A perspective on complementary/alternative medicine use among survivors of hematopoietic stem cell transplant: Benefits and uncertainties.

The widespread use of complementary and alternative medicine (CAM) in cancer survivors is well known despite a paucity of scientific evidence to support its use. The number of survivors of hematopoietic stem cell transplant (HCT) is growing rapidly and HCT clinicians are aware that many of their patients use CAM therapies consistently. However, due to a paucity of data regarding the benefits and harms of CAM therapies in these survivors, clinicians are reluctant to provide specific recommendations for or against particular CAM therapies. A systematic literature review was conducted with a search using PubMed, the Cochrane Database of Systematic Reviews, and Ovid online for each CAM therapy as defined by the National Center of Complementary and Alternative Medicine. The search generated 462 references, of which 26 articles were deemed to be relevant for the review. Due to extensive heterogeneity in data and limited randomized trials, a meta-analysis could not be performed but a comprehensive systematic review was conducted with specified outcomes for each CAM therapy. In randomized controlled trials, certain mind and body interventions such as relaxation were observed to be effective in alleviating psychological symptoms in patients undergoing HCT, whereas the majority of the other CAM treatments were found to have mixed results. CAM use is an understudied area in HCT survivorship and clinicians should convey the benefits and uncertainties concerning the role of CAM therapies to their patients.

Patient activation, self-efficacy and usage of complementary and alternative medicine in cancer patients.

Complementary and alternative medicine (CAM) is used by many cancer patients by themselves. Therefore, we conducted a survey regarding the association between CAM, self-efficacy, and patient activation in adult cancer patients. A standardized questionnaire, consisted of the ASKU, the PAM 13-D, and a structured questionnaire on CAM usage from our own working group, was distributed to 880 potential participants. Six hundred and thirty-nine (639) patients (male 32.9%, female 63.2%; gynecological cancer 41%, gastrointestinal 19.2%, urogenital 15.6%) took part. 60% of all patients used CAM in the last 3 months (biological 73%, holistic 63%, mind-body methods 62%). Higher self-efficacy was associated with higher interest in CAM (p = 0.03), but not usage of CAM, compared to patients with lower self-efficacy (p = 0.099). Higher patient activation was associated with higher interest in CAM (p = 0.004) and usage of CAM (p = 0.012). Patients with higher activation significantly more often used homeopathy (p = 0.007), prayer (p = 0.002), yoga, etc. (p = 0.032), meditation (p = 0.002), low carb or ketogenic diets (p < 0.001) (but not vegan or other cancer diets). Higher patient activation is associated with higher usage of CAM. Focusing on patient activation as a goal in patient-physician relationship will help patients to adhere to a healthy lifestyle and to actively participate in the whole treatment process.

Cancer Patient Motives and Expectations on Non-medical Practitioners.

BACKGROUND/AIM: Non-medical practitioners (NMPs) are an ill-defined group of professionals offering patient diagnostic and therapeutic methods mostly in the field of complementary and alternative medicine (CAM). Despite a lack of quality-assessed structured professional formation, many patients with cancer visit NMPs for advice. This study aimed to learn more on patients' motives and expectations for consulting an NMP. PATIENTS AND METHODS: A standardized questionnaire was distributed to adult cancer patients addressing attitudes towards NMPs, motives and expectations for consulting an NMP. RESULTS: A total of 279 patients took part in the survey. Of the included patients 44.8% had already visited an NMP and 16.5% planned to do so. Reasons to visit an NMP were seeking for a supplementary treatment (72.0%) or control of side-effects (68.0%). While the oncologist ranked higher than the NMP in all aspects of physician-patient interaction and patients more often trusted in the oncologist, those patients rating their oncologist rather low in any of these questions significantly more often consulted an NMP. The methods applied or recommended by the NMPs were highly heterogenous ranging from biologically-based methods to mind-body-techniques. Most often used methods were homeopathy (72.0%) vitamin D (62.7%), selenium (42.7%), acupuncture (38.7%). CONCLUSION: There is a high proportion of cancer patients visiting NMPs mostly for additional treatment. Biologically-based treatments may induce side-effects and interactions, especially as NMPs are not trained on medically accepted cancer treatment and medications. Offering information on CAM and improving the physician-patient relationship are important means to answer unmet needs from the side of the patient.

The use of complementary and alternative medicine in children with atopic eczema at a tertiary care centre in Malaysia.

