The Effects of Complementary Therapies on Patient-Reported Outcomes: An Overview of Recent Systematic Reviews in Oncology.

Many patients with cancer make use of complementary medicine alongside conventional medicine, but clinicians in oncology often lack the knowledge to adequately advise patients on the evidence base for complementary therapies. This study aims to provide an overview of recently published systematic reviews that assess the effects of complementary therapies on patient-reported health outcomes in patients with cancer. Systematic reviews, including a meta-analysis of at least two randomized controlled trials, were identified from the PubMed, Embase, Cochrane Library, CINAHL and PsycINFO databases. The methodological quality was assessed with AMSTAR 2. One hundred systematic reviews were included. The results suggest that several complementary therapies can improve health outcomes reported by patients with cancer, such as acupuncture to relieve pain, music interventions to reduce anxiety and yoga to improve cancer-related fatigue. The side effects related to complementary therapy use are generally mild. The results remain inconclusive for some intervention-outcome combinations. Many of the included systematic reviews insufficiently assessed the causes and impact of bias in their interpretation of the results. This overview of systematic reviews can support clinicians in counselling their patients on this topic and provide directions for future research and clinical practice guidelines in the field of complementary medicine.

A Randomized Study of Yoga for Fatigue and Quality of Life in Women with Breast Cancer Undergoing (Neo) Adjuvant Chemotherapy.

OBJECTIVES: To compare the effectiveness of yoga added to standard care (SC) versus SC only, in women with breast cancer during chemotherapy. DESIGN: A multicenter pragmatic, randomized controlled study. SETTINGS/LOCATION: Three hospitals in the Netherlands. SUBJECTS: Women with stage I-III breast cancer undergoing chemotherapy. INTERVENTIONS: Women were randomized either to a program based on Dru Yoga, once a week yoga sessions for 12 weeks (N = 47), or SC only (N = 36). OUTCOME MEASURES: Primary outcome fatigue (Multidimensional Fatigue Inventory [MFI]; general fatigue) and secondary outcomes fatigue (MFI, Fatigue Quality List [FQL]), quality of life (30-item Quality of Life Questionnaire-C of the European Organization for Research and Treatment of Cancer [EORTC-QLQ-C-30]) and psychological distress (Hospital Anxiety Depression Scale [HADS], Impact of Events Scale [IES]) were measured at baseline (T0), 3 months (T1), and 6 months (T2) and analyzed on observed cases. Other outcomes were adequate relief, reintegration to work, and adverse events. RESULTS: No significant differences were found in general fatigue at T1 (MFI: yoga; 14.6 ± 4.5 vs. SC; 14.2 ± 4.2, p = 0.987). Similar findings were observed for other fatigue (sub)scales of MFI and FQL and functional domains of EORTC. With respect to EORTCs symptom scales, women in the yoga group reported significantly less nausea and vomiting compared with SC at T2 (p = 0.004), but not at T1 (p = 0.807). Depressive symptoms were significantly lower with yoga at T1 (HADS: yoga; 4.7 ± 4.1 vs. SC; 5.1 ± 4.2, p = 0.031). More women in the yoga group experienced adequate relief compared with SC at T1 (yoga; 51% vs. SC; 19%) and had returned to work at T2 (yoga; 53% vs. SC; 23%). No adverse events were reported with yoga. CONCLUSIONS: A Dru-based yoga program failed to demonstrate a significant beneficial effect on fatigue. Possible favorable effects of the yoga program on nausea and vomiting and early return to work in breast cancer survivors warrant further research.

Arthralgia during aromatase inhibitor treatment in early breast cancer patients: prevalence, impact, and recognition by healthcare providers.

BACKGROUND: Many breast cancer patients experience arthralgia symptoms during aromatase inhibitor (AI) treatment, which leads to poor compliance and a lower quality of life. OBJECTIVE: The research questions of this study were as follows: (1) What is the incidence of arthralgia during AI treatment in early breast cancer patients, (2) what is the impact of AI-associated arthralgia on hand function, daily activities, and AI adherence, and (3) does the healthcare provider recognize AI-associated arthralgia as relevant in clinical practice? METHODS: A total of 57 breast cancer patients of a University Breast Cancer Clinic participated in this study. Each patient completed a questionnaire, performed 2 function tests (goniometry of the wrist and a handgrip strength measurement), and consented to a review of the medical chart. RESULTS: Forty-two breast cancer patients (74%) reported symptoms of arthralgia. All patients with arthralgia symptoms experienced an impact on their daily activities, and 65% had a decrease in hand and finger function. Sixty-nine percent of all patients were fully adherent in their medicine treatment. In 26% of cases with arthralgia, the symptoms were not reported in the medical chart. CONCLUSION: Given the large number of patients with AI-associated arthralgia and its impact on daily life and functioning, it is of great importance to improve the recognition and care of arthralgia symptoms during AI treatment. IMPLICATIONS FOR PRACTICE: Oncology nurses could play an important role in assessment of modifiable risk factors, providing lifestyle advice and support in coping.

(18)F-FLT-PET for Response Evaluation of MEK Inhibitor Selumetinib (AZD6244, ARRY-142886) in Patients with Solid Tumors.

Selumetinib (AZD6244, ARRY-142886) is a potent, selective, uncompetitive inhibitor of MEK 1 / 2, part of the RAF/MEK/ERK protein kinase signal cascade, which is responsible for tumor. This pilot study was used to explore if (18)F-fluoro-l-thymidine (FLT), a thymidine analogue positron emission tomography (PET) tracer and a surrogate marker for proliferation, can be used as an early predictor of response for patients with solid cancers treated with Selumetinib. FLT-PET scans were performed in four patients at baseline and after 2 weeks of treatment with Selumetinib. FLT uptake in tumors was analyzed qualitatively and quantitatively by measuring standard uptake value (SUV) max in regions of interest (ROI). Results were compared to computed tomography (CT) scans (baseline and after 8 weeks), which were evaluated using the response evaluation criteria in solid tumors (RECIST) 1.0 criteria. One patient with melanoma showed both a qualitative and quantitative decrease in FLT uptake associated with a decrease in sum of longest diameter of 12% RECIST on CT evaluation. Another patient who had colorectal carcinoma (CRC) showed a significant increase in FLT uptake with initially stable, but eventually progressive disease on CT. The other two patients (one with melanoma and one with CRC) showed no significant changes in FLT uptake, whereas CT evaluation showed progressive disease. This is the first report describing changes in FLT-PET in patients receiving Selumetinib. In two patients, changes in FLT uptake as early as after 2 weeks of treatment were consistent with CT results after 8 weeks. Biomarkers to predict and evaluate treatment the outcome of targeted therapies are highly warranted. These initial results need further investigation.