[Integrative Oncology for Women with Breast Cancer]. / Integrative Onkologie in der Behandlung von Frauen mit Brustkrebs.

Integrative Oncology for Women with Breast Cancer Abstract. Integrative oncology is a patient-centered, evidence-informed field of cancer care, used worldwide to complement standard cancer care and is actively sought by patients. It is also well established in Switzerland. A wide range of procedures are used, such as mind body medicine, art therapies, exercise, nutrition, herbal medicines, nursing measures and specific complementary medical procedures. They support patients to regain health, improve their quality of life and enable them to take an active role in their health care management. An evidence-based guideline for integrative breast cancer treatment has been published by the Society of Integrative Oncology and implemented by the American Society of Clinical Oncology. Mistletoe therapy is a widely used herbal remedy to support cancer treatment and to improve quality of life. Its mode of action, safety and efficacy are being intensively investigated. The central focus of integrative oncology is a trusting and appreciative consultation on eye-level, so that a patient-centered and safe treatment concept can be designed.

Influence of alternative lifestyles on self-reported body weight and health characteristics in women.

BACKGROUND: Alternative lifestyles are often associated with distinct practices with respect to nutrition, physical activity, smoking, alcohol use and usage of complementary medicine. Evidence concerning effects of these lifestyle-related practices on health status is still fragmentary. OBJECTIVE: To describe maternal health characteristics related to alternative lifestyles, with emphasis on body-weight status, during pregnancy and maternity periods. METHODS: We compared self-reported health-related features of mothers with alternative lifestyles and conventional lifestyles during pregnancy and maternity period in the KOALA Birth Cohort Study. This cohort comprises two recruitment groups of mother-infant pairs, one with a conventional (no selection based on lifestyle, n = 2333), the other with an alternative lifestyle (selected via organic food shops, anthroposophic clinicians and midwives, anthroposophic under-five clinics, Rudolf Steiner schools and relevant magazines, n = 485). Mothers in the alternative group more frequently chose organic foods, adhered to specific living rules, practised vegetarianism and identified themselves with anthroposophy. RESULTS: Mothers in the alternative group showed lower BMI and lower prevalence of overweight and obesity than the conventional group, before pregnancy as well as 4-5 years after delivery. This difference was partly retained after adjusting for potential confounders. Furthermore, women in the alternative group had a lower prevalence of pregnancy-related hypertension, more often started breastfeeding and gave exclusive and prolonged breastfeeding for a longer period. Finally, they smoked less often, but more often drunk alcohol during pregnancy. CONCLUSION: The results suggest that an alternative lifestyle is associated with favourable body weight and with several differences in other health features.

Use of complementary and alternative medicine by patients presenting to a Paediatric Emergency Department.

Although the popularity of complementary and alternative medicine (CAM) has risen in the last decade, information about its use by paediatric patients presenting to an Emergency Department is still sparse. We report here the results of a cross-sectional survey of paediatric patients presenting to an urban, tertiary paediatric Emergency Department between October 2006 and March 2007. In total, 1143 questionnaires (68% of those distributed) were completed and available for analysis. Of these, 58% (n = 665) of all respondents admitted that their child had received some form of CAM therapy, while 25% (n = 291) admitted that their child was receiving CAM for the present illness. In 31% of the respondents (n = 354), CAM had been prescribed by a physician, while 50% (n = 575) used CAM as self-medication. Patients presented to the Emergency Department mostly because of an infection (42% of total; 29% of these used CAM) or a trauma (38% of total; 19% of these used CAM). Parents of CAM-users were significantly older, more often born in Switzerland and had significantly higher school education than those of the non-users. Nearly two-thirds of the administered CAM therapies were not prescribed by a physician, and 50% of the families using CAM did not discuss this with their general practitioner. Parental requirements implied that medical professionals on a paediatric Emergency Department should know the effects and side-effects of CAM therapies and even be able to recommend them. The study population, even trauma patients, frequently used CAM. The use of CAM is characterised by a high rate of self-medication and the exclusion of the physicians from the decision-making process. The parents of paediatric patients frequently demand that CAM be considered as a possible treatment option and wish to have an open discussion with the medical professionals on this topic.

Attitudes towards vaccination: users of complementary and alternative medicine versus non-users.

