Safety of acupuncture in oncology: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Acupuncture is frequently used to treat the side effects of cancer treatment, but the safety of this intervention remains uncertain. The current meta-analysis was conducted to assess the safety of acupuncture in oncological patients. METHODS: The PubMed, Cochrane Central Register of Controlled Trials, and Scopus databases were searched from their inception to August 7, 2020. Randomized controlled trials in oncological patients comparing invasive acupuncture with sham acupuncture, treatment as usual (TAU), or any other active control were eligible. Two reviewers independently extracted data on study characteristics and adverse events (AEs). Risk of bias was assessed using the Cochrane Risk of Bias Tool. RESULTS: Of 4590 screened articles, 65 were included in the analyses. The authors observed that acupuncture was not associated an with increased risk of intervention-related AEs, nonserious AEs, serious AEs, or dropout because of AEs compared with sham acupuncture and an active control. Compared with TAU, acupuncture was not associated with an increased risk of intervention-related AEs, serious AEs, or drop out because of AEs but was associated with an increased risk for nonserious AEs (odds ratio, 3.94; 95% confidence interval, 1.16-13.35; P = .03). However, the increased risk of nonserious AEs compared with TAU was not robust against selection bias. The meta-analyses may have been biased because of the insufficient reporting of AEs in the original randomized controlled trials. CONCLUSIONS: The current review indicates that acupuncture is as safe as sham acupuncture and active controls in oncological patients. The authors recommend researchers heed the CONSORT (Consolidated Standards of Reporting Trials) safety and harm extension for reporting to capture the side effects and better investigate the risk profile of acupuncture in oncology. LAY SUMMARY: According to this analysis, acupuncture is a safe therapy for the treatment of patients with cancer. Acupuncture seems to be safe compared with sham acupuncture and active controls.

The INTREST registry: protocol of a multicenter prospective cohort study of predictors of women's response to integrative breast cancer treatment.

BACKGROUND: Cancer registries usually assess data of conventional treatments and/or patient survival. Beyond that, little is known about the influence of other predictors of treatment response related to the use of complementary therapies (CM) and lifestyle factors affecting patients' quality and quantity of life. METHODS: INTREST is a prospective cohort study collecting register data at multiple German certified cancer centers, which provide individualized, integrative, in- and outpatient breast cancer care. Patient-reported outcomes and clinical cancer data of anticipated N = 715 women with pTNM stage I-III breast cancer are collected using standardized case report forms at the time of diagnosis, after completing neo-/adjuvant chemotherapy, after completing adjuvant therapy (with the exception of endocrine therapy) as well as 1, 2, 5, and 10 years after baseline. Endpoints for multivariable prediction models are quality of life, fatigue, treatment adherence, and progression-based outcomes/survival. Predictors include the study center, sociodemographic characteristics, histologic cancer and comorbidity data, performance status, stress perception, depression, anxiety, sleep quality, spirituality, social support, physical activity, diet behavior, type of conventional treatments, use of and belief in CM treatments, and participation in a clinical trial. Safety is recorded following the Common Terminology Criteria for Adverse Events. DISCUSSION: This trial is currently recruiting participants. Future analyses will allow to identify predictors of short- and long-term response to integrative breast cancer treatment in women, which, in turn, may improve cancer care as well as quality and quantity of life with cancer. TRIAL REGISTRATION: German Clinical Trial Register DRKS00014852 . Retrospectively registered at July 4th, 2018.

Complementary medicine use in US adults with a history of colorectal cancer: a nationally representative survey.

