Communication Between Cancer Patients and Physicians About Complementary and Alternative Medicine: A Systematic Review.

Objectives: Complementary and alternative medicine (CAM) has become increasingly popular among cancer patients and is often used concomitantly with standard cancer therapies. Nonetheless, disclosure of CAM utilization by cancer patients to physicians, along with the provision of information on CAM therapies by physicians, is poor. This review explores the literature to synthesize existing information on communication about CAM usage, reasons for nondisclosure, and the clinical implications thereof. Methods: A search of medical literature published between December 1, 2009, and October 1, 2021 (last searched on April 18, 2022), on communications between physicians and cancer patients about CAM treatments was conducted through MEDLINE and EMBASE. Results were screened for inclusion, dually reviewed, and assessed using the QualSyst quality appraisal instrument. Findings were categorized and synthesized for review. Results: A total of 30 articles were located (n = 8721 total participants), which discussed elements related to patient disclosure of CAM use (n = 16), provider experiences or perceptions related to communication about CAM (n = 3), patterns of this communication (n = 6), and recommendations for effectively discussing CAM with cancer patients (n = 5). Reports indicate that nondisclosure is common throughout the cancer care spectrum. Factors influencing nondisclosure range from patient beliefs and attitudes about their provider, demographic characteristics, disease progression, physician-patient relationship, physician noninquiry, and type of CAM used; ultimately creating a gap in care that may have serious medical implications. Discussion: Many of the studies identified are small and confined to a single-center, hospital-network, or geographic setting, thereby limiting the applicability of findings and recommendations. Nonetheless, improving patient-physician communication is essential in delivering evidence-informed, patient-centered care and crucial for achieving patient satisfaction and positive health outcomes. The lack of adequate CAM dialogue about CAM use increases the risk of adverse interactions with conventional cancer treatments and results in missed opportunities for providers and patients to engage in vital information exchange. Future research and education are necessary to further identify barriers surrounding patient-provider communication about CAM treatments.

Survey of Lifestyle, Past Medical History and Complementary and Alternative Medicine Use Among Adult Patients Participating in the National Cancer Institute's Exceptional Responders Initiative.

INTRODUCTION: The Exceptional Responders Initiative (ERI) at the National Cancer Institute attempts to correlate unusually good outcomes in patients with cancer with genetic targets in tumors and the therapies the patients received. It is not known if other factors might contribute to exceptional responses or outcomes. We explored aspects of the medical history, lifestyle changes, complementary and alternative medicine (CAM) use and communication between health care practitioners and patients who experienced an exceptional response following cancer treatment. METHODS: All subjects whose case was submitted to the ERI were eligible to participate in the survey. A 121-question survey questionnaire was developed to assess aspects of the subject's past medical history, lifestyle (e.g., diet, exercise, spirituality) and use of CAM. RESULTS: Thirty subjects completed and returned the questionnaire from approximately 88 patients invited to participate (approximate response rate = 34%). Approximately 68% were female and 32% were male. Fifty percent of subjects changed their diet after their cancer diagnosis. Eighteen patients (60%) reported using a CAM therapy (not including oral vitamins/minerals or spiritual practices) during their Exceptional Response (ER). CONCLUSION: Multiple factors, including features of the tumor itself, the patient, or the environment, could affect tumor response or patient survival, either solely or in combination with the treatments received. Many patients use other medications, change their diet or physical activity or use CAM interventions after their cancer diagnosis. Investigators attempting to understand the exceptional response phenomenon should acquire rich data sets of their subjects that include information about these factors.

Complementary and alternative medicine use among persons with multiple chronic conditions: results from the 2012 National Health Interview Survey.

