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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.

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Conference

Registration is open: SIO's 13th International Conference will be held November 5-7, 2016, with a theme of "Advancing the Global Impact of Integrative Oncology" in Miami, Florida. Check out the conference website

Register here for the conference. See you in Miami!

 

 

 

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 Medicine for Cancer Digest: July, 2016

 

ACUPUNCTURE/ACUPRESSURE

Authors: Minchom A; Punwani R; Filshie J; Bhosle J; Nimako K; Myerson J; Gunapala R; Popat S; O'Brien ME.
Title: A randomised study comparing the effectiveness of acupuncture or morphine versus the combination for the relief of dyspnoea in patients with advanced non-small cell lung cancer and mesothelioma.
Source: European Journal of Cancer. 61:102-10, 2016 Jul.
Abstract: BACKGROUND: Dyspnoea is one of the commonest symptoms of lung cancer. Opioids can reduce dyspnoea. This study investigates acupuncture for relief of breathlessness in lung cancer.
METHODS: We performed a single-centre, randomised phase II study of 173 patients with non-small cell lung cancer or mesothelioma with dyspnoea score of >4 on visual analogue scale (VAS). Randomisation was to acupuncture alone (A), morphine alone (M) or both (AM). Acupuncture was administered at upper sternal, thoracic paravertebral, trapezius trigger points and LI4. Manubrial semi-permanent acupuncture studs were inserted and massaged when symptomatic. Arm A patients received rescue morphine. Primary end-point was proportion of patients achieving >1.5 improvement in VAS dyspnoea at 4 h. Measurements continued to day 14 and included VAS relaxation, line analogue rating (Lar) anxiety, hospital anxiety and depression and European Organisation for Research and Treatment of Cancer quality-of-life scores.
RESULTS: Dyspnoea VAS improved >1.5 in 74%, 60% and 66% of arms A, M and AM, respectively, and was maintained in 45% at 2 weeks. There was no statistically significant difference between arms. VAS relaxation improved in arms A (1.06 points) and AM (1.48 points) compared to arm M (-0.19 points, p<0.001). At 7 d, the Lar anxiety score improved in arm A (1.5 points), arm AM (1.2 points) and arm M (no change, p=0.003). Fewer patients received at least one morphine dose in arm A compared with arm M or AM (21% versus 87% versus 87%, respectively, p<0.001).
CONCLUSIONS: A, M and AM were effective in relieving dyspnoea. Acupuncture relieved anxiety and was morphine sparing, providing an alternative to morphine.

Authors: Chae HD; Kwak MA; Kim IH.
Title: Effect of Acupuncture on Reducing Duration of Postoperative Ileus After Gastrectomy in Patients with Gastric Cancer: A Pilot Study Using Sitz Marker.
Source: Journal of Alternative & Complementary Medicine. 22(6):465-72, 2016 Jun.
Abstract: OBJECTIVES: Postoperative ileus (POI) is a common problem after abdominal surgery. Acupuncture is being accepted as an option for reducing POI and managing various functional gastrointestinal disorders. Therefore, this pilot study was conducted to evaluate the effect of acupuncture on reducing duration of POI and other surgical outcomes in patients who underwent gastric surgery.
DESIGN: A prospective, randomized, controlled pilot study was conducted on patients who underwent gastric cancer surgery from January 2013 to December 2013. Ten patients were randomly assigned into the acupuncture (A) or nonacupuncture (NA) groups at a 1:1 ratio.
INTERVENTIONS: The acupuncture treatment was performed by Korean traditional medicine doctors (KMDs). The style of acupuncture was Korean. In the A group, acupuncture treatment was given once daily for 5 consecutive days starting on postoperative day 1. Each patient received acupuncture at 16 acupoints based on expert consensus provided by qualified and experienced KMDs. No acupuncture treatment was performed in the NA group.
OUTCOME MEASURES: The primary outcome measure was the number of remnant Sitz markers in the small intestine on abdominal radiography. Secondary outcome measures were time to first flatus, start of sips water, start of soft diet, hospital stay, and laboratory findings.
RESULTS: The A group had significantly fewer remnant Sitz markers in the small intestine on postoperative days 3 and 5 compared with those in the NA group (p=0.025 and 0.005). A significant difference was observed in the numbers of remnant Sitz marker in the small intestine with respect to time difference by group (p=0.019). The A group showed relatively better surgical outcomes, but without statistical significance.
CONCLUSIONS: Although further studies are warranted, acupuncture may reduce duration of POI after gastric surgery and could be a potential factor in enhanced recovery after surgery protocols.

