Reflexology in oncological treatment - a systematic review.

BACKGROUND: As cancer and its therapy comes with a wide range of negative effects, people look for options to mitigate these effects. Reflexology is among the options of complementary medicine. METHOD: In March 2022 a systematic search was conducted searching five electronic databases (Embase, Cochrane, PsychInfo, CINAHL and Medline) to find studies concerning the use, effectiveness and potential harm of reflexology on cancer patients. RESULTS: From all 821 search results, 29 publications concerning 26 studies with 2465 patients were included in this systematic review. The patients treated with reflexology were mainly diagnosed with breast, lung, gastrointestinal and hematological cancer. Outcomes were mainly pain, quality of life, anxiety, depression, fatigue. The studies had moderate to low quality and reported heterogeneous results: Some studies reported significant improvements in above mentioned outcomes while other studies did not find any changes concerning these endpoints. CONCLUSION: Due to the very heterogeneous results and methodical limitations of the included studies, a clear statement regarding the effectiveness of reflexology on cancer patients is not possible. The current evidence indicates that reflexology is superior to passive control groups for pain, quality of life and fatigue, however, more studies with comparable active control groups are needed.

[Complementary and alternative medicine-An option for chronic pain patients?] / Komplementäre und alternative Medizin ­ eine Option bei chronischen Schmerzpatienten?

The interest of patients with chronic pain in complementary and alternative medicine (CAM) is high. The aim of an accompanying complementary therapy is to strengthen the patient's self-efficacy, the ability to make decisions and the autonomy. The best evidence exists for physical activity and a balanced diet. Exercise combinations of strength and endurance as well as targeted strengthening of the muscles in the area of the pain are particularly suitable. When choosing the form of exercise, low-threshold training options are recommended. There is no reliable evidence for kinesio taping, homeopathy, neural therapy and draining procedures. The extensive data on acupuncture must be interpreted taking methodological limitations into account. Heat applications can support multimodal pain therapy. In the case of anti-inflammatory phytotherapeutic agents, there are good rationales from basic research and reliable empirical knowledge regarding the dosage. The evidence on cannabis is low.

Umbrella review: Summary of findings for acupuncture as treatment for radiation-induced xerostomia.

Acupuncture is a common part of complementary medicine. However, traditional Chinese acupuncture has been built on concepts which are not in accordance with science-based medicine. Our aim was to critically assess the evidence presented in systematic reviews (SRs) and meta-analyses (MAs) about the effectiveness of acupuncture on radiotherapy induced xerostomia. A systematic search was conducted in February 2022. We evaluated all SRs/MAs using the AMSTAR-2 instrument. Eight SRs, with 12 controlled studies were included. All SRs summarize that the methodological drawbacks do not allow to give a clear statement about the effectiveness of acupuncture. While objective assessments in most SRs/MAs reported no difference between real and sham acupuncture, some favorable effects on subjective xerostomia symptoms are found. No clinical meaningful effectiveness of acupuncture on xerostomia has been proven so far, but positive subjective findings need to be explored more. While most SRs recommend further studies, studies involving patients with a serious cancer diagnosis are ethically questionable.

Usage of Complementary and Alternative Methods, Lifestyle, and Psychological Variables in Cancer Care.

BACKGROUND/AIM: People who are undergoing cancer treatment often ask themselves what they can do in addition to conventional medical therapy with regard to nutrition, activity, and complementary methods. However, we know little about the motivation why people opt for one or the other measure. The aim of this study was therefore to examine the extent of physical activity (PA), healthy nutrition, and the use of complementary methods in relation to both demographic and psychological data. MATERIALS AND METHODS: A questionnaire was used to collect data on demographic data, resilience, coherence, self-efficacy, spirituality, satisfaction, and complementary and alternative medicine (CAM) behavior, PA, and diet. Between March and July 2021, data from 446 patients were collected. Regression models and correlation analyzes were used to examine the associations between CAM use, diet and PA with the other variables surveyed. RESULTS: CAM usage could only be predicted based on the patient's spirituality. Women used CAM more often and ate more healthily. Healthy eating was also related to younger age, shorter medical history, resilience, satisfaction, and coherence. In addition, the results showed that daily PA was related to the level of resilience, spirituality, and self-efficacy. CONCLUSION: Which people or why patients use CAM remains a question to be further investigated. Our data suggest that CAM seeks to address similar needs that others find in spirituality. In order to promote a healthy diet and PA in cancer patients in the future, various psychological variables seem conceivable. Resilience stands out, which is related to an overall healthier lifestyle.

[Complementary and Alternative Medicine Offers of Teaching Practices for General Medicine]. / Komplementär- und alternativmedizinische Angebote von Lehrpraxen für Allgemeinmedizin.

