Image1

Clinical Practice Guidelines

SIO is pleased to provide two new resources on integrative oncology. SIO developed new Clinical Practice Guidelines on the Use of Integrative Therapies as Supportive Care in Patients Treated for Breast Cancer, published in November 2014. 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 evaluated the efficacy and safety of more than 80 therapies.

The Journal of the National Cancer Institute Monograph has released a special issue co-sponsored by SIO, The Role of Integrative Oncology for Cancer Survivorship, highlighting original peer-reviewed research in the field of integrative oncology. The articles in the special Monograph were all peer-reviewed.

PhotoSIOPosterSessionClose1website

Conference

Mark your calendar: SIO's 13th International Conference will be held November 5-7, 2016, with a theme of "Advancing the Global Impact of Integrative Onclolgy" in Miami, Florida. More information coming soon! 

Thank you for making our 2015 conference such a success.  More than 350 physicians, researchers, nurses, integrative medicine practitioners, patient advocates, and patients from 19 countries convened in Boston, Massachusetts, from November 14-17 at the 12th International Conference.

 

One of the main goals of SIO’s research committee is to disseminate updated research to our members.  As such, we recently started a Research Update program.  We will provide bi-monthly updates of relevant literature by selecting a number of 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.  For chosen papers we will include the abstract and link to the journal cite for downloads.  We hope you enjoy this new feature and appreciate your comments and feedback! 

SIO Research Poster Session               

 

 

Archive

Complementary & Alternative Medicine Digest – December 2015

Our current literature update includes:

ACUPUNCTURE

Authors
Garcia MK; Graham-Getty L; Haddad R; Li Y; McQuade J; Lee RT; Spano M; Cohen L.
Title
Systematic review of acupuncture to control hot flashes in cancer patients.
Source
Cancer. 121(22):3948-58, 2015 Nov 15.
Abstract
Hot flashes (HFs) are a common side effect of cancer treatment. The purpose of this systematic review was to evaluate evidence related to the use of acupuncture for HFs in cancer patients. EMBASE, MEDLINE, Cochrane (all databases), PubMed, the Cumulative Index to Nursing and Allied Health Literature, and Scopus were searched from their inception through December 2014. Included studies had to be randomized controlled trials with a usual-care and/or placebo comparison group that investigated acupuncture to treat HFs in cancer patients. No language limits were applied. The risk of bias (ROB) was rated as low, high, or unclear according to Cochrane criteria. Both within-group and between-group changes were evaluated. Four hundred two items were identified, and 192 duplicates were omitted; this left 210 publications to be screened. Eight studies met the inclusion criteria, and all involved women with breast cancer. All studies showed significant within-group improvement from the baseline for true acupuncture (TA). One study showed significant improvement in favor of TA over sham acupuncture (SA; P < .001), 1 study found in favor of TA over SA for nighttime HFs only (P = .03), and 1 study found in favor of TA over SA or untreated controls (P < .01 and P < .001, respectively). Between-group (TA vs SA) effect size (ES) estimates for daytime and nighttime HFs were calculated (ES range, 0.04-0.9) whenever possible. No studies were rated with a low ROB. In conclusion, the current level of evidence is insufficient to either support or refute the benefits of acupuncture for the management of HFs in cancer patients. Future studies should provide within-group and between-group ES estimates in addition to P values.

