January 2020 Research Findings

Integrative Oncology January 2020 Digest

Agin-Liebes GI, Malone T, Yalch MM, Mennenga SE, Ponte KL, Guss J, Bossis AP, Grigsby J, Fischer S, Ross S. Long-term follow-up of psilocybin-assisted psychotherapy for psychiatric and existential distress in patients with life threatening cancer. J Psychopharmcol 2020 Feb;34(2):156-166. PMID 31916890

BACKGROUND: A recently published randomized controlled trial compared single-dose psilocybin with single-dose niacin in conjunction with psychotherapy in participants with cancer-related psychiatric distress. Results suggested that psilocybin-assisted psychotherapy facilitated improvements in psychiatric and existential distress, quality of life, and spiritual well-being up to seven weeks prior to the crossover. At the 6.5-month follow-up, after the crossover, 60-80% of participants continued to meet criteria for clinically significant antidepressant or anxiolytic responses. METHODS: The present study is a long-term within-subjects follow-up analysis of self-reported symptomatology involving a subset of participants that completed the parent trial. All 16 participants who were still alive were contacted, and 15 participants agreed to participate at an average of 3.2 and 4.5 years following psilocybin administration. RESULTS: Reductions in anxiety, depression, hopelessness, demoralization, and death anxiety were sustained at the first and second follow-ups. Within-group effect sizes were large. At the second (4.5 year) follow-up approximately 60-80% of participants met criteria for clinically significant antidepressant or anxiolytic responses. Participants overwhelmingly (71-100%) attributed positive life changes to the psilocybin-assisted therapy experience and rated it among the most personally meaningful and spiritually significant experiences of their lives. CONCLUSION:These findings suggest that psilocybin-assisted psychotherapy holds promise in promoting long-term relief from cancer-related psychiatric distress. Limited conclusions, however, can be drawn regarding the efficacy of this therapy due to the crossover design of the parent study. Nonetheless, the present study adds to the emerging literature base suggesting that psilocybin-facilitated therapy may enhance the psychological, emotional, and spiritual well-being of patients with life-threatening cancer.

Bossi P, Ghiani M, Argenone A, Depenni R. Is pain part of a systemic syndrome in head and neck cancer? Support Care Cancer 2020 Feb;28(2):451-459 PMID 31713692

Head and neck cancers (HNC) represent 5% of all malignancies worldwide with about 180,000 cancer deaths per year. Patients with HNC are characterized by a systemic inflammatory state, generally associated with worse outcomes. Treatment-related toxicity is common among HNC patients and causes systemic consequences such as fatigue or cognitive dysfunction. The therapeutic treatments of HNC involve the release in circulation of inflammatory systemic mediators, whose effects trigger a vicious circle that may lead to functional and behavioral alterations. The areas of the head and neck are highly sensitive to pain. Literature data confirm that in HNC patients, pain is one of the most distressing symptoms across all the phases of treatment. Pain is associated with worse general conditions, depression, fatigue, impaired cognitive functions, and lower survival rate. The treatment of advanced HNC cases is multimodal and requires a multidisciplinary psycho-socio-pharmacological approach mediated by a team of experts. The pharmacological approach in management of HNC patients with pain is fundamental and involves the use of opioids, NSAIDs, steroids, or other drugs. Opioids in pain management therapy in patients with HNC could allow the pain level to be adequately monitored, thus improving quality of life. The integration of opioid and non-opioid therapy as well as non-pharmacological interventions is essential for the rehabilitation of physical, social, and psychological functions and to achieve pain control in patients with HNC. Opioid treatment is the mainstay for pain control, being used both for background and breakthrough cancer pain (BTcP) episodes. Fentanyl, easily absorbed and generally well tolerated, appears to be a possible choice due to its versatility. Non-pharmacological interventions, such as tailored yoga, physical exercise, and acupuncture, may have a role in pain management in patients with HNC.