PRINCIPLES: Children whose parents use complementary and alternative medicine (CAM) often show a lower rate of vaccination than those of parents favouring conventional medicine. We have investigated whether this applies to the paediatric patients presenting to an emergency department in German-speaking Switzerland, where popularity of CAM is rather high. METHODS: A cross-sectional survey was performed of paediatric patients presenting to an urban, tertiary paediatric emergency department. 1,007 (63%) of the distributed 1,600 questionnaires were available for analysis. RESULTS: 12.7% of all respondents reported refusing some basic vaccination: 3.9% because of recommendation of the physician, 8.7% despite their physician's recommendation. Socio-demographic characterisation of the group of patients refusing vaccination showed older age of children, higher proportion of girls, more single-mothers families and decreased household income. Refusal of basic vaccination was significantly more frequent among CAM-users than among non-users (18.2% versus 3.5%, p <0.001). The highest frequencies of refusal were reported by patients who consulted physicians practicing herbal medicine, anthroposophical medicine or homeopathy. Users and non-users of CAM however, showed comparable rates of immunisation in the case of the vaccinations against invasive meningococcal, pneumococcal disease and flu. Surprisingly, the rate for vaccination against tick-borne encephalitis was higher in the CAM-users group than among the non-users (21.2% versus 15.4%, p <0.05). CONCLUSIONS: A considerable proportion of the study population did not fully accept basic vaccinations. Refusal to follow the basic vaccination schemata was more frequent among CAM-users than non-users and reflected in most cases parental wishes rather than physicians' recommendations.

Mistletoe lectin is not the only cytotoxic component in fermented preparations of Viscum album from white fir (Abies pectinata).

BACKGROUND: Preparations of mistletoe (Viscum album) are the form of cancer treatment that is most frequently used in the complementary medicine. Previous work has shown that these preparations are able to exert cytotoxic effects on carcinoma cells, the extent of which might be influenced by the host tree species and by the content of mistletoe lectin. METHODS: Using colorimetric assays, we have now compared the cytotoxic effects of Viscum album preparations (VAPs) obtained from mistletoe growing on oak (Quercus robur and Q. petraea, VAP-Qu), apple tree (Malus domestica,, VAP-M), pine (Pinus sylvestris, VAP-P) or white fir (Abies pectinata, VAP-A), on the in vitro growth of breast and bladder carcinoma cell lines. While MFM-223, KPL-1, MCF-7 and HCC-1937 were the breast carcinoma cell lines chosen, the panel of tested bladder carcinoma cells comprised the T-24, TCC-SUP, UM-UC-3 and J-82 cell lines. RESULTS: Each of the VAPs inhibited cell growth, but the extent of this inhibition differed with the preparation and with the cell line. The concentrations of VAP-Qu, VAP-M and VAP-A which led to a 50 % reduction of cell growth (IC50) varied between 0.6 and 0.03 mg/ml. Higher concentrations of VAP-P were required to obtain a comparable effect. Purified mistletoe lectin I (MLI) led to an inhibition of breast carcinoma cell growth at concentrations lower than those of VAPs, but the sensitivity towards purified MLI did not parallel that towards VAPs. Bladder carcinoma cells were in most cases more sensitive to VAPs treatment than breast carcinoma cells. The total mistletoe lectin content was very high in VAP-Qu (54 ng/mg extract), intermediate in VAP-M (25 ng/mg extract), and very low in VAP-P (1.3 ng/mg extract) and in VAP-A (1 ng/mg extract). As to be expected from the low content of mistletoe lectin, VAP-P led to relatively weak cytotoxic effects. Most remarkably, however, the lectin-poor VAP-A revealed a cytotoxic effect comparable to, or even stronger than, that of the lectin-rich VAP-Qu, on all tested bladder and breast carcinoma cell lines. CONCLUSION: The results suggest the existence of cytotoxic components other than mistletoe lectin in VAP-A and reveal an unexpected potential of this preparation for the treatment of breast and bladder cancer.

Intravenous tocolysis with Bryophyllum pinnatum is better tolerated than beta-agonist application.

OBJECTIVE: To compare tolerability and tocolytic outcome between i.v. infused plant extract, Bryophyllum pinnatum, and beta-agonists. STUDY DESIGN: In a retrospective study, 67 pairs of pregnant women in preterm labor treated with intravenous B. pinnatum or beta-agonists were closely matched for maternal age, gestational age at tocolysis, CTG recorded contractions, cervical effacement, preterm premature rupture of the membranes, and history of preterm labor. Endpoints were prolongation of pregnancy, gestational age at delivery, pre- and postpartum duration of hospitalization, maternal tolerability, neonatal outcome and morbidity. RESULTS: Pregnant women with B. pinnatum and beta-agonists were equal in the prolongation of pregnancy (6.2 versus 5.4 days, NS), the gestaional age at delivery (38.0 versus 37.1 weeks, NS) and the duration of hospitalisations, but had less adverse effects (34.3 versus 55.2% with palpitation or dyspnea, P=0.02). The neonatal outcome and morbidity in the B. pinnatum group were equal or better (oxygen use 10.4 versus 44.8%, P<0.001; respiratory distress syndrome 4.5 versus 19.4%, P=0.01). CONCLUSION: In the management of preterm labor B. pinnatum is no less effective than beta-agonists, but is significantly better tolerated.