BACKGROUND: Although a quarter of Americans are estimated to have multiple chronic conditions, information on the impact of chronic disease dyads and triads on use of complementary and alternative medicine (CAM) is scarce. The purpose of this study is to: 1) estimate the prevalence and odds of CAM use among participants with hypercholesterolemia, hypertension, diabetes, and obesity; and 2) examine the effects of chronic condition dyads and triads on the use of CAM modalities, specifically manipulative and body-based methods, biological treatments, mind-body interventions, energy therapies, and alternative medical systems. METHODS: Data were obtained from the 2012 National Health Interview Survey and the Adult Alternative Medicine supplement. Statistical analyses were restricted to persons with self-reported hypercholesterolemia, hypertension, diabetes, or obesity (n = 15,463). RESULTS: Approximately 37.2% of the participants had just one of the four chronic conditions, while 62.4% self-reported multiple comorbidities. CAM use among participants was as follows (p < 0.001): hypercholesterolemia (31.5%), hypertension (28.3%), diabetes (25.0%), and obesity (10.8%). All combinations of disease dyads and triads were consistently and significantly associated with the use of mind-body interventions (2-4%, p < 0.001). Two sets of three dyads were associated with use of manipulative methods (23-27%, p < 0.05) and energy therapies (0.2-0.3%, p < 0.05). Use of biological treatments (0.04%, p < 0.05) and alternative systems (3%, p < 0.05) were each significant for one dyad. One triad was significant for use of manipulative methods (27%, p < 0.001). CONCLUSIONS: These findings point to future directions for research and have practical implications for family practitioners treating multimorbid patients.

The National Cancer Institute's Conference on Acupuncture for Symptom Management in Oncology: State of the Science, Evidence, and Research Gaps.

The Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, at the National Cancer Institute (NCI) held a symposium on "Acupuncture for Cancer Symptom Management" on June 16 and 17, 2016. Invited speakers included 19 scientists and scholars with expertise in acupuncture and cancer research from the United States, Europe, and China. The conference reviewed the NCI's grant funding on acupuncture, analyzed the needs of cancer patients, reviewed safety issues, and assessed both the current scientific evidence and research gaps of acupuncture in oncology care. Researchers and stakeholders presented and discussed basic mechanisms of acupuncture; clinical evidence for specific symptoms; and methodological challenges such as placebo effects, novel biostatistical methods, patient-reported outcomes, and comparative effectiveness research. This paper, resulting from the conference, summarizes both the current state of the science and clinical evidence of oncology acupuncture, identifies key scientific gaps, and makes recommendations for future research to increase understanding of both the mechanisms and effects of acupuncture for cancer symptom management.

Cancer in the Medically Underserved Population.

Cancer is characterized by uncontrolled growth and spread of abnormal cells. It is the second most common cause of death in the United States, and a significant proportion can be prevented. Underrepresented and underserved populations are less likely to receive routine medical procedures and experience a lower quality of health services. Despite the increase in cancer screening, there are disparities in the incidence and mortality of various cancers. These disparities are not fully explained by the correlations between minority race and lower socioeconomic status or minority race and insurance status. Considerations for global cancer control in low-resource settings are presented.

Complementary and Alternative Medicine Use Among Overweight and Obese Cancer Survivors in the United States.

PURPOSE: The purpose of the study was to determine the prevalence of complementary and alternative medicine (CAM) use among US cancer survivors; examine whether use varies by underweight/normal weight, overweight, and obese body mass index status; determine reasons for use; and document disclosure rates of CAM use to medical professionals. METHODS: Data for 1785 cancer survivors were obtained from the 2007 National Health Interview Survey and CAM supplement. The prevalence and associations of CAM use in the previous 12 months were compared among underweight/normal weight, overweight, and obese adult cancer survivors. RESULTS: Nearly 90% of cancer survivors used at least one type of CAM therapy in the 12 months preceding the survey. Those who were overweight, but not obese, were more likely to use a CAM modality compared to normal/underweight respondents. Over two thirds (71%) reported using CAM therapy for general health and wellness and 39.3% used CAM because a health care provider recommended it. Disclosure rates of CAM use to conventional medical professionals varied widely by CAM modality. CONCLUSIONS: An overwhelming majority of US cancer survivors use CAM for a variety of reasons. Overweight cancer survivors may be more likely to use CAM than those who are underweight, normal weight, or obese. Cancer survivors should be screened by medical providers for the use of CAM therapies; furthermore, prospective clinical research evaluating the efficacy and safety of biologically based CAM therapies, often used by cancer survivors, is important and necessary for the well-being of this population.

