RESUMO
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.
Assuntos
Terapias Complementares/estatística & dados numéricos , Transplante de Células-Tronco Hematopoéticas , Terapias Mente-Corpo/estatística & dados numéricos , Estresse Psicológico/terapia , Sobreviventes , Terapia por Acupuntura/estatística & dados numéricos , Aromaterapia/estatística & dados numéricos , Técnicas de Exercício e de Movimento/estatística & dados numéricos , Transplante de Células-Tronco Hematopoéticas/psicologia , Humanos , Hipnose , Manipulação da Coluna/estatística & dados numéricos , Massagem/estatística & dados numéricos , Materia Medica/uso terapêutico , Meditação , Minerais/uso terapêutico , Musicoterapia , Plantas Medicinais , Probióticos/uso terapêutico , Qigong/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto , Terapia de Relaxamento/estatística & dados numéricos , Estresse Psicológico/etiologia , Estresse Psicológico/prevenção & controle , Tai Chi Chuan/estatística & dados numéricos , Toque Terapêutico/estatística & dados numéricos , Incerteza , Vitaminas/uso terapêutico , YogaRESUMO
A group of activist clinicians have offered to volunteer for clinical trials of live attenuated HIV vaccines. This has provided an important conceptual challenge to medical ethics, and to work on the development of HIV vaccines. In exploring these issues, this article highlights how the HIV field has altered the content as well as the tone of ethical discourse. The balance of expertise and authority between research subjects and triallists is profoundly changed, raising questions about the limits of voluntarism and differing perspectives on risk-benefit analysis. Care is needed to ensure that the novelty of the situation does not confuse the central ethical and scientific issues.