Authors
You XM; Mo XS; Ma L; Zhong JH; Qin HG; Lu Z; Xiang BD; Wu FX; Zhao XH; Tang J; Pang YH; Chen J; Li LQ.
Title
Randomized Clinical Trial Comparing Efficacy of Simo Decoction and Acupuncture or Chewing Gum Alone on Postoperative Ileus in Patients With Hepatocellular Carcinoma After Hepatectomy.
Source
Medicine. 94(45):e1968, 2015 Nov.
Abstract
To compare the efficacy of simo decoction (SMD) combined with acupuncture at the tsusanli acupoint or chewing gum alone for treating postoperative ileus in patients with hepatocellular carcinoma (HCC) after hepatectomy. In postoperative ileus, a frequent complication following hepatectomy, bowel function recovery is delayed, which increases length of hospital stay. Studies suggest that chewing gum may reduce postoperative ileus; SMD and acupuncture at the tsusanli acupoint have long been used in China to promote bowel movement. Patients with primary HCC undergoing hepatectomy between January 2015 and August 2015 were randomized to receive SMD and acupuncture (n = 55) or chewing gum (n = 53) or no intervention (n = 54) starting on postoperative day 1 and continuing for 6 consecutive days or until flatus. Primary endpoints were occurrence of postoperative ileus and length of hospital stay; secondary endpoints were surgical complications. Groups treated with SMD and acupuncture or with chewing gum experienced significantly shorter time to first peristalsis, flatus, and defecation than the no-intervention group (all P < 0.05). Hospital stay was significantly shorter in the combined SMD and acupuncture group (mean 14.0 d, SD 4.9) than in the no-intervention group (mean 16.5 d, SD 6.8; P = 0.014), while length of stay was similar between the chewing gum group (mean 14.7, SD 6.2) and the no-intervention group (P = 0.147). Incidence of grades I and II complications was slightly lower in both intervention groups than in the no-intervention group. The combination of SMD and acupuncture may reduce incidence of postoperative ileus and shorten hospital stay in HCC patients after hepatectomy. Chewing gum may also reduce incidence of ileus but does not appear to affect hospital stay.

Authors
Mallory MJ; Croghan KA; Sandhu NP; Lemaine V; Degnim AC; Bauer BA; Cha SS; Croghan IT.
Title
Acupuncture in the postoperative setting for breast cancer patients: a feasibility study.
Source
American Journal of Chinese Medicine. 43(1):45-56, 2015.
Abstract
Acupuncture is used to treat a variety of symptoms and conditions associated with cancer and cancer treatments. The present study was performed to evaluate the feasibility of providing acupuncture in the hospital setting for breast cancer patients and to evaluate the short-term effect of acupuncture on stress, anxiety, and pain. This was an open label study conducted at Mayo Clinic Hospital, Methodist and Saint Marys Campus, Rochester, Minnesota. A total of 20 adult breast cancer patients undergoing mastectomy and/or breast reconstruction were recruited and offered daily acupuncture intervention beginning postoperative day 1 and continuing for the duration of the hospital stay. Outcome measures included the Symptom Visual Analog Scale (VAS) and Satisfaction Question and Was-it-Worth-it (WIWI) Questionnaire. It was found that acupuncture is a feasible option for postoperative breast cancer patients. In addition, it can significantly decrease the levels of anxiety (p = 0.0065), tension/muscular discomfort (p < 0.001) and pain (p = 0.023). The association between acupuncture and relaxation was found to be statistically borderline (p = 0.053). This feasibility study showed that acupuncture can be integrated into a busy postsurgical clinical practice. These results also suggest that acupuncture may be an important intervention in the postoperative setting for breast cancer patients.

Authors
Bastani F; Khosravi M; Borimnejad L; Arbabi N.
Title
The effect of acupressure on cancer-related fatigue among school-aged children with acute lymphoblastic leukemia.
Source
Iranian Journal of Nursing and Midwifery Research. 20(5):545-51, 2015 Sep-Oct.
Abstract
BACKGROUND: Fatigue is the most common side effect of chemotherapy in children with acute lymphoblastic leukemia (ALL). Acupressure is one of the most popular non-pharmacologic methods used to reduce fatigue in other settings. The aim of the study was to evaluate the effect of acupressure on reducing fatigue among children with ALL compared with a placebo treatment.
MATERIALS AND METHODS: In a single-blind, randomized, placebo-controlled clinical trial of 120 hospitalized school-aged children with ALL, 24 h after chemotherapy, they were randomly divided into experimental (n = 60) and placebo groups (n = 60). Intensity of fatigue was rated using the Visual Analog Scale. The intervention (finger acupressure) was applied on ST36 (true points) in the experimental group and on LI12 (sham points) in the placebo group. We evaluated the symptoms of fatigue intensity immediately and 1 h after intervention. Fatigue was also measured 24 h after intervention by Fatigue Scale-Child (FS-C). Data were analyzed by SPSS version 16.0 using descriptive statistics, independent t-test, and Chi-square and Fisher exact tests.
RESULTS: Significant differences were observed between the two groups in the intensity of fatigue 1 h after intervention (P < 0.001). But there was no significant difference between them regarding fatigue 24 h after intervention.
CONCLUSIONS: Applying one time acupressure may reduce the intensity of fatigue at 1 h post-treatment. Therefore, acupressure could be recommended as an effective, non-pharmacologic method for some CRF control. Applying one time acupressure did not have a long-term effect.