The Role of Grape Seed Extract in the Treatment of Chemo/Radiotherapy Induced Toxicity: A Systematic Review of Preclinical Studies.

Grapes are one of the most consumed fruits in the world and are rich in polyphenols. Grape seed proanthocyanidins (GSP) have demonstrated chemopreventive and/or chemotherapeutic effects in various cancer cell cultures and animal models. The clinical efficacy of chemotherapy is often limited by its adverse effects. Several studies show that reactive oxygen species mediate the cardiotoxicity and neurotoxicity induced by various cancer chemotherapeutic agents. This implies that concomitant administration of antioxidants may prevent these adverse effects. The review was carried out in accordance with the PRISMA guidelines. An electronic search strategy in Medline and Embase databases was conducted. Of the 41 studies reviewed, 27 studied GSP while the remainder (14) studied grape seed or skin extracts (GSE). All the studies were published in English, except 2 in Chinese. A significant percentage (34%) of the studies we reviewed assessed the effect of GSE or GSP on cardiotoxicity induced by chemotherapy. Doxorubicin was the most common chemotherapeutic drug studied followed by cisplatin. Research studies that assessed the effect of GSE or GSP on radiation treatment accounted for 22% of the articles reviewed. GSE/GSP ameliorates some of the cytotoxic effects on normal cells/tissues induced by chemo/radiotherapy.

The National Cancer Institute best case series program: a summary of cases of cancer patients treated with unconventional therapies in India.

OBJECTIVES: The National Cancer Institute (NCI) Best Case Series (BCS) Program provides an independent review of medical records, imaging, and pathology of cancer patients treated with unconventional therapies. The goal of the NCI BCS Program is to identify preliminary evidence of tumor regression and assess whether there is sufficient evidence to move forward with NCI-initiated research. The objective was to review case reports submitted by 4 practitioners from India who used ayurvedic and homeopathic therapies to treat cancer. DESIGN: Retrospective review of case reports of 4 practitioners from India who used ayurvedic and homeopathic therapies to treat cancer. RESULTS: A total of 68 cases were submitted to the NCI BCS Program. Fifty-one percent of the cases represented homeopathy and 49% ayurveda. Of the 68 cases, 32 (47%) of the cases were collectively designated as "persuasive" (P) or "supportive"(S), and 36 (53%) as "not evaluable." Forty-one (60%) patients did not have any prior conventional treatment. CONCLUSION: The challenge for submitters rests in their ability to supply sufficient documentation for the NCI BCS Program. The NCI BCS Program represents a unique avenue for the rigorous evaluation of "best cases" to identify complementary and alternative medicine modalities that are promising for prospective preclinical evaluation or prospective research.

Herbal therapy use by cancer patients: a literature review on case reports.

Complementary and alternative medicine use is common amongst cancer patients. In many surveys, herbal medicines are amongst the most commonly used group of treatments. Herbal remedies are believed by the general public to be safe, cause less side-effects and less likely to cause dependency. The authors performed a literature review to assess which herbal approaches have had associated cancer case reports and determine which of these have been studied in prospective research. Eighteen case reports of patients having apparent antitumour effects from herbal therapy and 21 case reports of toxic effects of herbs used by cancer patients were identified. Clinicaltrials.gov and MEDLINE (via PubMed) were searched for each of the herbal products identified in these reports. Clinical trials in cancer populations were identified for green tea extracts or compounds (n=34), phytoestrogens (n=27), mistletoe (n=8), Ganoderma lucidum (n=1), noni (n=1) and Silymarin (n=1). Daikenchuto, PC-SPES, Nyoshinsan/TJ and Saw palmetto have also been studied prospectively. In conclusion, some of the herbs with promising case report findings have undergone prospective clinical investigations but many others have either not yet been explored or the results have not been reported in English. Unconventional therapies, such as herbs and minerals, used in ancient medical traditions have led to the identification of active anticancer agents. Mechanisms to support prospective research with such approaches are discussed.

