December 2018 Research Findings

Cifu G, Power MC, Shomstein S, Arem H. Mindfulness-based interventions and cognitive function among breast cancer survivors: a systematic review. BMC Cancer 2018 Nov 26;18(1):1163-018-5065-3 PMID 30477450

BACKGROUND: Breast cancer survivors have an elevated risk of cognitive impairment compared to age-matched women without cancer. Causes of this impairment are complex, including both treatment and psychological factors. Mindfulness-based interventions, which have been shown to improve cognitive function in the general population, may be one approach to mitigate cognitive impairment in this survivor population. Our objective was to conduct a systematic literature review of studies on the effect of mindfulness-based interventions on cognition among breast cancer survivors. METHODS: We conducted searches of three electronic databases (Scopus, PubMed and Cochrane Database of Systematic Reviews) in September 2017 for studies pertaining mindfulness and cognitive function among breast cancer survivors. Abstracts were manually searched by two reviewers and additional articles were identified through reference lists. RESULTS: A total of 226 articles were identified through our systematic search and six met inclusion criteria for this review. The reviewed studies lacked consistency in terms of the cognition domains studied (e.g. executive function, recent memory, etc) and in the measures used to assess cognition. Of the included studies, two found no association between mindfulness interventions and cognitive function, two found improvement that was not sustained at the follow-up, and another two found sustained improvement at 2- or 6-months. CONCLUSIONS: Mindfulness-based interventions have shown some evidence for improving cognition among breast cancer survivors, but further research using validated and comprehensive cognitive assessments is needed. More research is also needed related to the timing, duration and content of mindfulness interventions.

        Hershman DL, Unger JM, Crew K. Acupuncture for Aromatase Inhibitor-Related Joint Pain Among Breast Cancer Patients. JAMA 2018 Dec 4;320(21):2270-2271 PMID 30512095

        Liu C, Zhang H, Sun C. Acupuncture for Aromatase Inhibitor-Related Joint Pain Among Breast Cancer Patients. JAMA 2018 Dec 4;320(21):2270 PMID 30512093

        Mao JJ, Farrar JT. Acupuncture for Aromatase Inhibitor-Related Joint Pain Among Breast Cancer Patients. JAMA 2018 Dec 4;320(21):2269-2270 PMID 30512092


        Huberty J, Eckert R, Larkey L, Gowin K, Mitchell J, Mesa R. Perceptions of Myeloproliferative Neoplasm Patients Participating in an Online Yoga Intervention: A Qualitative Study. Integr Cancer Ther 2018 Dec;17(4):1150-1162 PMID 30352518

Myeloproliferative neoplasms (MPNs) are rare hematological malignancies with a significant symptom burden often left unresolved despite recent advances in pharmacological therapy. Yoga is a nonpharmacological strategy that has been shown to improve symptoms in other cancers and may be effective for improving symptoms in MPN patients. Online yoga helps address many of the commonly reported barriers of cancer patients to in-person interventions and may make yoga more accessible to MPNs. An exploration of MPN patient perceptions of participation in online yoga is needed to tailor interventions to patient needs and inform future studies. The purpose of this study was to explore the perceptions of MPN patients participating in a 12-week online yoga intervention. This article represents the combined qualitative interview data from two studies. Participants were asked to complete 60 min/wk of online, home-based yoga and were asked to participate in a 15- to 20-minute phone interview postintervention. The qualitative data was coded in NVivo 11 for content analysis. The total sample included 39 MPN patients. Online yoga was well accepted and liked among these patients. They reported physical (eg, improved sleep, reduced fatigue) and mental (eg, reduced stress) health benefits and liked the convenience of being able to do yoga at home. Online yoga provides a feasible and attractive format through which to deliver a nonpharmacological intervention among MPN patients. Randomized controlled trials are needed to confirm the effects of online yoga on MPN patient symptoms. The qualitative findings presented here help inform the development of these future trials.

