Acupuncture for Dyspnea in Lung Cancer: Results of a Feasibility Trial.

PURPOSE: Dyspnea is a common and distressing symptom for patients with lung cancer (LC) because of disease burden, therapy toxicity, and comorbid illnesses. Acupuncture is a centuries-old therapy with biological plausibility for relief of dyspnea in this setting. This pilot study aimed to evaluate the feasibility and preliminary effectiveness of acupuncture for dyspnea among patients with LC. METHODS: Eligible patients had a diagnosis of LC and clinically significant dyspnea without a clear organic cause. The treatment consisted of 10 weekly acupuncture sessions, with a follow-up visit 4 weeks after therapy. The primary outcome was dyspnea severity as measured using a validated Numerical Rating Scale (NRS) of 0 to 10 (10 being "most severe shortness of breath imaginable"). RESULTS: We enrolled 12 patients in the study. The median age was 64.5 years; 66.7% of the patients were female, and 66.7% were Caucasians. Among those enrolled, 10 (83.3%) were able to complete all 10 acupuncture sessions. Acupuncture was well tolerated; adverse events were mild and self-limited. Mean (SD) dyspnea scores on the NRS improved from 6.3 (1.7) at baseline to 3.6 (1.9; P = .003) at the end of treatment and 3.2 (2.3; P = .008) at follow-up. Fatigue and quality of life also improved significantly with acupuncture (P < .05). CONCLUSION: Among patients with LC, acupuncture was well tolerated and exhibited promising preliminary beneficial effects in the treatment of dyspnea, fatigue, and quality of life. Performing a trial in this population appears feasible.

Do attitudes and beliefs regarding complementary and alternative medicine impact its use among patients with cancer? A cross-sectional survey.

BACKGROUND: Complementary and alternative medicine (CAM) incorporates treatments used by cancer survivors in an attempt to improve their quality of life. Although population studies have identified factors associated with its use, to the best of the authors knowledge, assessment of why patients use CAM or the barriers against its use have not been examined to date. METHODS: The authors conducted a cross-sectional survey study in the thoracic, breast, and gastrointestinal medical oncology clinics at an academic cancer center. Clinical and demographic variables were collected by self-report and chart abstraction. Attitudes and beliefs were measured using the validated Attitudes and Beliefs about CAM (ABCAM) instrument. This instrument divides attitudes and beliefs into 3 domains: expected benefits, perceived barriers, and subjective norms. RESULTS: Among 969 participants (response rate, 82.7%) surveyed between June 2010 and September 2011, patient age ≤65 years, female sex, and college education were associated with a significantly greater expected benefit from CAM (P<.0001 for all). Nonwhite patients reported more perceived barriers to CAM use compared with white patients (P<.0001), but had a similar degree of expected benefit (P = .76). In a multivariate logistic regression analysis, all domains of the ABCAM instrument were found to be significantly associated with CAM use (P<.01 for all) among patients with cancer. Attitudes and beliefs regarding CAM explained much more variance in CAM use than clinical and demographic variables alone. CONCLUSIONS: Attitudes and beliefs varied by key clinical and demographic characteristics, and predicted CAM use. By developing CAM programs based upon attitudes and beliefs, barriers among underserved patient populations may be removed and more patient centered care may be provided.

Does perceived control predict Complementary and Alternative Medicine (CAM) use among patients with lung cancer? A cross-sectional survey.

PURPOSE: Scant literature exists on the use of complementary and alternative medicine (CAM) among patients with lung cancer. Preliminary data indicates that perceived control is an important factor leading patients to CAM. This study aimed to evaluate the relationship between perceived control and CAM use in patients with lung cancer. METHODS: We performed a cross-sectional survey in patients with lung cancer under active treatment and follow-up at the oncology clinic of an academic medical center. Self-reported CAM use was the primary outcome. Multivariate logistic regression was performed to determine the relationship between perceived control and CAM use, controlling for other factors. RESULTS: Among 296 participants, 54.4 % were female, 83.5 % were Caucasian, 57.6 % were ≤65 years old, 52.4 % were in stage IV, and 86.4 % had non-small cell lung cancer; 50.9 % of patients had used CAM, most commonly vitamins (31.5 %), herbs (19.3 %), relaxation techniques (16 %), and special diets (15.7 %). In multivariate analysis, CAM use was associated with having greater perceived control over the cause of cancer (adjusted odds ratio (AOR) 2.27, 95 % confidence interval (CI) 1.35-3.80), age ≤ 65 (AOR 1.64, 95 % CI 1.01-2.67), higher education (AOR 2.17, 95 % CI 1.29-3.64), and never having smoked tobacco (AOR 2.39, 95 % CI 1.25-4.54). Nearly 60 % of patients who used CAM were receiving active treatment. CONCLUSION: Over half of lung cancer patients have used CAM since diagnosis. Greater perceived control over the cause of cancer was associated with CAM use. Given the high prevalence of CAM, it is essential that oncologists caring for patients with lung cancer discuss its use.