BACKGROUND: In the USA, colorectal cancer is among the top diagnosed cancers. The current study specifically targets the US adult population that have a history of colorectal cancer. METHODS: We used the 2017 National Health Interview Survey (NHIS) to investigate the prevalence and predictors of colorectal cancer survivors using complementary medicine in the past 12 months in a representative sample of the US population (N = 26,742). We descriptively analyzed the 12-month prevalence of any complementary medicine use separately for individuals with a prior diagnosis of colorectal cancer and those without. Using chi-squared tests and backward stepwise multiple logistic regression analyses, we identified predictors of complementary medicine use in the past 12 months. RESULTS: A weighted total of 1,501,481 US adults (0.6%) had a history of colorectal cancer. More individuals without (weighted n = 76,550,503; 31.2%) than those with a history of colorectal cancer (weighted n = 410,086; 27.3%) had used complementary medicine. The most commonly used complementary medicine among colorectal cancer patients was mind-body medicine, followed by chiropractic. A higher prevalence of complementary medicine use was associated with being female, higher educated and/or living in the US Midwest or South. CONCLUSIONS: In this study, over one fourth of the US colorectal cancer survivors had used complementary medicine. Mind-body medicine was found to be the most commonly used. With evidence supporting the effectiveness and safety of mind-body medicine use among colorectal cancer patients, promoting the use of evidence-based mind-body medicine for colorectal cancer management could be considered.

Gynecologists' attitudes toward and use of complementary and integrative medicine approaches: results of a national survey in Germany.

PURPOSE: Despite patients' widespread use and acceptance of complementary and integrative medicine (IM), few data are available regarding health-care professionals' current implementation of it in clinical routine. A national survey was conducted to assess gynecologists' attitudes to and implementation of complementary and integrative treatment approaches. METHODS: The Working Group on Integrative Medicine of the German Society of Gynecological Oncology conducted an online survey in collaboration with the German Society of Gynecology and Obstetrics (DGGG) in July 2019. A 29-item survey was sent to all DGGG members by email. RESULTS: Questionnaires from 180 gynecologists were analyzed, of whom 61 were working office-based in private practice and 95 were employed in hospitals. Seventy percent stated that IM concepts are implemented in their routine clinical work. Most physicians reported using IM methods in gynecological oncology. The main indications for IM therapies were fatigue (n = 98), nausea and vomiting (n = 89), climacteric symptoms (n = 87), and sleep disturbances (n = 86). The most commonly recommended methods were exercise therapy (n = 86), mistletoe therapy (n = 78), and phytotherapy (n = 74). Gynecologists offering IM were more often female (P = 0.001), more often had qualifications in anthroposophic medicine (P = 0.005) or naturopathy (P = 0.019), and were more often based in large cities (P = 0.016). CONCLUSIONS: There is strong interest in IM among gynecologists. The availability of evidence-based training in IM is increasing. Integrative therapy approaches are being implemented in clinical routine more and more, and integrative counseling services are present all over Germany. Efforts should focus on extending evidence-based knowledge of IM in both gynecology and gynecological oncology.

Prevalence and predictors of mind-body medicine use among women diagnosed with gynecological cancer: Findings from the 2017 US National Health Interview Survey.

BACKGROUND: Gynecological cancer is a major health burden globally. In the US, it is common for cancer patients to utilize different types of complementary medicine. This study aims to investigate the prevalence of mind-body medicine use among US women diagnosed with gynecological cancer. METHODS: We used data from the 2017 National Health Interview Survey (NHIS) to investigate prevalence and predictors of mind-body medicine utilization in the past 12 months among gynecological cancer patients in a representative sample of the US population (N = 26,742). We descriptively analyzed the 12-month prevalence of any mind-body medicine use, separately for women with a prior diagnosis of gynecological cancer and those without. Using and b multiple logistic regression analyses, we identified predictors of mind-body medicine use. RESULTS: A weighted total of 2,526,369 women (2.0%) reported having received a diagnosis of gynecological cancer. More women diagnosed with gynecological cancer (weighted n = 964,098; 38.2%) than those not diagnosed with gynecological cancer (weighted mean = 36,102,852; 28.8%) had used mind-body medicine in the past 12 months. A higher prevalence of mind-body medicine use was associated with being non-Hispanic White, living in Western US and having received higher education. Spiritual meditation was found to be the most frequently used mind-body medicine modality, followed by yoga and progressive relaxation. CONCLUSIONS: While mind-body medicine is popular among US gynecological cancer patients, clinical evidence supporting the effectiveness of different mind-body medicine modalities is yet to be established. Randomized controlled trials should be conducted to evaluate the effectiveness of popular modalities like spiritual meditation or yoga to inform clinical decision and patient choice.

Mind-body medicine use by women diagnosed with breast cancer: results of a nationally representative survey.