        Kim K, Lee S. Intradermal Acupuncture Along with Analgesics for Pain Control in Advanced Cancer Cases: A Pilot, Randomized, Patient-Assessor-Blinded, Controlled Trial. Integr Cancer Ther 2018 Dec;17(4):1137-1143 PMID 30009652

PURPOSE: Ninety percent of patients with advanced cancer have moderate to severe pain, and up to 70% of patients with cancer pain do not receive adequate pain relief. This randomized controlled clinical trial was designed to determine the feasibility and evaluate the effects and safety of intradermal acupuncture (IA) in patients who were being administered analgesics for cancer pain. METHODS: Advanced cancer patients experiencing pain were randomly assigned to IA or sham IA treatment for 3 weeks (15 patients for each group), wherein the CV12, bilateral ST25, LI4, LR3, PC06, and Ashi points were selected and stimulated. Follow-up evaluations were conducted 3 weeks after the end of treatments. The grade and dosage of analgesics for cancer pain, pain intensity, quality of life, and safety were assessed. RESULTS: Twenty-seven patients (90%) completed 6-week trial, and no serious adverse events were associated with either IA or sham IA procedures except the transient side effect such as fatigue. Nine patients in the IA group (64.3%) and 5 in the sham IA group (38.5%) responded to the 3-week intervention. These patients were mostly in the nonopioid and the weak opioid levels of the World Health Organization analgesic ladder. Self-reported pain declined by -1.54 +/- 1.45 and -1.15 +/- 1.57 in the IA and sham IA groups, respectively, with improved quality of life reported. CONCLUSIONS: IA treatment appears feasible and safe for advanced cancer patients. It might reduce analgesic usage in the early World Health Organization analgesic ladder stage cancer patient, though it could not show significant outcome differences due to design limitation of sham IA.

        Lim CH, Yoo JE. A case report of traditional Korean medicine treatments on uterine myoma with thyroid cancer. Integr Med Res 2018 Dec;7(4):303-306 PMID 30505680

Uterine myoma is a common benign tumor. When the symptoms are not severe, patients are often suggested to wait for menopause without treatment. If the size becomes too large or the symptoms get worse, the patient will receive surgery or hormone therapy. If a patient does not receive surgery or hormone therapy because of the waiting period, traditional Korean medicine (TKM) treatment can be applied. This is a case of a 47-year-old woman who was diagnosed with thyroid cancer and uterine myoma. She was diagnosed with thyroid cancer in 2012 and uterine myoma in 2013. She had not received treatments. In December 2017, the size of the uterine myoma increased to more than 8 cm, and the patient suffered from dysmenorrhea, urination frequency, and vaginal discharges. She wanted TKM treatment instead of surgery or hormone therapy. From January 16, 2018 to April 12, 2018, she received TKM treatment; herbal medicine, acupuncture, moxibustion, and pharmacopuncture. Before the treatment, the urination frequency was more than 10 times a day, but decreased to 6-7 times a day after treatments. Dysmenorrhea decreased from VAS8 to VAS5 after treatments. After menstruation, the duration of vaginal secretion persisted for 3-4 days, but after treatments, it was visible only for a 1 day after menstruation. Ultrasonography showed that the thyroid cancer did not worsen and the size of uterine myoma decreased by 2 cm. It is considered that TKM treatment, as a substitute for surgery or hormone therapy, will exert positive effect on uterine myoma without the aggravation of thyroid cancer.

