Navajo Nation's Regional Healthcare Facility Needs Our Help

The current COVID-19 pandemic has acutely affected the Navajo Nation, which lives in a region spanning parts of Arizona, Utah and New Mexico. Historically, the Navajo People have suffered high rates of diabetes, cardiovascular disease and cancer, all of which contribute to increased risk for poorer COVID-19 outcomes.

For decades, tribal land has been left without basic infrastructure such as running water, electricity and paved roads.

The Indian Health Service has been chronically underfunded, and the Tuba City Regional Healthcare Corporation is the only cancer treatment location on any Native American soil. The SIO is honored to present this support initiative. Donations will go directly to Tuba City Regional Healthcare through the Cancer Support Community donation page, and will be used for essential healthcare needs such as PPE for staff and hand sanitizer. Please join us in this opportunity to improve the lives of those who suffer such health disparities. Learn  more on our COVID-19 Resources page and submit your contribution on our Donation page.

 

Integrative Oncology Talk Podcast to Feature Navajo Nation Recording Artist, Inspirational Speaker and Spiritual Healer, Tony Redhouse

 
Dr. Rao and Mr Redhouse are joined by Leigh Leibel, MSc. Ms. Leibel holds a Masters in Science in Yoga Therapy (S-Vyasa in Bengaluru, India) and maintains a clinical practice in Integrative Oncology at Columbia University Irving Medical Center.  She initiated the Yoga Sig for the Society for Integrative Oncology and, more recently, co-created Wellspring.Global, a collaborative of healthcare providers delivering evidence based digital interventions for no charge to vulnerable populations and frontline providers to help with stress and anxiety during covid.  For more information, please visit leighleibel.com
 

The Society for Integrative Oncology is assisting the Navajo nation as they have been deeply impacted by the COVID-19 pandemic.  Please consider contributing to our SIO fundraiser for the Tuba City Regional Health Care Corporation, the only cancer treatment center on Native American soil, which is in need of community and medical supplies to combat COVID-19.  For more information on this ongoing fundraising initiative, please visit https://integrativeonc.org/covid-19-resources and visit SIO's donation page to contribute.

  

18th International Conference Rescheduled to September 24-26, 2021 

Read letter from SIO President, Ting Bao, MD, DABMA, MS.

SIO Abstract Submissions Portal Will Re-Open in Early 2021

Due to the 17th International Conference being postponed until September 24-26, 2021, we have closed the abstract submisssions portal. Please watch for notifications of its re-opening in early 2021. All abstracts that have been submitted to date will be saved and submitted to the review committee. 

 


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Clinical Practice Guidelines

SIO is pleased to provide its updated clinical practice guidelines for breast cancer. In June 2018, ASCO announced endorsement of the guidelines. The guidelines were published in 2017. Researchers analyzed which integrative treatments are most effective and safe for patients with breast cancer. The guidelines are a resource for clinicians and patients to inform evidence-based decisions on the use of integrative therapies during breast cancer treatment. Researchers at US and Canadian institutions evaluated the efficacy and safety of more than 80 therapies.

The Journal of the National Cancer Institute Monograph has  published a special issue co-sponsored by SIO, "Advancing the Global Impact of Integrative Oncology"; including a comprehensive definition for integrative oncology. The articles in the special Monograph were all peer-reviewed.


                                                                    

Please read the press release about the joint SIO/ASCO work on guidelines for integrative approaches for cancer care on our news page.
 
 
 Read the latest blog from Eugene  and Linda Carlson, PhD, C.Psych 

"What Now? Navigating cancer treatment during a possible COVID-19 'second wave'"

"The Use of Traditional Chinese Herbal Medicine in COVID-19 - Where's the Evidence?"

Webinar presentation by Weidong Lu, MB, MPH, PhD, Dana-Farber Cancer Institute - recording now available on YouTube.

TCM and Integrative Oncology Practice in China During COVID-19 Outbreak

by Yufei Yang, MD 

Given the rapidly progressing global COVID-19 crisis, SIO leadership has decided to launch a COVID-19 column to specifically address our members’ needs. Our first interview is with Yufei Yang, MD, who is the director of integrative oncology at Beijing Xiyuan Hospital. We would like to learn from our Chinese colleagues’ recent advances in combating COVID-19. This is in keeping with SIO’s practice of facilitating opportunities to share our members’ experiences and perspectives. The full article - TCM and Integrative Oncology Practice in China During COVID-19 Outbreak represents Dr. Yang and her team’s views only.

 

Call for Applications: SIO 2020 Africa Travel Scholarship - Postponed Until 2021

Please watch for details in early 2021.

 

Watch Video on Abstract Writing Best Practices 

Please be sure to watch this video in preparation for submitting abstracts in early 2021.

 

SIO 2019 Conference Presentations Available on VuMedi

As a resource to SIO conference attendees, presentations from SIO's 16th International Conference in NYC are now accessible through VuMedi.com, a video hosting platform that posts content from a broad range of healthcare organizations and medical professionals.