PURPOSE: Worldwide breast cancer is the most commonly diagnosed cancer in women and often associated with a profound physiological stress reaction. Mind-body medicine modalities have been proven effective in reducing stress symptoms. This article will cover the prevalence of MBM use in women with and without breast cancer in the US population and detect predictors of MBM use in women diagnosed with breast cancer. METHODS: The 2017 National Health Interview Survey (NHIS) was used to study the prevalence of breast cancer and the use of mind-body medicine (MBM) among individuals with breast cancer in the US population. Using chi-squared tests and backward stepwise multiple logistic regression analyses, predictors of MBM use in women with breast cancer in the past 12 months were identified. RESULTS: The prevalence of breast cancer in women was 3.1%. Among women diagnosed with breast cancer, 25.2% had used MBM in the past 12 months. Spiritual meditation (14.3%), followed by yoga (9.6%), and mindfulness meditation (4.3%) were the most commonly used MBM approaches for women with breast cancer diagnosis. Only higher education independently predicted the use of MBM among them. CONCLUSIONS: In this nationally representative sample of the USA, the most common used MBM approach was spiritual meditation, while this approach is much less researched than the evidence based approaches of yoga and mindfulness meditation. Especially stressed individuals worldwide could benefit from MBM the literature suggests. Particularly in the acute survivorship stage, influencing the initial stress reaction could be beneficial.

Cancer, sleep problems, and mind-body medicine use: Results of the 2017 National Health Interview Survey.

BACKGROUND: Sleep problems affect physical and emotional well-being as well as immune system function. Evidence has demonstrated an improvement in sleep problems in patients with cancer through the use of mind-body medicine (MBM). In the current study, the authors sought to elucidate the prevalence of sleep problems and the use of MBM in adult cancer survivors. METHODS: The authors analyzed data from the 2017 US National Health Interview Survey (NHIS) to estimate the prevalence of sleep problems and use of MBM in adult cancer survivors using means, standard deviations, weighted frequencies, and distributions. Backward stepwise multiple logistic regression analyses were used to identify independent predictors of MBM use within the past 12 months: age, sex, ethnicity, region, educational level, employment, and time since cancer diagnosis. RESULTS: A weighted total of 13,750,028 cancer survivors (59.2%) reported sleep problems. For the most part, survivors with sleep problems were aged ≥40 years, female, and non-Hispanic white. More survivors with (weighted N = 3,794,493; 27.6%) compared with without (weighted N = 1,695,435; 17.9%) sleep problems used MBM. Among cancer survivors with sleep problems, the most commonly used mind-body practice was spiritual meditation (weighted N = 1,972,578; 14.3%), followed by yoga (weighted N = 1,695,553; 17.9%). The use of MBM was independently predicted by being female, living in the western United States, having a higher educational level, and being employed. CONCLUSIONS: The high prevalence of sleep problems in cancer survivors is a major health issue that needs to be addressed. A considerable number of cancer survivors with sleep problems use MBM. This finding warrants the investigation of MBM concepts as treatment options for cancer survivors experiencing sleep problems.

Gynecologic oncologists' attitudes and practices relating to integrative medicine: results of a nationwide AGO survey.

PURPOSE: The growing popularity and acceptance of integrative medicine is evident both among patients and among the oncologists treating them. As little data are available regarding health-care professionals' knowledge, attitudes, and practices relating to the topic, a nationwide online survey was designed. METHODS: Over a period of 11 weeks (from July 15 to September 30, 2014) a self-administered, 17-item online survey was sent to all 676 members of the Research Group on Gynecological Oncology (Arbeitsgemeinschaft Gynäkologische Onkologie) in the German Cancer Society. The questionnaire items addressed the use of integrative therapy methods, fields of indications for them, advice services provided, level of specific qualifications, and other topics. RESULTS: Of the 104 respondents (15.4%) using integrative medicine, 93% reported that integrative therapy was offered to breast cancer patients. The second most frequent type of tumor in connection with which integrative therapy methods were recommended was ovarian cancer, at 80% of the participants using integrative medicine. Exercise, nutritional therapy, dietary supplements, herbal medicines, and acupuncture were the methods the patients were most commonly advised to use. CONCLUSION: There is considerable interest in integrative medicine among gynecological oncologists, but integrative therapy approaches are at present poorly implemented in routine clinical work. Furthermore there is a lack of specific training. Whether future efforts should focus on extending counseling services on integrative medicine approaches in gynecologic oncology or not, have to be discussed. Evidence-based training on integrative medicine should be implemented in order to safely guide patients in their wish to do something by themselves.