Authors
Hu Y; Yang H; Wang P; Liu T; Tang W.
Title
Altered Impedance of Ear Acupuncture Point MT2 in Breast Cancer Patients: A Preliminary Observation.
Source
Evidence-Based Complementary & Alternative Medicine: eCAM. 2015:909246, 2015.
Abstract
Skin impedance at acupuncture points (APs) has been used as a diagnostic aid for more than 50 years. In this study, we have a diagnostic tool (JXT-2008) to measure the skin impedance of ear APs of 30 breast cancer patients and the corresponding skin impedance of ear APs of 30 healthy humans, and then we compared these changes in ear AP impedance in breast cancer patients and healthy individuals.

Authors
Bardy J; Finnegan-John J; Molassiotis A; Mackereth P.
Title
Providing acupuncture in a breast cancer and fatigue trial: The therapists' experience.
Source
Complementary Therapies in Clinical Practice. 21(4):217-22, 2015 Nov.
Abstract
OBJECTIVE: To explore the experiences of therapists providing acupuncture in a trial context, to women with fatigue, following breast cancer treatment.
METHODS: The focus groups were nested within a multi-site randomised control trial. Therapists (n = 15) involved in the trial were invited to participate in one of the focus groups, which took place in the north and south of England. The treatment protocol imposed constraints on dialogue to essential procedural conversation and stipulated needling times of 20 min.
RESULTS: All 15 therapists (100%) participated. Whilst they reported learning more about fatigue and cancer, adhering to the trial protocol limited the holistic nature of their practice. Seeing improvements, despite the protocol, made some therapists question their practice, in terms of needling times and limiting dialogue.
CONCLUSIONS: The study provided information about the therapists' perspective of working within a trial. This could have implications for providing acupuncture treatments more cost effectively and timely within clinical practice.

YOGA

Authors
Diorio C; Schechter T; Lee M; O'Sullivan C; Hesser T; Tomlinson D; Piscione J; Armstrong C; Tomlinson G; Sung L.
Title
A pilot study to evaluate the feasibility of individualized yoga for inpatient children receiving intensive chemotherapy.
Source
BMC Complementary & Alternative Medicine. 15:2, 2015.
Abstract
BACKGROUND: Fatigue is an important problem in paediatric cancer patients and yoga may be an effective intervention. The primary objective was to determine the feasibility of individualized yoga for hospitalized children receiving intensive chemotherapy.
METHODS: We included English-speaking children and adolescents aged 7-18 years receiving intensive chemotherapy or haematopoietic stem cell transplantation (HSCT). Yoga was conducted three times weekly for three weeks. The primary outcome was feasibility, defined as ability to deliver at least 60% of planned sessions. Secondary outcomes were parent-reported Pediatric Quality of Life Inventory (PedsQL) Multidimensional Fatigue Scale, Fatigue Scale-Parent, PedsQL Generic Core Scales and PedsQL Acute Cancer Module.
RESULTS: Between January and October 2013, 11 patients were enrolled. Median age was 14.0 (range 7.7-16.4) years and 6 (55%) were boys. Yoga was feasible with 10/11 participants meeting the threshold for feasibility. The median number of yoga sessions was 9 (range 3-13). No adverse events were attributed to yoga. Mean+/-standard deviation for the day 21 proxy-reported PedsQL general fatigue scores was 55.6+/-15.5. Qualitative comments suggested design changes for future yoga studies.
CONCLUSIONS: Individualized yoga is feasible for inpatient children receiving intensive chemotherapy. Future work will include development and conduct of a randomized trial for fatigue amelioration.