OBJECTIVE: Germany's new medical licensure act has increased the importance of general practice in academic medical education. This study gives an overview of complementary and alternative medicine in general teaching practices in Germany and their adherence to evidence-based criteria which is required in order to qualify as a teaching practice. METHODS: After a systematic search for German teaching practices, we assessed their diagnostic and therapeutic offers via their websites. We calculated the various frequencies of treatments and differentiated between evidence-based complementary medicine and alternative medicine with little to no evidence. RESULTS: Of 4102 practices, more than half offered complementary and/or alternative treatment. Most of those were treatments approved of by the German medical association. Alternative medicine was offered by 18.2% of the practices. CONCLUSION: Collective terms and conflicting evidence complicate the classification of treatments. Teaching practices offering non-evidence-based treatment raise the question whether recruitment of additional teaching practices stands at odds with the quality of medical education. Explicit offers of alternative treatment should disqualify a teaching practice as such. Controversial treatment may be taught academically and during residency with a focus on evidence-based guidelines and communication skills in order to prepare young medical practitioners for talks with their patients about the subject.

Decision-making by cancer patients and the role of a counselling facility for complementary and alternative medicine: a cohort study.

OBJECTIVE: The aim of this cohort study was to gain insight on influencing factors on the decision-making process in conventional medicine compared to complementary and alternative medicine (CAM). METHODS: A standardized questionnaire was distributed among cancer patients who attended the counselling facility for CAM of a German university hospital in 2020. RESULTS: Fifty patients (30.3%) returned the questionnaire. After counselling on CAM, most patients made a decision in CAM but also in conventional medicine. Thus, the focus on informed decision-making during counselling on CAM had a strong effect on the decision-making process in conventional medicine. Patients reporting good support also reported making decisions together with physicians and relatives. Moreover, after counselling on CAM, patients reported being more satisfied with their decision in both settings afterwards. CONCLUSION: Information on CAM which focuses on informed decision-making, supports patient's ability to understand and weigh risks and benefits of treatments, supports shared decision-making and enables patients to transfer these competences also to decisions on conventional medicine. So counselling on CAM may further decision-making competences in cancer patients. This encourages patients to engage in shared decision-making and increases patient's satisfaction with decisions.

[Alternative medicine in uro-oncology]. / Alternativmedizin in der Uroonkologie.

BACKGROUND: Alternative medicine is used instead of conventional therapy. Some patients use it in parallel with conventional medicine. OBJECTIVE: Narrative compilation of the evidence on alternative medicine in the (uro)oncological context. MATERIALS AND METHODS: A selective literature search in MEDLINE via PubMed was performed. RESULTS: The data on 3­bromopyruvate, Miracle Mineral Supplement (MMS), insulin-potentiated therapy, base therapy, hyperthermia, Artemisia annua, amygdalin (vitamin B17), Amanita therapy, homeopathy, apitherapy, dendritic cells, galavit, Germanic new medicine, and spiritual healing show either no or little clinical evidence of efficacy or clearly exhibit a negative benefit-risk profile. CONCLUSIONS: Alternative medicine is pseudo-medicine that may have a positive effect on mental well-being in the short term, but is mostly associated with disadvantages for the patient in the long term.

Phytotherapy known and applied by head-neck cancer patients and medical students to treat oral discomfort in Germany: an observational study.

BACKGROUND: Plant remedies are often used next to conventional standard of care by cancer patients. However, user rates are often underestimated and physicians usually feel not equipped to counsel patients. Hence, routinely recording the use of phytotherapy and sufficient knowledge on herbal medicine of the medical staff are required to improve the situation. Appraising the current state of knowledge of medical students may offer insight if education on herbals needs improvement. Here, we propose a simple anamnesis tool to assess knowledge and usage pattern of medical plants and demonstrate how to extrapolate symptom cluster participants associated with plants investigated in this study focussing on the common symptom of oral discomfort. METHODS: By screening German literature (popular science, specialist's literature, books for the interested layman) on medical plants used for treating oral discomfort, we were able to deviate a list of plants most often recommended for treating oral discomfort and to develop an anamnesis tool to assess knowledge and usage of 16 different plants. A group of 120 head-neck cancer patients (under surveillance, after receiving treatment) and 168 medical students were questioned at a collaborating out-patient clinic and via an online survey, respectively, in 2020. Students were additionally asked to write down indications of the plants they used in daily life. Knowledge and usage pattern were compared between both groups. Primary component analysis and heat-map analysis were used to visualize common and distinguishing features. Network analysis and VENN diagrams were used to extrapolate data of the medical students' cohort. RESULTS: Head-neck cancer patients and students show similar knowledge. However, students used significantly more plants in daily life than patients (p < 0.001). Overall, the user rate of patients and students were 82.50 and 93.94%, respectively. The top five most commonly known plants were similar in both groups (Marticaria recutita L., Zingiber offinicale ROSCOE, Taraxacum Wigg. Calendula officinalis L.) with the exception of Salvia officinalis L. (patients' cohort) and Carum carvi/Cuminum cyminum L. (students' cohort). Despite this slight difference, usage pattern of the top five most commonly used plants was the same between the groups. Students' indications were compared to indications found in the literature, unmasking several differences between commonly practiced and written knowledge on German phytotherapy. Network analysis revealed, that students associated certain plants with corresponding symptom clusters (e.g., coughing, oral mucositis). CONCLUSION: The majority of surveyed cancer patients as well as medical students use phytotherapy for treating oral discomfort. Both groups know and use similar plants. However, indications of written folk medicine differ from the lived and practiced tradition.