Authors: Solanki SL; Doctor JR; Kapila SJ; Gehdoo RP; Divatia JV.
Title: Acupressure versus dilution of fentanyl to reduce incidence of fentanyl-induced cough in female cancer patients: a prospective randomized controlled study.
Source: Korean Journal of Anesthesiology. 69(3):234-8, 2016 Jun.
Abstract: BACKGROUND: Fentanyl-induced cough (FIC) is a transient condition with a reported incidence of 18% to 65% depending on the dose and route of administration of fentanyl. Nonpharmacological methods to prevent FIC are more cost-effective than medications. Dilution of fentanyl has a proven role in the prevention of FIC. Acupressure can also prevent FIC because it has a proven role in the treatment of cough.
METHODS: This study included 225 female patients with an American Society of Anesthesiologists physical status of I or II who were randomly divided into 3 groups of 75 patients each. Patients in the control group received undiluted fentanyl at 3 microg/kg, patients in the acupressure group received undiluted fentanyl at 3 microg/kg with acupressure, and patients in the dilution group received diluted fentanyl at 3 microg/kg. Coughing was noted within 2 min of fentanyl administration. The severity of FIC was graded as mild (1-2 coughs), moderate (3-4 coughs), or severe (>5 coughs). The timing of coughs was also noted.
RESULTS: The incidence of FIC was 12.7% in the control group, 6.8% in the dilution group, and 1.3% in the acupressure group. The difference in the incidence of cough was statistically significant (P = 0.008) between the control and acupressure groups. The difference in the severity of cough among the groups was not statistically significant. The median onset time of cough among all groups was 9 to 12 seconds.
CONCLUSIONS: The application of acupressure prior to administration of fentanyl significantly reduces the incidence of FIC. Dilution of fentanyl also reduces the incidence of FIC, but the difference is not statistically significant.

EXERCISE

Authors: Fairman CM; Focht BC; Lucas AR; Lustberg MB.
Title: Effects of exercise interventions during different treatments in breast cancer.
Source: The Journal of community and supportive oncology. 14(5):200-9, 2016 May.
Abstract: Previous findings suggest that exercise is a safe and efficacious means of improving physiological and psychosocial outcomes in female breast cancer survivors. To date, most research has focused on post-treatment interventions. However, given that the type and severity of treatment-related adverse effects may be dependent on the type of treatment, and that the effects are substantially more pronounced during treatment, an assessment of the safety and efficacy of exercise during treatment is warranted. In this review, we present and evaluate the results of randomized controlled trials (RCTs) conducted during breast cancer treatment. We conducted literature searches to identify studies examining exercise interventions in breast cancer patients who were undergoing chemotherapy or radiation. Data were extracted on physiological and psychosocial outcomes. Cohen's d effect sizes were calculated for each outcome. A total of 17 studies involving 1,175 participants undergoing active cancer therapy met the inclusion criteria. Findings revealed that, on average, exercise interventions resulted in moderate to large improvements in muscular strength: resistance exercise (RE, = 0.86), aerobic exercise (AE, = 0.55), small to moderate improvements in cardiovascular functioning (RE, = 0.45; AE, = 0.17, combination exercise (COMB, = 0.31) and quality of life (QoL; RE, = 0.30; AE, = 0.50; COMB, = 0.63). The results of this review suggest that exercise is a safe, feasible, and efficacious intervention in breast cancer patients who are undergoing different types of treatment. Additional research addressing the different modes of exercise during each type of treatment is warranted to assess the comparable efficacy of the various exercise modes during established breast cancer treatments.

CAM USE

Authors: Black DS; Lam CN; Nguyen NT; Ihenacho U; Figueiredo JC.
Title: Complementary and Integrative Health Practices Among Hispanics Diagnosed with Colorectal Cancer: Utilization and Communication with Physicians.
Source: Journal of Alternative & Complementary Medicine. 22(6):473-9, 2016 Jun.
Abstract: OBJECTIVE: Complementary and integrative health (CIH) use among Hispanic adults with colorectal cancer (CRC) diagnosis is not well documented. Understanding the prevalence and patterns of CIH use among Hispanics offers insights to uncover potential needs for clinical services.
DESIGN: Participants were age 21 years or older with a first-time diagnosis of CRC from population-based cancer registries in California. In-person and/or telephone-based interviews were administered to collect data on CIH use. Demographic and clinical diagnosis data were abstracted from medical records. Descriptive statistical and logistic regression was used to analyze the frequencies and associations between selected patient characteristics and CIH use.
RESULTS: Among 631 Hispanic patients, 40.1% reported ever using CIH. Herbal products/dietary supplements were used most often (35.3%), followed by bodywork (16.5%), mind-body practices (7.8%), and homeopathy (6.7%). About 60% of participants reported CIH use to address specific health conditions; however, most patients did not discuss CIH use with their physicians (76.3%). Women reported higher CIH use than did men (45.1% versus 35.9%; odds ratio, 1.49 [95% confidence interval, 1.07-2.08]; p=0.02). CIH use did not differ by clinical stage, time since diagnosis, or preferred language.
CONCLUSIONS: CIH use is prevalent among Hispanic patients with CRC, especially women. Little communication about CIH use occurs between participants and their healthcare providers. Efforts aimed at improving integrative oncology services provide an opportunity to address such gaps in healthcare service.

