A Systematic Review and Quality Assessment of Breast Cancer Clinical Practice Guidelines Providing Complementary and Alternative Medicine Recommendations.

PURPOSE OF REVIEW: Up to 80% of patients with breast cancer are reported to use complementary and alternative medicine (CAM). Despite this high prevalence, many healthcare providers have little knowledge and education surrounding this topic and may be inadequately prepared to discuss such therapies with their patients. Given this knowledge gap, the purpose of this study was to systematically identify the quantity and assess the quality of CAM recommendations in clinical practice guidelines (CPGs) for the treatment and/or management of breast cancer. RECENT FINDINGS: Thirty-four CPGs were deemed eligible, 5 of which mentioned CAM, and 4 of which made CAM recommendations. Eligible CPGs containing CAM recommendations were assessed with the AGREE II instrument. Scaled domain percentages from highest to lowest were (% overall, % CAM) as follows: scope and purpose (100.0%, 100.0%), editorial independence (100.0%, 100.0%), clarity of presentation (97.2%, 80.6%), rigour of development (80.2%, 80.2%), stakeholder involvement (88.9%, 77.8%), and applicability (58.3%, 58.3%). CPGs with favourable scores may provide practitioners with guidance on safe and effective use of CAM therapies. A need exists to improve the quality of CAM recommendations in CPGs.

The effect of Apis dorsata honey as complementary therapy on IL-37 levels and fatigue in breast cancer patients undergoing chemotherapy.

OBJECTIVE: The purpose of this study is to determine the effect of Apis dorsata Honey as a complementary therapy on IL-37 levels and fatigue in breast cancer patients undergoing chemotherapy. METHOD: The study used a quasi-experimental pretest-posttest design with a control group. A total of 30 subjects were recruited using a concurrent sampling technique. The intervention group consisted of 15 subjects who received oral honey at a dose of 13 ml (1 tablespoon × 3) for 15 days, and the control group consisted of 15 subjects. The groups' samples were chosen at random. The Fatigue Symptom Inventory (FSI) was used to assess the side effects of chemotherapy. RESULTS: Although the effect of Apis dorsata Honey on IL-37 levels was not statistically significant (p > 0.05), the group given honey experienced a clinically significant increase in IL-37 levels, with a mean before (632.37514.93) and post (632.37514.93). (1,003.021,248.88). Fatigue decreased statistically significantly in the group given mean honey values prior to 13.205.59 and after 11.805.07 (p = 0.004). CONCLUSION: Honey administration increases IL-37 levels clinically, though the increase is not statistically significant. Giving honey to patients with breast cancer can help alleviate fatigue caused by chemotherapy.

Does UV Light as an Adjunct to Conventional Treatment Improve Healing and Reduce Infection in Wounds? A Systematic Review.

OBJECTIVE: To examine the effect of UV light on wound healing and infection in patients with skin ulcers or surgical incisions. Outcomes of interest included healing time, wound size and appearance, bacterial burden, and infection. DATA SOURCES: Ovid MEDLINE, Embase, Cochrane, PubMed, CINAHL, and Web of Science. STUDY SELECTION: Comparative and noncomparative clinical studies were considered, including observational cohort, retrospective, and randomized controlled studies. They addressed the research question: "Does the use of UV light as an adjunct to conventional treatment help improve healing and reduce infection in wounds?" Selection criteria included any English language study in adults who used UV light to improve wound healing and prevent or treat wound infection. DATA EXTRACTION: Authors extracted information pertaining to patient demographics, treatment protocols, and the following wound outcomes: appearance, healing time, infection, and bacterial burden. DATA SYNTHESIS: The search yielded 30,986 articles, and screening resulted in 11 studies that underwent final analysis. Of these (N = 27,833), seven (64%) demonstrated an improvement in healing outcomes with adjunctive UV therapy, and the results of four (36%) achieved statistical significance. CONCLUSIONS: There is limited research on the utility of adjunctive UV therapy to improve wound healing outcomes in humans. The majority of literature included in this review supported improved wound healing outcomes with adjuvant UV therapy. Future well-designed randomized controlled trials will be essential in further determining the benefit and utility of UV therapy in wound healing.