        Loescher LJ, Howerter AL, Heslin KM, Azzolina CM, Muramoto ML. A Survey of Licensed Massage Therapists' Perceptions of Skin Cancer Prevention and Detection Activities. Int J Ther Massage Bodywork 2018 Dec 1;11(4):4-10 PMID 30524632

Background: Skin cancer is the most common cancer in the US. Training massage therapists (MTs) in skin cancer prevention and detection creates opportunity for reducing skin cancer burden. Little is known about MTs' perceptions of skin cancer prevention and detection, their discussions of these topics with clients, or their referral recommendations for suspicious skin lesions. Purpose: We surveyed MTs' perceptions of their role in engaging in conversations about skin cancer prevention, viewing the skin for suspicious lesions, and referring clients with such lesions to health care providers. Setting Participants Research Design: We administered an online survey from 2015-2017 of licensed MTs practicing in the US and at least age 21 years (n = 102); quantitative and qualitative data were analyzed in 2017. Main Outcome Measures: The main variables assessed were MTs perceptions of (a) appropriateness for asking clients about skin cancer history, skin cancer prevention, suspicious lesion referral and follow-up; and (b) comfort with recognizing and discussing suspicious lesions, recommending a client see a doctor for suspicious lesion, and discussing skin cancer prevention. Results: Quantitative data revealed that most MTs were amenable to discussing skin cancer prevention during appointments; few were engaging in these conversations. MTs were more comfortable discussing suspicious lesions and recommending that a client see a doctor than they were sharing knowledge about skin cancer and sun safety. Categories based on qualitative content analysis were: sharing information for the client's benefit, and concerns about remaining within scope of practice. Conclusions: MTs have boundaries for skin cancer risk-reduction content to include in a client discussion and remain in their scope of practice. These findings will help support a future educational intervention for MTs to learn about and incorporate skin cancer risk-reduction messages and activities into their practice.

Lopez G, Chaoul A, Powers-James C, Eddy CA, Mallaiah S, Gomez TI, et al. Group Yoga Effects on Cancer Patient and Caregiver Symptom Distress: Assessment of Self-reported Symptoms at a Comprehensive Cancer Center. Integr Cancer Ther 2018 Dec;17(4):1087-1094 PMID 30168358

BACKGROUND: Complementary and integrative health approaches such as yoga provide support for psychosocial health. We explored the effects of group-based yoga classes offered through an integrative medicine center at a comprehensive cancer center. METHODS: Patients and caregivers had access to two yoga group classes: a lower intensity (YLow) or higher intensity (YHigh) class. Participants completed the Edmonton Symptom Assessment System (ESAS; scale 0-10, 10 most severe) immediately before and after the class. ESAS subscales analyzed included global (GDS; score 0-90), physical (PHS; 0-60), and psychological distress (PSS; 0-20). Data were analyzed examining pre-yoga and post-yoga symptom scores using paired t-tests and between types of classes using ANOVAs. RESULTS: From July 18, 2016, to August 8, 2017, 282 unique participants (205 patients, 77 caregivers; 85% female; ages 20-79 years) attended one or more yoga groups (mean 2.3). For all participants, we observed clinically significant reduction/improvement in GDS, PHS, and PSS scores and in symptoms (ESAS decrease >/=1; means) of anxiety, fatigue, well-being, depression, appetite, drowsiness, and sleep. Clinically significant improvement for both patients and caregivers was observed for anxiety, depression, fatigue, well-being, and all ESAS subscales. Comparing yoga groups, YLow contributed to greater improvement in sleep versus YHigh (-1.33 vs -0.50, P = .054). Improvement in fatigue for YLow was the greatest mean change (YLow -2.12). CONCLUSION: A single yoga group class resulted in clinically meaningful improvement of multiple self-reported symptoms. Further research is needed to better understand how yoga class content, intensity, and duration can affect outcomes.

