Integrative Oncology Digest October 2019

Arring NM, Barton DL, Brooks T, Zick SM. Integrative Therapies for Cancer-Related Fatigue. Cancer J 2019 Sep/Oct;25(5):349-356 PMID 31567463

Cancer-related fatigue (CRF) is a common symptom for which cancer patients often use integrative and integrative therapies; however, evidence supporting these therapies is limited. The aim of this review is to provide evidence-based recommendations for integrative interventions during and after cancer treatment for CRF. These recommendations are based on a systematic literature review from 1990 through 2019. Cognitive behavior therapy plus hypnosis and American ginseng can be considered during active treatment, and acupressure, mindfulness-based cognitive therapy, and qigong/tai chi easy can be considered during posttreatment. Coenzyme Q10 and L-carnitine are not recommended during active-treatment. All other integrative therapies for CRF had insufficient evidence to make a recommendation. While there is increasing evidence for integrative therapies for CRF, because of lack of rigorous trials and replication, no therapies could be definitively recommended. Further rigorously designed integrative therapy research is needed and should consider implementation and dissemination.


Bossio JA, Miller F, O'Loughlin JI, Brotto LA. Sexual Health Recovery For Prostate Cancer Survivors: The Proposed Role Of Acceptance And Mindfulness-Based Interventions. Sex Med Rev 2019 Oct;7(4):627-635 PMID 31029619

INTRODUCTION: 1 in every 7 Canadian men is affected by prostate cancer. Given impressive advances in detection, treatment, and survival rates, there is a considerable focus on survivors' supportive care needs. Among the top unmet supportive care needs for prostate cancer survivors are concerns related to sexual health and intimacy. AIM: To provide a rationale for introducing mindfulness- and acceptance-based approaches into the role of psychosexual interventions aimed at improving sexual satisfaction among prostate cancer survivors (and their partners). METHODS: A literature review was performed to examine the prevalence of sexual difficulties after prostate cancer treatment and the efficacy of current pharmacologic and psychological treatment approaches. MAIN OUTCOME MEASURE: The main outcome measure was focused on sexual satisfaction in prostate cancer survivors. RESULTS: Current pharmacologic interventions for sexual difficulties after prostate cancer treatment are not fully meeting the needs of prostate cancer survivors and their partners. Conclusions cannot be drawn from existing psychological interventions because of methodologic inconsistencies. Additionally, the focus on erectile function as a measure of treatment effectiveness is likely to instill a greater sense of hopelessness and loss for prostate cancer survivors, which may exacerbate issues around sexual intimacy and satisfaction. An impressive body of evidence supports the role of mindfulness in improving women's sexual functioning and there is preliminary evidence suggesting the efficacy of this approach for improving men's sexual functioning. CONCLUSION: We propose that psychosexual interventions that prioritize mindfulness and acceptance-based frameworks may help men to tune into sensations while challenging the foci on performance and erections, thereby increasing the potential for improvement to sexual satisfaction among prostate cancer survivors.

Calcagni N, Gana K, Quintard B. A systematic review of complementary and alternative medicine in oncology: Psychological and physical effects of manipulative and body-based practices. PLoS One 2019 Oct 17;14(10):e0223564 PMID 31622362

BACKGROUND: Complementary and Alternative Medicines (CAM) are widely used by cancer patients, despite limited evidence of efficacy. Manipulative and body-based practices are some of the most commonly used CAM. This systematic review evaluates their benefits in oncology. METHOD: A systematic literature review was carried out with no restriction of language, time, cancer location or type. PubMed, CENTRAL, PsycArticle, PsychInfo, Psychology and Behavioral Sciences Collection and SOCindex were queried. Inclusion criteria were adult cancer patients and randomized controlled trials (RCT) assessing manipulative and body-based complementary practices on psychological and symptom outcomes. Effect size was calculated when applicable. RESULTS: Of 1624 articles retrieved, 41 articles were included: massage (24), reflexology (11), acupressure (6). Overall, 25 studies showed positive and significant effects on symptom outcomes (versus 9 that did not), especially pain and fatigue. Mixed outcomes were found for quality of life (8 papers finding a significant effect vs. 10 which did not) and mood (14 papers vs. 13). In most studies, there was a high risk of bias with a mean Jadad score of 2, making interpretation of results difficult. CONCLUSION: These results seem to indicate that manipulative CAM may be effective on symptom management in cancer. However, more robust methodologies are needed. The methodological requirements of randomized controlled trials are challenging, and more informative results may be provided by more pragmatic study design.
Carlson LE, Toivonen K, Subnis U. Integrative Approaches to Stress Management. Cancer J 2019 Sep/Oct;25(5):329-336 PMID 31567460