One of the main goals of SIO’s research committee is to disseminate recent research findings to members. This page is used as a resource, providing monthly updates of relevant literature. Each month, SIO Research Committee co-chairs select recent papers to be listed on the SIO website, based on search criteria that focus on original clinical research in human populations spanning a full range of complementary therapy modalities. We will include the abstracts and links to the journals cited for downloads. We hope you enjoy this feature and we appreciate your comments and feedback.

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September 2020 SIO New Research Review

Article: Roydhouse JK, Menapace LA, Xia H, Song P, Berman T, Agarwal R, et al. Concomitant botanical medicine use among patients participating in commercial prostate cancer trials. Complement Ther Med. 2020;54:102549.

Abstract: Objectives: Patients with cancer frequently use botanical medications. The concomitant use of such medications by patients on commercial trials has not been well-described, despite the importance of these trials for evaluating the safety and efficacy of new agents. We sought to describe the use of botanical medications taken by patients with prostate cancer enrolled on global commercial trials.Design: Retrospective study.Setting: Regulatory repository of commercial clinical trial data.Interventions: Anti-cancer therapy.Main outcome measures: Botanical and medication use data were pooled across six international commercial randomized trials for metastatic prostate cancer with detailed information on medication and indications. Botanical products were considered to have potential for drug interaction if they led to a change in drug exposure in human trials. Potential for interaction was ascertained by PubMed review. Descriptive statistics were used for analysis.Results: Of 7318 enrolled patients, 700 (10 %) reported botanical use at any time and 653 (9%) reported use of botanical products while on trial. Nearly half of botanical product types were not classified by plant (43 %). The highest proportion of botanical use was among patients in Asian countries (32 %), followed by patients in North America (13 %). Eighty-six different types of botanical products were used; of these, nineteen had a patient-reported anti-cancer indication.Conclusions: Botanical medicine use among patients with prostate cancer in commercial trials is moderate, although it varies by region. Practitioners should be aware of the use of botanical interventions in a clinical trial context.

Review: Clinical trial results may be impacted by intake of other agents such as botanical medications outside of the anti-cancer therapy being studied. A large retrospective study of international randomized trial data for metastatic prostate cancer was examined for patient-reported botanical use. Nine percent of the sample had used botanicals while on trial. Prevalence was higher in Asian countries (32%) and North America (13%). Research teams should assess participants for botanical use which may produce drug interactions and be aware that regional differences are influential. 


Article: Guglielmo, M., et al. (2020). "A randomized, double-blind, placebo controlled, phase II study to evaluate the efficacy of ginseng in reducing fatigue in patients treated for head and neck cancer." J Cancer Res Clin Oncol 146(10): 2479-2487.

Abstract: Purpose: Fatigue is a distressing symptom in head & neck cancer patients before, during and at the end of curative therapy. Pharmacologic and not pharmacologic treatments have been proposed with scarce or no evidence of efficacy. The aim of the study is to evaluate the efficacy of American ginseng in respect to placebo in reducing fatigue in patients treated for head and neck cancer with curative intent. Methods: Thirty-two patients who had completed oncological treatment for a primary Head & neck tumor for at least 1 year and had a global fatigue score > 4 by means of Brief Fatigue Inventory (BFI) were randomized to receive 1000 mg of American ginseng or placebo per day for 8 weeks with the aim to assess their efficacy. Changes in fatigue scores in the 2 subgroups of patients before and after the treatment with American ginseng or placebo, were assessed by the BFI at baseline and at the end of week 8. Results: The mean of the mean values of the BFI measured at 8 weeks (end of treatment) was 4.6 in the Ginseng arm and 3.4 in the Placebo arm (p = ns). Mean comparison showed a tendency to statistical significance only for the single item on interference with general activity (p = 0.06), with better performance for placebo. The mean of the differences between baseline values and 8 weeks values was not significantly different between treatment arms considering the entire questionnaire. Conclusion: The present data shows that American ginseng has insufficient evidence to be recommended for Cancer Related Fatigue (CRF) in post treatment HNC survivors.

Review: Randomized, double-blind, placebo-controlled trials are the gold standard for research on the effectiveness of interventions on health outcomes. In this case, American Ginseng was compared to placebo for fatigue in head & neck cancer patients. The ginseng intervention did not perform better than the placebo, indicating that there is not enough clinical evidence to recommend ginseng for fatigue. Dietary supplements should continue to be rigorously examined for effectiveness in diverse populations to assist clinicians and practitioners in therapeutic recommendations. 

 

Archive

Integrative Oncology Digest

 

July 2020 Reviews

Reviewed by SIO Research Committee Member Danielle Gentile, PhD, Health Services Researcher, Assistant Professor of Medicine, Department of Supportive Oncology, Levine Cancer Institute, Atrium Health

Block KI. Integrative Cancer Therapies: Learning From COVID-19. Integr Cancer Ther. 2020;19:1534735420932652. doi:10.1177/1534735420932652

Review: The coronavirus pandemic has changed many healthcare processes, including within Integrative Oncology. Telehealth may help to reduce barriers in access to integrative cancer therapies and consultations such as transportation and feeling well enough to leave home. Additional research on the practicality and efficacy of telehealth are needed and encouraged during this unprecedented public health event. 