[Mind-body medicine in integrative uro-oncology : Studies and areas of application]. / Mind-body-Medizin in der integrativen Uroonkologie : Studienlage und Einsatzgebiete.

BACKGROUND: Mind-body medicine (MBM) complements somatically oriented medical practice with behavioral and lifestyle-oriented approaches: Thus, health-promoting attitudes and behaviors are strengthened in everyday life. In integrative oncology, it helps promote emotional and physical well-being. RESEARCH QUESTION: Guideline recommendations and the current study situation in integrative uro-oncology are presented. RESULTS: During and after completion of primary therapy, mindfulness-based stress reduction (MBSR) shows positive effects on anxiety, stress, and fatigue. However, it appears that the offer needs to be better tailored to the needs of prostate cancer patients. The effects of yoga are well documented, especially on fatigue, quality of life, and sexual function. Prostate cancer patients also showed a significantly increased immune response after completing a yoga intervention. Tai Ji Quan/Qigong improve quality of life, fatigue, and other symptoms. Hypnosis-especially in the palliative setting-mitigates anxiety, and relaxation techniques alleviate sleep problems and nausea/vomiting. Multimodal services improve quality of life on numerous levels. Higher resilience correlates with better quality of life and stronger male self-esteem. CONCLUSIONS: MBSR alleviates many symptoms but needs to be adapted to the needs of prostate cancer patients; yoga and Tai Ji Chuan/Qigong alleviate fatigue and improve quality of life. Hypnosis and relaxation training reduce nausea/vomiting, and improve sleep and anxiety. Resilience promotion is important to support oncological patients.

Acupuncture in chemotherapy-induced dysgeusia (AcuDysg): study protocol of a randomised controlled trial.

INTRODUCTION: Dysgeusia is a common side effect of chemotherapy in patients with cancer, but to date, there is no effective treatment. Many patients with cancer request complementary medicine treatment in addition to their cancer treatments, and acupuncture is highly accepted for patients with cancer; however, evidence regarding the effectiveness of acupuncture for dysgeusia is scarce.The study investigates the effectiveness of an additional dysgeusia-specific acupuncture plus self-acupressure intervention compared with supportive acupuncture plus self-acupressure intervention alone for chemotherapy-induced dysgeusia in patients with cancer. METHODS AND ANALYSIS: This is a multicentre, randomised, controlled and two-armed parallel-group, single-blind trial involving 130 patients. Both groups will receive eight sessions of acupuncture treatment over a period of 8 weeks and will be trained to perform self-acupressure (eLearning combined with therapist instruction) at predefined acupressure points once a day during the whole treatment period. Patients in the control group will receive supportive routine care acupuncture and self-acupressure treatment only; in addition to this treatment, the intervention group will receive the dysgeusia-specific acupuncture and acupressure within the same treatment session. The primary outcome is the perceived dysgeusia over 8 weeks, measured weekly after the acupuncture treatment. Secondary outcomes include the indices from the objective taste and smell test, weight loss, perceived dysgeusia, fatigue, distress, nausea and vomiting, odynophagia, xerostomia and polyneuropathy, as well as quality of life at the different time points. ETHICS AND DISSEMINATION: The study has been approved by the Cantonal Ethics Committee (CEC) (Kanton Zürich Kantonale Ethikkommission) (approval no. KEK-ZH-Nr. 2020-01900). The results will be submitted to a peer-reviewed journal for publication. TRIAL REGISTRATION NUMBERS: DRKS00023348, SNCTP000004128.

Prevention and Treatment of Chemotherapy-Induced Peripheral Neuropathy (CIPN) with Non-Pharmacological Interventions: Clinical Recommendations from a Systematic Scoping Review and an Expert Consensus Process.