This narrative review provides an overview of the scope of psychosocial distress and stress in cancer patients and survivors and the potential negative consequences of untreated symptoms. Evidence-based interventions to treat these symptoms are reviewed, beginning with a summary of published clinical practice guidelines, followed by more detailed reviews of the specific integrative interventions with the largest empirical support: cognitive-behavioral stress management, yoga, mindfulness-based interventions, and massage. We also comment on use of natural health products because of their popularity. Finally, we conclude with recommendations to improve the quality of research in integrative interventions for stress management.

Deng G. Integrative Medicine Therapies for Pain Management in Cancer Patients. Cancer J 2019 Sep/Oct;25(5):343-348 PMID 31567462

Pain management for cancer patients should include pharmacologic and nonpharmacologic interventions. Integrative medicine therapies, such as mind-body practice, acupuncture, massage therapy, and music therapy, have been studied for their roles in pain management. Data from randomized controlled trials support the effect of hypnosis, acupuncture, and music therapy in reduction of pain. Mindfulness meditation, yoga, qigong, and massage therapy, although may not reduce pain per se, can relieve anxiety and mood changes, which are commonly associated with pain. In clinical practice, one should also consider burdens and risks to patients, patient preference, and the presence or absence of better alternatives when making decisions on whether an integrative medicine therapy is of clinical value.

Garland SN, Mahon K, Irwin MR. Integrative Approaches for Sleep Health in Cancer Survivors. Cancer J 2019 Sep/Oct;25(5):337-342 PMID 31567461

Sleep disturbance and insomnia are prevalent problems for the more than 15 million cancer survivors in the United States. If not addressed, poor-quality sleep can negatively impact physical and psychological recovery from cancer diagnosis and treatment. Cancer survivors are increasingly turning to integrative therapies to improve sleep and optimize their health. The purpose of this article is to review the evidence for the use of nonpharmacological integrative therapies to improve sleep health in cancer patients. Therapies are grouped into the following categories: cognitive-behavioral, meditative (e.g., mindfulness-based interventions, yoga, qigong/tai chi), and body based (e.g., acupuncture, acupressure, massage, reflexology). Cognitive-behavioral therapy for insomnia, mindfulness-based therapies, qigong/tai chi, and acupuncture have the most evidence for improving sleep and insomnia, whereas yoga, acupressure, massage, and reflexology are still being investigated or building their evidence base. Several areas of strength are identified, gaps in the literature are highlighted, and recommendations for improving future research are provided.


Hauser W, Welsch P, Klose P, Radbruch L, Fitzcharles MA. Efficacy, tolerability and safety of cannabis-based medicines for cancer pain : A systematic review with meta-analysis of randomised controlled trials. Schmerz 2019 Oct;33(5):424-436 PMID 31073761