Song S, Cohen AJ, Lui H, et al. Use of GoFundMe® to crowdfund complementary and alternative medicine treatments for cancer. J Cancer Res Clin Oncol. 2020;146(7):1857-1865. doi:10.1007/s00432-020-03191-0

Review: GoFundMe is an online crowdfunding platform that allows individuals to raise money for specific events or challenging circumstances including illnesses. Five hundred GoFundMe campaigns detailing financial need for cancer treatment were reviewed. Compared to non- complementary and alternative medicine (CAM) users, CAM users expressed high value in quality of life, comfort and autonomy. Healthcare providers should help patients to set realistic expectations for the risks and benefits of CAM whether used in combination with or in place of conventional caner treatment. 

 

June 2020 Reviews

Reviewed by SIO Research Committee Member Danielle Gentile, PhD, Health Services Researcher, Assistant Professor of Medicine, Department of Supportive Oncology, Levine Cancer Institute, Atrium Health

Gall, A., Anderson, K., Adams, J., Matthews, V., & Garvey, G. (2019). An exploration of healthcare providers’ experiences and perspectives of Traditional and complementart medicine usage and disclosure by Indigenous cancer patients. BMC Complement Altern Med, 19 (1), 259.

Review: 19% of indigenous Australians with cancer use traditional and complementary medicine (T&CM), yet little is known about healthcare providers’ views toward T&CM. Eighteen healthcare providers were interviewed to offer perspectives on their experiences and attitudes toward T&CM by indigenous cancer patients. Common themes included concern about risk; no ‘real’ benefits; perception of T&CM and conventional medicine as antithetical; barriers to disclosure; ‘patients’ choice’ a double-edged sword; and providers’ lack of knowledge about T&CM. Most providers lacked knowledge about T&CM and felt it was outside of their role. These results suggest providers need improved understanding about T&CM given its importance to indigenous cancer patients.

Ee, C., Cave, A.E., Naidoo, D., & Boyages, J. (2019) Prevalence of and attitudes toward complementary therapy use for weight after breast cancer in Australia: a national survey. BMC Complemt Altern Med, 19(1), 332. (Muhlenpfordt, Stritter, Bertram, Ben-Arye, & Seifert, 2020)

Review: Weight gain after breast cancer treatment is common and may increase risk of recurrence. This study assessed use of complementary medicine (CM) for weight loss among n=309 respondents of the Breast Cancer Network Australia Survey and Review Group. Three quarters had used CM and one-third had tried CM for weight loss. The most popular CMs were acupuncture, relaxation, yoga, supplements, and meditation. Advantages of CM for weight loss included the ability to improve general wellbeing, relaxation, and being non-pharmacological while disadvantages were financial cost, finding a reliable practitioner, and lack of research for effectiveness. Additional research on the effectiveness of CM for weight loss in breast cancer survivors is warranted.

 

Other June 2020 Articles

Atteiah A, Marouf A, Alhazmi R, Alghamdi A, Almalki K, Albugamy F, et al. Prevalence of complementary and alternative medicine use in brain tumor patients at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Saudi Med J 2020 Jun;41(6):614-621 PMID 32518928

To determine the prevalence and types of complementary and alternative medicine (CAM) being utilized and the possible factors that prompted the use of CAM in patients with brain tumors. Methods: The study conducted was a questionnaire-based, cross-sectional study of patients diagnosed with brain tumors at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia from January 2011 to May 2018. Patients with primary and secondary brain tumors, were included. Our questionnaire was conducted via phone interviews after obtaining patient consent.  Results: A total of 72 patients were included. The mean age of the participants was 45.89 (±16.52) years. We found that education level significantly affected the use of CAM. Fewer users of CAM held bachelor's degree and patients with lower degrees used CAM more frequently (p=0.027). The most frequent types of CAM were Zamzam (holy water) and Ruqya (Quran reading). Family members were the most frequent source of information about the use of CAM (81.6%).  Conclusion: Education level has a significant effect on CAM use. Gender plays a role in the type of CAM used. Future research should focus on the adverse effects of some CAM therapies, how effective CAM therapies are, and the effect CAM may play in delaying patients from seeking medical advice.

 

Borm KJ, Schiller K, Asadpour R, Combs SE. Complementary and Alternative Medicine in Radiotherapy: A Comprehensive Review. Top Magn Reson Imaging 2020 Jun;29(3):149-156 PMID 32568977

Complementary and alternative medicine (CAM) approaches are widely used by patients throughout a broad range of medical fields and diseases, and often self-administered by patients without the involvement of physicians or other members of the health care team. CAM use is well documented in cancer and chronic illnesses, and emerging data in radiation oncology show CAM usage of 26% to 97% in radiation therapy patients. No information is, however, available on CAM usage in radiology and in the imaging procedure fields. This article reviews the fundamental principles and the experience with the wide spectrum of CAM in radiation oncology-a field that shares many parallels with radiology, such as prevalence of imaging, procedural requirements, and cooperation demanded from patients.CAM is defined as "approaches and practices that are typically not part of conventional medical care," and includes the use of mind- and body-based practices (eg, meditation, massage, acupuncture), natural products (eg, herbs, vitamins, minerals), and other interventions. Supplements are used frequently to alleviate side effects of therapy and promote overall well-being. Specifically, the mindfulness/meditation approaches of CAM are known to reduce anxiety and enhance physical and emotional wellbeing in patients with chronic diseases, such as cancer or neurologic diseases, through physiological, psychological, and perhaps placebo mechanisms. Such patients often require repetitive and invasive imaging examinations or procedures, such as for cancer treatment, cancer surveillance/follow-up, or monitoring of chronic diseases, for example, surveillance MRI in multiple sclerosis. Such parallels suggest that the vastly understudied area of CAMs deserve further investigation in both the radiation oncology and the imaging fields. Further research on CAM is needed to develop refined recommendations and national/and international guidelines on its use.