Background: Most individuals affected by cancer who are treated with certain chemotherapies suffer of CIPN. Therefore, there is a high patient and provider interest in complementary non-pharmacological therapies, but its evidence base has not yet been clearly pointed out in the context of CIPN. Methods: The results of a scoping review overviewing the published clinical evidence on the application of complementary therapies for improving the complex CIPN symptomatology are synthesized with the recommendations of an expert consensus process aiming to draw attention to supportive strategies for CIPN. The scoping review, registered at PROSPERO 2020 (CRD 42020165851), followed the PRISMA-ScR and JBI guidelines. Relevant studies published in Pubmed/MEDLINE, PsycINFO, PEDro, Cochrane CENTRAL, and CINAHL between 2000 and 2021 were included. CASP was used to evaluate the methodologic quality of the studies. Results: Seventy-five studies with mixed study quality met the inclusion criteria. Manipulative therapies (including massage, reflexology, therapeutic touch), rhythmical embrocations, movement and mind-body therapies, acupuncture/acupressure, and TENS/Scrambler therapy were the most frequently analyzed in research and may be effective treatment options for CIPN. The expert panel approved 17 supportive interventions, most of them were phytotherapeutic interventions including external applications and cryotherapy, hydrotherapy, and tactile stimulation. More than two-thirds of the consented interventions were rated with moderate to high perceived clinical effectiveness in therapeutic use. Conclusions: The evidence of both the review and the expert panel supports a variety of complementary procedures regarding the supportive treatment of CIPN; however, the application on patients should be individually weighed in each case. Based on this meta-synthesis, interprofessional healthcare teams may open up a dialogue with patients interested in non-pharmacological treatment options to tailor complementary counselling and treatments to their needs.

Integrative oncology for breast cancer patients: introduction of an expert-based model.

BACKGROUND: Malignant breast neoplasms are among the most frequent forms of cancer in the Western world. Conventional treatment of breast cancer may include surgery, hormonal therapy, chemotherapy, radiation and/or immunotherapy, all of which are often accompanied by severe side effects. Complementary and alternative medicine (CAM) treatments have been shown to be effective in alleviating those symptoms. Furthermore, with patient survival rates increasing, oncologists, psychologists and other therapists have to become more sensitive to the needs of cancer survivors that go beyond than the mere alleviation of symptoms. Many CAM methods are geared to treat the patient in a holistic manner and thus are also concerned with the patient's psychological and spiritual needs. DISCUSSION: The use of certain CAM methods may become problematic when, as frequently occurs, patients use them indiscriminately and without informing their oncologists. Herbal medicines and dietary supplements, especially, may interfere with primary cancer treatments or have other detrimental effects. Thus, expertise in this highly specialized field of integrative medicine should be available to patients so that they can be advised about the benefits and negative effects of such preparations and practices.Being a beneficial combination of conventional and CAM care, integrative oncology makes possible the holistic approach to cancer care. The concept of integrative oncology for breast cancer is jointly practiced by the Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, academic teaching hospital of the University of Duisburg-Essen, and the Breast Center at Kliniken Essen-Mitte in Germany. This model is introduced here; its scope is reviewed, and its possible implications for the practice of integrative medicine are discussed. SUMMARY: Evidence-based integrative care is crucial to the field of oncology in establishing state-of-the-art care for breast cancer patients.

Effects of an Interdisciplinary Integrative Oncology Group-Based Program to Strengthen Resilience and Improve Quality of Life in Cancer Patients: Results of a Prospective Longitudinal Single-Center Study.