BACKGROUND: The importance of medical cannabis and cannabis-based medicines for cancer pain management needs to be determined. METHODS: A systematic literature search until December 2018 included CENTRAL, PubMed, SCOPUS and trial registers. Randomised controlled trials (RCTs) investigating medical cannabis and/or pharmaceutical cannabinoids for pain control in cancer patients with a study duration of at least 2 weeks and a sample size of at least 20 participants per study arm were included. Clinical outcomes comprised efficacy (pain intensity, patient impression of improvement, combined responder, sleep problems, psychological distress, opioid maintenance and breakthrough dosage), tolerability (dropout rate due to adverse events) and safety (nervous system, psychiatric and gastrointestinal side effects; serious adverse events). The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: Five RCTs with oromucosal nabiximols or tetrahydrocannabinol (THC) including 1534 participants with moderate and severe pain despite opioid therapy were identified. Double blind period of the RCTs ranged between 2 and 5 weeks. Four studies with a parallel design and 1333 patients were available for meta-analysis. The quality of evidence was very low for all comparisons. Oromucosal nabiximols and THC did not differ from placebo in reducing pain, sleep problems, opioid dosages and in the frequency of combined responder, serious adverse events and psychiatric disorders side effects. The number of patients who reported to be much or very much improved was higher with oromucosal nabiximols and THC than with placebo (number needed to treat for an additional benefit 16; 95% confidence interval [CI] 8 to infinite). The dropout rates due to adverse events (number needed to treat for an additional harm [NNTH]: 20; 95% CI 11-100), the frequency of nervous system (NNTH: 10; 95% CI 7-25) and of gastrointestinal side effects (NNTH: 11; 95% CI 7-33) was higher with oromucosal nabiximols and THC than with placebo. CONCLUSIONS: Very low quality evidence suggests that oromucosal nabiximols and THC have no effect on pain, sleep problems and opioid consumption in patients with cancer pain with insufficient pain relief from opioids. The complete manuscript is written in English.


Khosravi N, Stoner L, Farajivafa V, Hanson ED. Exercise training, circulating cytokine levels and immune function in cancer survivors: A meta-analysis. Brain Behav Immun 2019 Oct;81:92-104 PMID 31454519

BACKGROUND: Anti-cancer therapies lead to chronic non-resolving inflammation and reduced immune function. One potential therapy is exercise training, but the effectiveness of these interventions to improve immune-related outcomes, the gaps in the literature, and recommendations to progress the field need to be determined. OBJECTIVES: (1) to conduct separate meta-analyses in cancer survivors to determine the effects of exercise training on pro- and anti-inflammatory markers, and immune cell proportions and function; and (2) to perform subgroup analyses to determine whether exercise modality, cancer type, and specific markers help to explain heterogeneity in each meta-analysis. DATA SOURCES: Electronic databases (PubMed/MEDLINE, EMBASE, CENTRAL, and CINAHL) from inception to March 2018. The reference lists of eligible articles and relevant reviews were also checked. STUDY SELECTION: Inclusion criteria were adult cancer survivors from randomized controlled trials performing structured exercise intervention (aerobic, resistance or combined training or Tai Chi/yoga) compared to usual care control group and included pro-inflammatory, anti-inflammatory, and/or immune cell outcomes. APPRAISAL AND SYNTHESIS METHODS: A total of 5349 potentially eligible articles were identified, of which 26 articles (27 trials) met the inclusion criteria. Effect sizes were calculated as standardized mean differences (SMD), where 0.8 as a large effect. RESULTS: Exercise training decreased pro-inflammatory markers (SMD: -0.2, 95% CI: -0.4, -0.1, p<0.001). Sub-group analysis for the pro-inflammatory markers indicated that combined aerobic and resistance training had the greatest effect (SMD: -0.3, 95% CI: -0.5, -1.9, p<0.001), that prostate (SMD: -0.5, 95% CI: -0.8, 0.1, p=0.004) and breast cancer populations were most responsive (SMD: -0.2, 95% CI: -0.3, -0.1, p=0.001), and that C-reactive protein (SMD: -0.5, 95% CI: -0.9, -0.06, p=0.025) and tumor necrosis factor (SMD: -0.3, 95% CI: -0.5, -0.06, p=0.004) were the most sensitive to change. Exercise training tended to decrease anti-inflammatory markers (p=0.072) but had no effect on natural killer or natural killer T cell proportions or cytotoxic activity. CONCLUSIONS: Exercise training reduces pro-inflammatory markers in cancer survivors, with the strongest evidence for combined training and for prostate and breast cancer survivors. Further research is warranted to determine if these changes are clinically relevant or are associated with improvements in symptoms. To strengthen future research, focusing on novel immune populations that include functional parameters and standardized reporting of key immune outcomes is recommended.