Complementary and alternative medicine use and benefit finding among cancer patients.

PURPOSE: An increasing number of cancer patients are choosing Complementary and Alternative Medicine (CAM) as an active way to manage the physical, psychological, and spiritual consequences of cancer. This trend parallels a movement to understand how a difficult experience, such as a cancer diagnosis, may help facilitate positive growth, also referred to as benefit finding. Little is known about the associations between the use of CAM and the ability to find benefit in the cancer experience. METHODS: We conducted a cross-sectional survey of medical oncology outpatients in an urban academic cancer center. Patients completed measures of CAM use and benefit finding following a diagnosis of cancer. A hierarchical regression, adjusting for covariates, was performed to evaluate the unique contribution of CAM use on benefit finding. The relationship between specific CAM modalities and benefit finding was explored. RESULTS: Among 316 participants, 193 (61.3%) reported CAM use following diagnosis. Factors associated with CAM use were female gender (p=0.005); college, or higher, education (p=0.09); breast cancer diagnosis (p=0.016); and being 12 to 36 months post-diagnosis (p=0.017). In the hierarchical regression, race contributed the greatest unique variance to benefit finding (23%), followed by time from diagnosis (18%), and age (14%). Adjusting for covariates, CAM use uniquely accounted for 13% of the variance in benefit finding. Individuals using energy healing and healing arts reported significantly more benefit than nonusers. Special diet, herbal remedies, vitamin use, and massage saw a smaller increase in benefit finding, while acupuncture, chiropractic, homeopathy, relaxation, yoga, and tai chi were not significantly associated with benefit finding. CONCLUSIONS: Patients who used CAM following a cancer diagnosis reported higher levels of benefit finding than those who did not. More research is required to evaluate the causal relationship between CAM use, benefit finding, and better psychosocial well-being.

Pemetrexed plus gemcitabine as first-line chemotherapy for patients with peritoneal mesothelioma: final report of a phase II trial.

PURPOSE: Pemetrexed in combination with cisplatin is approved for the treatment of pleural mesothelioma and is active in malignant peritoneal mesothelioma (MPeM). Pemetrexed and gemcitabine are synergistic in preclinical models, but the activity of this combination in MPeM is unknown. This clinical study assessed safety and efficacy of pemetrexed plus gemcitabine in chemotherapy-naïve patients with MPeM. PATIENTS AND METHODS: Treatment consisted of gemcitabine 1,250 mg/m(2) on days 1 and 8, and pemetrexed 500 mg/m(2) on day 8, administered immediately before gemcitabine. Treatment was repeated every 21 days for six cycles or until disease progression. All patients received folic acid, vitamin B(12), and dexamethasone supplementation. End points included tumor response, toxicity, time to disease progression (TTPD), and overall survival (OS). Disease control rate (DCR) was also calculated. RESULTS: Twenty patients were enrolled between December 2002 and May 2004. The confirmed response rate was 15% (95% CI, 3.2% to 37.9%), with three patients experiencing a partial response. The DCR was 50% (95% CI, 27.2% to 72.8%). The most common grade 3 to 4 nonhematologic toxicities included fatigue (20%), constipation (10%), vomiting (10%), and dehydration (10%). Hematologic toxicities included grade 3 to 4 neutropenia (60%) and febrile neutropenia (10%). One patient death was attributed to treatment. Median TTPD and OS times were 10.4 months and 26.8 months, respectively. CONCLUSION: The combination of pemetrexed plus gemcitabine was active in patients with MPeM with a notably high incidence of neutropenia. Median TTPD and OS seem promising. This regimen may provide an alternative to standard therapies, especially for patients who cannot tolerate a platinum-based regimen.

Phase II trial of pemetrexed and gemcitabine in chemotherapy-naive malignant pleural mesothelioma.

