Complimentary Therapies for Cancer– Digest – July/August 1, 2015
Our current literature update includes:
Mao, J; Bowman, MA; Xie SX; Bruner D; DeMichele A; Farrar JT.
Electroacupuncture Versus Gabapentin for Hot Flashes Among Breast Cancer Survivors: A Randomized Placebo-Controlled Trial
Journal of Clinical Oncology, August 24, 2015; DOI:10.1200/JCO.2015.60.9412.
Purpose Hot flashes are a common and debilitating symptom among survivors of breast cancer. This study aimed at evaluating the effects of electroacupuncture (EA) versus gabapentin (GP) for hot flashes among survivors of breast cancer, with a specific focus on the placebo and nocebo effects.
Patients and Methods We conducted a randomized controlled trial involving 120 survivors of breast cancer experiencing bothersome hot flashes twice per day or greater. Participants were randomly assigned to receive 8 weeks of EA or GP once per day with validated placebo controls (sham acupuncture [SA] or placebo pills [PPs]). The primary end point was change in the hot flash composite score (HFCS) between SA and PP at week 8, with secondary end points including group comparisons and additional evaluation at week 24 for durability of treatment effects.
Results By week 8, SA produced significantly greater reduction in HFCS than did PP (−2.39; 95% CI, −4.60 to −0.17). Among all treatment groups, the mean reduction in HFCS was greatest in the EA group, followed by SA, GP, and PP (−7.4 v −5.9 v −5.2 v−3.4; P = < .001). The pill groups had more treatment-related adverse events than did the acupuncture groups: GP (39.3%), PP (20.0%), EA (16.7%), and SA (3.1%), with P = .005. By week 24, HFCS reduction was greatest in the EA group, followed by SA, PP, and GP (−8.5 v −6.1 v −4.6 v −2.8; P = .002).
Conclusion Acupuncture produced larger placebo and smaller nocebo effects than did pills for the treatment of hot flashes. EA may be more effective than GP, with fewer adverse effects for managing hot flashes among breast cancer survivors; however, these preliminary findings need to be confirmed in larger randomized controlled trials with long-term follow-up.
Commentary by Ting Bao
Over the past three months, there have been a number of acupuncture clinical trials published. Among them, the electroacupuncture clinical trial conducted by Mao et al1 and published in the Journal of Clinical Oncology is the most innovative and thought-provoking.
In this trial, investigators randomized 120 breast cancer survivors suffering from hot flashes at least twice daily into four arms: electroacupuncture (EA), sham acupuncture (SA), gabapentin (GP), and placebo pills (PP) for 8 weeks. Unlike other acupuncture efficacy trials, however, the primary end point was the change in hot flash composite scores (HFCS) between SA and PP at week 8, with secondary end points including post-treatment comparisons of all groups at different time points and to examine treatment durability at week 24.
The emphasis on SA and PP outcomes and their placebo versus nocebo effects stems from the paradox that while some trials indicate similar results with real and sham acupuncture for hot flashes,2-4 real acupuncture also produces responses equivalent with pharmacologic treatments such as venlafaxine, but without adverse effects.5 Therefore, investigators further identified the value in learning the extent to which sham acupuncture may or may not also perform better than a corresponding GP placebo pill, based on gabapentin efficacy.6
In Mao et al1, SA produced significantly greater reductions in HFCS than PP by week 8, indicating a greater placebo effect with SA. Compared with baseline scores, although all arms experienced HFCS reductions, SA produced significantly better results than both GP and PP interventions (EA −7.4, SA −5.9, GP −5.2, and PP −3.4). In addition, SA had a smaller nocebo effect than PP, as evidenced by the significantly higher percentage of reported adverse events for PP compared with SA (20.0% vs 3.1%, respectively).
An intriguing finding is the more durable effect in HFCS reductions produced at week 24 (16 weeks post-treatment) with both EA and SA treatments (EA −8.5 , SA −6.1) than with gabapentin (GP −2.8), suggesting that both types of acupuncture may elicit underlying physiologic changes not induced by pharmacologic intervention. On the other hand, the effect size of EA compared with SA was small at week 8 (Cohen’s d = 0.21) but got bigger at week 24 (Cohen’s d = 0.31), suggesting EA may produce additional or longer-lasting physiological effects than SA.