2. Chan K, Lui L, Yu K, Lau K, Lai M, Lau W, et al. The efficacy and safety of electro-acupuncture for alleviating chemotherapy-induced peripheral neuropathy in patients with colorectal cancer: study protocol for a single-blinded, randomized sham-controlled trial. Trials 2020 Jan 9;21(1):58-019-3972-5 PMID 31918748

BACKGROUND: Colorectal cancer is the most common cancer in Hong Kong. Oxaliplatin-based chemotherapy is a major first-line conventional therapy for advanced and metastatic colorectal cancer. However, oxaliplatin causes chemotherapy-induced peripheral neuropathy (CIPN). Acupuncture has long been used to alleviate limb numbness in Chinese medicine. This study aims to examine the efficacy and safety of acupuncture for alleviating CIPN in patients with colorectal cancer in Hong Kong. METHODS/DESIGN: This is a single-blinded, randomized, sham-controlled efficacy trial. Eighty-four eligible patients, who are Hong Kong Chinese, aged >/= 18 years, diagnosed with colorectal cancer and undergoing oxaliplatin-based chemotherapy, will be randomized in a ratio of 1:1 to the electro-acupuncture group or the sham-controlled group. During a 12-week treatment period, patients in the electro-acupuncture group will undergo electro-acupuncture once a week from the first cycle of chemotherapy, while patients in the control group will receive sham acupuncture, and the patients in both groups will be followed up for 12 weeks. The primary outcome measure is the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOC-Ntx) questionnaire. The secondary outcome measures include numerical rating scale (NRS) for numbness/pain, vibration and light touch sense test, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) and Constitution of Chinese Medicine Questionnaire (CCMQ). DISCUSSION: The study will compare electro-acupuncture with sham acupuncture to explore the feasibility for electro-acupuncture in improving symptoms caused by chemotherapy-induced peripheral neuropathy. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03582423. Registered on 11 July 2018.


Elimimian E, Elson L, Bilani N, Farrag SE, Dwivedi AK, Pasillas R, et al. Long-Term Effect of a Nonrandomized Psychosocial Mindfulness-Based Intervention in Hispanic/Latina Breast Cancer Survivors. Integr Cancer Ther 2020 Jan-Dec;19:1534735419890682 PMID 31957499

Background: There is a paucity of research on the long-term impact of stress-reduction in Hispanic/Latina breast cancer (BC) survivors, a growing minority. In this article, we assess the long-term efficacy of an 8-week training program in mindfulness-based stress reduction (MBSR) on quality of life (QoL) in Hispanic BC survivors. Methods: Hispanic BC survivors, within the first 5 years of diagnosis, stages I to III BC, were recruited. Participants were enrolled in bilingual, 8-week intensive group training in MBSR and were asked to practice a- home, daily. They were also provided with audio recordings and a book on mindfulness practices. Patient-reported outcomes for QoL and distress were evaluated at baseline, and every 3 months, for 24 months. Results: Thirty-three self-identified Hispanic women with BC completed the MBSR program and were followed at 24 months. Statistically significant reduction was noted for the Generalized Anxiety Disorder measure (mean change -2.39, P=0.04); and Patient Health Questionnaire (mean change -2.27, P=0.04), at 24 months, compared with baseline. Improvement was noted in the Short-Form 36 Health-related QoL Mental Component Summary with an increase of 4.07 (95% confidence interval = 0.48-7.66, P=0.03). However, there was no significant change in the Physical Component Summary. Conclusions: Hispanic BC survivors who participated in an 8-week MBSR-based survivorship program reported persistent benefits with reduced anxiety, depression, and improved mental health QoL over 24 months of follow-up. Stress reduction programs are beneficial and can be implemented as part of a comprehensive survivorship care in BC patients.


Genik LM, McMurtry CM, Marshall S, Rapoport A, Stinson J. Massage therapy for symptom reduction and improved quality of life in children with cancer in palliative care: A pilot study. Complement Ther Med 2020 Jan;48:102263 PMID 31987232

BACKGROUND: For children with cancer in palliative care, pain and worry are common and frequently under-managed, which negatively impacts quality of life (QOL). Massage therapy (MT) can lead to reduced pain in children with chronic illnesses. Children with cancer have experienced lower anxiety after MT. No studies have examined the effects of MT in pediatric oncology patients receiving palliative care. OBJECTIVE: Conduct a MT intervention to determine intervention acceptability and initial effects on ratings of pain, worry reduction, and quality of life. DESIGN: Pre-post single group pilot study. SETTING/SUBJECTS: Eight children with cancer (age 10-17) and one of their parents were recruited from a palliative care service. PROCEDURE/MEASUREMENTS: Baseline (one week prior to intervention): demographics, MT expectations, QOL, and pain measures. Intervention (one month): MT was provided once per week, with children's pain and worry ratings occurring immediately before and after each MT session. Follow Up (4-6 weeks after baseline): QOL, pain, and MT/study acceptability questionnaires. RESULTS: Participants reported significant decreases in pain following two MT sessions, and worry following one session. No significant changes in pain symptoms and QOL were found between baseline and follow up. Participants positively endorsed the study and the MT intervention, and there were no adverse effects reported. CONCLUSIONS: MT may lead to immediate decreases in pain and worry in children with cancer who are receiving palliative care, however the effects may not be sustained long term. Difficulties regarding protocol feasibility including recruitment and study compliance remain important considerations for future work.