OBJECTIVE: Globally, the use of complementary and alternative medicines (CAMs) for children with atopic eczema (AE) is gaining popularity. At present, information on the pattern of CAM use in Malaysia among children with AE is limited. This study aimed to investigate the pattern of CAM use in children with AE and factors associated with its use. METHODS: This was a cross-sectional survey conducted at a tertiary care centre in Kuala Lumpur, Malaysia among parents of children with AE aged ≤ 12 years using validated questionnaires including Beliefs about Medicines Questionnaire (BMQ-General) and Patient-Oriented Eczema Measure (POEM) scale. RESULTS: In total, 173 parents were recruited. The prevalence of CAM use over the last 12-month period was 46.8 %. The most commonly used CAM was Ruqyah (Islamic prayer), followed by Malay herbs, virgin coconut oil, nutritional therapy and homeopathy. AE severity from parental perspective was the major predictor of CAM use based on multiple logistic regression analysis. Parents of children with 'clear or almost clear' (adjusted OR 0.06; 95 % CI 0.01-0.54; p = 0.012) and 'mild' (adjusted OR 0.15; 95 % CI 0.03-0.85; p = 0.032) eczema were less likely to use CAM than those with 'very severe eczema'. CONCLUSION: CAM use was prevalent among children with AE. Its use was significantly associated with AE severity from a parental perspective. Healthcare providers may need to enquire parents about CAM use for their child during routine clinic appointment.

[Complementary and alternative medicine use in two French pediatric oncology centers: A common practice]. / Utilisation des médecines complémentaires et alternatives chez l'enfant et l'adolescent atteint de cancer : une pratique fréquente.

BACKGROUND: The use of complementary and alternative medicine (CAM) in children with cancer is commonly used. However, studies and data on this topic are still scarce in France. METHODS: Our aim was to investigate the prevalence of CAM usage in pediatric cancer patients and describe the modality of use. Our study population comprised children and young people treated from 2011 to 2012 in 2 French centers (Nantes, Paris). An anonymous self-administered questionnaire was addressed to families and data was collected from them and from the medical record. RESULTS: Out of the 202 patients selected for the study, 111 families answered the questionnaire (55%). Fifty-four (48.6%) of respondents reported CAM used. Forty-seven (87%) patients used CAM during initial therapy of cancer. Thirty-two (59.3%) of them talked about their CAM usage with health professionals, whose 25 (75.8%) with their oncologist. The three most common therapies used were homeopathy (75.8%), chiropractic (31.5%) and faith healing (42.6%). The main reason for the use of CAM was to control the side effects of conventional treatment (85.2%). Overall perceived satisfaction was rated 7.4/10. CONCLUSION: The prevalence of complementary and alternative medicines administration is high, even if scientific evidence is limited regarding the effects, mechanisms of action and security of CAM. Research is necessary to improve the communication and council quality to the family, optimize supportive cares and reinforce the pharmacovigilance.

Evaluating the Demand for Integrative Medicine Practices in Breast and Gynecological Cancer Patients.

INTRODUCTION: Integrative medicine is becoming increasingly relevant to modern oncology. The present study aims to assess the demand for integrative therapeutic approaches including complementary and alternative medicine (CAM), body and mind practices, nutritional counseling, and psychological assistance among breast and gynecological cancer patients. METHODS: From April to July 2017, a pseudo-anonymous questionnaire was distributed to cancer patients at the Department of Gynecology and Obstetrics, Technical University of Munich. Patterns of CAM use and demand for integrative health approaches were investigated by generating descriptive statistics. RESULTS: 182 (90%) of 203 patients participated in the survey. 59% indicated the use of CAM practices in general, and 41% specifically in relation to their oncological disease. Most frequently used modalities were herbal supplements (32%), homeopathy (29%), vitamins (28%), and selenium (21%). Integrative health approaches that patients would have desired alongside conventional oncological treatment were CAM (54%), relaxation therapies (44%), and dietary counseling (43%). CONCLUSION: There is a considerable demand for integrative medicine among breast and gynecological cancer patients. Our results underline the need for the implementation of evidence-based integrative treatments in cancer care in order to meet the standards of modern oncology.

Utilization, preference, perception and characteristics of people adopting traditional and AYUSH systems of medicine in India: a systematic review.

Background Albeit Indian system of medicine has been practised since long however it has got recent prominence after some policy decisions made to make it more accessible to the people of India. Methods A two fold search strategy was adopted to obtain the literature; search through PUBMED and hand search through cross references. Of the 58 articles obtained through both the search approaches 13 articles were finally included in the review. Results The studies reviewed assessed the utilization, preference, perception and characteristics of people adopting traditional and AYUSH systems of medicine in India. Utilization was observed in a particular geographical area (states) and by a specific group of people such as tribal and general population, medical practitioners and religious groups. Perception about AYUSH system was mixed with different segments of the society. Preference among the general population revolved around distrust or frustration with allopathic medicine, cost effectiveness, accessibility, non-availability of other options and less side effects of AYUSH medicines. Moreover people primarily adopted AYUSH systems of medicine based on their personal experiences and recommended the same to other people as well. Conclusions A mixed response was observed through this systematic review with regard to utilization, preference, perception and characteristics of people adopting traditional and AYUSH systems of medicine in India. A higher level of awareness and governmental patronization is required to make it available to the common man at the last corner of the society for the benefit of the former and the system as well.

Use of complementary and alternative medicine (CAM) by parents in their children and adolescents with epilepsy - Prevelance, predictors and parents' assessment.