PURPOSE: Pemetrexed and gemcitabine have single-agent activity in malignant pleural mesothelioma (MPM). The combination of pemetrexed/gemcitabine has not previously been studied in MPM to our knowledge. PATIENTS AND METHODS: Patients with histologic or cytologic diagnosis of MPM were included. Cohort 1 received gemcitabine 1,250 mg/m(2) on days 1 and 8, with pemetrexed 500 mg/m(2) on day 8, and cohort 2 received gemcitabine 1,250 mg/m(2) on days 1 and 8, with pemetrexed 500 mg/m(2) on day 1. Cycles were repeated every 21 days; all patients were supplemented with folic acid and vitamin B(12) and received dexamethasone. RESULTS: One hundred eight patients (cohort 1, n = 56; cohort 2, n = 52) with pleural mesothelioma were enrolled. Among assessable patients, response rate was 26.0% in cohort 1 and 17.1% in cohort 2. Median time to disease progression was 4.34 months for cohort 1 and 7.43 months for cohort 2. Median survival was 8.08 months for cohort 1 (1-year survival = 31.14%) and 10.12 months for cohort 2 (1-year survival = 45.80%). In cohorts 1 and 2, incidence of grade 4 neutropenia was 25.0% and 29.4%, grade 4 thrombocytopenia was 14.3% and 3.9%, grade 3 or 4 anemia was 5.4% and 5.9%, and grade 3 or 4 fatigue was 23.2% and 15.7%, respectively. CONCLUSION: The combination of pemetrexed and gemcitabine resulted in moderate clinical activity in MPM. However, the median survival times are similar to those with single-agent pemetrexed and inferior to outcomes observed with cisplatin in combination with an antifolate.

Comparing cancer patients who enroll in a smoking cessation program at a comprehensive cancer center with those who decline enrollment.

BACKGROUND: Despite the availability of smoking interventions for cancer patients, many eligible patients decline enrollment into such programs. We examined reasons patients provide for declining smoking treatment and compared treatment decliners to enrollees. METHODS: Eligible cancer patients (N = 231) were offered smoking cessation treatment. During recruitment, demographic, medical (eg, cancer stage), and smoking-related behavioral (eg, readiness to quit) data were collected, and decliners stated a reason for refusal. Patients who enrolled in the cessation program (N = 109) were compared with those who declined (N = 122) in terms of recruitment data, and reasons for declining were compiled. RESULTS: Decliners were significantly more likely to: (1) have head and neck cancer (vs lung cancer); (2) exhibit fewer physical symptoms (eg, shortness of breath); (3) report a lower readiness to quit smoking; (4) indicate no intention to quit smoking; and (5) smoke fewer cigarettes. A preference to quit without professional assistance was the most common reason for declining treatment. CONCLUSIONS: Our findings highlight important differences between patients who enroll in a smoking cessation program and those who decline and underscore the need for motivational interventions to facilitate enrollment into smoking interventions for cancer patients.

Processes of change related to smoking behavior among cancer patients.

PURPOSE: The purpose of this study was to examine the degree to which transtheoretical model processes of change (methods and strategies for cessation) were associated with smoking status and quitting behavior (ie, intentions and attempts to quit) among patients with head and neck or lung cancer. The relationship between medical variables and processes of change was also explored. DESCRIPTION OF STUDY: Twenty-nine smokers and 45 abstainers who were recruited from treatment clinics within a comprehensive cancer center completed a brief survey. Multivariate analysis of variance and Pearson correlation procedures were used to evaluate hypothesized relationships. RESULTS: As hypothesized, quitters used behavioral processes such as counter-conditioning and reinforcement management significantly more than smokers and used self-reevaluation, an experiential process, significantly less than smokers. Contrary to the hypothesis, however, quit attempts and intentions were associated with both experiential (ie, consciousness raising and self-reevaluation) and behavioral (ie, reinforcement management and self-liberation) processes of change. Use of the processes of change was not influenced by medical variables, including cancer type, illness phase, disease stage, type of current medical treatment, and duration of illness. CLINICAL IMPLICATIONS: These findings suggest that behavioral counseling to promote smoking cessation for patients with cancer should involve assisting the patient to do the following: develop an awareness of the health risks related to continued smoking; devise and use alternative behaviors; implement the use of reinforcement strategies for cessation successes; and develop a sense of confidence and commitment about quitting as well as healthy lifestyle values. These strategies are discussed within the context of models and guidelines for smoking cessation in clinical practice.