Miwa S, Kamei M, Yoshida S, Yamada S, Aiba H, Tsuchiya H, et al. Local dissemination of osteosarcoma observed after massage therapy: a case report. BMC Cancer 2019 Oct 23;19(1):993-019-6246-4 PMID 31646993

BACKGROUND: Limited evidence is available regarding the dissemination of tumor tissues due to compression during massage therapy, a routine procedure in patients with various symptoms in Asian countries. CASE PRESENTATION: A 12-year-old male presented at a massage clinic with pain and swelling of his left knee, which worsened the same night. Consistent with conventional osteosarcoma, radiography revealed cortical bone destruction, osteoblastic changes, and periosteal reactions. Magnetic resonance imaging revealed a tumor in the distal femur, an extraskeletal mass, and an infiltrative lesion in the intramuscular and neurovascular areas surrounding the distal femur; this was considered as hemorrhage and dissemination of the tumor tissue. (18)Fluorine-labelled fluorodeoxyglucose-positron emission tomography and computed tomography revealed multiple metastases in the spine, liver, and lung. Consistent with osteosarcoma, histopathological examination revealed tumor cell proliferation with extensive pleomorphism and mitoses. Despite undergoing chemotherapy, radiation therapy, and hip disarticulation, the patient died due to multiple metastases 13 months after the initial diagnosis. CONCLUSIONS: The present case suggests association of massage therapy with the local dissemination of tumor tissues, although influence of massage therapy on metastatic lesions remains unclear. Massage therapists should be aware of the possibility for dissemination of hidden malignancies due to the procedure.


Noh GO, Park KS. Effects of aroma self-foot reflexology on peripheral neuropathy, peripheral skin temperature, anxiety, and depression in gynaecologic cancer patients undergoing chemotherapy: A randomised controlled trial. Eur J Oncol Nurs 2019 Oct;42:82-89 PMID 31473465

PURPOSE: Chemotherapy-induced peripheral neuropathy (CIPN) can interfere with activities of daily living and can negatively affect symptoms. Thus, this study aimed to develop and implement an aroma self-foot reflexology regimen based on Cox's Interaction Model of Client Health Behaviour (IMCHB) as an intervention that can be self-performed at home and at any time. The effects of aroma self-foot reflexology on peripheral neuropathy, peripheral skin temperature, anxiety, and depression were examined in patients with gynaecologic cancer who were undergoing chemotherapy. METHODS: This randomized controlled trial included 32 experimental and 31 control patients with CIPN. Data were collected using self-reported questionnaires (CIPN assessment tool, HADS). In the experimental group, peripheral neuropathy, peripheral skin temperature, anxiety, and depression were measured before and after aroma self-foot reflexology therapy for 6 weeks. The control group was provided with identical aroma self-foot reflexology training 6 weeks later and underwent the intervention at that time. RESULTS: The intervention resulted in lower levels of symptoms of peripheral neuropathy, less interference with activities (p<.001), and higher peripheral skin temperature level (p<.001). Anxiety and depression decreased in the experimental group (p<.001). The ratio of borderline and definite cases of anxiety and depression did not differ between groups. CONCLUSIONS: An aroma self-foot reflexology intervention can reduce CIPN, anxiety, and depression in gynaecologic cancer patients. Further research is required to assess the effects of differences in the content of the intervention and the effects of various numbers of applications and durations of applications based on each individual patient's condition.


Olivas-Aguirre M, Torres-Lopez L, Valle-Reyes JS, Hernandez-Cruz A, Pottosin I, Dobrovinskaya O. Cannabidiol directly targets mitochondria and disturbs calcium homeostasis in acute lymphoblastic leukemia. Cell Death Dis 2019 Oct 14;10(10):779-019-2024-0 PMID 31611561

Anticancer properties of non-psychoactive cannabinoid cannabidiol (CBD) have been demonstrated on tumors of different histogenesis. Different molecular targets for CBD were proposed, including cannabinoid receptors and some plasma membrane ion channels. Here we have shown that cell lines derived from acute lymphoblastic leukemia of T lineage (T-ALL), but not resting healthy T cells, are highly sensitive to CBD treatment. CBD effect does not depend on cannabinoid receptors or plasma membrane Ca(2+)-permeable channels. Instead, CBD directly targets mitochondria and alters their capacity to handle Ca(2+). At lethal concentrations, CBD causes mitochondrial Ca(2+) overload, stable mitochondrial transition pore formation and cell death. Our results suggest that CBD is an attractive candidate to be included into chemotherapeutic protocols for T-ALL treatment.