The benefits of vitamin A as a complementary treatment for oncology patients: a systematic review.

PURPOSE: Vitamin A and its derivatives positively influence the differentiation of epithelia and other tissues and prevent the proliferation of preneoplastic and neoplastic cells. Vitamin A is therefore taken into account as a potential supporting factor in cancer therapy. METHODS: In November 2020, a systematic search was conducted searching five electronic databases (EMBASE, Cochrane, PsycINFO, CINAHL and Medline) to find studies looking at the effects of using vitamin A as a complementary therapy for cancer patients. From all 12,823 search results, 9 publications referring to 9 studies with 4296 patients were included in this systematic review. RESULTS: The patients treated with vitamin A were diagnosed with various cancers and stages. Outcome variables were overall survival of cancer, progression-free survival, occurrence of second primary tumours and recurrences, improvement of chronic radiation-induced proctopathy and side effects of vitamin A. For the most part, the studies had a limited methodological quality. In summary, it can be said that due to the methodological deficiencies of the studies, no concrete statement can be made regarding the prolongation of overall survival and progression-free survival. There is also no evidence of the benefit of vitamin A in the treatment of chronic radiation-induced proctopathy, which can be attributed to methodological deficiencies in the study, as well. In the studies that report on side effects, it becomes clear that side effects, such as mucocutaneous symptoms, temporary increase in liver enzymes and gastrointestinal side effects occur more frequently in the group with vitamin A intervention. CONCLUSION: The limited interpretability of the results due to the methodological deficiencies of the included studies does not allow a final statement on the benefits of vitamin A as a complementary treatment for cancer patients.

Methodological Review: Summary of Findings for Acupuncture as Treatment for Cancer Therapy-induced Xerostomia.

BACKGROUND/AIM: With a rapidly growing number of studies, systematic reviews (SRs) and meta-analyses (MAs) on acupuncture, the level of evidence seems to be high. Yet, traditional Chinese acupuncture is built on concepts which are not in accordance with science-based medicine. Accordingly, our aim was to critically assess the evidence presented in SRs and MAs on xerostomia induced by treatment of head and neck cancer with radiotherapy. MATERIALS AND METHODS: In February 2022, a systematic search of five electronic databases (Embase, Cochrane, PsychInfo, CINAHL and Medline) was conducted to find SRs/MAs on acupuncture use against cancer-treatment induced xerostomia. We evaluated all SRs/MAs using the AMSTAR instrument, comparing the assessment of the individual studies included and the conclusions drawn by the authors. In case of heterogeneity between the SRs, we evaluated the controversial items of the assessments directly from the studies. RESULTS: Finally, eight SRs/MAs were included. Most of them show methodological drawbacks in several domains of the AMSTAR instrument, which influences the credibility of the results. CONCLUSION: The evidence on the use of acupuncture as treatment for radiotherapy-induced xerostomia is low. Present SRs/MAs mainly summarize results of a few and mostly small studies. Even though the included studies greatly overlap, the quality of the presentation and interpretation of the authors differs greatly. Therefore, a high quality and conclusive summary of the present evidence on the use of acupuncture to treat radiotherapy induced xerostomia is still missing.

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.

Systematic review about complementary medical hyperthermia in oncology.

Hyperthermia is a generic term for different techniques using heat in cancer therapies. Temperatures of about 42° Celsius in combination with chemo- or radiotherapy may improve the effectiveness of those treatments. Clinical benefit is shown in "standard hyperthermia" with tumour temperatures assessed during treatment. This systematic review thoroughly assesses the state of evidence concerning the benefits and side effects of electro hyperthermia or whole-body hyperthermia ("alternative hyperthermia") in oncology. From 26 April 2021 to 09 May 2021, a systematic search was conducted searching five electronic databases (Embase, Cochrane, PsycINFO, CINAHL and Medline) to find studies concerning the use, effectiveness and potential harm of alternative medical hyperthermia therapy on cancer patients. From all 47,388 search results, 53 publications concerning 53 studies with 2006 patients were included in this systematic review. The patients were diagnosed with different types of cancer. The hyperthermic methods included whole-body hyperthermia (WBH) with different methods and electro hyperthermia (EH). The majority of the included studies were single-arm studies, counting in total 32 studies. Six studies were randomized controlled trials (RCT). In addition, one systematic review (SR) was found. The most critical endpoints were tumour response, survival data, pain relief, myelosuppression and toxicities. Outcome was heterogeneous, and considering the methodological limitations, clinical evidence for the benefit of alternative hyperthermia in cancer patients is lacking. Neither for whole-body hyperthermia nor for electro hyperthermia there is any evidence with respect to improvement of survival or quality of life in cancer patients.