Chen R, Gao Y, Qiu X, Hong P, Zhou D, Chen Q. Acupuncture for the treatment of radiation-induced xerostomia among patients with cancer: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2020 Jun 12;99(24):e20658 PMID 32541507

BACKGROUND: With the number of cancer patients growing, radiotherapy and chemotherapy have been a necessary treatment. Unfortunately, there are many side effects after radiation and chemotherapy, one of which is xerostomia that always harasses patients. Although there are many ways of treatment of xerostomia, they have many disadvantages. With the rare side effects and the excellent effect, acupuncture has been widely applied to dry mouth after radiotherapy, but it has not been recognized as the standard treatment. Because acupuncture prescription is mostly different and the sample size of studies is small, we need more high-quality meta-analysis to provide relatively reliable evidence for the treatment of radiation-induced xerostomia. The objective of this study is to assess the curative effect of acupuncture treatment of cancer patients after radiotherapy and provide more reliable evidence for acupuncture treatment of xerostomia after radiotherapy for cancer patients. METHODS: We will search the following databases: CENTRAL (The Cochrane Central Register of Controlled Trials), MEDLINE, EMBASE, PubMed, CNKI (China National Knowledge Infrastructure), VIP (China Science and Technology Journal Database), Wan Fang Data Knowledge Service Platform. At any rate, 2 review authors will assess all randomized controlled trials (RCTs), seemingly conformance to the inclusion criteria, to confirm qualification, determine the risk of bias and extract data using a running data extraction form. The revolution of disagreements is a discussion. We will use the approach recommended by Cochrane reviews to assess the bias in studies. Risk ratios (RR) and 95% confidence intervals (CIs) will be used to assess the treatment effects of an intervention for dichotomous results. We will use mean differences (MD) and standard deviation (SD) to aggregate the data of every trial for continuous results. The heterogeneity test of Cochran and quantification of the I statistic will be used to assess the variation of treatment effects. Only if there are studies of semblable comparisons reporting the same results, we will conduct a meta-analysis. RESULTS: From the study, we will evaluate the efficacy of acupuncture for xerostomia patients who has cancer and been treated by radiation. CONCLUSION: The conclusion of this study will be the evidence, which can ensure the efficacy of acupuncture for cancer patients with radiation-evoked xerostomia among and provide guidance for the treatment of xerostomia. INPLASY REGISTRATION NUMBER: INPLASY202040211.

Fukuhara JS, O'Haver J, Proudfoot JA, Spies JM, Kuo DJ. Yoga as a Complementary and Alternative Therapy in Children with Hematologic and Oncologic Disease. J Pediatr Oncol Nurs 2020 Jul/Aug;37(4):278-283 PMID 32167404

A diagnosis of a hematologic or oncologic disease in a child can be stressful for the patient and the family. Yoga as an intervention has been reported to decrease stress in adults diagnosed with chronic disorders but few studies have been reported with children and their families. A convenience sample of patients diagnosed with cancer or a blood disorder (ages 7-17 years) and their caregivers was selected to participate in a single bedside yoga class. Participants were surveyed pre and post yoga with the Spielberger State Trait Anxiety Scale. Children were also surveyed pre and post yoga with the Wong-Baker Faces Pain Scale. Children had a significant decrease in pain post yoga but no change in anxiety. Adolescents and parents had a significant decrease in anxiety post yoga intervention.

Liou KT, Root JC, Garland SN, Green J, Li Y, Li QS, et al. Effects of acupuncture versus cognitive behavioral therapy on cognitive function in cancer survivors with insomnia: A secondary analysis of a randomized clinical trial. Cancer 2020 Jul 1;126(13):3042-3052 PMID 32320061