The Presence of Complementary and Alternative Medicine Recommendations in Head and Neck Cancer Guidelines: Systematic Review and Quality Assessment.

PURPOSE OF REVIEW: A high proportion of head and neck cancer (HNC) patients use complementary and alternative medicine (CAM), however, healthcare professionals generally have little knowledge about the safety and efficacy of these therapies. The purpose of this study was to determine the quantity and assess the quality of CAM recommendations across clinical practice guidelines (CPGs) for the treatment and/or management of HNC. RECENT FINDINGS: MEDLINE, EMBASE, and CINAHL were systematically searched for HNC CPGs published between 2009 and April 2020; the Guidelines International Network and the National Center for Complementary and Integrative Health websites were also were searched. Eligible CPGs containing CAM recommendations were assessed twice with the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument, once for the overall CPG and once for the CAM sections. Of 305 unique search results, 7 CPGs mentioned CAM and 4 CPGs made CAM recommendations. The overall CPG scored higher than the CAM section for 4 of 6 domains (overall, CAM): scope and purpose (93.8%, 93.8%), clarity of presentation (88.2%, 64.6%), stakeholder involvement (68.8%, 39.6%), rigor of development (58.3%, 34.6%), editorial independence (42.7%, 42.7%), and applicability (51.6%, 19.8%). Quality varied within and between CPGs. Highly scoring CPGs serve as evidence-based resources that clinicians can use to inform their patients about safe and effective CAM use; CPGs achieving variable or lower scores could be improved in future updates based on currently available guideline development/implementation tools. Future research should identify CAM therapies supported by sufficient evidence to be included as part of HNC CPGs.

The quality of online consumer health information at the intersection of complementary and alternative medicine and arthritis

Abstract Background: Complementary and alternative medicine (CAM) use is prevalent among patients living with arthritis. Such patients often seek information online, for the purpose of gaining a second opinion to their healthcare provider or even self-medication. Little is known about the quality of web-based consumer health information at the intersection of CAM and arthritis; thus, investigating the quality of websites containing this information was the purpose of this study. Methods: Four unique search terms were searched on Google across four English-speaking countries. We assessed the first 20 results of each search, including them if they contained CAM consumer health information for the treatment and/or management of arthritis. Eligible websites were assessed in duplicate using the DISCERN instrument, which consists of 16-items designed to assess quality. Results: Of total of 320 webpages, 239 were duplicates, and a total of 38 unique websites were deemed eligible and assessed using the DISCERN instrument. The mean summed DISCERN scores across all websites was 55.53 (SD = 9.37). The mean score of the overall quality of each website was 3.71 (SD = 0.63), thus the majority of websites are ranked as slightly above 'fair' quality. Conclusion: Eligible websites generally received scores better than 'moderate' in terms of overall quality. Several shortcomings included a lack of transparency surrounding references used and underreporting of risks associated with treatment options. These results suggest that health providers should be vigilant of the variable quality of information their patients may be accessing online and educate them on how to identify high quality resources.(AU)

Investigation of the Role of Complementary Medicine on Anxiety of Patients Before and After Surgery: A Review Study.

Every year millions of patients undergo surgery worldwide. Anxiety is a common pre- and postoperative problem. Nonpharmacologic anxiety control has been demonstrated to be more suitable in patients. The objective of this study was to apprise the evidence of the effect of various complementary therapies on pre- and postoperative anxiety among patients. A comprehensive literature search was made on Web of Science, Scopus, Cochrane, PubMed Irandoc, SID Science, ScienceDirect, Ovid, Mag Iran, and Google Scholar for original research studies published between 1980 and 2019. Original articles that reported the effect of complementary therapies in patients undergoing surgery were included. Ninety-six studies were analyzed. All of the studies have documented the effects of complementary therapies on improving pre- and postoperative outcomes of patients. Although methods varied considerably, most of the studies included in this review reported positive results. Therefore, there is some evidence that complementary therapies can lead to positive pre- and postoperative outcomes. Therefore, the efficiency and use of complementary medicine, along with the use of therapeutic techniques in classical medicine, can provide a new model for reducing anxiety before and after surgery. It is recommended that nurses conduct additional reviews or clinical studies so that effective approaches to integrated medical care can be developed and patients' health enhanced.

