Integrative Oncology Research Digest July 2019

Alsharif FH, Mazanec SR. The use of complementary and alternative medicine among women with breast cancer in Saudi Arabia. Appl Nurs Res 2019 Aug;48:75-80 PMID 31266612

PURPOSE: The purpose of the study was to explore the frequency of use of complementary and alternative medicine (CAM) therapies among women with breast cancer in Saudi Arabia. DESIGN: A descriptive cross-sectional study design was used with face-to-face interviews using a structured questionnaire. SAMPLE: A convenient sample of 85 Saudi women with breast cancer who were undergoing cancer treatment was recruited from the Oncology Department of King Faisal Hospital, Jeddah, Kingdom of Saudi Arabia. METHODS: Using structured questionnaire "Use of Complementary Therapies Survey," consisted of diet and nutritional supplements, stress-reducing therapies, and other traditional treatments. RESULT: Participants were predominantly married (76.5%), resided in an urban area (83.5%), unemployed (62%), and about half reported no income (49.4%). The mean age was 48years. All participants reported using at least three or more CAM therapies (mean=21.15, SD=8.85) since their diagnosis. There were significant correlations between other CAM use and time since diagnosis (rs=-0.33, p<.05). The highest usage of dietary and nutritional supplements occurred with honey, olive oil, antioxidants, Fennel flower seeds, and ginger. The highest stress reducing CAM techniques included reading the Holy Qur'an, and praying. For other traditional CAM therapies, positive thinking and relaxation techniques were the most frequent methods reported by women. Other CAM treatments involved ZamZam water and listening to music. CONCLUSIONS: The use of complementary therapies among Saudi women with breast cancer is highly prevalent, with a predominance of interventions of religious background, indicating the strong influence of religion on peoples' lives, especially when people are faced with a life-threatening illness. The results of this study will guide future studies examining the efficacy of CAM on symptom management in Saudi Arabian women with breast cancer and other types of cancer.


Armstrong M, Flemming K, Kupeli N, Stone P, Wilkinson S, Candy B. Aromatherapy, massage and reflexology: A systematic review and thematic synthesis of the perspectives from people with palliative care needs. Palliat Med 2019 Jul;33(7):757-769 PMID 31060455

BACKGROUND: Effectiveness evidence of complementary therapies in people with advanced disease is uncertain, and yet people are still keen to engage in complementary therapy. Insights into people's experiences of complementary therapy in palliative care, the perceived benefits, and how they want it delivered, can inform clinical guidelines and suggest ways to test therapies more appropriately in future evaluations. AIMS: Explore in people with advanced disease (1) the experiences and perceptions of benefits and harms of aromatherapy, massage, and reflexology and (2) how they would like these therapies delivered. DESIGN: A systematic review and thematic synthesis of qualitative studies. Database search terms were related to palliative care, aromatherapy, reflexology and massage. Citations and full texts were reviewed independently against predefined inclusion criteria. Studies were appraised for quality. This review is registered at PROSPERO (22/11/2017 CRD42017081409). DATA SOURCES: MEDLINE, EMBASE, PsycINFO, AMED, CINAHL, KoreaMed and ProQuest with a bibliography search to June 2018. RESULTS: Five qualitative studies in advanced cancer were identified. Three analytical themes were identified: (1) Experience during the therapy (enhanced well-being and escapism), (2) beyond the complementary therapy session (lasting benefits and overall evaluation), and (3) delivery of complementary therapy in palliative care (value of the therapist and delivery of the complementary therapy). CONCLUSIONS: People with advanced cancer experience benefits from aromatherapy, reflexology and massage including enhanced well-being, respite, and escapism from their disease. Complementary therapy interventions should be developed in consultation with the target population to ensure they are delivered and evaluated, where feasible, as they wish.