BACKGROUND: Patients with cancer receiving oncological treatment often suffer from a reduced quality of life (QoL) and resilience. OBJECTIVES: The aim of this study was to evaluate the effect of an interdisciplinary integrative oncology group-based program on resilience and quality of life in patients with cancer during or after conventional oncological therapy. METHODS: This prospective longitudinal single-center study evaluated the resilience (Resilience Scale), quality of life (EORTC-QLQ C30), anxiety, depression (Hospital Anxiety and Depression Scale), and distress levels (Distress Thermometer) of 60 patients with cancer who participated in a 10-week interdisciplinary integrative oncology group-based program during or after cancer treatment in outpatient clinics. An average of 12 (range 11-13) patients participated in each 10-week group. The program included recommendations for diet, stress management, relaxation, and exercise, as well as naturopathic self-help strategies and psychosocial support. RESULTS: There were slight increases in global quality of life scores (week 0: 58.05 ± 20.05 vs week 10: 63.13 ± 18.51, n = 59, P = .063, d = -.25) and resilience scores (week 0: 63.50 ± 13.14 vs week 10: 66.15 ± 10.17, n = 52, P = .222, d = -.17) after the group program compared to before; however, these changes were not statistically significant and had small effect sizes. Patients with at least moderate anxiety symptoms (P = .022, d = .42) and low resilience (P = .006, d = -.54) benefited most from the program. The patients reported no relevant side effects or adverse events from the program. CONCLUSIONS: No significant effects on global quality of life or resilience were found in the general sample; notably, patients with anxiety and low initial resilience benefited the most from the program.

Efficacy and Safety of Auricular Acupuncture for the Treatment of Insomnia in Breast Cancer Survivors: A Randomized Controlled Trial.

Among women, breast cancer is the most commonly diagnosed cancer worldwide. Sleep problems impair 40-70% of breast cancer survivors. This randomized controlled trial evaluates the effect of auricular acupuncture on sleep quality in breast cancer survivors suffering from insomnia. Fifty-two female breast cancer survivors with insomnia (mean age 55.73 ± 8.10 years) were randomized either to 10 treatments of auricular acupuncture within five weeks (n = 26), or to a single session of psychoeducation plus an insomnia advice booklet (n = 26). The primary outcome was sleep quality (measured by the Pittsburgh Sleep Quality Index) at week 5. Secondary outcomes were inflammation parameter (interleukin-6), stress, anxiety, depression, quality of life, and fatigue at week 5, and sleep quality, stress, anxiety, depression, quality of life, and fatigue 17 and 29 weeks after randomization. Intention-to-treat analysis showed a significantly stronger increase in sleep quality in the auricular acupuncture group compared to the psychoeducation group (p = 0.031; η2p = 0.094) at week 5. Furthermore, auricular acupuncture improved stress (p = 0.030; η2p = 0.094), anxiety (p = 0.001; η2p = 0.192), and fatigue (p = 0.006; η2p = 0.148) at week 5 compared to psychoeducation. No significant group difference was found concerning the other outcomes at week 5, or in any outcome at week 17 or week 29. No serious adverse events occurred during the study period. In conclusion, a semi-standardized group auricular acupuncture might be an effective and safe intervention in treating insomnia in breast cancer survivors in the short term, and may reduce stress, anxiety, and fatigue as well. Long-term effects remain questionable.

Effects of an Integrative Mind-Body-Medicine Group Program on Breast Cancer Patients During Chemotherapy: An Observational Study.

BACKGROUND: Breast cancer is one of the leading cancers in women in the Western world. Cancer treatment, especially chemotherapy, is often associated with physical and psychosocial side effects. OBJECTIVE: To improve the quality of life and manage side effects, a new integrative mind-body-medicine group concept for breast cancer patients receiving chemotherapy was developed and pilot tested. METHODS: Breast cancer patients participated in a 66 hours mind-body-medicine group program tailored to the needs of cancer patients during chemotherapy. The program was integrated into standard care encompassing mindfulness training, yoga, moderate exercise, nutrition, complementary self-help strategies, cognitive restructuring, and acupuncture. Quality of life (EORTC QLQ-C30), depression and anxiety (HADS), stress (PSS-10), and fatigue (BFI) were assessed before and after the program, as well as satisfaction and safety. Analyses were carried out on exploratory basis with paired samples t-tests. RESULTS: Fifty-seven female patients, aged 51.3±10.5 years, with breast cancer diagnoses were enrolled. After completing the program, global EORTC quality of life was improved (D=9.5; 95%-CI=[2.9|16.1]; p=.005), although the EORTC-symptom scales assessing fatigue (D=9.9; 95%-CI=[1|18.8]; p=.030), nausea (D=7.1; 95%- CI=[0.6|13.6]; p=.031), and dyspnea (D=12.5; 95%-CI=[2.9|22.1]; p=.011) were found to be increased. Stress (D=-3.5; 95%-CI=[-5|-2.1]; p=.000), anxiety (D=-3.8; 95%-CI=[-4.9|-2.7]; p=.000) and depression (D=-3.9; 95%-CI=[-4.9|-2.8]; p=.000) were also found to be significantly reduced. Regarding the severity of (D=0.2; 95%- CI=[-0.8|0.5]; p=.644) and the impairment due to fatigue (D=0.1; 95%-CI=[-0.8|0.6]; p=.696), no significant worsening was observed. Patients were satisfied with the program. No serious adverse events were reported. CONCLUSION: Breast cancer patients benefit from an integrative mind-body-medicine group program during chemotherapy regarding the quality of life and psychological symptoms. Randomized controlled trials are warranted.