Survey of complementary and alternative medicine practitioners regarding cancer management and research.

The primary purpose of this survey was to assess the interest and concerns of a group of cancer complementary and alternative medicine (CAM) practitioners regarding CAM research issues. These issues include the CAM modalities used most often by CAM practitioners in the treatment of cancer patients, cancer CAM practitioners' perceptions of the most promising areas of cancer CAM research, the perceived obstacles to carrying out research objectives in the emerging field of cancer CAM research, the extent of awareness of the National Cancer Institute (NCI) Best Case Series Program, and CAM practitioners' level of interest in research collaboration with CAM researchers. A cross-sectional survey of a convenience sample of cancer CAM practitioners was conducted. One hundred thirty-four respondents completed the survey. About 72% of the respondents were involved in the care of cancer patients, and these were considered the informative respondents. All results were from the informative respondent group. Respondent practitioners provided care using interventions from all seven of the predefined CAM categories. This care was provided to improve both quality of life and survival. Over two-thirds of the respondents rated research in pharmacologic and biologic treatments, alternative medical systems and nutritional therapeutics for cancer treatment, and symptom/side-effect management as high-priority areas. Although no single obstacle to research predominated as the most significant, the most frequently encountered obstacle was lack of awareness of appropriate funding sources (75.4%). More than 83% of respondents expressed some interest in or willingness to establish research collaboration with a cancer researcher. The results from this survey indicate that many cancer CAM practitioners have shared interests, perceived obstacles, and desired research opportunities. Despite a small sample size and lack of a feasible process for random sampling, this survey highlights avenues to promote and support collaborative research. The NCI/Office of Cancer Complementary and Alternative Medicine will continue to respond to the concerns elucidated by the survey by developing strategies for future program opportunities within the NCI.

Survey of cancer researchers regarding complementary and alternative medicine.

The primary purpose of this survey was to assess the interest and concerns of a group of cancer researchers regarding complementary and alternative medicine (CAM) research issues. These issues include cancer researchers' perceptions of the most promising areas of cancer CAM research, their needs for support, the perceived obstacles to carrying out research objectives in the emerging field of cancer CAM research, and their level of interest in research collaboration with CAM practitioners. A cross-sectional survey of a convenience sample of cancer researchers interested in CAM was conducted. Three hundred twenty-one respondents completed the survey, and 298 of them had participated in cancer research. About 85% of the respondents had participated in cancer CAM research. For all CAM categories, the percentage of respondents who would like to conduct research was greater than the percentage of those who have already done so. About two-thirds of the respondents rated research in pharmacologic and biologic treatments and nutritional therapeutics for cancer treatment and symptom/side-effect management as high-priority areas. The obstacle considered to be the most significant by the greatest percentage of the respondents (26.7%) was the lack of success in receiving research funds. This was also the most frequently encountered obstacle. The assistance that was considered to be very useful by the greatest percentage of respondents was support for developmental research or pilot projects, indicated by more than four-fifths (85.4%) of the respondents. More than 83% of respondents expressed some interest in or willingness to establish research collaboration with a CAM practitioner. The results from this survey indicate that many cancer CAM researchers have shared interests, needs, perceived obstacles, and desired research opportunities. These factors and other forces are likely to lead to further growth in the numbers and activity of cancer CAM researchers. If this occurs, then it will become even more important for the National Cancer Institute and other organizations to study the development and changes in this emerging research field.