            Matsushita Y, Furutani Y, Matsuoka R, Furukawa T. Hot water extract of Agaricus blazei     Murrill specifically inhibits growth and induces apoptosis in human pancreatic cancer            cells. BMC Complement Altern Med 2018 Dec 4;18(1):319-018-2385-4 PMID 30514293

            BACKGROUND: Pancreatic cancer is one of the most aggressive human malignancies. The    development of a novel drug to treat pancreatic cancer is imperative, and it is thought that           complementary and alternative medicine (CAM) could yield such a candidate. Agaricus blazei        Murrill is a CAM that has been tested as an anticancer drug, but its efficacy against pancreatic        cancer is poorly understood. To study the potential of A. blazei in the treatment of pancreatic       cancer, we examined the effects of its hot water extract on the proliferation and global gene   expression profile of human pancreatic cancer cells. METHODS: Three distinct human             pancreatic cancer cell lines, MIAPaCa-2, PCI-35, and PK-8, and the immortalized human             pancreatic duct-epithelial cell line, HPDE, were employed. The cells were incubated with the             appropriate growth medium supplemented with the hot water extract of A. blazei at final             concentrations of 0.005, 0.015%, or 0.045%, and cellular proliferation was assessed for five             consecutive days using an MTT assay. Apoptosis was examined by using flow cytometry and           the terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) assay. Caspase-         dependent apoptosis was assayed using immunoblotting. Global gene expression profiles were            examined using a whole human genome 44 K microarray, and the microarray results were       validated by using real-time reverse transcription PCR. RESULTS: The hot water extract of A.          blazei significantly inhibited the proliferation of cultured pancreatic cancer cells through the   induction of G0/G1 cell cycle arrest and caspase-dependent apoptosis; the effect was the smallest in HPDE cells. Furthermore, significant alterations in the global gene expression       profiles of pancreatic cancer cells occurred following treatment with the hot water extract of A.             blazei. Genes associated with kinetochore function, spindle formation, and centromere        maintenance were particularly affected, as well as cyclins and cyclin-dependent kinases that         are essential for cell cycle progression. In addition, proapoptotic genes were upregulated.        CONCLUSIONS: The hot water extract of A. blazei may be useful for the treatment of        pancreatic cancer and is a potential candidate for the isolation of novel, active compounds         specific for mitotic spindle dysfunction.

            Zhi WI, Ingram E, Li SQ, Chen P, Piulson L, Bao T. Acupuncture for Bortezomib-Induced    Peripheral Neuropathy: Not Just for Pain. Integr Cancer Ther 2018 Dec;17(4):1079-1086      PMID 30027756

            BACKGROUND: Bortezomib-induced peripheral neuropathy (BIPN) is a common and debilitating side effect. Our pilot study demonstrated that acupuncture is safe and can          decrease total neuropathic symptoms. However, there is lack of knowledge in which individual   BIPN symptoms benefited from acupuncture. PURPOSE: To characterize individual symptoms             reduced by acupuncture in patients with BIPN. METHODS: Patients with multiple myeloma        treated with bortezomib who developed BIPN grade 2 or above, based on National Cancer         Institute Common Terminology Criteria for Adverse Events (NCI CTCAE), were enrolled and        received 10 acupuncture treatments over 10 weeks. Self-reported BIPN-associated symptoms       assessments were collected weekly at baseline, during, and after acupuncture treatment using             the Neuropathy Pain Scale (NPS) and the Functional Assessment of Cancer   Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx) questionnaires.          Changes in individual symptoms were analyzed based on FACT/GOG-Ntx and NPS scores.      RESULTS: There were statistically significant reductions in individual symptoms in both NPS         and FACT/GOG-Ntx. The FACT/GOG-Ntx reductions were most pronounced in hand/feet     numbness/tingling, discomfort, and trouble walking. The sensory symptoms, such as tingling             and numbness, especially in the feet, reduced the most ( P < .0001), and motor dysfunction          also reduced significantly ( P = .0001). Both hearing and dysfunction scores were also     statistically significantly increased, indicating improved symptoms. The NPS scores showed significant symptom relief in all 10 items from the NPS assessment, particularly in cold             sensitivity and an unpleasant feeling. CONCLUSIONS: Acupuncture can improve multiple      symptoms associated with BIPN, particularly numbness and tingling in hands and feet, cold    sensitivity, and an unpleasant feeling. Further randomized control trials are warranted to             confirm our findings.