YOGA

Authors: Komatsu H; Yagasaki K; Yamauchi H; Yamauchi T; Takebayashi T.
Title: A self-directed home yoga programme for women with breast cancer during chemotherapy: A feasibility study.
Source: International Journal of Nursing Practice. 22(3):258-66, 2016 Jun.
Abstract: Recent studies suggest yoga as a promising approach for improving the cognitive function of cancer survivors. We studied whether a self-directed home yoga programme was feasible for patients with breast cancer who were undergoing chemotherapy. Participants' preferences for the type of yoga course and the clinical effects of the programme were also assessed. In this study, 18 women (mean age, 43.9years) were enrolled (44.7% recruitment rate). Of the participants, 63.6% had stage II cancer and 71.4% received adjuvant chemotherapy. Favourable retention (86%), adherence (94.4%) and acceptability (96.5%) rates were determined. Most (94.4%) of the women practiced the home programme more than twice a week on average. The participants preferred to gradually increase the intensity of the exercises. We only observed improvements in the cognitive aspects of fatigue. No serious adverse events were encountered during the programme. This self-directed home yoga programme was safe and feasible for patients with breast cancer undergoing chemotherapy.

REIKI, YOGA, MASSAGE

Authors: Rosenbaum MS; Velde J.
Title: The Effects of Yoga, Massage, and Reiki on Patient Well-Being at a Cancer Resource Center.
Source: Clinical Journal of Oncology Nursing. 20(3):E77-81, 2016 Jun 1.
Abstract: BACKGROUND: Cancer resource centers offer patients a variety of therapeutic services. However, patients with cancer and cancer healthcare practitioners may not fully understand the specific objectives and benefits of each service. This research offers guidance to cancer healthcare practitioners on how they can best direct patients to partake in specific integrative therapies, depending on their expressed needs.
OBJECTIVES: This article investigates the effects of yoga, massage, and Reiki services administered in a cancer resource center on patients' sense of personal well-being. The results show how program directors at a cancer resource center can customize therapies to meet the needs of patients' well-being.
METHODS: The experimental design measured whether engaging in yoga, massage, or Reiki services affects the self-perceived well-being of 150 patients at a cancer resource center at two times.
FINDINGS: All three services helped decrease stress and anxiety, improve mood, and enhance cancer center patrons' perceived overall health and quality of life in a similar manner. Reiki reduced the pain of patients with cancer to a greater extent than either massage or yoga.

THERAPEUTIC TOUCH

Authors: Matourypour P; Vanaki Z; Zare Z; Mehrzad V; Dehghan M; Ranjbaran M.
Title: Investigating the effect of therapeutic touch on the intensity of acute chemotherapy-induced vomiting in breast cancer women under chemotherapy.
Source: Iranian Journal of Nursing and Midwifery Research. 21(3):255-60, 2016 May-Jun.
Abstract: BACKGROUND: Nausea and vomiting are the worst and the most prevalent complications experienced by 70-80% of patients. Complementary treatments including therapeutic touch are cost-effective and low-risk, independent nursing interventions. Present research aims at investigating the effect of therapeutic touch on the intensity of acute chemotherapy-induced vomiting in these patients.
MATERIALS AND METHODS: As a single-blind, randomized clinical trial, the present research was carried out on women with breast cancer undergoing chemotherapy in Isfahan, Iran. The subjects were divided into three groups of control, placebo, and intervention. The intervention was applied to each patient once for 20 min on the aura (human energy field) focusing on solar chakra. Data gathering instruments included demographic questionnaire and acute vomiting intensity scale.
RESULTS: There was a significant difference among the three groups (and also after the intervention) (P < 0.0001). Paired comparisons among the groups using Mann-Whitney test showed that there was a statistically significant difference between the control group and the intervention group and between the control group and the placebo group (P < 0.0001). However, there was no significant difference between the placebo and intervention groups (P = 0.07).
CONCLUSIONS: Therapeutic touch was effective in reducing vomiting in the intervention group. However, the patients experienced lower-intensity vomiting which may be because of presence of a therapist and probably the reduced anxiety related to an additional intervention. So, further research is recommended considering the placebo group and employing another person in addition to the therapist, who is not skilled for this technique.