Ginex P, Coleman M, Vrabel M, Bevans M. Family Caregiver Strain and Burden: A Systematic Review of Evidence-Based Interventions When Caring for Patients With Cancer. Clin J Oncol Nurs 2020 Feb 1;24(1):31-50 PMID 31961843

BACKGROUND: Caregivers of patients with cancer experience high levels of caregiver-related strain and burden (CGSB). Cancer caregiving is complex and can change dramatically depending on the cancer trajectory. Often, this experience leads to poor health outcomes for the caregiver. OBJECTIVES: This review appraises the evidence on CGSB published from 2007 to October 2017. METHODS: 128 interventional studies found in PubMed(R) and CINAHL(R) were appraised and categorized based on the Oncology Nursing Society's Putting Evidence Into Practice schema. FINDINGS: Psychoeducation, supportive care/support interventions, and cognitive behavioral interventions are recommended to decrease CGSB. Caregiver skill training, couples therapy, decision support, mindfulness-based stress reduction, multicomponent interventions, and palliative care are likely to be effective. The evidence is not established for 13 interventions. Despite the proliferation of studies focusing on CGSB, studies with stronger designs and larger samples are needed.

Nissen ER, O'Connor M, Kaldo V, Hojris I, Borre M, Zachariae R, et al. Internet-delivered mindfulness-based cognitive therapy for anxiety and depression in cancer survivors: A randomized controlled trial. Psychooncology 2020 Jan;29(1):68-75 PMID 31600414

OBJECTIVE: Internet-delivered interventions may alleviate distress in cancer survivors with limited access to psychological face-to-face treatment. In collaboration with a group of cancer survivors, we developed and tested the efficacy of a therapist-assisted internet-delivered mindfulness-based cognitive therapy (iMBCT) program for anxiety and depression in cancer survivors. METHODS: A total of 1282 cancer survivors were screened for anxiety and depression during their routine oncology follow-up; eligible breast (n = 137) and prostate cancer (n = 13) survivors were randomized to iMBCT or care-as-usual (CAU) wait-list. Primary outcomes of anxiety and depression were assessed at baseline, 5 weeks, 10 weeks (post intervention), and 6 months. RESULTS: Significant effects were found for both anxiety (Cohen's d = 0.45; P = .017) and depressive symptoms (d = 0.42; P = .024) post intervention. The effects were maintained at follow-up for anxiety (d = 0.40; P = .029), but not for depressive symptoms (d = 0.28; P = .131). CONCLUSIONS: Our preliminary findings suggest iMBCT to be a helpful intervention for cancer survivors suffering from symptoms of anxiety. Further studies on the efficacy for symptoms of depression are needed.


Nootim P, Kapol N, Bunchuailua W, Poompruek P, Tungsukruthai P. Current state of cancer patient care incorporating Thai traditional medicine in Thailand: A qualitative study. J Integr Med 2020 Jan;18(1):41-45 PMID 31889658

OBJECTIVE: To assess the current state of cancer treatment incorporating Thai traditional medicine (TTM) and to identify problems in the system, by using the health system framework of the World Health Organization. METHODS: A qualitative study was conducted by interviewing three groups of people involved in the healthcare system. The groups were constructed via purposive sampling of patients with cancer, caregivers and service providers. The study groups included 37 individuals from five TTM hospitals. In-depth interviews were conducted from October 2017 to March 2018. The interview questions were developed based on the six building blocks of a health system framework. Free form answers from participants were analyzed and interpreted to develop the study conclusions. RESULTS: All five TTM hospitals provided treatment to patients with cancer based on provincial public health policy. The policy allows patients with cancer to obtain TTM services in outpatient and inpatient departments and via home visits; most patients used outpatient services. The TTM services were primarily provided by TTM practitioners and included massage, herbal steam, herbal compress and meditation. Herbal medicines were widely used and included Benja-amarit, an anticancer formulation made from Wat Khampramong and Phytoplex. The problems included poor acceptance of TTM practitioners by other healthcare practitioners, lack of experience among TTM practitioners in treating patients with cancer, lack of herbal medicine research trials, contamination in herbal medicine preparations and absence of practical treatment guidelines. CONCLUSION: TTM is an alternative treatment modality for patients with cancer and is supported by a national policy in Thailand. To increase accountability to patients and other practitioners, TTM treatments should be refined to rely on scientific principles and practitioners of TTM should receive academic training. Practical treatment guidelines need to be established and thoroughly disseminated to TTM practitioners.