This is the one of the few studies comparing the placebo and nocebo effects of acupuncture with pills. These findings may help to explain the lack of statistically significant differences between treatment arms in many trials evaluating true acupuncture versus sham controls, since the placebo effect has now been determined to be larger with SA than PP interventions. Designing a sham acupuncture-controlled trial may require a much bigger sample size than placebo pill-controlled trials due to significant larger placebo in SA than PP. This study validates the importance of determining how and the extent to which SA differs from pharmacologic placebos as well as its performance against both types of active interventions. Further, the demonstrated durability with EA and to a lesser extent SA, 16 weeks post-intervention vis-à-vis the lack of durability with GP bears special mention and should influence design considerations of future acupuncture trials, as longer follow-up is warranted.
1. Mao JJ, Bowman MA, Xie SX, Bruner D, DeMichele A, Farrar JT: Electroacupuncture Versus Gabapentin for Hot Flashes Among Breast Cancer Survivors: A Randomized Placebo-Controlled Trial. J Clin Oncol, 2015
2. Vincent A, Barton DL, Mandrekar JN, Cha SS, Zais T, Wahner-Roedler DL, Keppler MA, Kreitzer MJ, Loprinzi C: Acupuncture for hot flashes: a randomized, sham-controlled clinical study. Menopause 14:45-52, 2007
3. Deng G, Vickers A, Yeung S, D'Andrea GM, Xiao H, Heerdt AS, Sugarman S, Troso-Sandoval T, Seidman AD, Hudis CA, Cassileth B: Randomized, controlled trial of acupuncture for the treatment of hot flashes in breast cancer patients. J Clin Oncol 25:5584-90, 2007
4. Bao T, Cai L, Snyder C, Betts K, Tarpinian K, Gould J, Jeter S, Medeiros M, Chumsri S, Bardia A, Tan M, Singh H, Tkaczuk KH, Stearns V: Patient-reported outcomes in women with breast cancer enrolled in a dual-center, double-blind, randomized controlled trial assessing the effect of acupuncture in reducing aromatase inhibitor-induced musculoskeletal symptoms. Cancer 120:381-9, 2014
5. Walker EM, Rodriguez AI, Kohn B, Ball RM, Pegg J, Pocock JR, Nunez R, Peterson E, Jakary S, Levine RA: Acupuncture versus venlafaxine for the management of vasomotor symptoms in patients with hormone receptor-positive breast cancer: a randomized controlled trial. J Clin Oncol 28:634-40, 2010
6. Loprinzi CL, Sloan J, Stearns V, Slack R, Iyengar M, Diekmann B, Kimmick G, Lovato J, Gordon P, Pandya K, Guttuso T, Jr., Barton D, Novotny P: Newer antidepressants and gabapentin for hot flashes: an individual patient pooled analysis. J Clin Oncol 27:2831-7, 2009
Greenlee H; Crew KD; Capodice J; Awad D; Jeffres A; Unger JM; Lew DL; Hansen LK; Meyskens FL Jr; Wade JL 3rd; Hershman DL.
Methods to Standardize a Multicenter Acupuncture Trial Protocol to Reduce Aromatase Inhibitor-related Joint Symptoms in Breast Cancer Patients.
Jams Journal of Acupuncture & Meridian Studies. 8(3):152-8, 2015 Jun.