Interactions in cancer treatment considering cancer therapy, concomitant medications, food, herbal medicine and other supplements.

PURPOSE: The aim of our study was to analyse the frequency and severity of different types of potential interactions in oncological outpatients' therapy. Therefore, medications, food and substances in terms of complementary and alternative medicine (CAM) like dietary supplements, herbs and other processed ingredients were considered. METHODS: We obtained data from questionnaires and from analysing the patient records of 115 cancer outpatients treated at a German university hospital. Drug-drug interactions were identified using a drug interaction checking software. Potential CAM-drug interactions and food-drug interactions were identified based on literature research. RESULTS: 92.2% of all patients were at risk of one or more interaction of any kind and 61.7% of at least one major drug-drug interaction. On average, physicians prescribed 10.4 drugs to each patient and 6.9 interactions were found, 2.5 of which were classified as major. The most prevalent types of drug-drug interactions were a combination of QT prolonging drugs (32.3%) and drugs with a potential for myelotoxicity (13.4%) or hepatotoxicity (10.1%). In 37.2% of all patients using CAM supplements the likelihood of interactions with medications was rated as likely. Food-drug interactions were likely in 28.7% of all patients. CONCLUSION: The high amount of interactions could not be found in literature so far. We recommend running interaction checks when prescribing any new drug and capturing CAM supplements in medication lists too. If not advised explicitly in another way drugs should be taken separately from meals and by using nonmineralized water to minimize the risk for food-drug interactions.

Salvation Expectations of Patients of Medicine, Complementary and Alternative Medicine and Religion.

Health and holistic quality of life, physical and emotional needs, somatic and spiritual aspects contain a comprehensive promise of healing. The aim of the current study is to measure the expectations of patients of medicine, alternative medicine and religion related to health and illness. The survey was carried out among 103 patients of a rural general practitioner from May to June 2013 and among 103 patients of the outpatient department for endocrinology and metabolic disease of the Jena University Hospital in 2013. All patients were asked by one interviewer (HM) on fears in relation to health/illness and expectations of help for its own life, medicine, alternative medicine and religion. The biggest fear of patients is "being in need of help of others." There is no significant difference between religious and non-religious patients. Overall, the expectations of medicine were significantly higher in all sectors than in alternative medicine or religion. Comparing alternative medicine and religion, the expectations of alternative medicine were significantly higher excluding consolation and inner peace. The expectations for medicine in general and for the physician are very high and comprehensive and go beyond diagnosis and realization of therapies. Patients expect hope, guidance, support, comfort, inner peace and advice most from medicine. This results in considerable challenges for the physician, especially in a healthcare system with limited resources and without suitable offers. There is an urgent need to integrate these requirements into daily routine.

[Religiosity and spirituality as ressources for head neck cancer patients]. / Religiosität und Spiritualität als Ressourcen in der Betreuung von Patienten mit Kopf-Hals-Tumoren.

OBJECTIVE: Spiritual Care is a well established part of palliative medicine. Are religiosity / spirituality also ressources of patients during the early phases of a head neck cancer (HNC) disease? MATERIAL AND METHODS: We included 113 HNC patients (27 women, 84 men, 2 divers) to a prospective study using questionnaires focused on actual burden (NRS), spirituality as ressource (SpREUK-15, spiritual needs (SpNQ-20), interpretation of illness (IIQ), and life satisfaction of patients (BMLSS-10, BMLSS-Support, WHO-5). 39 patients were still under therapy, 74 participants were cancer-survivors. RESULTS: Only 31/111 (28 %) patients feel themselve as spiritual and/or religious. 72 % are neither spiritual nor religious. 51/111 see reflexion about their cancer disease as a specific ressource to overcome their actual cancer situation. Spiritual needs are religious in 35/112, existential in 67/112, inner peace in 90/112, and generativity in 84/112 patients. The accepted own religiosity and the actual stadium of disease are highly relevant impact factors on spiritual needs and ressources. HNC patients show a high part of depressive moods (WHO-5) and are (in trend) un-satisfied with their life and support situation. CONCLUSION: Up to 90 % of HNC patients have specific spiritual needs which are often hidden. Modern concepts of integrative oncology discover them, and enourage via these ressources the quality of life and the coping of cancer patients.