BACKGROUND: Cancer-related cognitive impairment is a prevalent, disruptive condition potentially exacerbated by sleep disturbances. The current study was performed to evaluate the effects of acupuncture versus cognitive behavioral therapy for insomnia (CBT-I) on objective and subjective cognitive function in cancer survivors with insomnia. METHODS: Using data from a randomized clinical trial (160 survivors) that compared acupuncture versus CBT-I for insomnia occurring in cancer survivors, the authors analyzed cognitive outcomes and their relationship to insomnia symptoms. Analysis was limited to 99 patients who reported baseline cognitive difficulties. Interventions were delivered over 8 weeks. Objective attention, learning, and memory were evaluated using the Buschke Selective Reminding Test. Subjective cognitive function was assessed using the Brown Attention-Deficit Disorder Scales. Insomnia symptoms were assessed using the Insomnia Severity Index. All outcomes were collected at baseline, week 8, and week 20. RESULTS: From baseline to week 8, acupuncture produced statistically significant within-group improvements in objective attention (Cohen D, 0.29), learning (Cohen D, 0.31), and memory (Cohen D, 0.33) that persisted to week 20 (all P < .05), whereas CBT-I produced a statistically significant within-group improvement in objective attention from baseline to week 20 (Cohen D, 0.50; P < .05); between-group differences were not statistically significant. Both interventions produced statistically significant within-group improvements in subjective cognitive function at weeks 8 and 20 compared with baseline (all P < .001); between-group differences were not statistically significant. In the acupuncture group, patients with clinically meaningful responses with regard to insomnia symptoms demonstrated a significantly greater improvement in subjective cognitive function compared with those without clinically meaningful insomnia responses (P = .006). CONCLUSIONS: Among cancer survivors with insomnia, both acupuncture and CBT-I produced significant improvements in objective and subjective cognitive function. However, the effect sizes varied and only survivors in the acupuncture group demonstrated a significant relationship between cognitive and sleep outcomes. These preliminary findings warrant further investigation to guide the personalized management of patients with cancer-related cognitive impairment.

Liu C, Sadat SH, Ebisumoto K, Sakai A, Panuganti BA, Ren S, et al. Cannabinoids Promote Progression of HPV-Positive Head and Neck Squamous Cell Carcinoma via p38 MAPK Activation. Clin Cancer Res 2020 Jun 1;26(11):2693-2703 PMID 31932491

PURPOSE: Human papillomavirus (HPV)-related head and neck squamous cell carcinoma (HNSCC) is associated with daily marijuana use and is also increasing in parallel with increased marijuana use in the United States. Our study is designed to define the interaction between cannabinoids and HPV-positive HNSCC. EXPERIMENTAL DESIGN: The expression of cannabinoid receptors CNR1 and CNR2 was analyzed using The Cancer Genome Atlas (TCGA) HNSCC data. We used agonists, antagonists, siRNAs, or shRNA-based models to explore the roles of CNR1 and CNR2 in HPV-positive HNSCC cell lines and animal models. Cannabinoid downstream pathways involved were determined by Western blotting and analyzed in a primary HPV HNSCC cohort with single-sample gene set enrichment analysis (ssGSEA) and the OncoGenome Positioning System (Onco-GPS). RESULTS: In TCGA cohort, the expression of CNR1 and CNR2 was elevated in HPV-positive HNSCC compared with HPV-negative HNSCC, and knockdown of CNR1/CNR2 expression inhibited proliferation in HPV-positive HNSCC cell lines. Specific CNR1 and CNR2 activation as well as nonselective cannabinoid receptor activation in cell lines and animal models promoted cell growth, migration, and inhibited apoptosis through p38 MAPK pathway activation. CNR1/CNR2 antagonists suppressed cell proliferation and migration and induced apoptosis. Using whole-genome expression analysis in a primary HPV HNSCC cohort, we identified specific p38 MAPK pathway activation signature in tumors from HPV HNSCC patients with objective measurement of concurrent cannabinoid exposure. CONCLUSIONS: Cannabinoids can promote progression of HPV-positive HNSCC through p38 MAPK pathway activation.

Münstedt K, Männle H. Bee products and their role in cancer prevention and treatment. Complement Ther Med 2020 Jun;51:102390 PMID 32507447

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.

Pawasarat IM, Schultz EM, Frisby JC, Mehta S, Angelo MA, Hardy SS, et al. The Efficacy of Medical Marijuana in the Treatment of Cancer-Related Pain. J Palliat Med 2020 Jun;23(6):809-816 PMID 32101075

Background: The opioid epidemic has spurred investigations for nonopioid options, yet limited research persists on medical marijuana's (MMJ) efficacy in managing cancer-related symptoms. Objective: We sought to characterize MMJ's role on symptomatic relief and opioid consumption in the oncologic population. Design: Retrospective chart review of MMJ-certified oncology patients was performed. Divided patients into MMJ use [MMJ(+)] versus no use [MMJ(-)], and Edmonton Symptom Assessment System (ESAS)-reported pain cohorts: "mild-moderate" versus "severe." Measurements: Medical records were reviewed for ESAS, to measure physical and emotional symptoms, and opiate consumption, converted into morphine milligram equivalents (MME). Minimal clinically important differences were determined. Wilcoxon signed-rank tests determined statistical significance between MMJ-certification and most recent palliative care visit. Results: Identified 232 patients [95/232 MMJ(-); 137/232 MMJ(+)]. Pain, physical and total ESAS significantly improved for total MMJ(-) and MMJ(+); however, only MMJ(+) significantly improved emotional ESAS. MMJ(-) opioid consumption increased by 23% (97.5-120 mg/day MME, p = 0.004), while it remained constant (45-45 mg/day MME, p = 0.522) in MMJ(+). Physical and total ESAS improved in mild-moderate-MMJ(-) and MMJ(+). Pain and emotional symptoms worsened in MMJ(-); while MMJ(+)'s pain remained unchanged and emotional symptoms improved. MMJ(-) opioid consumption increased by 29% (90-126 mg/day MME, p = 0.012); while MMJ(+)'s decreased by 33% (45-30 mg/day MME, p = 0.935). Pain, physical, emotional, and total ESAS scores improved in severe-MMJ(-) and MMJ(+); opioid consumption reduced by 22% in MMJ(-) (135-106 mg/day MME, p = 0.124) and 33% in MMJ(+) (90-60 mg/day MME, p = 0.421). Conclusions: MMJ(+) improved oncology patients' ESAS scores despite opioid dose reductions and should be considered a viable adjuvant therapy for palliative management.