Robust methods are needed to efficiently conduct large, multisite, randomized, controlled clinical trials of acupuncture protocols. The Southwest Oncology Group (SWOG) S1200 trial is a randomized, controlled (i.e., sham-controlled and waitlist-controlled) trial of a standardized acupuncture protocol for treating aromatase inhibitor (AI)-associated arthralgias in early-stage breast cancer patients (n = 228). The primary objective of this study was to determine whether true acupuncture administered twice weekly for 6 weeks, as compared to sham acupuncture or a waitlist control, reduced AI-associated joint pain at 6 weeks as assessed by patient reports. The study was conducted at 11 institutions across the United States. The true acupuncture protocol was developed using a consensus-based process. The true acupuncture and the sham acupuncture protocols each consisted of 12 sessions administered for 6 weeks, followed by one weekly session for 6 weeks. The true acupuncture protocol used standardized protocol points, and the standardized acupoints were tailored to a patient's joint symptoms. The similarly standardized sham acupuncture protocol utilized superficial needling of nonacupoints. Standardized methods were developed to train and monitor acupuncturists and included online and in-person training, study manuals, monthly phone calls, and remote quality assurance monitoring throughout the study period. The research staff similarly received online and in-person training and monthly phone calls.
Kim JS; Lee HJ; Lee SH; Lee BH.
Recurrent Oligodendroglioma Treated with Acupuncture and Pharmacopuncture.
Jams Journal of Acupuncture & Meridian Studies. 8(3):147-51, 2015 Jun.
Acupuncture and pharmacopuncture have been shown to be effective in tumor treatment. However, their effectiveness for treating oligodendroglioma has not been reported yet. The purpose of this study was to provide an initial report on the effectiveness of acupuncture and pharmacopuncture for the treatment of an oligodendroglioma by presenting a case that was treated successfully. A 54-year-old man, who had experienced intracranial hemorrhage, was diagnosed with recurrent oligodendroglioma. His expected survival period was 3-6 months. The patient received daily acupuncture and weekly pharmacopuncture of mountain ginseng and bee venom. After treatment for 18 months, the tumor size was decreased markedly on brain magnetic resonance imaging, and severe seizures had disappeared. In this case, a combination of acupuncture and pharmacopuncture was shown to be effective for the treatment of recurrent oligodendroglioma.
Thompson LM; Osian SR; Jacobsen PB; Johnstone PA.
Patient-reported Outcomes of Acupuncture for Symptom Control in Cancer.
Jams Journal of Acupuncture & Meridian Studies. 8(3):127-33, 2015 Jun.
Acupuncture is increasingly offered as a treatment option for managing cancer-related symptoms. In addition to randomized controlled trials, patient-reported outcomes may be needed to establish treatment effectiveness. This study retrospectively examined the symptoms and the satisfaction ratings of 90 patients receiving acupuncture at an integrative oncology clinic. At least two acupuncture sessions were completed by 72% of the sample. The prevalence rates of fatigue, pain, anxiety, physical distress, emotional distress, and poor quality of life before acupuncture were > 62%. Paired t tests revealed a significant reduction in symptoms from baseline until after the first acupuncture session and after the last session (p < 0.05). Fewer (21%) patients reported nausea, which was significantly reduced after the first session, but not the last session. Reductions represented clinically meaningful differences in 33-41% of patients after the first session and in 41-53% of patients after the last session for all symptoms, except nausea. A small subset of patients (0-8%) reported worsening symptoms after acupuncture. The majority were satisfied with the service. The results of this study suggest that acupuncture may be useful as an adjunct treatment for cancer symptom management. While high-quality trials are still needed to establish the treatment's efficacy, patients may benefit from these primarily safe, low-cost services.
Halsey EJ; Xing M; Stockley RC. Metropolitan University,
Acupuncture for joint symptoms related to aromatase inhibitor therapy in postmenopausal women with early-stage breast cancer: a narrative review.
Acupuncture in Medicine. 33(3):188-95, 2015 Jun.
BACKGROUND: Aromatase inhibitor-induced musculoskeletal syndrome (AIMSS) leads to discontinuation of aromatase inhibitor therapy in a significant proportion of patients with breast cancer. Acupuncture is popular among cancer patients and has previously been shown to improve symptoms in a range of musculoskeletal complaints.
AIM: To determine the effectiveness and safety of acupuncture for the management of AIMSS in postmenopausal women with early-stage breast cancer.
METHODS: A literature search was carried out for randomised controlled trials (RCTs) on acupuncture for AIMSS in postmenopausal women with early-stage breast cancer. Characteristics of trials and outcomes were extracted from the retrieved articles, which were also assessed for risk of bias and quality of reporting.