BACKGROUND: The use of complementary and alternative medicine (CAM) is popular. Parents of children suffering from epilepsy may also consider administering CAM to their children. Systematic data about frequency of and motivations for CAM use, however, are scarce. METHODS: In a university hospital's neuropaediatric department parents of patients aged 0-18 years suffering from epilepsy were consecutively invited to take part in a structured interview during 4 months in 2014. RESULTS: Of the invited parents, 164/165 (99%) agreed to participate. From those, 21/164 (13%) stated that they used CAM in their child. The highest independent predictive value of CAM use was the occurrence of adverse drug events (ADE) of anticonvulsants as judged by parents. Patients affected by ADE had a 5.6 higher chance of receiving CAM compared to patients without ADE. Most commonly used were homeopathy (14/21, 67%) and osteopathy (12/21, 57%). The internet was the most frequently used source of information (14/21, 67%). Of the parents, 10/21 (48%) described positive effects of CAM on seizure frequency, 12/21 (57%) on general condition of their child, and 20/21 (95%) wished to continue CAM for epilepsy therapy. From the non-users of CAM, 91/143 (66%) expressed the desire to learn more about CAM for epilepsy therapy. LIMITATIONS: Our study was performed in a university hospital in a large urban city in Eastern Germany. CAM user rates can differ in other parts of Germany and Europe, in other institutions and for chronic diseases other than epilepsy. CONCLUSION: The main reason for CAM use was the occurrence of ADE of anticonvulsants. More than half of the parents saw a benefit of CAM for their children. Almost all parents wished to continue CAM use, even those who did not see concrete positive effects.

Epidemiology of complementary and alternative medicine therapy use in allogeneic hematopoietic stem cell transplant survivorship patients in Australia.

In addition to prescribed conventional medicines, many allogeneic hematopoietic stem cell transplant (HSCT) survivors also use complementary and alternative medical therapies (CAM), however, the frequency and types of CAMs used by allogeneic HSCT survivors remain unclear. Study participants were adults who had undergone an allogeneic HSCT between 1st January 2000 and 31st December 2012. Participants completed a 402-item questionnaire regarding the use of CAM, medical complications, specialist referrals, medications and therapies, infections, vaccinations, cancer screening, lifestyle, and occupational issues and relationship status following stem cell transplantation. A total of 1475 allogeneic HSCT were performed in the study period. Of the 669 recipients known to be alive at study sampling, 583 were contactable and were sent study packs. Of 432 participants who returned the completed survey (66% of total eligible, 76% of those contacted), 239 (54.1%) HSCT survivors used at least one form of CAM. These included dietary modification (13.6%), vitamin therapy (30%), spiritual or mind-body therapy (17.2%), herbal supplements (13.5%), manipulative and body-based therapies (26%), Chinese medicine (3.5%), reiki (3%), and homeopathy (3%). These results definitively demonstrate that a large proportion of HSCT survivors are using one or more form of CAM therapy. Given the potential benefits demonstrated by small studies of specific CAM therapies in this patient group, as well as clearly documented therapies with no benefit or even toxicity, this result shows there is a large unmet need for additional studies to ascertain efficacy and safety of CAM therapies in this growing population.

La sanación desde otro paradigma: neochamanismos y su emergencia global en el caso español / The healing from another paradigm: neoshamanisms and its global emergency in the Spanish case

Resumen Entre la multitud de medicinas y terapias alternativas presentes en el mundo Occidental, el neochamanismo es una de las que, en la actualidad, ha despertado mayor interés y que se sitúa entre las nuevas formas espirituales y los procesos de patrimonialización fruto de la modernidad globalizada. En este artículo se muestra el proceso de reconfiguración de prácticas y conocimientos ancestrales, -etiquetados como chamánicos- y cómo éstos constituyen una respuesta adaptativa en la búsqueda de nuevos espacios vitales y de experiencias colectivas que den sentido a la existencia en el contexto occidental. Desde el caso español y tomando la Comunidad Valenciana como unidad de análisis, nos adentramos en el proceso de adaptación de distintas corrientes chamánicas que han llegado a nuestras tierras y en cómo, desde ellas, mostrando ejemplos concretos, se entiende la sanación como un proceso de recuperar la salud y el bienestar que incluye al ser humano en su totalidad, así como las relaciones que establece con los demás y con su entorno.

Abstract Amongst multitude of alternative medicines and therapies that are present in the western world, neo-shamanism is one that has awakened more interest and has been established between the new spiritual ways and the heritagisation of processes as a result of globalized modernity. In this article, we will show the process of reconfiguration of shamanic practices and knowledge and how they constitute an adaptive response in the search of new vital spaces and collective experiences that give meaning to existence in western context. From the Spanish case and using the Autonomous Community of Valencia as an analysis unit, we will go in depth into the adaptation process that different shamanic movements reaching our land have suffered and how one can understand healing as a process to regain health and wellbeing that includes the human being in entirety of bodies, as well as established relationships with others and with the environment.