Riklikienė O, Harvey C, Spirgienė L, Luneckaitė Ž, Karosas L. Perceptions of Clergy Regarding the Provision of Spiritual Care in Lithuanian Hospitals for Cancer Patients. J Relig Health 2020 Jun;59(3):1494-1509 PMID 31463828

This paper presents an analysis of narratives drawn from research that examined the views of clergy in regard to the provision of spiritual care in Lithuanian hospitals. The purpose of this research was to examine the shared responsibilities between what nurses do in the provision of holistic care and that of the clergy who are employed to provide spiritual care. A thematic analysis was undertaken, guided by questions related to how spirituality was perceived by the clergy; how spiritual care was defined; clergy's perceptions to nurses' provision of spiritual care, and whether there was a delineation between these two roles. Findings showed that although the clergy believed that their role was important in the provision of spiritual care, both nurses and clergy acknowledged that both played a role in spiritual support. However, scope of practice for each role was not yet defined. For nurses and clergy to understand their roles and the boundaries between them, clear standards of practice need to be developed.

Rosewall T, Feuz C, Bayley A. Cannabis and Radiation Therapy: A Scoping Review of Human Clinical Trials. J Med Imaging Radiat Sci 2020 Jun;51(2):342-349 PMID 32249134

INTRODUCTION: It is estimated that at least 20% of Canadian patients with cancer use cannabis to alleviate symptoms of their disease and/or cope with the side effects of their treatment. Most patients want to learn more about cannabis from their healthcare team, but most oncology professionals feel too uninformed to make recommendations. The purpose of this scoping review was to address this oncology professionals' knowledge gap, by summarizing the literature on evaluations of the benefits and harms of cannabis use before, during, or after radiation therapy (RT). METHODS AND MATERIALS: A literature search was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines, using multiple electronic databases and combinations of key terms. To be included, studies must address the use of cannabis in patients undergoing RT. In vitro and in vivo evaluations, reviews, and editorials were excluded. Eligible full text manuscripts were then subjected to a formal risk of bias assessment using the Cochrane RoB 2.0 or ROBINS-I frameworks. RESULTS: A total of 48 records were identified, and 8 articles were included after vetting. These 8 studies suggest that the use of cannabinoids may calm anxious patients about to start RT, reduce nausea and vomiting consistent with the contemporary standard of care, reduce the symptoms of relapse for patients with glioma, and provide symptom relief >3 years after head and neck RT but not during or immediately. Six of these studies contained a high risk of bias (eg lack of randomization, poor blinding, and subjective outcome assessments). Most studies reported mild episodes of drowsiness and dry mouth with Δ(9)tetrahydrocannabinol, but substantial rates of dizziness, fatigue, and disorientation were also seen. It is important to note that these studies did not measure the impact of long-term cannabis consumption. CONCLUSIONS: The existing body of literature evaluating the use of cannabinoids by patients undergoing RT is very limited. Well-designed randomized controlled trials are urgently needed, which address the significant design flaws of previous studies and evaluate the impact of phytocannabinoids in patients undergoing RT.

Shi K, Tang Y, He F, Xiao X, Zhang J, Jin Y, et al. The maintenance effect of acupuncture on the side effects of breast cancer endocrine therapy: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020 Jun 12;99(24):e20567 PMID 32541483

BACKGROUND: Breast cancer is common among women throughout the world and endocrine therapy is an established part of its treatment. But, unfortunately, this has also resulted in intolerable side effects affecting the quality of life. Acupuncture has been widely used to treat endocrine-related side effects in patients with breast cancer, but how long its effect can be maintained has not been published. The systematic review is designed to evaluate the maintenance efficacy of acupuncture for related side effects after breast cancer endocrine therapy. METHODS AND ANALYSIS: We will search for the following databases: PubMed, Embase, Cochrane Library, Web of Science, including China National Knowledge Infrastructure (CNKI), WanFang Data, Technology Periodical Database (VIP), and China Biology Medicine (CBM) from inception to May 2020. Two reviewers will search these databases, collect all articles, and assess the quality of studies separately, and there will be no limitations on language. The primary outcomes will be assessed using acupuncture for endocrine-related hot flashes and joint pain duration (1 month, 3 months, 6 months). Measurement tools include the Kupperman index, Brief Pain Inventory Short Form (BPI-SF), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Brief Pain Inventory-Short (BPI-SF). We will use RevMan V.5.3 for meta-analysis and employ the Grading of Recommendations Assessment, Development and Evaluation System to assess the quality of evidence. RESULTS: This systematic review will evaluate the maintenance efficacy of acupuncture on the side effects of breast cancer endocrine therapy. CONCLUSION: This study will provide high-quality current evidence of how long its effect can be maintained after acupuncture for related side effects after breast cancer endocrine therapy. ETHICS AND DISSEMINATION: Ethical committee approval is not required for this systematic review as patient data will not be collected. This study will help to inform doctors and researchers on the duration of acupuncture treatment for endocrine-related hot flashes and joint pain. The results will be published in a peer-reviewed journal and will be disseminated in relevant conferences. INPLASY REGISTRATION NUMBER: INPLASY202040024.