RESULTS: Four RCTs were retrieved of sample size 32-67 (totalling 190 participants). Compliance with treatment was high and rates of adverse events were low. Of the three two-arm RCTs, two found no difference between acupuncture and sham acupuncture and one found that acupuncture was statistically superior to sham acupuncture. The fourth RCT, which incorporated three arms, found acupuncture and sham acupuncture to be statistically superior to usual care but there was no difference between true and sham acupuncture. Three trials that used non-penetrating sham as the control found no effect of acupuncture over sham, but the one trial that used superficial needle insertion found acupuncture to be superior.
CONCLUSIONS: Acupuncture is safe and results in improvement in AIMSS
symptoms, but similar benefits are also elicited by non-penetrating sham acupuncture. Future research should seek to establish the durability of improvements.
McKeon C; Smith CA; Gibbons K; Hardy J.
EA versus sham acupuncture and no acupuncture for the control of acute and delayed chemotherapy-induced nausea and vomiting: a pilot study.
Acupuncture in Medicine. 33(4):277-83, 2015 Aug.
OBJECTIVE: To assess the feasibility of undertaking a high-quality randomised controlled study to determine whether EA gives better control of delayed chemotherapy-induced nausea and vomiting (CINV) than sham EA or standard antiemetic treatment alone.
METHODS: Patients having their first cycle of moderately or highly emetogenic chemotherapy were randomised to EA, sham EA or standard care. EA was given for 30 min on day 1 at the time of chemotherapy and on day 3 using standard acupuncture points bilaterally. Sham EA was given to points adjacent to true EA points. All patients received usual care, comprising antiemetics, according to hospital guidelines. The primary outcomes related to study feasibility, and the clinical outcome measure was the change in Functional Living Index Emesis (FLIE) score captured on days 1 and 7.
RESULTS: 153 participants were screened between April 2009 and May 2011. Eighteen patients did not meet the inclusion criteria, 37 declined to participate and the absence of an acupuncturist or lack of consent from the treating oncologist excluded a further 38 patients; 60 patients were recruited. The FLIE was completed on day 7 by 49 participants; 33 of 40 patients returned on day 3 for treatment. The nausea and vomiting scores were low in all three arms. Adverse events were generally mild and infrequent.
CONCLUSIONS: It was feasible to undertake a randomised EA trial on a busy day oncology unit. As few patients experienced nausea with their first cycle of chemotherapy, it was not possible to determine whether EA improves CINV over standard care. An enriched enrolment strategy is indicated for future studies. A simple numerical rating scale may prove a better objective nausea measure than the FLIE.
Liu X; Li S; Wang B; An L; Ren X; Wu H.
Intraoperative and postoperative anaesthetic and analgesic effect of multipoint transcutaneous electrical acupuncture stimulation combined with sufentanil anaesthesia in patients undergoing supratentorial craniotomy.
Acupuncture in Medicine. 33(4):270-6, 2015 Aug.
OBJECTIVES: To investigate the anaesthetic and analgesic effect of multipoint transcutaneous electrical acupuncture stimulation (TEAS) during supratentorial tumour resection for postoperative recovery and side effects.
METHODS: In a blinded clinical trial, 92 patients scheduled for supratentorial craniotomy under general anaesthesia were randomly allocated into either a multipoint TEAS (n=46) or a sham TEAS group (n=46). All patients received total intravenous anaesthesia (TIVA) with propofol and sufentanil. The target concentration of sufentanil was adjusted and recorded according to mean arterial pressure (MAP), heart rate (HR) and bispectral index (BIS). Patients in the TEAS group received TEAS 30 min before anaesthesia induction and this was maintained throughout the operation at four pairs of acupuncture points. Postoperative pain, recovery and side effects were evaluated.
RESULTS: Eighty-eight patients completed the study. Continuous monitoring of MAP, HR and BIS showed stable values with no significant differences between the two groups (p>0.05). Sufentanil target plasma concentration in TEAS patients was significantly lower at some time points during supratentorial craniotomy, and total sufentanil consumption was significantly higher in the sham group (p<0.05). Postoperative recovery and pain were significantly improved by TEAS (p<0.001), without the postoperative side effects.