The legitimacy and safety of using alternative diets in cancer.

Alternative diets are used by cancer patients, especially among those who are not treated with conventional methods. Due to worrying data published by the World Health Organisation and its Agenda, the International Agency for Research on Cancer and the International Cancer Union, as well as epidemiological data from all over the world, it has been concluded that cancer will be the main cause of death in the world and that, therefore, the popularity of alternative diets among cancer patients may increase. The paper reviews the scientific literature and assesses the legitimacy and safety of selected alternative diets, as well as the description of research in terms of assumed anticancer efficacy in the following diets: ketogenic, Dr. Budwig and macrobiotic. The article also contains a summary of the analyzed scientific research and conclusions concerning the legitimacy of their use by cancer patients.

Use of Complementary and Alternative Medicine in Fibromyalgia: Results of an Online Survey.

BACKGROUND: Fibromyalgia is a chronic condition which may negatively impact various aspects of patients' lives. Many people with fibromyalgia look to complementary and alternative medicine treatments for symptom relief. AIMS: The three main objectives of this study were to examine self-reported complementary and alternative medicine use in patients with fibromyalgia, to determine associations between the use of complementary and alternative medicine treatments and patients' self-reported quality of live and self-reported pain levels. DESIGN: Cross-sectional survey. SETTING: Web-based. PARTICIPANTS/SUBJECTS: Adults over the age of 18 years who had been diagnosed with fibromyalgia. METHODS: Patients with fibromyalgia responded to an online questionnaire regarding the following: treatments (complementary and alternative medicine, prescription and over-the-counter medications), quality of life (Quality of Life Scale-16), assessment of current pain (visual analog scale), and demographic information. RESULTS: Approximately 66% of the respondents used complementary and alternative treatments. Vitamins, massage therapy, and meditation were the most commonly used complementary and alternative therapies. Results indicated respondents using a combination of complementary and alternative medicine and pharmacologic treatments (prescription or over-the-counter) had significantly higher quality of life versus those using pharmacologic treatments alone, p = .011. Similarly, respondents using only complementary and alternative medicine treatment reported significantly lower pain levels versus those using pharmacologic treatment alone, p = .046. CONCLUSIONS: The study suggests that a large proportion of fibromyalgia patients use complementary and alternative medicine, and these treatments may offer beneficial effects to these patients. Integration of complementary and alternative medicine into conventional treatment regimens may provide opportunities for a holistic treatment approach and greater symptom relief for fibromyalgia patients. This approach is timely, as controlled substances are increasingly difficult for patients with fibromyalgia to access.

Recommendations on complementary and alternative medicine within S3 guidelines in oncology: systematic quality assessment of underlying methodology.

PURPOSE: Complementary and alternative medicine (CAM) is used by about half of all patients with cancer. Guidelines are an important tool to introduce evidence-based medicine into routine cancer care. The aim of our study was to assess methodology of the statements and recommendations concerning CAM. METHODS: A systematic assessment of all S3 guidelines published until November 2018 was done. Methodology of all statements and recommendations concerning CAM which were declared as evidence-based was evaluated with respect to international standards. According to the AMSTAR-2 instrument search strategy including filters, searched databases, restrictions to the research question and description of the included studies were examined. In case of adaptations from other guidelines, all underlying guidelines were examined as well. RESULTS: After examining 212 guidelines, 82 evidence-based statements and recommendations regarding CAM could be identified. Four were derived by adaptation, 78 by a de-novo search. Only 11 of 78 (14%) fulfilled all assessment criteria. In 18 (19%) cases no information on search strategy was attainable in any document affiliated to the guideline, in 35 (45%) cases information on search strategy was superficial and in 54 (78%) cases the referred evidence was not presented in adequate detail. CONCLUSIONS: Concerning CAM statements and recommendations within S3 guidelines quality of evidence processing has several shortcomings. Guideline adaptions often lack transparency and traceability.

Pharmacological and non-pharmacological treatments for neuropathic pain: Systematic review and French recommendations.