Skiba MB, McElfresh JJ, Howe CL, Crane TE, Kopp LM, Jacobs ET, et al. Dietary Interventions for Adult Survivors of Adolescent and Young Adult Cancers: A Systematic Review and Narrative Synthesis. J Adolesc Young Adult Oncol 2020 Jun;9(3):315-327 PMID 31904297

Adolescent and young adult (AYA) cancer survivors, here defined as individuals diagnosed with cancer between 15 and 39 years of age, are at high risk for adverse late-term metabolic effects of treatment through adulthood. Diet is a modifiable lifestyle behavior that may improve metabolic health outcomes in AYA cancer survivors. However, the details of dietary interventions for this unique population remain largely undescribed. In this systematic review, we aim to synthesize the results of dietary interventions for adult AYA cancer survivors. Seven databases and clinical trial registries were searched in March 2019 for interventions targeting dietary behaviors in AYA cancer survivors (PROPSERO systematic review number: CRD42019126376). Descriptive statistics and a narrative synthesis were completed to detail intervention participants and components. After full text review of 233 studies, four studies met all inclusion criteria. All studies were heterogeneous for participant age, cancer type, and duration, and were designed for feasibility and preliminary efficacy. Included studies followed different dietary guidance; however, each resulted in a significant change on a primary outcome of either dietary quality or body composition. Three of the four studies included a theoretical framework, where self-efficacy was a central construct. Counseling, in person, telephone, or electronic, provided behavioral support. Results of this systematic review suggest high potential to change dietary behaviors in AYA, but interventions remain limited. AYA cancer survivors demonstrate unique physiological and psychosocial needs, and future interventions designed to address this care gap should be targeted for this population with consideration of social support, delivery mode, and individual tailoring.

Song A, Myung NK, Bogumil D, Ihenacho U, Burg ML, Cortessis VK. Incident testicular cancer in relation to using marijuana and smoking tobacco: A systematic review and meta-analysis of epidemiologic studies. Urol Oncol 2020 Jul;38(7):642.e1-642.e9 PMID 32409200

BACKGROUND: Recent epidemiologic studies identified credible associations between marijuana smoking and risk of nonseminomatous testicular germ cell tumors (TGCTs), but did not distinguish exposure to cannabinoid compounds from exposure to other constituents of smoke. METHODS: We implemented a systematic review of scholarly literature followed by random effects meta-analysis to quantitatively synthesize published data relating incident TGCT to each of 2 exposure histories: ever using marijuana, and ever smoking tobacco. RESULTS: We identified four epidemiologic studies of marijuana use and 12 of tobacco smoking. Summary data concur with earlier reports of a specific association of marijuana use with nonseminoma, summary odds ratio [sOR] = 1.71 (95% confidence interval [CI] 1.12-2.60), and identify a positive association, sOR = 1.18 (95% CI 1.05-1.33), between tobacco smoking and all TGCT. CONCLUSIONS: Available data accord with positive associations between incident TGCT and each exposure, implicating both cannabinoid compounds and other constituents of smoke. Etiologic interpretation awaits epidemiologic studies that assess associations between tobacco smoking and nonseminomatous TGCT, investigating not only these exposures but also both co-use of tobacco and marijuana and smoke-free sources of cannabinoids, while adequately evaluating potential confounding among all of these exposures.

Song S, Cohen AJ, Lui H, Mmonu NA, Brody H, Patino G, et al. Use of GoFundMe(®) to crowdfund complementary and alternative medicine treatments for cancer. J Cancer Res Clin Oncol 2020 Jul;146(7):1857-1865 PMID 32219517

PURPOSE: Complementary and alternative medicine (CAM) use is common amongst cancer patients. However, there is growing concern about its safety and efficacy. Online crowdfunding campaigns represent a unique avenue to understand the cancer patient's perspective for using CAM or declining conventional cancer therapy (CCT). METHODS: Five hundred GoFundMe campaigns from 2012 to 2019 detailing financial need for cancer treatment were randomly selected and reviewed for endorsement of CAM use, reasons for using CAM, and reasons for declining CCT. Descriptive statistics were used to compare patient and campaign characteristics between 250 CAM users and 250 non-CAM users. RESULTS: Compared to non-CAM users, CAM users were more likely to be female (70% vs. 54%, p < 0.01), to report more stage IV cancer (54% vs. 12%, p < 0.01), and to have a history of delayed, missed, or misdiagnosis (10% vs. 4%, p < 0.01). Reasons for using CAM include endorsing curative/therapeutic effects 212 (85%), pain/stress reduction 137 (55%), and dissatisfaction with current or past medical treatment options 105 (42%). 87 (35%) CAM users that declined CCT reported that they wanted to try to fight off cancer using CAM first 57 (61%), that CCT was too "toxic" to the body 39 (42%), and cancer was already too advanced, so that CCT would be futile or too aggressive 25 (27%). CONCLUSION: Cancer patients on GoFundMe using CAM highly value quality of life, comfort, and autonomy. Physicians should educate themselves on CAM to set realistic expectations and provide comprehensive counseling of the risks and benefits of CAM usage to patients who choose to use CAM to either augment or completely replace CCT.