Hand M, Margolis J, Staffileno BA. Massage Chair Sessions: Favorable Effects on Ambulatory Cancer Center Nurses' Perceived Level of Stress, Blood Pressure, and Heart Rate. Clin J Oncol Nurs 2019 Aug 1;23(4):375-381 PMID 31322619

BACKGROUND: High stress levels over time can contribute to compassion fatigue and burnout and negatively affect individual health and well-being. OBJECTIVES: A pre-/post-test initiative was implemented to determine the effects of massage chair sessions on ambulatory cancer center nurses (RNs and advanced practice providers) based on their perceived stress, blood pressure (BP), and heart rate (HR). METHODS: A mechanical massage chair was available for 20-minute sessions in a secure room, and nurses self-recorded perceived stress using a visual analog scale, as well as BP and HR using a wrist cuff device. Descriptive statistics and paired t tests were used to assess nurse characteristics and differences before and after massage chair sessions. FINDINGS: Nurses participated in 200 massage chair sessions during a six-month period. Significant reductions were noted in perceived stress, systolic and diastolic BP, and HR. These data indicate that providing a relaxing room with chair massage has favorable effects on nurses' perceived stress, BP, and HR.


Hsieh CC, Yu CJ, Chen HJ, Chen YW, Chang NT, Hsiao FH. Dispositional mindfulness, self-compassion, and compassion from others as moderators between stress and depression in caregivers of patients with lung cancer. Psychooncology 2019 Jul;28(7):1498-1505 PMID 31087458

OBJECTIVE: The present study aimed to identify the most important protective factors predicting caregivers' depressive symptoms among factors of caregivers' dispositional mindfulness, self-compassion, compassion from others, and patients' dispositional mindfulness and their moderator effects on the relationship between caregiving stress and depressive symptoms. METHODS: A total of 72 lung cancer outpatients and their family caregivers participated in this study. Family caregivers completed the Kingston Caregiver Stress Scale, Beck Depression Inventory-II (BDI-II), Five Facet Mindfulness Questionnaire (FFMQ), Self-Compassion Scale, and Compassion from Others Scale. Patients completed the EORTC Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), BDI-II, and FFMQ. RESULTS: After controlling for patients' factors (treatment status, symptom distress, and depressive symptoms) and caregivers' health status, caregivers' stress and dispositional mindfulness, the domain of mindful awareness, and self-compassionate action were significantly associated with their depressive symptoms. Further analysis indicated that mindful awareness or self-compassionate action could buffer the effect of caregiving stress on depressive symptoms. When the two moderators, mindful awareness and self-compassionate action, were tested simultaneously, only self-compassionate action remained as a significant moderating effect. CONCLUSIONS: Caregivers' mindful awareness and self-compassionate action were protective factors, which mitigate the impact of caregiving stress on their depressive symptoms. Therefore, the future supportive program aims at training the competencies of self-compassionate action with mindful awareness, which may enhance caregivers' coping resources.


Luo Z, Wang L, Sikorskii A, Wyatt G. Healthcare service utilization and work-related productivity in reflexology intervention for advanced breast cancer women. Support Care Cancer 2019 Aug;27(8):2837-2847 PMID 30552595

PURPOSE: This project's purpose was to determine the effects of a home-based reflexology intervention on symptom-related use of health services and work-related productivity during the 11-week study. METHODS: A total of 256 patients were randomized to four weekly reflexology sessions (each lasting 30 min, delivered by lay caregivers who received two training sessions by a professional reflexologist) or attention control. The Conventional Health Service and Productivity Costs Form was used to collect information on health service utilization and out-of-pocket expenditure of symptom management. The Health and Work Performance Questionnaire was used to measure workplace performance for patients during the study period. We used weighted and unweighted logistic and linear regression analyses. RESULTS: Patients in the reflexology group were less likely to have hospital visits compared to the control group in the weighted unadjusted (odds ratio [OR] = 0.49; 95% confidence interval [CI] = [0.25, 0.97]), unweighted adjusted (OR = 0.35; 95% CI = [0.16, 0.75]), and weighted adjusted (OR = 0.30, 95% CI = [0.13, 0.66]) logistic regressions. Compared to attention control, patients in the reflexology group had lower relative absenteeism in the unweighted adjusted (- 0.32; 95% CI = [- 0.60, - 0.03]) linear regressions and less absolute presenteeism (15.42, 95% CI = [0.87, 29.98]) in the weighted unadjusted analysis. CONCLUSION: The reflexology intervention delivered by lay caregivers reduced hospital visits and increased workplace productivity in a short-term period, which has potential for cost saving for health care systems and employers. TRIAL REGISTRATION: NCT01582971.