[Creating evidence for naturopathic nursing interventions in oncology - a systematic approach]. / Generierung von Evidenz zu naturheilkundlichen Pflegeinterventionen in der Onkologie ­ ein systematisches Verfahren.

BACKGROUND: Nurses working in oncology use a wide range of naturopathic interventions in their daily practice to alleviate symptoms and improve the quality of life of oncological patients. However, there is no external evidence for many of these interventions. Due to a lack of scientific studies in the field, the aim of the project described here is to develop a standardized procedure to generate evidence on naturopathic interventions, on the basis of which recommendations may be derived for nursing practice. METHOD: The systematic procedure presented here was developed by the working group (WG) Integrative Nursing in Oncology over a period of four years in an iterative process. This process is based on the expert panel members' experience with the development of guidelines and/or quality instruments such as practice standards. RESULT: The systematic methodological approach presented here consists of three successive steps where internal and external evidence have been combined: a scoping review, a structured consensus process with oncology nurses to collect and evaluate naturopathic interventions, and finally a further supplementary literature review based on additional findings of the consensus conference. The procedure was successfully carried out for mucositis, insomnia, fatigue, hand-foot syndrome and chemotherapy-induced polyneuropathy. CONCLUSION: Through the step-by-step synthesis of internal evidence and the best available external evidence, the evidence base for naturopathic nursing interventions in oncology can be generated and practice recommendations derived. The procedure represents a successful theory-practice transfer through structured cooperation between (nursing) scientists and nursing practitioners. In terms of the AWMF classification, the practice recommendations developed in the process described fall somewhere in between an S1 guideline (informal consensus of an expert group) and an S2e guideline (evidence-based).

Nursing Procedures for the Prevention and Treatment of Mucositis Induced by Cancer Therapies: Clinical Practice Guideline Based on an Interdisciplinary Consensus Process and a Systematic Literature Search.

BACKGROUND: Patients with cancer receiving tumor therapy often suffer from oral mucositis. OBJECTIVES: The aim of this project was to summarize experiences with nursing procedures by experts in integrative oncology and to establish recommendations for nursing interventions that can prevent or cure mucositis. METHODS: The study design was an interdisciplinary consensus process based on a systematic literature search. RESULTS: The panel discussed and agreed on 19 nursing procedures, which included mouthwashes, such as teas, supplements, oil applications, and different kinds of ice cubes to suck, as well as flaxseed solution, propolis, and mare milk. Twelve interventions were classified as effective, with effectiveness for OraLife, propolis, sea buckthorn pulp oil, marshmallow root tea also for xerostomia, Helago chamomile oil, mare milk, and Saliva Natura rated as highly effective in clinical experience. In the systematic literature search, a total of 12 out of 329 randomized controlled trials and meta-analyses on chamomile (n = 3), Calendula (n = 1) and sage (n = 1), propolis (n = 2), and sucking ice cubes (cryotherapy; n = 5) met all inclusion criteria. Trial evidence for effectiveness in oral mucositis was revealed for propolis and cryotherapy. CONCLUSIONS: The current evidence supports the use of some nursing procedures (f.e. propolis for 2 and 3 grade mucositis) for improving oral mucositis during cancer therapies. There is still a need to define general clinical practice guidelines for the supportive treatment of mucositis, as well as for more interdisciplinary research in this area.

Complementary Medicine Use and Uptake of Cancer Screening Among US Adults: A Nationally Representative Cross-Sectional Survey.

