. MAIN OUTCOMES AND MEASURES: Chemotherapy initiation was assessed via self-report up to 12 months after baseline. Multivariable logistic regression models examined a priori hypotheses testing whether CAM use was associated with chemotherapy initiation, adjusting for demographic and clinical covariates, and delineating groups by age and chemotherapy indication. RESULTS: A cohort of 685 women younger than 70 years (mean age, 59 years; median age, 59 years) with nonmetastatic invasive breast cancer were recruited and followed for up to 12 months to examine predictors of breast cancer treatment initiation. Baseline CAM use was reported by 598 women (87%). Chemotherapy was initiated by 272 women (89%) for whom chemotherapy was indicated, compared with 135 women (36%) for whom chemotherapy was discretionary. Among women for whom chemotherapy was indicated, dietary supplement users and women with high CAM index scores were less likely than nonusers to initiate chemotherapy (odds ratio [OR], 0.16; 95% CI, 0.03-0.51; and OR per unit, 0.64; 95% CI, 0.46-0.87, respectively). Use of mind-body practices was not related to chemotherapy initiation (OR, 1.45; 95% CI, 0.57-3.59). There was no association between CAM use and chemotherapy initiation among women for whom chemotherapy was discretionary. CONCLUSIONS AND RELEVANCE: CAM use was high among patients with early-stage breast cancer enrolled in a multisite prospective cohort study. Current dietary supplement use and higher number of CAM modalities used but not mind-body practices were associated with decreased initiation of clinically indicated chemotherapy. Oncologists should consider discussing CAM with their patients during the chemotherapy decision-making process.

Effect of Acupuncture on Reducing Duration of Postoperative Ileus After Gastrectomy in Patients with Gastric Cancer: A Pilot Study Using Sitz Marker.

OBJECTIVES: Postoperative ileus (POI) is a common problem after abdominal surgery. Acupuncture is being accepted as an option for reducing POI and managing various functional gastrointestinal disorders. Therefore, this pilot study was conducted to evaluate the effect of acupuncture on reducing duration of POI and other surgical outcomes in patients who underwent gastric surgery. DESIGN: A prospective, randomized, controlled pilot study was conducted on patients who underwent gastric cancer surgery from January 2013 to December 2013. Ten patients were randomly assigned into the acupuncture (A) or nonacupuncture (NA) groups at a 1:1 ratio. INTERVENTIONS: The acupuncture treatment was performed by Korean traditional medicine doctors (KMDs). The style of acupuncture was Korean. In the A group, acupuncture treatment was given once daily for 5 consecutive days starting on postoperative day 1. Each patient received acupuncture at 16 acupoints based on expert consensus provided by qualified and experienced KMDs. No acupuncture treatment was performed in the NA group. OUTCOME MEASURES: The primary outcome measure was the number of remnant Sitz markers in the small intestine on abdominal radiography. Secondary outcome measures were time to first flatus, start of sips water, start of soft diet, hospital stay, and laboratory findings. RESULTS: The A group had significantly fewer remnant Sitz markers in the small intestine on postoperative days 3 and 5 compared with those in the NA group (p = 0.025 and 0.005). A significant difference was observed in the numbers of remnant Sitz marker in the small intestine with respect to time difference by group (p = 0.019). The A group showed relatively better surgical outcomes, but without statistical significance. CONCLUSIONS: Although further studies are warranted, acupuncture may reduce duration of POI after gastric surgery and could be a potential factor in enhanced recovery after surgery protocols.

Acupuntura como tecnologia aplicada ao cuidado de enfermagem a adultos hipertensos: um estudo experimentl

Estudo sobre a eficácia de um protocolo de acupuntura (AP) como tecnologia aplicada ao cuidado de enfermagem a portadores de hipertensão arterial sistêmic a primária (HAS) em tratamento convencional/medicamentoso. As Práticas Integrativas e Complementares de Saúde (PICS) vêm se constituindo como uma racionalidade em saúde complementar ao modelo biomédico hegemônico. O foco está na atenção primária com vistas à prevenção e tratamento complementar para diversas situações de saúde - doença, entre as quais se incluem as Doenças Crônicas Não Transmissíveis (DCNT), como a HAS, uma patologia de complicações graves a médio e longo praz. Estudos metanalíticos e ensaios clínicos apontam a possibilidade do emprego da AP como terapia não farmacológica associada às demais condutas terapêuticas adotadas para as DCNT cardiovasculares; e sua intervenção em diagnósticos de enfermagem (DE). Mas ainda são incipientes aqueles que destacam quais diagnósticos indicam intervenções pela acupuntura bem como sua eficácia enquanto tecnologia aplicada ao cuidado de enfermagem. Os objetivos foram: identificar os efeitos da AP na pressão arterial e sobre os DE identificados em portadores de HAS; e analisar os efeitos da AP como PICS associada ao tratamento convencional /medicamentoso de portadores de HAS. Adotou - se o conceito de DE na perspectiva da taxionomia II da North American Nursing Diagnosis Association International (NANDA - I). O ptou - se por trabalhar com DE já apontados por expertises como passíveis de intervenção com AP e desenvolveu - se um modelo teórico - experimental de pequeno alcance para validação de PICS como tecnologia aplicada ao cuidado de enfermagem...

Study on the effectiveness of an acupuncture protocol (AP) as technology applied to nursing care of patients with primary arterial hypertension (AH) in conventional / drug treatment. The Complementary and Integrative Practices in Health Care(PICS) are being formed as a health supplement rationality to the hegemonic biomedical model. The focus is on primary care with a view to prevention and complementary treatment for diverse situations of health and illness, among which the Chronic Noncommunicable Diseases (NCDs) are included, such as hypertension, a condition of severe complications in the medium and long term. Studies of meta-analysis and clinical trials indicate the possibility of using the AP as non-pharmacological therapy associated with other clinical strategies for cardiovascular NCDs; and its intervention in nursing diagnostics (DE). But they are still incipient those which highlight which diagnosis indicate acupuncture intervention as well as its efficiency as tecnology applied to the nursing care. The goals were to identify the effects of AP in blood pressure and on the DE identified in patients with hypertension; and analyze the effects of AP as PICS associated with conventional / drug treatment of patients with SAH. The concept of DE on taxonomy II’s perspective of theNorth American Nursing Diagnosis Association International (NANDA-I) was adopted. We chose to work with DE already pointed out by expertise as amenable to intervention with AP and developed a theoretical and experimental model for short-range PICS validation as technology applied to nursing care...