Maindet C, Burnod A, Minello C, George B, Allano G, Lemaire A. Strategies of complementary and integrative therapies in cancer-related pain-attaining exhaustive cancer pain management. Support Care Cancer 2019 Aug;27(8):3119-3132 PMID 31076901

PURPOSE: Complementary integrative therapies (CITs) correspond to growing demand in patients with cancer-related pain. This demand needs to be considered alongside pharmaceutical and/or interventional therapies. CITs can be used to cover certain specific pain-related characteristics. The objective of this review is to present the options for CITs that could be used within dynamic, multidisciplinary, and personalized management, leading to an integrative oncology approach. METHODS: Critical reflection based on literature analysis and clinical practice. RESULTS: Most CITs only showed trends in efficacy as cancer pain was mainly a secondary endpoint, or populations were restricted. Physical therapy has demonstrated efficacy in motion and pain, in some specific cancers (head and neck or breast cancers) or in treatments sequelae (lymphedema). In cancer survivors, higher levels of physical activity decrease pain intensity. Due to the multimorphism of cancer pain, certain mind-body therapies acting on anxiety, stress, depression, or mood disturbances (such as massage, acupuncture, healing touch, hypnosis, and music therapy) are efficient on cancer pain. Other mind-body therapies have shown trends in reducing the severity of cancer pain and improving other parameters, and they include education (with coping skills training), yoga, tai chi/qigong, guided imagery, virtual reality, and cognitive-behavioral therapy alone or combined. The outcome sustainability of most CITs is still questioned. CONCLUSIONS: High-quality clinical trials should be conducted with CITs, as their efficacy on pain is mainly based on efficacy trends in pain severity, professional judgment, and patient preferences. Finally, the implementation of CITs requires an interdisciplinary team approach to offer optimal, personalized, cancer pain management.


Morishima T, Miyashiro I, Inoue N, Kitasaka M, Akazawa T, Higeno A, et al. Effects of laughter therapy on quality of life in patients with cancer: An open-label, randomized controlled trial. PLoS One 2019 Jun 27;14(6):e0219065 PMID 31247017

BACKGROUND: Few randomized controlled trials have assessed the effects of laughter therapy on health-related quality of life (QOL) in cancer patients. This study aimed to evaluate these effects as an exploratory endpoint in cancer patients as part of a randomized controlled trial conducted at a single institution in Japan. METHODS: The Initiative On Smile And CAncer (iOSACA) study was an open-label randomized controlled trial conducted in 2017 in which participants aged 40-64 years with cancer were randomly assigned to either an intervention group (laughter therapy) or control group (no laughter therapy). Each participant in the intervention group underwent a laughter therapy session once every two weeks for seven weeks (total of four sessions). Each session involved a laughter yoga routine followed by Rakugo or Manzai traditional Japanese verbal comedy performances. We assessed QOL as a secondary endpoint in this intention-to-treat population using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). The questionnaire was completed at baseline (Week 0) and at Weeks 3 and 7. Mixed-effects models for repeated measures were developed to compare time-dependent changes in each QOL domain from baseline between the intervention and control groups. RESULTS: Four participants retracted consent and one participant was retrospectively excluded from analysis due to unmet inclusion criteria. The analysis was conducted using 56 participants, with 26 in the intervention group and 30 in the control group. Questionnaire completion rates were high (>90%), with similar QOL scores reported at baseline in both groups. The mixed-effects models showed that the intervention group had significantly better cognitive function and less pain than the control group for a short period. CONCLUSION: Laughter therapy may represent a beneficial, noninvasive complementary intervention in the clinical setting. Further studies are needed to verify the hypotheses generated from this exploratory study.