Maternal dietary Alpine butter intake affects human milk: fatty acids and conjugated linoleic acid isomers.

Consumption of CLA by lactating women affects the composition of their milk, but the pattern of the different CLA isomers is still unknown. We determined the effects of short maternal supplementation with CLA-rich Alpine butter on the occurrence of FA and CLA isomers in human milk. In an open randomized controlled study with a two-period cross-over design, milk FA and CLA isomer concentrations were measured on postpartum days > or = 20 in two parallel groups of lactating women before, during, and after consumption of defined quantities of Alpine butter or margarine with comparable fat content (10 d of butter followed by 10 d of margarine for one group, and vice versa in the other). In the 16 women who completed the study (8/group), Alpine butter supplementation increased the C16 and C18 FA, the sum of saturated FA, the 18:1 trans FA, and the trans FA with CLA. The CLA isomer 18:2 c9,t11 increased by 49.7%. Significant increases were also found for the isomers t9,t11, t7,c9, t11,c13, and t8,c10 18:2. The remaining nine of the total 14 detectable isomers showed no changes, and concentrations were <5 mg/100 g fat. A breastfeeding mother can therefore modulate the FA/CLA supply of her child by consuming Alpine butter. Further studies will show whether human milk containing this FA and CLA isomer pattern acts as a functional food for newborns.

Effect of Bryophyllum pinnatum versus fenoterol on uterine contractility.

OBJECTIVE: To characterise the phytotherapeutic tocolytic Bryophyllum pinnatum in vitro versus the conventional betamimetic, fenoterol, in human myometrium. STUDY DESIGN: Contractility (endpoints: area under the curve (AUC), amplitude and frequency of isometric force development) was measured in strips of term myometrium biopsied at caesarean section in 14 women and exposed to increasing concentrations of B. pinnatum versus +/- oxytocin 1 U/l. RESULTS: Inhibition of spontaneous contraction by B. pinnatum was concentration-dependent: 16% at maximum concentration (10(4) mg/l), or 53% that with fenoterol 5 x 10(-8)mol/l. B. pinnatum increased contraction frequency by 91% at constant amplitude and inhibited oxytocin-stimulated contractions by 20% (AUC) at constant amplitude with slightly decreased frequency. Fenoterol decreased contraction AUC by 50% with a significant decrease in frequency. CONCLUSION: Our in vitro data confirm the tocolytic activity of B. pinnatum observed in alternative medicine centres and may justify further clinical studies.

Self-reported health characteristics and medication consumption by CAM users and nonusers: a Swiss cross-sectional survey.

OBJECTIVES: Complementary and alternative medicine (CAM) is very popular in Switzerland. The objective of this work was to find out whether the use of CAM therapies is associated with distinct health characteristics and altered consumption of conventional medications. DESIGN AND PARTICIPANTS: Self-reported data from the 2007 Swiss Health Survey were analyzed. Two groups of participants were defined and compared with each other: CAM users (those who had used CAM during the last 12 months, n=3333) and nonusers (those who stated they had not used CAM during the last 12 months, n=9821). OUTCOME MEASURES: Multivariate logistic regression models were used to determine the predictors of CAM use and to address relevance and magnitude of the differences in medication consumption between CAM users and nonusers. RESULTS: Comparatively lower body-mass index (BMI) values and migraine, arthritis, allergies, and depression were associated with increased probability of CAM use. Multivariate logistic regression models that adjusted for the effects of relevant demographic factors, BMI, and perceived health status showed that CAM users consumed fewer medications for cardiovascular diseases--high blood pressure and high cholesterol (and, by trend, heart problems and diabetes)--than nonusers. On the other hand, their consumption of analgesics and medications for depression and for constipation (and, by trend, sedatives and soporifics), was higher than that of nonusers. CONCLUSIONS: Migraine, arthritis, depression, and constipation might lead patients to use CAM therapies and, in addition, to consume more of some conventional medications. Given the long intake period and considerable adverse effects of medications, the lower consumption of these agents for chronic cardiovascular problems by CAM users might be beneficial and deserves further investigations.