CONCLUSIONS: Multipoint TEAS at both proximal and distal points combined with TIVA can significantly decrease intraoperative sufentanil requirements, increase pain relief on postoperative day 1 and improve postoperative recovery of patients during supratentorial tumour resection, with no significant increase of side effects. These findings suggest that multipoint TEAS may be clinically effective as an adjunct to analgesia in intraoperative anaesthesia and postoperative pain treatment and may speed recovery.
Derry HM; Jaremka LM; Bennett JM; Peng J; Andridge R; Shapiro C; Malarkey WB; Emery CF; Layman R; Mrozek E; Glaser R; Kiecolt-Glaser JK.
Yoga and self-reported cognitive problems in breast cancer survivors: a randomized controlled trial.
Psycho-Oncology. 24(8):958-66, 2015 Aug.
OBJECTIVES: Cancer survivors often report cognitive problems. Furthermore, decreases in physical activity typically occur over the course of cancer treatment. Although physical activity benefits cognitive function in noncancer populations, evidence linking physical activity to cognitive function in cancer survivors is limited. In our recent randomized controlled trial, breast cancer survivors who received a yoga intervention had lower fatigue and inflammation following the trial compared with a wait list control group. This secondary analysis of the parent trial addressed yoga's impact on cognitive complaints.
METHODS: Posttreatment stage 0-IIIA breast cancer survivors (n=200) were randomized to a 12-week, twice-weekly Hatha yoga intervention or a wait list control group. Participants reported cognitive complaints using the Breast Cancer Prevention Trial Cognitive Problems Scale at baseline, immediately postintervention, and 3-month follow-up.
RESULTS: Cognitive complaints did not differ significantly between groups immediately postintervention (p=0.250). However, at 3-month follow-up, yoga participants' Breast Cancer Prevention Trial Cognitive Problems Scale scores were an average of 23% lower than wait list participants' scores (p=0.003). These group differences in cognitive complaints remained after controlling for psychological distress, fatigue, and sleep quality. Consistent with the primary results, those who practiced yoga more frequently reported significantly fewer cognitive problems at 3-month follow-up than those who practiced less frequently (p<0.001).
CONCLUSIONS: These findings suggest that yoga can effectively reduce breast cancer survivors' cognitive complaints and prompt further research on mind-body and physical activity interventions for improving cancer-related cognitive problems
Commentary by Linda Carlson
There have been many yoga studies in cancer survivors over the last several years, particularly in breast cancer, and in 2012 alone there were seven review papers and meta-analyses published 1-7. These summarize results showing consistent benefit across outcomes including quality of life and psychological well-being, but until now there has only been one report of a case series of four women which studied the impact of yoga on cognitive function 8. Hence this study is significant in that it is the first to include a large sample size, and it randomized women into intervention and wait-list groups, providing a fair comparator for efficacy of the program.
Improvements in cognitive function were not apparent immediately following the program, but were evident 3 months later, and were particularly strong in women who practiced more yoga. The effects do not appear to be secondary to improvements in sleep, fatigue or distress in the yoga group. These results are compelling and beg the question of just why or how yoga could impact the cognitive problems of mental fuzziness, memory and concentration difficulties collectively known as “chemo brain”. Further research should be conducted to better understand this phenomenon, perhaps supplementing objective and patient-reported measures with qualitative interviews in an attempt to triangulate findings and better understand the mechanisms of such an effect, should it prove reproducible.
Indeed, should these benefits be real and significant for cancer survivors, this would be quite a boon for the high proportion of patients who continue to suffer from treatment-related cognitive difficulties.
1. Buffart LM, van Uffelen JG, Riphagen II, et al. Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials. BMC Cancer. 2012;12:559-2407-12-559.
2. Levine AS, Balk JL. Yoga and quality-of-life improvement in patients with breast cancer: A literature review. Int J Yoga Therap. 2012;(22)(22):95-99.
