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.

Survey on the Necessity, Sensibility, and Timing of Psycho-Oncological Counseling and the Willingness to Discuss Various Topics During the Inpatient Stay in the Case of Breast Cancer.

After the diagnosis of cancer patients require a lot of information because the disease affects all aspects of life. Some important issues regarding optimal counseling remain to be determined. This includes the time-related relevance of various topics and questions regarding who and when to consult on the topics. We analyzed the answers of 155 women with non-metastatic breast cancer undergoing primary surgery, primary chemotherapy, and having completed adjuvant treatment regarding the above-mentioned issues. We found that counseling must consider the treatment situation. Breast cancer patients in the follow-up phase reported that they preferred being counseled by female consultants. Our results largely support a counseling concept which puts the breast care nurse at the center of interest rather than psychologists and social service workers. A breast care nurse centered counseling system for women with non-metastatic breast cancer appears to meet patients' needs best.

Do breast cancer patients adapt CAM methods according to the therapeutic situation?

BACKGROUND: and purpose: Complementary and alternative medicine (CAM) is frequently used among cancer patients. It is unclear whether and how far patients adapt CAM to the treatment situation. The objective is to assess the changes of CAM use between radiotherapy for breast cancer and the follow-up. MATERIALS AND METHODS: 107 patients who participated in a study assessing the possible effects of vitamin D and selenium on radiation-induced skin toxicity completed the CAM-PRIO (Working Group for Prevention and Integrative Oncology of the German Cancer Society) questionnaire during and after radiotherapy. The results were compared. RESULTS: Overall, 79.8% of the patients used at least one CAM method. Supplementation with vitamin D (49.4%) and selenium (28.7%) and prayer (37.1%) were the methods most used. After completing radiotherapy, many patients started using selenium, vitamin D, relaxation techniques, and yoga to a greater extent. Prior chemotherapy or concurrent endocrine treatments were not associated with the changes in CAM use. CONCLUSION: CAM use is mainly reported to be a static phenomenon. However, this study shows that this is not the case and that after the end of radiotherapy patients started using new CAM methods or increased the number of methods used.

Seasonal allergic rhinitis and the role of apitherapy

BACKGROUND: Apitherapy represents a certain form of complementary and alternative medicine that uses bee products in combination with other methods from this field. One of the basic concepts of this type of medicine is that all diseases can be treated using apitherapy. This study was performed to assess the recommendations from authors of books on apitherapy regarding the treatment of seasonal allergic rhinitis and compare them to findings from the scientific literature. METHODS: One hundred and twenty-nine books on apitherapy were analysed regarding recommendations for allergic seasonal rhinitis. Scientific evidence regarding the efficacy of using various bee products was searched via PubMed and JUSTfind. RESULTS: Only 38.8% of the apitherapy books mentioned seasonal allergic rhinitis. Among these books, we found 29 different recommendations in favour of bee products and one against the use of honey. The most reasonable recommendation according to clinical studies on the subject, namely the use of a mix of honey and pollen, was only found once (0.8%). CONCLUSIONS: The large discrepancies and number of different recommendations demonstrate that apitherapy is not a consistent type of medicine. The recommendations regarding seasonal allergic rhinitis in the vast majority of apitherapy books cannot be considered adequate when compared to the scientific findings

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Survey of reasons why women utilize honey therapeutically, and reasons for not utilizing honey.

There are various situations when honey can be reasonably used in cases of disease, for example radiotherapy and/or chemotherapy-induced oral mucositis. We investigated the underlying reasons why women eat honey and why some would refuse to use honey even if it was reasonable to do so. In order to answer these questions, we asked 201 women to answer various questions related to the consumption of honey. We found that the preferred routes of administration change when honey is used as a remedy. Most importantly, we identified "organic beekeeping" and a second factor related to the perception of honey regarding price, handling and health by principal component analysis as relevant regarding the refusal of the use of honey even when scientifically reasonable. If honey is to become an acceptable treatment option, it seems important to address all aspects of ethical beekeeping in the production of medicinal bee products.

Beekeepers who tolerate bee stings are not protected against SARS-CoV-2 infections.