Pasyar N, Barshan Tashnizi N, Mansouri P, Tahmasebi S. Effect of yoga exercise on the quality of life and upper extremity volume among women with breast cancer related lymphedema: A pilot study. Eur J Oncol Nurs 2019 Oct;42:103-109 PMID 31479846

PURPOSE: This pilot study aimed to evaluate the effect of an 8-weeks-yoga intervention on quality of life and upper extremity edema volume in women with breast cancer related lymphedema. METHODS: This was a controlled trial with pre-post design. A total of 40 women with breast cancer related lymphedema were randomly assigned into an intervention or control groups. The intervention group participated in a yoga exercise class for 8 weeks, in a twice a week instructor-led practice and once a week home practice. Outcomes were EORTC QLQ_C30 to measure quality of life, and water displacement volume-meter to measure upper extremity edema volume. The outcomes were evaluated at baseline, 4th and 8th week. Data were analyzed using SPSS. RESULTS: Four weeks after the intervention, a significant difference was observed between the groups with respect to role functioning of quality of life (P=0.03). Eight weeks after the intervention, a significant difference was observed between groups concerning physical and emotional functioning of quality of life (P0.05). CONCLUSION: As yoga exercise might improve physical, role, and emotional functioning of quality of life as well as reduce fatigue, pain, and insomnia, using this intervention can be suggested amongst women with breast cancer related lymphedema.


Porter LS, Carson JW, Olsen M, Carson KM, Sanders L, Jones L, et al. Feasibility of a mindful yoga program for women with metastatic breast cancer: results of a randomized pilot study. Support Care Cancer 2019 Nov;27(11):4307-4316 PMID 30877596

PURPOSE: Patients with metastatic breast cancer (MBC) experience high levels of symptoms. Yoga interventions have shown promise for improving cancer symptoms but have rarely been tested in patients with advanced disease. This study examined the acceptability of a comprehensive yoga program for MBC and the feasibility of conducting a randomized trial testing the intervention. METHODS: Sixty-three women with MBC were randomized with a 2:1 allocation to yoga or a support group comparison condition. Both interventions involved eight weekly group sessions. Feasibility was quantified using rates of accrual, attrition, and session attendance. Acceptability was assessed with a standardized self-report measure. Pain, fatigue, sleep quality, psychological distress, mindfulness, and functional capacity were assessed at baseline, post-intervention, and 3 and 6 months post-intervention. RESULTS: We met goals for accrual and retention, with 50% of eligible patients enrolled and 87% of randomized participants completing post-intervention surveys. Sixty-five percent of women in the yoga condition and 90% in the support group attended >/= 4 sessions. Eighty percent of participants in the yoga condition and 65% in the support group indicated that they were highly satisfied with the intervention. Following treatment, women in the yoga intervention had modest improvements in some outcomes; however, overall symptom levels were low for women in both conditions. CONCLUSIONS: Findings suggest that the yoga intervention content was highly acceptable to patients with MBC, but that there are challenges to implementing an intervention involving eight group-based in-person sessions. Alternative modes of delivery may be necessary to reach patients most in need of intervention.


Reblin M, Sahebjam S, Peeri NC, Martinez YC, Thompson Z, Egan KM. Medical Cannabis Use in Glioma Patients Treated at a Comprehensive Cancer Center in Florida. J Palliat Med 2019 Oct;22(10):1202-1207 PMID 31081711

Background: Glioma is a devastating primary tumor of the central nervous system with difficult-to-manage symptoms. Cannabis products have been postulated to potentially benefit glioma patients. Recent state legalization allowed investigators an opportunity to study glioma patients' adoption of medical marijuana (MM). Objective: Our goals were to: (1) determine the prevalence of marijuana use, both through physician recommendation and self-medication, and (2) evaluate its perceived risks and benefits in glioma patients. Design: Self-report data were collected and descriptive analyses were conducted. Setting/Subjects: Participants were adult, English-speaking patients undergoing treatment for primary non-recurrent malignant glioma in neuro-oncology clinics at an NCI-designated Comprehensive Cancer Center. Measurements: The survey on MM was adapted from previous research and included questions on knowledge and attitudes toward MM; use, frequency, type, and sourcing of MM; and reasons for use of MM and perceived symptom relief among users. Results: A total of 73 patients were surveyed. The majority of participants were aware that MM was legal in the state, and most reported learning of this through the media. Over 70% of participants reported having considered using MM, and a third reported using marijuana products after their diagnosis. Most received recommendations from friends/family rather than a medical provider, and only half of the users had obtained a physician's recommendation. Users generally reported benefits. Conclusions: With the increasing national conversation that accompanies legalization, glioma patients are pursuing marijuana for the treatment for their symptoms. More research and education is needed to bring health care providers into the conversation.