3. Harder H, Parlour L, Jenkins V. Randomised controlled trials of yoga interventions for women with breast cancer: A systematic literature review. Support Care Cancer. 2012;20(12):3055-3064.
4. Cramer H, Lange S, Klose P, Paul A, Dobos G. Yoga for breast cancer patients and survivors: A systematic review and meta-analysis. BMC Cancer. 2012;12:412-2407-12-412.
5. Cramer H, Lange S, Klose P, Paul A, Dobos G. Can yoga improve fatigue in breast cancer patients? A systematic review. Acta Oncol. 2012;51(4):559-560.
6. Zhang J, Yang KH, Tian JH, Wang CM. Effects of yoga on psychologic function and quality of life in women with breast cancer: A meta-analysis of randomized controlled trials. J Altern Complement Med. 2012;18(11):994-1002.
7. Culos-Reed SN, Mackenzie MJ, Sohl SJ, Jesse MT, Zahavich AN, Danhauer SC. Yoga & cancer interventions: A review of the clinical significance of patient reported outcomes for cancer survivors. Evid Based Complement Alternat Med. 2012;2012:642576.
Explore (NY). 2012 Mar-Apr;8(2):127-35. doi: 10.1016/j.explore.2011.12.001.
8. Galantino ML, Greene L, Daniels L, Dooley B, Muscatello L, O'Donnell L. Longitudinal impact of yoga on chemotherapy-related cognitive impairment and quality of life in women with early stage breast cancer: a case series. Explore (NY). 2012 Mar-Apr;8(2):127-35.
Milbury K; Mallaiah S; Lopez G; Liao Z; Yang C; Carmack C; Chaoul A;
Spelman A; Cohen L.
Vivekananda Yoga Program for Patients With Advanced Lung Cancer and Their Family Caregivers.
Integrative Cancer Therapies. 14(5):446-51, 2015 Sep.
BACKGROUND: The primary purpose of this study was to establish the feasibility of a couple-based Vivekananda Yoga (VKC) intervention in lung cancer patients and caregivers. Secondly, we examined preliminary efficacy regarding quality of life (QOL) outcomes.
METHOD: In this single-arm feasibility trial, patients with lung cancer undergoing radiotherapy and their caregivers participated in a 15-session VKC program that focused on the interconnectedness of the dyad. We assessed pre-and post-intervention levels of fatigue, sleep disturbances, psychological distress, overall QOL, spirituality, and relational closeness. We tracked feasibility data, and participants completed program evaluations.
RESULTS: We approached 28 eligible dyads of which 15 (53%) consented and 9 (60%) completed the intervention. Patients (mean age = 73 years, 63% female, all stage III) and caregivers (mean age = 62 years, 38% female, 63% spouses) completed a mean of 10 sessions and 95.5% of them rated the program as very useful. Paired t tests revealed a significant increase in patients' mental health (d = 0.84; P = .04) and a significant decrease in caregivers' sleep disturbances (d = 1.44; P = .02). Although not statistically significant, for patients, effect sizes for change scores were medium for benefit finding and small for distress (d = 0.65 and 0.37, respectively). For caregivers, medium effects were found for improvement in physical functioning (d = 0.50).
CONCLUSION: This novel supportive care program appears to be safe, feasible, acceptable, and subjectively useful for lung cancer patients and their caregivers and lends support for further study.
McCall M; Thorne S; Ward A; Heneghan C.
Yoga in adult cancer: an exploratory, qualitative analysis of the patient experience.
BMC Complementary & Alternative Medicine. 15:245, 2015.
BACKGROUND: Some patients receiving treatment in conventional health care systems access therapeutic yoga outside their mainstream care to improve cancer symptoms. Given the current knowledge gap around patient preferences and documented experiences of yoga in adult cancer, this study aimed to describe patient-reported benefits, barriers and characteristics of programming for yoga practice during conventional treatment.
METHODS: In depth semi-structured interviews (n=10) were conducted in men and women recruited from cancer care clinics in Vancouver, Canada using a purposive sampling technique. The exploratory interviews were audio-recorded, transcribed and analyzed using Interpretive Description methodology and constant comparative analysis methods.