A survey on 5115 beekeepers and 121 patients treated with bee venom by an apitherapy clinic in the Hubei province, the epicenter of COVID-19 in China, reported that none of the beekeepers developed symptoms associated with COVID-19, the new and devastating pandemic. The hypothesis that immunity to bee venom could have a preventive effect was expressed and the authors of the Chinese survey suggested that the next step should be animal experiments on monkeys. We believed that before starting such studies, a second independent survey should verify the findings and define the hypothesis more clearly. Thus we asked all German beekeepers to complete an assessment form which would summarize their experiences with COVID-19. In contrast to the Chinese study we found that two beekeepers had died from a SARS-CoV-2 infection and forty-five were affected. The reaction to bee stings (none; mild swelling; severe swelling) correlated with the perceived severity of the SARS-CoV-2-infection-associated symptoms - exhaustion and sore throat. Beekeepers comorbidity correlated with problems with breathing at rest, fever, and diarrhea. Our results did not confirm the findings of the Chinese study. However, since the antiviral effects of bee venom have been found in several studies, we cannot exclude that there could be a direct preventive or alleviating effect when bee venom is administered during the infection.

Apitherapy for menopausal problems.

PURPOSE: Apitherapy, a method from the field of complementary and alternative medicine, claims that all health problems including menopausal problems can be cured using bee products, especially honey, bee-collected pollen, propolis, and royal jelly. This study was to investigate the recommendations of protagonists of holistic apitherapy and compare these to the current evidence. METHODS: Since holistic apitherapy is only promoted in books and apitherapeutical congresses, we identified books on the topic in English, French, and German language via bookseller platforms and the JUSTfind system of the Justus-Liebig-University Gießen, Germany, which comprises 337 databases from the EBSCO Discovery Service. RESULTS: Only 29.5% (n = 38) of the apitherapy books mentioned the topic of menopausal problems. Among these, there were 24 different recommendations. Royal jelly is the number one recommended therapy, followed by pollen, the combination of pollen and royal jelly, and propolis. All other recommendations are mentioned just once. The recommendation regarding royal jelly must be regarded as correct. Strictly speaking, evidence regarding bee-collected pollen is poor, since all studies on pollen did not investigate pollen directly, but pollen extracts and these pollens came from pollen that was anemophilous but not entomophilous. CONCLUSION: Royal jelly and pollen could be interesting treatment options in cases of menopausal symptoms. In order to promote bee products for menopausal symptoms with a good conscience trials, comparing bee products against other options, such as selective serotonin reuptake inhibitors, C. racemosa extracts, and/or yoga should be initiated, since these methods have already proven their value.

Bee products and their role in cancer prevention and treatment.

OBJECTIVES: Apitherapy, a method from the field of complementary and alternative medicine, promises better survival and even cure in cases of cancer. DESIGN: 129 books on apitherapy in English, French and German languages were analysed regarding the recommendations concerning cancer. The recommendations were compared to the results from clinical studies in the literature. RESULTS: Eighteen books recommend apitherapy for cancer prevention, thirty-nine for complementary cancer treatment and seventeen books considered apitherapy able to cure cancer. Pollen and Propolis were mainly recommended in order to stimulate the immune system and/or to improve cancer nutrition. Interestingly, few books provided specific information and no book provided adequate information in comparison to what is known from clinical studies on bee products. Data on relevant aspects of cancer treatment were not mentioned. This especially refers to data of bee products and radiotherapy, chemotherapy and radio-chemotherapy-induced oral mucositis, radiotherapy-induced skin toxicity, radiotherapy-induced xerostomia, cancer-related fatigue, febrile neutropenia, cisplatin-induced nephrotoxicity, tyrosine kinase inhibitor-induced toxicity, side effects of antihormonal treatment and cancer-related wounds. CONCLUSIONS: Apitherapeutic books are not good advisors regarding all aspects of cancer. However, the potential of some bee products justifies further trials, especially on cancer prevention and complementary treatment.

Seasonal allergic rhinitis and the role of apitherapy.

BACKGROUND: Apitherapy represents a certain form of complementary and alternative medicine that uses bee products in combination with other methods from this field. One of the basic concepts of this type of medicine is that all diseases can be treated using apitherapy. This study was performed to assess the recommendations from authors of books on apitherapy regarding the treatment of seasonal allergic rhinitis and compare them to findings from the scientific literature. METHODS: One hundred and twenty-nine books on apitherapy were analysed regarding recommendations for allergic seasonal rhinitis. Scientific evidence regarding the efficacy of using various bee products was searched via PubMed and JUSTfind. RESULTS: Only 38.8% of the apitherapy books mentioned seasonal allergic rhinitis. Among these books, we found 29 different recommendations in favour of bee products and one against the use of honey. The most reasonable recommendation according to clinical studies on the subject, namely the use of a mix of honey and pollen, was only found once (0.8%). CONCLUSIONS: The large discrepancies and number of different recommendations demonstrate that apitherapy is not a consistent type of medicine. The recommendations regarding seasonal allergic rhinitis in the vast majority of apitherapy books cannot be considered adequate when compared to the scientific findings.