Qan'ir Y, DeDeaux D, Godley PA, Mayer DK, Song L. Management of Androgen Deprivation Therapy-Associated Hot Flashes in Men With Prostate Cancer. Oncol Nurs Forum 2019 Jul 1;46(4):E107-E118 PMID 31225840

PROBLEM IDENTIFICATION: To determine best practices for managing hot flashes associated with androgen deprivation therapy (ADT) in men with prostate cancer. LITERATURE SEARCH: The CINAHL(R), Embase(R), PsycINFO(R), PubMed(R), and Scopus(R) databases were used to identify randomized controlled trials (RCTs) and quasiexperimental studies published between January 1994 and June 2018. DATA EVALUATION: Using the Cochrane Handbook for Systematic Reviews of Interventions, the authors reviewed 15 studies examining the effects of pharmacologic or complementary and alternative medicine interventions on ADT-associated hot flashes in men with prostate cancer. SYNTHESIS: Pharmacologic interventions (e.g., cyproterone, medroxyprogesterone, megestrol acetate) showed some promise for reducing hot flashes but were associated with side effects and risks. Acupuncture demonstrated potential benefit in reducing hot flashes without side effects. IMPLICATIONS FOR RESEARCH: Evidence is insufficient to support interventions for ADT-associated hot flashes in men with prostate cancer. Future RCTs should be sufficiently powered, include a control group, and use standardized outcome measures.


Son SH, Lee CH, Jung JH, Kim DH, Hong CM, Jeong JH, et al. The Preventive Effect of Parotid Gland Massage on Salivary Gland Dysfunction During High-Dose Radioactive Iodine Therapy for Differentiated Thyroid Cancer: A Randomized Clinical Trial. Clin Nucl Med 2019 Aug;44(8):625-633 PMID 31274608

PURPOSE: To evaluate the preventive effect of parotid gland (PG) massage for PG damage during the I therapy, we prospectively investigated the serum amylase value and salivary gland scintigraphy (SGS) after I therapy. MATERIALS AND METHODS: One hundred patients with thyroidectomized differentiated thyroid cancer who underwent high-dose I therapy were enrolled in the clinical trial and randomized into 2 groups (PG massage group and nonmassage group). The serum amylase value was obtained before and 24 hours after I therapy, and the SGSs were also taken just before and at 8 months after the I therapy. Change in serum amylase value and SGS was compared between PG massage and nonmassage groups. RESULTS: The difference value of serum amylase was significantly lower in PG massage group than in nonmassage group (P = 0.0052). Worsening of PG function on SGS was observed in 43 (45.3%) of the 95 patients. The incidence rate of PG abnormality on F/U SGS was significantly lower in PG massage group than in nonmassage group (odds ratio, 0.3704; P = 0.0195). In the multiple regression analysis, PG massage significantly affected the abnormality on the 8-month F/U SGS (rpartial = -0.2741, P = 0.0090) after adjusting for clinical variables (age, sex, TNM stage, TSH preparation methods for the I therapy, and I dose). CONCLUSIONS: PG gland massage significantly reduced the incidence rates of salivary gland dysfunction on the 8-month F/U SGS and the level of the serological marker of salivary gland destruction after I therapy. Therefore, PG gland massage could alleviate salivary gland damage related to I therapy.