Authors
Jacobsen PB; Muchnick S; Marcus S; Amheiser P; Reiersen P; Gonzalez
B; Gomez M; Jim HS; Thompson LM; Minton S; Bower J.
Title
Pilot study of Iyengar yoga for management of aromatase inhibitor-associated arthralgia in women with breast cancer.
Source
Psycho-Oncology. 24(11):1578-80, 2015 Nov.

MINDFULNESS

Authors
Dobos G; Overhamm T; Bussing A; Ostermann T; Langhorst J; Kummel S; Paul A; Cramer H.
Title
Integrating mindfulness in supportive cancer care: a cohort study on a mindfulness-based day care clinic for cancer survivors.
Source
Supportive Care in Cancer. 23(10):2945-55, 2015 Oct.
Abstract
PURPOSE: The aim of this study was to investigate the effects of a mindfulness-based day care clinic group program for cancer survivors on health-related quality of life and mental health; and to investigate which psychological variables are associated with changes in health variables.
METHODS: One hundred seventeen cancer survivors (91.0 % female; mean age 53.9 +/- 10.7 years; 65.0 % breast cancer; mean time since diagnosis 27.2 +/- 46.5 months) participated in an 11-week mindfulness-based day care clinic group program, 6 h per week. The intervention incorporated mindfulness-based meditation, yoga, cognitive-behavioral techniques, and lifestyle modification. Outcome measures including health-related quality of life (EORTC QLQ-C30), depression and anxiety (HADS); and psychological variables including life satisfaction (BMLSS), mindfulness (FMI), adaptive coping styles (AKU), spiritual/religious attitudes in dealing with illness (SpREUK), and interpretation of illness (IIQ) were assessed before, after, and 3 months after the intervention.
RESULTS: Using mixed linear models, significant improvements in global health status, physical functioning, role functioning, emotional functioning, cognitive functioning, and social functioning were found. Cancer-related symptoms, including fatigue, pain, insomnia, constipation, anxiety, and depression, also improved significantly. Mindfulness, life satisfaction, health satisfaction, all coping styles, all spiritual/religious attitudes, and interpretation of illness as something of value increased; interpretation of illness as punishment decreased significantly (all p < 0.05). Improved outcomes were associated with increases in psychological variables, mainly life satisfaction, health satisfaction, and trust in medical help (R (2) = 7.3-43.6 %).
CONCLUSION: Supportive mindfulness-based interventions can be considered as an effective means to improve cancer survivors' physical and mental health. Functional improvements are associated with improved satisfaction and coping styles.

CAM USE SURVEYS

Authors
Mani J; Juengel E; Arslan I; Bartsch G; Filmann N; Ackermann H; Nelson K; Haferkamp A; Engl T; Blaheta RA.
Title
Use of complementary and alternative medicine before and after organ removal due to urologic cancer.
Source
Patient preference & adherence. 9:1407-12, 2015.
Abstract
OBJECTIVE: Many patients use complementary and alternative medicine (CAM) as primary treatment or symptom relief for a variety of illnesses. This study was designed to investigate the influence of surgical removal of a tumor-bearing urogenital organ on CAM use.
METHODS: From 2007 to 2011, 350 patients underwent major urological surgery for kidney, prostate, or bladder cancer at the Goethe-University Hospital, Frankfurt, Germany. Data from 172 patients (49%), who returned a questionnaire, were retrospectively evaluated using the hospital information system along with the questionnaire to objectify CAM use 2 years before and after surgery.
RESULTS: From the 172 patients returning questionnaires, 56 (33%) used CAM before and/or after surgery and 116 (67%) never used CAM. Of the 56 CAM users, 30 (54%) used CAM presurgery and 53 (95%) used CAM postsurgery, indicating a significant change of mind about CAM use. Patients of German nationality used CAM significantly more than patients of other nationalities. Higher educational status (high-school diploma or higher) was a significant factor in favor of CAM use. The most common type of CAM used before/after surgery was an alternative medical system (63/49%), a manipulative and body-based method (50/19%), and a biological-based therapy (37/32%). Information about CAM, either provided by medical professionals or by other sources, was the main reason determining whether patients used CAM or not.
CONCLUSION: The number of patients using CAM almost doubled after surgical removal of a cancer-bearing organ. Better awareness and understanding of CAM use by medical professionals could improve patient counseling.