Pietrovito L, Iozzo M, Bacci M, Giannoni E, Chiarugi P. Treatment with Cannabinoids as a Promising Approach for Impairing Fibroblast Activation and Prostate Cancer Progression. Int J Mol Sci 2020 Jan 25;21(3):10.3390/ijms21030787 PMID 31991773

Endo-, phyto- and synthetic cannabinoids have been proposed as promising anti-cancer agents able to impair cancer cells' behavior without affecting their non-transformed counterparts. However, cancer outcome depends not only on cancer cells' activity, but also on the stromal cells, which coevolve with cancer cells to sustain tumor progression. Here, we show for the first time that cannabinoid treatment impairs the activation and the reactivity of cancer-associated fibroblasts (CAFs), the most represented stromal component of prostate tumor microenvironment. Using prostate cancer-derived CAFs, we demonstrated that WIN 55-212.2 mesylate, a synthetic full agonist of cannabinoid receptors (CBs) 1 and 2, downregulates alpha-smooth muscle actin and matrix metalloprotease-2 expression, and it inhibits CAF migration, essential features to ensure the activated and reactive CAF phenotype. Furthermore, by impairing stromal reactivity, WIN 55-212.2 mesylate also negatively affects CAF-mediated cancer cells' invasiveness. Using selective antagonists of CBs, we proved that CAFs response to WIN 55-212.2 mesylate is mainly mediated by CB2. Finally, we suggest that endocannabinoids self-sustain both prostate tumor cells migration and CAFs phenotype by an autocrine loop. Overall, our data strongly support the use of cannabinoids as anti-tumor agents in prostate cancer, since they are able to simultaneously strike both cancer and stromal cells.

Raybin JL, Barr E, Krajicek M, Jones J. How Does Creative Arts Therapy Reduce Distress for Children With Cancer? A Metasynthesis of Extant Qualitative Literature [Formula: see text. J Pediatr Oncol Nurs 2020 Mar/Apr;37(2):91-104 PMID 31766942

Introduction: As more children survive cancer, attention must be paid to their quality of life (QOL). Integrative therapies are an ideal modality for nurses to advocate for reducing distress and improving QOL for children with cancer. Creative arts therapy is a type of integrative health that may improve QOL in this population. Therefore, the research question was asked, "For children with cancer, what opportunities exist for creative arts therapy to reduce distress?" Method: A metasynthesis of the extant qualitative research was conducted to answer the research question. Seven qualitative studies were identified, which included 162 participants. New themes were identified through rigorous analyzation by the study team of each study as individual data. Results: Four derived analytic themes emerged through the analysis: (a) connection is established through creative expression, (b) coping is facilitated by creative arts, (c) communication is enabled by creative arts interventions, and (d) continuance (the concept of time) is experienced through creative arts. Examples of each theme with subthemes are delineated, including expressive quotes. Summary: Through this qualitative synthesis of studies with creative arts therapy, evocative opportunities to reduce the distress associated with the disease experience are revealed. Nurses are called now to promote creative arts therapy to improve the symptoms in children with cancer.