Neuropathic pain remains a significant unmet medical need. Several recommendations have recently been proposed concerning pharmacotherapy, neurostimulation techniques and interventional management, but no comprehensive guideline encompassing all these treatments has yet been issued. We performed a systematic review of pharmacotherapy, neurostimulation, surgery, psychotherapies and other types of therapy for peripheral or central neuropathic pain, based on studies published in peer-reviewed journals before January 2018. The main inclusion criteria were chronic neuropathic pain for at least three months, a randomized controlled methodology, at least three weeks of follow-up, at least 10 patients per group, and a double-blind design for drug therapy. Based on the GRADE system, we provide weak-to-strong recommendations for use and proposal as a first-line treatment for SNRIs (duloxetine and venlafaxine), gabapentin and tricyclic antidepressants and, for topical lidocaine and transcutaneous electrical nerve stimulation specifically for peripheral neuropathic pain; a weak recommendation for use and proposal as a second-line treatment for pregabalin, tramadol, combination therapy (antidepressant combined with gabapentinoids), and for high-concentration capsaicin patches and botulinum toxin A specifically for peripheral neuropathic pain; a weak recommendation for use and proposal as a third-line treatment for high-frequency rTMS of the motor cortex, spinal cord stimulation (failed back surgery syndrome and painful diabetic polyneuropathy) and strong opioids (in the absence of an alternative). Psychotherapy (cognitive behavioral therapy and mindfulness) is recommended as a second-line therapy, as an add-on to other therapies. An algorithm encompassing all the recommended treatments is proposed.

The use of complementary medicine in palliative care in France: an observational cross-sectional study.

PURPOSE: Palliative care for cancer deals with physical, psychosocial, and spiritual issues faced by cancer patients, their families, communities, and healthcare providers. Research on complementary medicine (CM) use in France is limited despite high rates of reported CM use in other countries including by palliative patients. This study describes the use of CM by individuals receiving palliative care in Lyon, France. DESIGN: This study employed an observational cross-sectional survey design. SETTING/PARTICIPANTS: The study was conducted in three palliative care centers in Lyon, France; two tertiary hospitals and one palliative care unit (3 sites). Inpatients and outpatients visiting the palliative care clinic with a primary diagnosis of cancer at each study site were invited to participate. RESULTS: Of 138 eligible patients, 100 completed the survey (RR 72.4%). The majority (90.7%) reported using CM in the previous 6 months or since their primary cancer diagnosis. Participant CM use was either the same (20.7%) or increased since their primary cancer diagnosis (33.7%). Average out-of-pocket expenses associated with CM use in the previous 6 months or since diagnosis were €157.40 (SD €330.15). The most common CM health professional visited was an aromatherapist (72.7%), a Coupeurs de feu (38.6%), osteopath (28.6%) and naturopath (15.3%). The most common CM used were aromatherapy oils (33.7%), homeopathy (30.0%), and vitamins (29.4%). CONCLUSION: This second survey on CM use in France; is the first conducted in palliative care centers. Results show people with cancer in Lyon, France, have a very high prevalence of CM utilization.

A systematic review of complementary and alternative medicine in oncology: Psychological and physical effects of manipulative and body-based practices.

BACKGROUND: Complementary and Alternative Medicines (CAM) are widely used by cancer patients, despite limited evidence of efficacy. Manipulative and body-based practices are some of the most commonly used CAM. This systematic review evaluates their benefits in oncology. METHOD: A systematic literature review was carried out with no restriction of language, time, cancer location or type. PubMed, CENTRAL, PsycArticle, PsychInfo, Psychology and Behavioral Sciences Collection and SOCindex were queried. Inclusion criteria were adult cancer patients and randomized controlled trials (RCT) assessing manipulative and body-based complementary practices on psychological and symptom outcomes. Effect size was calculated when applicable. RESULTS: Of 1624 articles retrieved, 41 articles were included: massage (24), reflexology (11), acupressure (6). Overall, 25 studies showed positive and significant effects on symptom outcomes (versus 9 that did not), especially pain and fatigue. Mixed outcomes were found for quality of life (8 papers finding a significant effect vs. 10 which did not) and mood (14 papers vs. 13). In most studies, there was a high risk of bias with a mean Jadad score of 2, making interpretation of results difficult. CONCLUSION: These results seem to indicate that manipulative CAM may be effective on symptom management in cancer. However, more robust methodologies are needed. The methodological requirements of randomized controlled trials are challenging, and more informative results may be provided by more pragmatic study design.