Authors
Abdallah R; Xiong Y; Lancaster JM; Judson PL.
Title
Complementary and Alternative Medicine Use in Women With Gynecologic Malignancy Presenting for Care at a Comprehensive Cancer Center.
Source
International Journal of Gynecological Cancer. 25(9):1724-30, 2015 Nov.
Abstract
OBJECTIVE: We evaluated complementary and alternative medicine (CAM) practices among women presenting to a National Cancer Institute-designated Comprehensive Cancer Center with a gynecologic malignancy.
METHODS: Women with a gynecologic malignancy who had consented to enrollment in our institutional prospective clinical registry between January 2003 and January 2014 and who had completed a questionnaire assessing sociodemographic characteristics, medical histories, quality of life, and CAM use were considered for analysis.
RESULTS: Among the 2508 women identified, responses to questions on CAM use were provided by 534 (21.3%). The majority of CAM question respondents were white (93.5%) and older than 50 years (76%). Overall, 464 women (87% of CAM question respondents) used at least 1 CAM therapy during the previous 12 months. The most commonly used CAM categories were biologically based approaches (83.5%), mind and body interventions (30.6%), and manipulative and body-based therapies (18.8%). The most commonly used individual CAM therapies were vitamins and minerals (78%), herbal supplements (27.9%), spiritual healing and prayer (15.1%), and deep breathing relaxation exercises (13.1%). Complementary and alternative medicine use was greatest in age groups 20 to 30 years and older than 65 years and was more prevalent among those who were widowed (P < 0.005), retired (P = 0.02), and with a higher level of education (P < 0.01). There was no association with cancer type, race, or ethnicity.
CONCLUSIONS: Complementary and alternative medicine use is common among women being treated for gynecologic malignancy. Given the potential interactions of some CAM modalities with conventional treatment and the possible benefits in controlling symptoms and improving quality of life, providers should discuss CAM with their patients.

Authors
Sanchez HC; Karlson CW; Hsu JH; Ostrenga A; Gordon C.
Title
Complementary and Alternative Medicine Use in Pediatric Hematology/Oncology Patients at the University of Mississippi Medical Center.
Source
Journal of Alternative & Complementary Medicine. 21(11):660-6, 2015 Nov.
Abstract
OBJECTIVE: To examine the prevalence and modalities of complementary and alternative medicine (CAM) use in children with cancer and sickle cell disease; the reasons for use of CAM; and the use of CAM before, during, and after treatment in children with cancer.
METHODS: This single-center, observational study administered caregivers a written questionnaire regarding the use of CAM therapies.
RESULTS: A total of 101 caregivers completed questionnaires. Including prayer, total CAM use in oncology and sickle cell disease was 64% and 63%, respectively. Non-prayer CAM use was 30% in oncology and 23% in sickle cell disease. Of respondents who reported using any CAM, the three most commonly used types were prayer (62.3% oncology; 60.0% sickle cell disease), vitamins/minerals (14.8% oncology; 10.0% sickle cell disease), and massage (9.8% oncology; 7.5% sickle cell disease). The primary reasons for using CAM were to provide hope, to improve quality of life, and to lessen adverse effects. In oncology patients, CAM use tended to increase during treatment compared with before and after treatment.
CONCLUSIONS: The reported prevalence of non-prayer CAM use was lower (23%-30%) in this sample than has been reported in national samples or other geographic regions of the United States. Nonetheless, participants reported many positive reasons for using CAM, including gaining hope, improving quality of life, and controlling pain. Thus, CAM use appears to be an important aspect of medical care for many pediatric hematology/oncology families and should be a consideration when providers are discussing treatment and quality of care with families.