Reis D, Guthlin C, Schildmann J, Zuzak TJ, Hilje CC, Langler A. Information and Training Needs of Pediatric Oncologists in Complementary and Integrative Medicine: A Cross-Sectional Study. J Pediatr Hematol Oncol 2019 Oct;41(7):551-556 PMID 31403489

More than one third of all German pediatric patients with cancer use complementary and integrative medicine (CIM). Parents want to discuss the topic of CIM with their pediatric oncologists (POs); however, POs mostly do not feel confident discussing these topics. POs report openness to receiving further information and training, but CIM training opportunities in medical education seem rare. We investigated POs' information and training needs and preference patterns regarding CIM training content with a paper-based or online survey. A total of 101 POs from Germany completed the survey. Only 11.4% agreed to being sufficiently informed of CIM. The participants stated needing further CIM information very often (8.6%), often (38.7%), or occasionally (44.1%). They considered an overview of CIM therapies and information about relaxation methods, herbal remedies, and acupuncture for cancer-related symptoms such as lack of appetite, nausea, or vomiting as most important in CIM training material, and also the topics of adverse effects and summary of evidence. Finally, POs reported on clinical situations in which a need for further information on CIM emerged. The results of our study indicate that there is a need for a structured training that offers knowledge and skills on the subject of patient counseling on CIM in pediatric oncology.

Schallock H, Bartmann B, Keinki C, Huebner J. Online information on oncologists' and non-medical practitioners' websites in Germany: A critical comparison. Patient Educ Couns 2019 Nov;102(11):2038-2048 PMID 31147090

OBJECTIVE: To survey websites of oncologists and non-medical practitioners (NMPs) in Germany regarding range of treated symptoms, diagnostic tools and therapies offered to cancer patients as well as the quality of websites. METHODS: Analysis of 98 websites of oncologists and NMPs was conducted between April and July 2018 with a standardized tool. RESULTS: Range of diagnostic and therapeutic methods was high and differed between both groups. Many NMPs (65.3%) intended to support conventional therapy rather than to treat cancer. Most oncologists (85.7%) did not mention the role of complementary and alternative medicine (CAM). Texts on oncologists' websites, showed high complexity according to readability analysis using LIX score as opposed to those on NMPs websites that showed medium complexity. Only small difference of quality of websites between both groups could be detected. CONCLUSION: Methods not acknowledged by evidence-based medicine as well as methods at risk for interaction with conventional cancer therapy but also treatment offers with potential benefits for cancer patients were found on NMPs websites. PRACTICE IMPLICATIONS: As evidence-based CAM methods can be a useful support of cancer treatment, risk of herb drug interactions can be minimized by oncologists offering reasonable CAM.


Singh V, Zarrabi AJ, Curseen KA, Sniecinski R, Welsh JW, McKenzie-Brown AM, et al. Concerns of Patients With Cancer on Accessing Cannabis Products in a State With Restrictive Medical Marijuana Laws: A Survey Study. J Oncol Pract 2019 Oct;15(10):531-538 PMID 31442099

PURPOSE: Several states, particularly in the Southeast, have restrictive medical marijuana laws that permit qualified patients to use specific cannabis products. The majority of these states, however, do not provide avenues for accessing cannabis products such as in-state dispensaries. METHODS: We conducted a survey of patients registered for medical marijuana (low tetrahydrocannabinol [THC] oil cards) in an ambulatory palliative care practice in Georgia (one of the states with restrictive medical marijuana laws). RESULTS: We had a total of 101 responses. Among our sample of patients who use cannabis as part of a state-approved low THC oil program, 56% were male and 64% were older than age 50 years. Advanced cancer was the most common reason (76%) for granting the patients access to a low THC oil card. Although patients reported cannabis products as being extremely helpful for reducing pain, they expressed considerable concerns about the legality issues (64%) and ability to obtain THC (68%). Several respondents were using unapproved formulations of cannabis products. For 48% of the patients, their physician was the source of information regarding marijuana-related products. Furthermore, they believed that their health care providers and family members were supportive of their use of cannabis (62% and 79%, respectively). CONCLUSION: Patients on Georgia's medical marijuana program are most concerned about the legality of the product and their ability to obtain marijuana-related products. Therefore, we recommend that states with medical marijuana laws should provide safe and reliable access to cannabis products for qualifying patients.