Physiologic effects of rhythmical massage: a prospective exploratory cohort study.

OBJECTIVE: This study was performed to characterize the physiologic effects of rhythmical massage (RM), an anthroposophic therapy whose effectiveness is supported by empirical observations and a prospective observational study. METHODS: Patients referred to RM at the Paracelsus Hospital Richterswil for any indication were continuously enrolled. They received an average of 10 RM sessions, which included not only the massage but also therapeutic rest in the supine position immediately thereafter. Effects of RM on surface temperature and on heart rate variability (HRV) were determined with infrared imaging (IRI) and electrocardiography (ECG), respectively. IRI of the patients' dorsal region was performed without clothes, in standing position, at the start and at the end of two waiting periods before and after RM. ECG was performed from the beginning of the first waiting period until the end of the second one. RESULTS: Results on IRI from 9 and ECG from 11 patients could be analyzed. RM led to an immediate increase in dorsal temperature. Furthermore, comparison of the IRI images for consecutive RM sessions showed a tendency toward improved warmth distribution as a progressive therapy effect. Analysis of the EGC results recorded during the waiting periods-in the sitting position--showed a significant increase of HRV after RM, as detected by the standard deviation of the beat-to-beat periods and a relative increase of low-frequency power. During the course of the RM sessions, the change in HRV during the therapeutic rest period depended on the initial value: Low initial values were enhanced, whereas high ones were reduced. CONCLUSIONS: RM led to an immediate increase in the patient's dorsal surface temperature, as well as increased HRV and sympathetic stimulation. In the long term, RM resulted in a progressive improvement of warmth distribution and regulation of the resting HRV.

An exploratory study on the quality of life and individual coping of cancer patients during mistletoe therapy.

BACKGROUND: Although several clinical studies have shown that mistletoe therapy (MT, Viscum album) may improve cancer patients' quality-of-life (QoL), qualitative information on the improvement's nature is still lacking. DESIGN: This exploratory, prospective, cohort-study comprised 25 patients with different types of cancer. The patients filled in the EORTC QLQ-C30 Version 3.0 questionnaire at the beginning of MT (n = 25) and three months later (n = 21). If patients agreed, they were interviewed on both occasions (n = 17); the interviews were transcribed verbatim and submitted to a qualitative content analysis (n = 12). RESULTS: Analysis of the questionnaires showed significant improvements in several subscales during MT. The interviews analysis revealed that most patients adopted the MT with a supportive goal, with all patients undergoing conventional therapies. After three months of MT, most interviewed patients revealed higher vitality and autonomy. MT was often seen as a chance to make an own personal contribution to the therapy, which was particularly appreciated in cases in which no conventional therapy was (anymore) advised. Concrete personal achievements such as changes in the private and/or in the professional environment were spontaneously mentioned by the patients, illustrating and corroborating their improvements in QoL. CONCLUSION: Our results show that the patients experienced an improvement of QoL during MT. This therapy seemed to offer a platform for an integrative coping with the disease, which might be important in reconciling the perceived shock of an existential illness with a good QoL.

Medicinal systems of complementary and alternative medicine: a cross-sectional survey at a pediatric emergency department.

OBJECTIVE: The purpose of this study was to find out which experiences adults are making while treating children with complementary and alternative medicine (CAM) therapies in German-speaking Switzerland. DESIGN AND SUBJECTS: A cross-sectional survey was performed on adults accompanying the children presenting to an urban, tertiary pediatric emergency department in Zurich; 71% of the distributed questionnaires (1143 of 1600) could be used for data analysis. The respondents were asked about their experiences while treating the child with CAM and--for comparison reasons--with conventional medicine (CM). RESULTS: The respondents perceived the effectiveness of CAM therapies in general to be inferior to that of CM, although 49% of all respondents stated that CAM therapies were more effective than CM in certain cases/against certain diseases and 13% that CAM therapies were as effective as CM. Higher frequency of use and lower compliance were observed in the case of CAM, relatively to CM. Respondents described the direct costs for the patient of both types of medicine to be comparable. Ninety-three percent (93%) of the respondents experienced no side-effects with CAM therapies, whereas only 52% of the respondents stated the same about CM therapies; the observed side-effects of CAM were weaker than those of CM. Homeopathy was the most frequently used form of CAM (77% of all CAM users), followed by herbal medicine (64%), anthroposophic medicine (24%), Traditional Chinese Medicine (13%), Ayurveda (5%), and others (34%). CONCLUSIONS: From the respondents' point of view, the most marked difference between CAM- and CM therapies concerns the frequency and intensity of side-effects, which were markedly higher in the latter case. The respondents made use of a wide variety of CAM therapies.