RESULTS: Four themes emerged from the data to address our research objectives: patient-perceived benefits of yoga, reasons and motivations for practising yoga, hurdles and barriers to practising yoga, and advice for effective yoga program delivery in adult cancer. Several patients reported yoga reduced stress and other symptoms associated with cancer treatment. Thematic analysis found the social dimension of group yoga was important, as well as yoga's ability to encourage personal empowerment and awareness of physical body and self. Barriers to yoga adherence from the patient perspective included lack of time, scheduling conflicts and worries about financial burden.
CONCLUSION: This small, diverse sample of patients reported positive experiences and no adverse effects following yoga practice for management of cancer and its symptoms. Results of this qualitative study identified patient-reported preferences, barriers and characteristics of yoga intervention optimal during adult cancer treatment.
McCall M; McDonald M; Thorne S; Ward A; Heneghan C.
Yoga for Health-Related Quality of Life in Adult Cancer: A Randomized Controlled Feasibility Study.
Evidence-Based Complementary & Alternative Medicine: eCAM. 2015:816820, 2015.
An increase in patient-led uptake of complementary therapies in adult cancer has led to a need for more rigorous study of such interventions and their outcomes. This study therefore aimed to evaluate the feasibility and acceptability of a yoga intervention in men and women receiving conventional treatment for a cancer diagnosis. Prospective, mixed methods feasibility trial allocated participants to receive one of three yoga interventions over a four-week study period. Data collection was completed through online survey of QOL-CA/CS and customized surveys. Fifteen participants were included (11 female) undergoing treatment for breast, prostate, colorectal, brain, and blood and lung cancer. Two participants dropped out and complete qualitative and quantitative data sets were collected from 12 participants and four yoga instructors. Other outcome measures included implementation costs patient-reported preferences for yoga intervention and changes in QOL-CA/CS. Three types of yoga intervention were safely administered in adult cancer. Mixed methods, cost-efficiency, QOL-CA/CS, and evidence-based design of yoga intervention have been used to establish feasibility and patient-preferences for yoga delivery in adult caner. Results suggest that, with some methodological improvements, a large-scale randomized controlled trial is warranted to test the efficacy of yoga for male and female cancer patients. This trial is registered with Clinicaltrials.gov NCT02309112.
MINDFULNESS BASED STRESS REDUCTION
Johns SA; Brown LF; Beck-Coon K; Monahan PO; Tong Y; Kroenke K.
Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors.
Psycho-Oncology. 24(8):885-93, 2015 Aug.
OBJECTIVE: Cancer-related fatigue (CRF) is one of the most common, persistent, and disabling symptoms associated with cancer and its treatment. Evidence-based treatments that are acceptable to patients are critically needed. This study examined the efficacy of mindfulness-based stress reduction (MBSR) for CRF and related symptoms.
METHOD: A sample of 35 cancer survivors with clinically significant CRF was randomly assigned to a 7-week MBSR-based intervention or wait-list control group. The intervention group received training in mindfulness meditation, yoga, and self-regulatory responses to stress. Fatigue interference (primary outcome) and a variety of secondary outcomes (e.g., fatigue severity, vitality, disability, depression, anxiety, and sleep disturbance) were assessed at baseline, post-intervention, and 1-month follow-up. Bonferroni correction was employed to account for multiple comparisons. Controls received the intervention after the 1-month follow-up. Participants in both groups were followed for 6months after completing their respective MBSR courses to assess maintenance of effects.
RESULTS: Compared to controls, the MBSR group reported large post-intervention reductions as assessed by effect sizes (d) in the primary outcome, fatigue interference (d=-1.43, p<0.001), along with fatigue severity (d=-1.55, p<0.001), vitality (d=1.29, p<0.001), depression (d=-1.30, p<0.001), and sleep disturbance (d=-0.74, p=0.001). Results were maintained or strengthened at 1-month follow-up, the point at which significant improvements in disability (d=-1.22, p<0.002) and anxiety (d=-0.98, p=0.002) occurred. Improvements in all outcomes were maintained 6months after completing the course. MBSR adherence was high, with 90% attendance across groups and high rates of participant-reported home practice of mindfulness.