Tanco K, Dumlao D, Kreis R, Nguyen K, Dibaj S, Liu D, et al. Attitudes and Beliefs About Medical Usefulness and Legalization of Marijuana among Cancer Patients in a Legalized and a Nonlegalized State. J Palliat Med 2019 Oct;22(10):1213-1220 PMID 31386595

Background: There is a growing preference for the use of marijuana for medical purposes, despite limited evidence regarding its benefits and potential safety risks. Legalization status may play a role in the attitudes and preferences toward medical marijuana (MM). Objectives: The attitudes and beliefs of cancer patients in a legalized (Arizona) versus nonlegalized state (Texas) regarding medical and recreational legalization and medical usefulness of marijuana were compared. Settings/Subjects: Two hundred adult cancer patients were enrolled from outpatient Palliative Care centers at Banner MD Anderson Cancer Center in Gilbert, AZ (n = 100) and The University of Texas MD Anderson Cancer Center in Houston, TX (n = 100). Design and Measurements: Adult cancer patients seen by the Palliative Care teams in the outpatient centers were evaluated. Various physical and psychosocial assessments were conducted, including a survey of attitudes and beliefs toward marijuana. Results: The majority of individuals support legalization of marijuana for medical use (Arizona 92% [85-97%] vs. Texas 90% [82-95%]; p = 0.81) and belief in its medical usefulness (Arizona 97% [92-99%] vs. Texas 93% [86-97%]; p = 0.33) in both states. Overall, 181 (91%) patients supported legalization for medical purposes whereas 80 (40%) supported it for recreational purposes (p < 0.0001). Patients preferred marijuana over current standard treatments for anxiety (60% [51-68%]; p = 0.003). Patients found to favor legalizing MM were younger (p = 0.027), had worse fatigue (p = 0.015), appetite (p = 0.004), anxiety (p = 0.017), and were Cut Down, Annoyed, Guilty, and Eye Opener-Adapted to Include Drugs (CAGE-AID) positive for alcohol/drugs (p < 0.0001). Conclusion: Cancer patients from both legalized and nonlegalized states supported legalization of marijuana for medical purposes and believed in its medical use. The support for legalization for medical use was significantly higher than for recreational use in both states.

Tsao Y, Creedy DK. Auricular acupressure: reducing side effects of chemotherapy in women with ovarian cancer. Support Care Cancer 2019 Nov;27(11):4155-4163 PMID 30796521

PURPOSE: Many women with ovarian cancer may experience adverse effects from adjuvant chemotherapy after surgery. Non-pharmacological interventions can be used to reduce these side effects. We tested auricular acupressure to reduce treatment side effects in this population. METHODS: A prospective, quasi-randomized controlled trial was carried out at a publicly-funded hospital in southern Taiwan. Thirty-four women in the intervention group received auricular acupressure at four points (Shenmen, subcortex, endocrine, and heart), three times per day for 3 min per time, for 6 weeks. Thirty-one women in the control group received routine nursing care alone. The M. D. Anderson Symptom Inventory (MDASI) was completed at four time points. RESULTS: After receiving the third cycle of chemotherapy, side effect severity was elevated among both groups. Auricular acupressure reduced side effects such as disturbed sleep (t = - 11.99; p < .001, eta squared = 0.69), fatigue (t = - 2.57; p < .01, eta squared = 0.10), and lack of appetite (t = - 2.37; p = .024, eta squared = 0.08). CONCLUSION: Auricular acupressure can reduce adverse side effects of chemotherapy in women with ovarian cancer. Future studies with a larger sample and using some laboratory-based tests (such as C-reactive protein, interleukin-6) are warranted to confirm the results.