Test of a homeopathic dilution of Aconitum napellus. A clinical, randomized, double-blind, controlled crossover study in healthy volunteers.

BACKGROUND: Although healthy persons often report on reactions to homeopathically diluted substances, the mechanism behind such reactions remains unclear. This study examines whether a distinction can be made between the short-term reactions of healthy volunteers to a homeopathically diluted substance - Aconitum napellus C30 - and to a placebo. PARTICIPANTS AND METHODS: From the 33 subjects randomized for this double-blind, placebo-controlled crossover study, 27 could be included in the analysis. The study comprised two 7-day-long treatment periods, each including the intake of a study preparation for 3 days and a wash-out period of 4 days. One group was first treated with Aconitum napellus C30 and then with placebo; the other group received the two study preparations in the reverse order. The signs and symptoms before the first treatment and after each treatment were collected, evaluated, weighted and repertorized. Based on this classification the blinded physician assessed these signs and symptoms as study outcome parameter to represent the responses to each of the study preparations. Statistical analysis of the data was performed using the Wilcoxon-Mann-Whitney rank test. RESULTS: Crossover differences yielded statistical significance between the classified reactions towards Aconitum napellus C30 and to placebo (p = 0.004). CONCLUSIONS: A clear difference between the reported short-term reactions of healthy subjects towards Aconitum napellus C30 and towards placebo was shown. The crossover design with intra-individual comparisons proved to be adequate to recognize the study preparations and for the statistical analysis of a small population sample.

Influence of organic diet on the amount of conjugated linoleic acids in breast milk of lactating women in the Netherlands.

The aim of the present study was to find out whether the incorporation of organic dairy and meat products in the maternal diet affects the contents of the conjugated linoleic acid isomers (CLA) and trans-vaccenic acid (TVA) in human breast milk. To this purpose, milk samples from 312 breastfeeding mothers participating in the KOALA Birth Cohort Study have been analysed. The participants had documented varying lifestyles in relation to the use of conventional or organic products. Breast milk samples were collected 1 month postpartum and analysed for fatty acid composition. The content of rumenic acid (the main CLA) increased in a statistically significant way while going from a conventional diet (no organic dairy/meat products, 0.25 weight % (wt%), n 186) to a moderately organic diet (50-90 % organic dairy/meat, 0.29 wt%, n 33, P = 0.02) and to a strict organic diet (>90 % organic dairy/meat, 0.34 wt%, n 37, P

Gene expression profiles of different breast cancer cells compared with their responsiveness to fermented mistletoe (Viscum album L.) extracts Iscador from oak (Quercus), pine (Pinus), white fir (Abies) and apple tree (Malus) in vitro.

Cytotoxicity assays in vitro (MTT test) showed that the different breast cancer cell lines Kpl-1, MCF-7 and Mfm-223 respond differently to the mistletoe (Viscum album L.) preparations Iscador. Quercus (Qu), Abies (A), Malus (M) and Pinus (P). In order to determine the differences in the responsiveness of the cells more exactly, the gene expression profiles were determined by cells, which were treated with Mistletoe extracts, compared with untreated control cells. Such differences can be analysed in more detail by looking at the gene expression using Human Whole Genome microarray chips (41,000 genes). The results of the transcriptome analyses suggested that Iscador preparations influenced the overregulation of genes regarding immune defense, stress response, apoptosis and cell-cell adhesion pathways. Within the Mfm-223-Zellen was the Genexpression in MCF-7 and Kpl-1. The MCF-7 cells were affected on the genes which are involved in cell-cell contacts whereas Kpl-1 responded to the mistletoe extracts by changing the mRNA levels of the immune and stress response pathways. Concerning the effects of the mistletoe extract, we conclude that Iscador Qu and M have a greater influence on the immune defense and stress response genes whereas Iscador A tends to affect the cell-cell adhesion and cytoskeleton pathways. In summary, cDNA microarray analyses give us information on whether a cancer cell is sensitive to mistletoe extracts in relation to how many genes are significantly overrepresented after mistletoe treatment, and whether a particular mistletoe extract is more effective on a specific cancer cell than the other preparation.