Raybin JL, Krajicek M. Creative Arts Therapy in the Context of Children With Cancer: A Concept Analysis. J Pediatr Oncol Nurs 2020 Mar/Apr;37(2):82-90 PMID 31592707

Aim: To report an analysis of the concept of creative arts therapy (CAT) in the context of pediatric cancer. Background: Literature supports the intuitive conclusion that creative interventions improve a patient's journey through the cancer trajectory. However, a new definition is needed to encompass CAT and creative expression interventions in order to better understand the concept of creativity in health care, specifically in pediatric oncology. Design: Concept analysis. Data Sources: The scientific databases CINAHL, PsycInfo (Ovid), AMED (Allied and Complementary Medicine), and PubMed were queried for English language research articles published between 2008 and 2018 using the search terms: creative arts therapy and cancer. Method: The Walker and Avant method of concept analysis was implemented. Results: CAT is a broad concept bringing creative arts in a therapeutic manner to children with cancer. Attributes include expression of feelings; creating art, music, or movement; and improvement of symptoms. CAT is frequently measured using quality of life and symptom assessment scales. Antecedents include the diagnosis of cancer, the distress caused by cancer, and a child's willingness to participate in creative activity. Consequences include improved quality of life, improved sense of well-being, decreased psychosocial symptoms, and less cancer pain. Conclusion: The literature supports CAT as a concept that may decrease distress for children with cancer.


Sieverding M, Ungar N, Fleischmann A, Lee M, Zhang H, Mohnke M, et al. Prevalence and frequency of self-management strategies among female cancer survivors: the neglected roles of social relations and conscious living. Support Care Cancer 2020 Feb;28(2):607-616 PMID 31104132

OBJECTIVE: To assess prevalence and frequency of use of self-management strategies among female cancer survivors and to empirically identify categories of self-management. METHODS: Female cancer survivors (N=673, mean age 51 years; >90% with breast cancer; M=5 years since diagnosis) completed an Internet survey indicating the frequency (never to very often) with which they had employed each strategy since diagnosis. The survey included commonly assessed self-management strategies, such as complementary and alternative medicine (CAM), religious practices, and exercise. Additionally we assessed the use of further strategies identified from recommendations of cancer survivors shared in Internet forums. RESULTS: A principal component analysis yielded five categories: More Conscious Living, Turning to Family/Friends, CAM, Religious/Spiritual Practices, and Exercise. Prevalence rates of commonly measured strategies like CAM, Religious Practices, and Exercise were similar to previous studies. Considering frequency of use, however, revealed that only few participants reported frequent use of these strategies (50%) reported Turning to Family/Friends and engaging in More Conscious Living strategies (very) often. CONCLUSIONS: Relying on prevalence assessments of commonly investigated behaviors such as CAM or exercise may overestimate their use among cancer survivors. Cancer survivors engage in a wide range of self-management strategies. Encouraging living more consciously and cultivating social relations might be of greater relevance compared with CAM use or exercise.


Sikorskii A, Niyogi PG, Victorson D, Tamkus D, Wyatt G. Symptom response analysis of a randomized controlled trial of reflexology for symptom management among women with advanced breast cancer. Support Care Cancer 2020 Mar;28(3):1395-1404 PMID 31267277

PURPOSE: To examine symptom responses resulting from a home-based reflexology intervention delivered by a friend/family caregivers to women with advanced breast cancer undergoing chemotherapy, targeted, and/or hormonal therapy. METHODS: Patient-caregiver dyads (N = 256) were randomized to 4 weekly reflexology sessions or attention control. Caregivers in the intervention group were trained by a reflexology practitioner in a 30-min protocol. During the 4 weeks, both groups completed telephone symptom assessments using the M. D. Anderson Symptom Inventory. Those who completed at least one weekly call were included in this secondary analysis (N = 209). Each symptom was categorized as mild, moderate, or severe using established interference-based cut-points. Symptom response meant an improvement by at least one category or remaining mild. Symptom responses were treated as multiple events within patients and analyzed using generalized estimating equations technique. RESULTS: Reflexology was more successful than attention control in producing responses for pain (OR = 1.84, 95% CI (1.05, 3.23), p = 0.03), with no significant differences for other symptoms. In the reflexology group, greater probability of response across all symptoms was associated with lower number of comorbid condition and lower depressive symptomatology at baseline. Compared to odds of responses on pain (chosen as a referent symptom), greater odds of symptom response were found for disturbed sleep and difficulty remembering with older aged participants. CONCLUSIONS: Home-based caregiver-delivered reflexology was helpful in decreasing patient-reported pain. Age, comorbid conditions, and depression are potentially important tailoring factors for future research and can be used to identify patients who may benefit from reflexology. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01582971.