Background: Cancer screenings can considerably reduce cancer mortality. There is limited information on the association between complementary medicine use and adherence to recommended cancer screenings. In this study, the potential associations between uptake of cancer screening and consultations with complementary medicine practitioners or mind-body medicine use are examined. Methods: This is a cross-sectional analysis of the 2017 National Health Interview Survey of a population-based sample (n = 26 742; response rate = 80.7%). Age- and sex-related risk groups for breast cancer (women 45 years and older), cervical cancer (women 21 years and older), and colorectal cancer (45 to 85 years) were analyzed in 2018. Prevalence of complementary medicine use in the past 12 months as well as prevalence of cancer screening uptake in the past 12 months were calculated. Results: At least one complementary medicine approach was used by 32.4% of participants. Controlling for sociodemographic and clinical variables, individuals who consulted a chiropractor or naturopath or who used mind-body medicine approaches were more likely to take up Pap smear test (odds ratio = 1.20-1.35), mammography (odds ratio = 1.22-1.38), and/or colorectal cancer screening (odds ratio = 1.18-1.37). Those consulting a homeopath were more likely to take up Pap smear test (odds ratio = 1.33). No association was found between consultations of practitioners of chelation therapy or traditional medicine and cancer screening uptake. Conclusion: Complementary medicine use seems to be associated with a better adherence to cancer screening. Individuals who consulted a chiropractor or naturopath or who used mind-body medicine approaches were more likely to take up the recommended screening.

Distinct patterns of short-chain fatty acids during flare in patients with ulcerative colitis under treatment with mesalamine or a herbal combination of myrrh, chamomile flowers, and coffee charcoal: secondary analysis of a randomized controlled trial.

OBJECTIVES: Short-chain fatty acids are involved in the regulation of the gut immune system. In ulcerative colitis, short-chain fatty acids are often reduced, especially during flare. This study evaluated exploratively the pattern of butyrate and total short-chain fatty acids in patients with ulcerative colitis during flare treated either with mesalamine or a herbal preparation consisting of myrrh, chamomile flowers, and coffee charcoal which showed promising results in maintaining remission in a randomized double-blind, double-dummy, controlled clinical trial (EudraCT-Number 2007-007928-18). METHODS: Patients were treated with the herbal preparation or mesalamine. Clinical activity was monitored by Clinical Colitis Activity Index. Using gas chromatography, we analyzed fecal samples of 38 patients who experienced a flare during treatment. RESULTS: Paired t-test showed a significant decline of total short-chain fatty acids [M before = 66.12, SD = 39.59; M after = 29.83, SD = 15.05; 95% bootstrap confidence interval (20.53-55.30); P = 0.01) and of butyrate [M before 11.35, SD = 7.56; M after = 6.50, SD = 3.55; 95% bootstrap confidence interval (2.06-8.11); P = 0.02] in the event of a flare for patients treated with mesalamine but not for patients treated with the herbal preparation. CONCLUSION: Patients who received the herbal preparation did not show a significant decline of total short-chain fatty acids in the event of a flare. Since a decline of short-chain fatty acids might lead to unfavorable health impairments, a combination of the two treatments should be further investigated.

Defining Criteria for Guiding Cancer Patients to Find a Reputable Complementary Medicine Provider: Results of a Literature Review and a Consensus Procedure.

PURPOSE: Even in cases of positive evidence for complementary medicine (CM) therapies, it is still difficult for cancer patients to identify reputable providers. The aim of this study was to develop and evaluate a criteria list to provide guidance to cancer patients seeking a reputable CM provider. METHODS: The design combined a literature review, an expert consensus procedure (n=15) and an assessment from three stakeholder perspectives (patients (n=18), CM providers (n=26) and oncology physicians (n=20)). RESULTS: A total of 30 existing CM criteria were extracted from the literature, and 12 more were added by the experts. The main challenge was to define criteria that could easily be applied by the patients. A final comprehensive list of 8 criteria guiding cancer patients to find a reputable CM provider was developed. CONCLUSION: Health professionals and cancer information services might find the criteria list helpful when aiming to strengthen patients' awareness of quality-related factors associated with CM providers. The criteria developed might be helpful when standards are established for quality assurance in CM in oncology.