How Theory Can Help Facilitate Implementing Relaxation as a Complementary Pain Management Approach.

Complementary therapies provide cancer survivors and clinicians with options for managing chronic pain. Recent published clinical guidelines and research findings support the use of relaxation therapy for managing chronic pain in cancer survivors. However, translating research findings into clinical practice remains a challenge. Using theory to guide implementation of a new practice can increase the likelihood of successful adoption. This article uses relaxation therapy for cancer survivors to describe how clinicians could use Rogers' Diffusion of Innovation Theory and the related Collaborative Research Utilization Model to implement a complementary therapy and ensure that it becomes standard practice.

Reasons for Use of and Experiences with Homeopathic Treatment as an Adjunct to Usual Cancer Care: Results of a Small Qualitative Study.

BACKGROUND: A significant proportion of patients with cancer consult with homeopaths. No former qualitative study has reported on experiences with homeopathy in this patient group. This study aimed to learn about the reasons for, and experiences with, treatment provided by homeopaths among Danish patients with cancer. METHODS: A small qualitative semi-structured interview study was carried out to collect preliminary knowledge to learn about reasons for and experiences with treatment provided by homeopaths as an adjunct to usual care among patients with cancer. Thematic analysis was used for the development of themes. RESULTS: Five patients, diagnosed with cancer, were interviewed. On the basis of qualitative interviews five themes emerged: concerns and hopes, obstacles and support, internal health locus of control, whole person approach, and improved well-being. CONCLUSION: The cancer patients in this study sought homeopathy to address their hopes and concerns and to help them face obstacles and find support. They were actively taking responsibility for their own health and valued the whole person approach used by their homeopaths. Participants reported improved well-being both at the physical and mental levels. The results provide a basis for further research to learn more from patients' experiences with this intervention. Such knowledge could potentially be helpful to improve healthcare practitioners' communication with patients, and thereby patients' overall care.

Nurses' Knowledge and Attitudes Toward Complementary and Alternative Medicine for Adult Patients With Cancer in Bandung, West Java, Indonesia: A Qualitative Study.

The aim of this study was to explore nurses' knowledge and attitudes toward the use of complementary and alternative medicine (CAM) among cancer patients in a palliative care setting. A descriptive qualitative approach was used in this study. Semistructured interviews were conducted with 10 nurses recruited using purposive sampling. The data were analyzed using an inductive semantic approach. Thematic analysis identified that nurses possess limited knowledge of CAM. Nurses were skeptical toward CAM and less confident to recommend its use. Four main themes (and two subthemes) emerged: Understanding of CAM, Hesitative Attitudes, Personal Experience, and Preferences in Learning about CAM. There is a need to integrate CAM topics into nursing education programs in order to develop nurses' knowledge and build positive attitudes toward CAM use. Sufficient knowledge and positive attitudes toward CAM would support safety and quality of care in management of patients with cancer who use or are contemplating using CAM.

Systematic Review of Nonpharmacologic Approaches for the Management of Gastrointestinal Symptoms.

PROBLEM IDENTIFICATION: To summarize and critique the literature for nonpharmacologic complementary approaches to manage gastrointestinal (GI) symptoms attributed to chemotherapy. LITERATURE SEARCH: A literature search was conducted using CINAHL®, MEDLINE®, and PsycINFO® from database inception through January 2018. DATA EVALUATION: Studies were independently appraised by each author regarding inclusion eligibility and summary of GI symptom outcomes and the nonpharmacologic complementary intervention. SYNTHESIS: 57 studies met inclusion criteria. GI symptoms most commonly evaluated as a chemotherapy outcome were nausea and vomiting and nausea alone. GI symptoms infrequently evaluated as outcomes included diarrhea, anticipatory nausea, and dysgeusia. Ten GI symptoms associated with chemotherapy were not evaluated by any study. Nonpharmacologic interventions included 15 different interventions. IMPLICATIONS FOR RESEARCH: Studies evaluating nonpharmacologic interventions for managing chemotherapy-related GI symptoms have been growing but tend to focus on nausea and vomiting to the exclusion of other relevant GI symptoms. Studies evaluating nonpharmacologic effects on other GI symptoms may make great strides in reducing patient symptom burden.