Wong CHL, Sundberg T, Chung VCH, Voiss P, Cramer H. Prevalence and predictors of mind-body medicine use among women diagnosed with gynecological cancer: Findings from the 2017 US National Health Interview Survey. Gynecol Oncol 2020 Jun;157(3):740-744 PMID 32197714

BACKGROUND: Gynecological cancer is a major health burden globally. In the US, it is common for cancer patients to utilize different types of complementary medicine. This study aims to investigate the prevalence of mind-body medicine use among US women diagnosed with gynecological cancer. METHODS: We used data from the 2017 National Health Interview Survey (NHIS) to investigate prevalence and predictors of mind-body medicine utilization in the past 12 months among gynecological cancer patients in a representative sample of the US population (N = 26,742). We descriptively analyzed the 12-month prevalence of any mind-body medicine use, separately for women with a prior diagnosis of gynecological cancer and those without. Using and b multiple logistic regression analyses, we identified predictors of mind-body medicine use. RESULTS: A weighted total of 2,526,369 women (2.0%) reported having received a diagnosis of gynecological cancer. More women diagnosed with gynecological cancer (weighted n = 964,098; 38.2%) than those not diagnosed with gynecological cancer (weighted mean = 36,102,852; 28.8%) had used mind-body medicine in the past 12 months. A higher prevalence of mind-body medicine use was associated with being non-Hispanic White, living in Western US and having received higher education. Spiritual meditation was found to be the most frequently used mind-body medicine modality, followed by yoga and progressive relaxation. CONCLUSIONS: While mind-body medicine is popular among US gynecological cancer patients, clinical evidence supporting the effectiveness of different mind-body medicine modalities is yet to be established. Randomized controlled trials should be conducted to evaluate the effectiveness of popular modalities like spiritual meditation or yoga to inform clinical decision and patient choice.

Yeung M, Wroot H, Charnock C, Forbes C, Lafay-Cousin L, Schulte F. Cannabis use in pediatric cancer patients: what are they reading? A review of the online literature. Support Care Cancer 2020 Aug;28(8):3503-3515 PMID 31960125

BACKGROUND: Recent changes to the legal status of marijuana in Canada warrant a review of the information that patients and families are accessing online regarding the role of cannabis in cancer. The aims of the current research were to identify the quality of literature available online as well as the themes, and opinion (i.e., pro-, neutral, or anti-cannabis) of online articles. METHODS: Searches were conducted using three primary search engines: Google, Yahoo, and DuckDuckGo. Articles were assessed for quality based on a modified scale for evaluating online sources. Content of all unique articles was coded using a qualitative thematic methodology in a line-by-line fashion. Codes were clustered to determine themes within articles. Finally, opinions were determined by examining all articles in a line-by-line fashion. Each statement was coded as either pro-cannabis (positive) or anti-cannabis (negative). RESULTS: We found most articles were authored by journalists (39.4%) and MDs (14.1%) and published as news (35.2%) or web articles (28.2%). The content of articles focused on four themes: the reasons for and against cannabis use; the opinions of health care providers; the restrictions placed by governing bodies and the need for additional research, education, and standardization. Article opinions were neutral-pro-cannabis. CONCLUSIONS: Health care providers should be aware that the overall quality of information found online is considered "satisfactory." The majority of articles present a pro-cannabis opinion.

Zhang X, Song H, Canup BSB, Xiao B. Orally delivered targeted nanotherapeutics for the treatment of colorectal cancer. Expert Opin Drug Deliv 2020 Jun;17(6):781-790 PMID 32237921

INTRODUCTION: Colorectal cancer (CRC), the third-most common malignancy, has high morbidity and mortality. Oral nanotherapeutics have emerged as a promising strategy to improve the therapeutic outcomes and alleviate the adverse effects of drugs in CRC treatment. AREAS COVERED: In this review, we introduce the beneficial features of oral drug administration for CRC therapy, and further address the three basic elements of nanotherapeutics, namely, therapeutic agents, carrier materials, and targeting ligands. In addition, we also discuss the potentials of the new emerging technologies (e.g., immunotherapy, gene editing and microbiota manipulation) in the treatment of CRC. EXPERT OPINION: Orally delivered targeted nanotherapeutics represent a promising strategy toward the efficient treatment of CRC. Although the current oral nanotherapeutics exert better therapeutic outcomes than the traditional drug formulations, their application has been restricted by drug resistance, tumor metastasis, and biosafety. Therefore, it is necessary to exploit new nanotherapeutics in the aspects of their three basic elements, and combine the new emerging technologies to those nanotherapeutics for CRC treatment.

 

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