CONCLUSIONS: Mindfulness-based stress reduction is a promising treatment for CRF and associated symptoms.
Demir M; Can G; Kelam A; Aydiner A.
Effects of Distant Reiki On Pain, Anxiety and Fatigue in Oncology Patients in Turkey: A Pilot Study.
Asian Pacific Journal of Cancer Prevention: Apjcp. 16(12):4859-62, 2015.
BACKGROUND: Fatigue, stress and pain are common symptoms among cancer patients, affecting the quality of life. The purpose of the present study was to determine the effect of distant Reiki on pain, anxiety and fatigue in oncology patients.
MATERIALS AND METHODS: Participants in the control group received usual medical and nursing care during their stay. The intervention group received usual care plus five distant Reiki sessions, one each night for 30 min. A face to face interview was performed and patient personal and illness related characteristics were evaluated using the Patient Characteristics form. Pain, stress and fatigue were evaluated according to a numeric rating scale.
RESULTS: The experimental group was predominantly composed of women (71.4%), married individuals (40%), and primary school graduates (40%). The control group was predominantly male (72.7%), married (60%), and primary school graduates (60%). The control group demonstrated greater levels of pain (p=0.002), stress (p=0.001) and fatigue (p=0.001). The Reiki group pain score (p <0.0001), stress score (p <0.001) and fatigue score were also significantly lower.
CONCLUSIONS: The results of this study indicate that Reiki may decrease pain, anxiety and fatigue in oncology patients.
Rossi E; Vita A; Baccetti S; Di Stefano M; Voller F; Zanobini A.
Complementary and alternative medicine for cancer patients: results of the EPAAC survey on integrative oncology centres in Europe.
Supportive Care in Cancer. 23(6):1795-806, 2015 Jun.
BACKGROUND: The Region of Tuscany Health Department was included as an associated member in WP7 "Healthcare" of the European Partnership for Action Against Cancer (EPAAC), initiated by the EU Commission in 2009.
AIMS: The principal aim was to map centres across Europe prioritizing those that provide public health services and operating within the national health system in integrative oncology (IO).
METHODS: A cross-sectional descriptive survey design was used to collect data. A questionnaire was elaborated concerning integrative oncology therapies to be administered to all the national health system oncology centres or hospitals in each European country. These institutes were identified by convenience sampling, searching on oncology websites and forums. The official websites of these structures were analysed to obtain more information about their activities and contacts.
RESULTS: Information was received from 123 (52.1 %) out of the 236 centres contacted until 31 December 2013. Forty-seven out of 99 responding centres meeting inclusion criteria (47.5 %) provided integrative oncology treatments, 24 from Italy and 23 from other European countries. The number of patients seen per year was on average 301.2+/-337. Among the centres providing these kinds of therapies, 33 (70.2 %) use fixed protocols and 35(74.5 %) use systems for the evaluation of results. Thirty-two centres (68.1 %) had research in progress or carried out until the deadline of the survey. The complementary and alternative medicines (CAMs) more frequently provided to cancer patients were acupuncture 26 (55.3 %), homeopathy 19(40.4 %), herbal medicine 18 (38.3 %) and traditional Chinese medicine 17(36.2 %); anthroposophic medicine 10 (21.3 %); homotoxicology 6 (12.8 %); and other therapies 30 (63.8 %). Treatments are mainly directed to reduce adverse reactions to chemo-radiotherapy (23.9 %), in particular nausea and vomiting (13.4 %) and leucopenia (5 %). The CAMs were also used to reduce pain and fatigue (10.9 %), to reduce side effects of iatrogenic menopause (8.8 %) and to improve anxiety and depression (5.9 %), gastrointestinal disorders (5 %), sleep disturbances and neuropathy (3.8 %).
CONCLUSIONS: Mapping of the centres across Europe is an essential step in the process of creating a European network of centres, experts and professionals constantly engaged in the field of integrative oncology, in order to increase, share and disseminate the knowledge in this field and provide evidence-based practice.