Immunological and Quality-of-Life Profiles in Women with Breast Cancer: Complementary versus Conventional Care.

BACKGROUND: Previous studies showed that women with breast cancer treated in anthroposophic clinic versus conventional care had increased quality of life (QoL) parameters, fighting spirit, and anxiety coping. We have now analyzed immune and QoL factors in these 2 groups for possible differences during the first 6 months after admission, prompted by anthroposophic studies, including mistletoe extracts, showing beneficial immune system effects. PATIENTS AND METHODS: Fourteen immunological variables, including leukocyte count, lymphocyte count, activated T cells (CD4+ and CD8+), NK cells, B cells, IL1ß, IL6, IL10, and oxytocin, were longitudinally analyzed in both groups (n = 2 × 26). A panel of QoL parameters were analyzed using 3 different instruments. Statistical evaluation included that each patient was its own control. RESULTS: Cytotoxic CD8+ T cell frequency (percent of lymphocytes analyzed by flow-cytometry) significantly decreased over time in the anthroposophic group versus the conventional group (repeated measures ANOVA, p = 0.05). No major differences were observed in other immunological parameters, whereas QoL variables, anxiety decreased and physical symptoms increased/improved significantly in the anthroposophic group (p = 0.04 and p = 0.05, respectively). CONCLUSION: Overall, women with breast cancer in anthroposophic or conventional therapy did not differ in their immune profiles over time, with exception of decreased cytotoxic T cells in the anthroposophic group. Improvement in physical symptoms along with less anxiety in this group may have influenced the brain-immune axis resulting in lower frequency of CD8+ T cells, a feature associated with less aggressive cancer stages. To evaluate whether this observation is associated with good or bad prognosis, further detailed analyses of memory and naïve CD8+ T cells at tumor site and in blood circulation are essential.

Perspectives of Oncology Nurses on Complementary and Alternative Medicine in Turkey: A Cross-Sectional Survey.

In Turkey, between 22.1% and 84.1% of patients with cancer use complementary and alternative medicine (CAM). However, few CAM-related studies have focused on the perspective of oncology nurses. This study aimed to determine the knowledge, attitudes, and practices of Turkish oncology nurses regarding CAM. A descriptive cross-sectional survey of 127 participants was conducted in Ankara, Turkey. A semistructured questionnaire including characteristics, knowledge, attitudes, and practices of oncology nurses toward CAM was administered to participants. We found that more than half of nurses (54.0%) surveyed had no information on CAM modalities. Most oncology nurses (81.1%) used audiovisual media sources to obtain CAM information. Many nurses (81.3%) reported not using any CAM in cancer care, and only 26.8% recommended CAM to patients. Most nurses used CAM to accelerate wound healing (19.7%) and to manage symptoms, including constipation and diarrhea (8.8%) and anxiety (7.9%). Music (52.8%), massage (49.6%), and exercise (48.8%) were stated to be beneficial. Important barriers to use CAM for patients with cancer involved a lack of knowledge (60.6%); needing physician approval to apply any CAM methods to patients (52.1%); legal and institutional issues (47.2%); and limited educational, training, or certificate programs (44.1%). There is a need for increased knowledge about CAM by oncology nurses, considering their vital role in symptom management of patients with cancer. This can be achieved through solving legal and institutional problems, structured and comprehensive education/training programs, and the integration of CAM therapy into cancer care guidelines.

Black salve in a nutshell

Background: Black salve is an alternative therapy increasingly chosen by patients to selfmanage their skin lesions. It is promoted as an effective, safe and natural skin cancer treatment, but such claims are not evidence-based, and serious complications have been reported. The sale of black salve in Australia is illegal. Objective: The aim of this article is to educate general practitioners (GPs) about black salve, enabling informed discussion with patients considering using black salve. An overview of the scientific literature is presented. Discussion: Case reports have described significant morbidity and even mortality associated with the use of black salve. Despite this, black salve is readily accessible to the public online; a simple internet search yields multiple links to websites endorsing black salve as an effective natural skin cancer remedy. As GPs are often called on in the initial presentation of skin complaints, they are well positioned to ask patients about their use of black salve and educate them about its risks.