Vitamin D and selenium blood levels and acute skin toxicity during radiotherapy for breast cancer.

OBJECTIVES: Vitamin D blood levels have been shown to influence acute chemotherapy toxicities. Therefore, it was investigated whether it is an intrinsic factor influencing acute skin toxicity in patients receiving radiotherapy for breast cancer. DESIGN/SETTING: In a total of 107 patients receiving radiotherapy for resected breast cancer, vitamin D and selenium blood levels were determined. Correlations between these levels and skin toxicity due to radiotherapy (CTC scores, Skindex scores) were investigated as primary endpoints. Furthermore, the statistical relationship between skin toxicity, vitamin D and selenium blood levels with patient and disease characteristics such as tumor stage, breast size, skin thickness, blood cell counts as well as individual quality of life measured by SEIQoL-Q was analyzed. MAIN OUTCOME MEASURES/RESULTS: In our patient collective large deficiencies of vitamin D (mean level 20.9 ng/ml, normal range 36-60 ng/ml) and selenium (mean level 76.1 µg/l, normal range 74-139 µg/l) were found. No correlations between skin toxicities, vitamin D and selenium blood levels were found. Neither did these blood levels correlate with any tumor or patient characteristics nor with individual quality of life. As expected by clinical experience, skin toxicities correlated significantly with breast size and skin thickness. CONCLUSIONS: In this study, radiotherapy skin toxicity was not influenced by vitamin D or selenium blood levels. On the basis of our data we cannot recommend vitamin D or selenium supplementation as a prophylaxis for skin toxicity. Nevertheless, large numbers of breast cancer patients have substantial deficiencies of both substances. Therefore, supplementation may be reasonable for other reasons.

What is wrong with the meta-analyses on honey and oral mucositis due to cancer therapies?

OBJECTIVES: The results of meta-analyses currently represent the highest level of evidence in modern medicine. Taking the example of radiotherapy and radiochemotherapy-induced oral mucositis and the effects of honey, we analysed six meta-analyses on the topic to assess the quality of the meta-analyses. DESIGN: We analysed the various meta-analyses in detail and compared whether the authors have correctly included the various trials or not. RESULTS: We found that the quality of these meta-analyses was low. Especially the more recent meta-analyses included trials in which radiotherapy was not part of the medical intervention or where substances other than pure honey were used. CONCLUSIONS: It is impossible to determine the underlying reasons why these meta-analyses were able to pass the peer-review system without the request for adequate improvements prior to publication. According to the literature at least 7% of the included meta-analyses revealed false results, but it was assumed that due to limitations of external validity and to the decreased likelihood of updating positive meta-analyses, the true proportion of false positives in the meta-analysis was likely to be higher. However, it is crucial that when severe flaws in meta-analyses are detected that they be reported or the meta-analyses are withdrawn, otherwise the normal reader will take the results as given.

Using Bee Products for the Prevention and Treatment of Oral Mucositis Induced by Cancer Treatment.

Oral mucositis is one of the most frequent complications after chemotherapy or radiotherapy or a combination of both. There is no standard therapy for its prevention or treatment. Considering that some bee products have been found to be of value in this situation, we decided to analyze the scientific literature on the subject. Scientific publications on bee products were identified by a literature search on Pubmed, Scopus and Google Scholar. There is a lot of evidence regarding the use of honey for oral mucositis due to chemotherapy or radiotherapy or a combination of both. Unfortunately, the quality of several meta-analyses on the topic is very low. There is some evidence on propolis, a little on royal jelly and none whatsoever on pollen and other bee products like apilarnil or bee venom. Bee products such as honey, propolis and royal jelly may be well suited to be integrated into a general concept for the prevention and treatment of oral mucositis which should also include other established concepts like oral care, oral cryotherapy, topical vitamin E and low-level-laser therapy. Bee products could become an integral part in the treatment of chemotherapy, radiotherapy and radio chemotherapy. High-quality meta-analyses and further studies, especially on the combinations of various strategies, are needed.