Yaguda S, Gentile D. Group Acupuncture Model in a Cancer Institute: Improved Access and Affordability. J Altern Complement Med 2019 Jul;25(7):675-677 PMID 31314555

Cancer patients may experience significant symptom mitigation from acupuncture. However, this service may not be easily accessible or affordable at all cancer institutions. The development of a group acupuncture program provided one institution with improved availability, lower cost to patients, and a foundation for oncology acupuncture research. This care delivery model was deployed at a large southeastern cancer institution within a multistate academic-community hybrid hospital system. The cancer institute serves >15,000 patients annually. Acupuncture is provided through the institute's Integrative Medicine section of the Department of Supportive Oncology. The purpose of this commentary is to describe the successful transition from an individual to group acupuncture model at this cancer institute. With the implementation of group acupuncture, patient visits increased 275% from individual care delivery. Although successful implementation of a group acupuncture model may be affordable and clinically positive, the authors also share unique challenges learned through the development and expansion of this program.


Yeh CH, Zhao TY, Zhao MD, Wu Y, Guo YM, Pan ZY, et al. Comparison of effectiveness between warm acupuncture with local-distal points combination and local distribution points combination in breast cancer-related lymphedema patients: a study protocol for a multicenter, randomized, controlled clinical trial. Trials 2019 Jul 5;20(1):403-019-3491-4 PMID 31277678

BACKGROUND: Lymphedema is the most common complication after breast cancer treatment, but management of lymphedema remains a clinical challenge. Several studies have reported the beneficial effect of acupuncture for treating breast cancer-related lymphedema (BCRL). Our objective is to verify the effectiveness of warm acupuncture on BCRL and compare the effectiveness of a local distribution acupoint combination with a local-distal acupoint combination for BCRL. METHODS: This is a study protocol for a multicenter, three-arm parallel, assessor blinded, randomized controlled trial. A total of 108 participants diagnosed as BCRL will be randomly allocated in equal proportions to a local distribution acupoint (LA) group, a local-distal acupoint (LDA) group, or a waiting-list (WL) group. The LA and LDA groups will receive 20 acupuncture treatment over 8 weeks with local distribution acupoint combination and local-distal acupoint combination, respectively. The WL group will receive acupuncture treatment after the study is concluded. The primary outcome is the mean change in inter-limb circumference difference from baseline to week 8. The secondary outcomes include volume measurement, skin hardness, common terminology criteria for adverse events 4.03 (edema limbs criteria), stages of lymphedema from the International Society of Lymphology, Disabilities of the Arm, Shoulder and Hand questionnaire, and the Medical Outcome Study 36-item Short-form Health Survey. DISCUSSION: This study aims to provide data on warm acupuncture as an effective treatment for BCRL and at the same time compare the effectiveness of different acupoint combinations. TRIAL REGISTRATION: Identifier NCT03373474 . Registered on 14th December 2017.


Zhang H, Li Y, Li M, Chen X. A randomized controlled trial of mindfulness-based stress reduction for insomnia secondary to cervical cancer: Sleep effects. Appl Nurs Res 2019 Aug;48:52-57 PMID 31266608

AIM: To evaluate the efficacy of mindfulness-based stress reduction on objective and subjective sleep parameters and hypnotic medication use of patients with insomnia secondary to cervical cancer. METHODS: This was a randomized controlled trial enrolled insomnia patient who were caused or worsened by cervical cancer. Seventy patients with insomnia caused or aggravated by cervical cancer were at random divided into either a usual care group or an 8-week mindfulness-based stress reduction group. Subjective sleep parameters, objective sleep parameters and hypnotic medication consumption were assessed at baseline, after the program, 6- and 12-month after finishing the interventions. RESULTS: The results showed that mindfulness-based stress reduction had a positive effect on subjective sleep parameters (Total wake time: =45.32, P<0.05; Sleep efficacy: =6.87, P<0.05; Total sleep time: =22.22, P<0.01). Compared with control group, polysomnography data in mindfulness-based stress reduction group were not improved significantly. There were no associations between subjective sleep parameters and objective sleep parameters. CONCLUSION: Mindfulness-based stress reduction had a definite impact on patients with insomnia that was secondary to cervical cancer just after the intervention, but no long-term influences. TRIAL REGISTRATION: ChiCTR1800018571; 9/25/2018; retrospectively registered.