Voiss P, Hoxtermann MD, Dobos G, Cramer H. Mind-body medicine use by women diagnosed with breast cancer: results of a nationally representative survey. Support Care Cancer 2020 Mar;28(3):1077-1082 PMID 31187251

PURPOSE: Worldwide breast cancer is the most commonly diagnosed cancer in women and often associated with a profound physiological stress reaction. Mind-body medicine modalities have been proven effective in reducing stress symptoms. This article will cover the prevalence of MBM use in women with and without breast cancer in the US population and detect predictors of MBM use in women diagnosed with breast cancer. METHODS: The 2017 National Health Interview Survey (NHIS) was used to study the prevalence of breast cancer and the use of mind-body medicine (MBM) among individuals with breast cancer in the US population. Using chi-squared tests and backward stepwise multiple logistic regression analyses, predictors of MBM use in women with breast cancer in the past 12 months were identified. RESULTS: The prevalence of breast cancer in women was 3.1%. Among women diagnosed with breast cancer, 25.2% had used MBM in the past 12 months. Spiritual meditation (14.3%), followed by yoga (9.6%), and mindfulness meditation (4.3%) were the most commonly used MBM approaches for women with breast cancer diagnosis. Only higher education independently predicted the use of MBM among them. CONCLUSIONS: In this nationally representative sample of the USA, the most common used MBM approach was spiritual meditation, while this approach is much less researched than the evidence based approaches of yoga and mindfulness meditation. Especially stressed individuals worldwide could benefit from MBM the literature suggests. Particularly in the acute survivorship stage, influencing the initial stress reaction could be beneficial.


Warth M, Zoller J, Kohler F, Aguilar-Raab C, Kessler J, Ditzen B. Psychosocial Interventions for Pain Management in Advanced Cancer Patients: a Systematic Review and Meta-analysis. Curr Oncol Rep 2020 Jan 21;22(1):3-020-0870-7 PMID 31965361

PURPOSE OF REVIEW: This systematic review and meta-analysis aimed to synthesize the evidence on the effects of psychosocial interventions on pain in advanced cancer patients. RECENT FINDINGS: The included studies investigated the effects of relaxation techniques, cognitive-behavioral therapy, music therapy, mindfulness- and acceptance-based interventions, and supportive-expressive group therapy. Overall, we found a small, but significant effect on pain intensity (d = - 0.29, CI = - 0.54 to - 0.05). Effect sizes were highly heterogeneous between studies. We did not find evidence for the superiority of any of the intervention types. However, psychosocial interventions may be more effective if they specifically targeted pain distress as the primary outcome. Although findings were mixed, psychosocial interventions can be recommended to complement comprehensive care to alleviate pain in patients facing an advanced or terminal stage of the disease. Future research should develop innovative interventions tailored specifically for pain relief.


Wells C, Malins S, Clarke S, Skorodzien I, Biswas S, Sweeney T, et al. Using smart-messaging to enhance mindfulness-based cognitive therapy for cancer patients: A mixed methods proof of concept evaluation. Psychooncology 2020 Jan;29(1):212-219 PMID 31654533

OBJECTIVE: Depression and anxiety lead to reduced treatment adherence, poorer quality of life, and increased care costs amongst cancer patients. Mindfulness-based cognitive therapy (MBCT) is an effective treatment, but dropout reduces potential benefits. Smart-message reminders can prevent dropout and improve effectiveness. However, smart-messaging is untested for MBCT in cancer. This study evaluates smart-messaging to reduce dropout and improve effectiveness in MBCT for cancer patients with depression or anxiety. METHODS: Fifty-one cancer patients attending MBCT in a psycho-oncology service were offered a smart-messaging intervention, which reminded them of prescribed between-session activities. Thirty patients accepted smart-messaging and 21 did not. Assessments of depression and anxiety were taken at baseline, session-by-session, and one-month follow-up. Logistic regression and multilevel modelling compared the groups on treatment completion and clinical effectiveness. Fifteen post-treatment patient interviews explored smart-messaging use. RESULTS: The odds of programme completion were eight times greater for patients using smart-messaging compared with non-users, controlling for age, gender, baseline depression, and baseline anxiety (OR = 7.79, 95% CI 1.75 to 34.58, p = .007). Smart-messaging users also reported greater improvement in depression over the programme (B = -2.33, SEB = .78, p = .004) when controlling for baseline severity, change over time, age, and number of sessions attended. There was no difference between groups in anxiety improvement (B = -1.46, SEB = .86, p = .097). In interviews, smart-messaging was described as a motivating reminder and source of personal connection. CONCLUSIONS: Smart-messaging may be an easily integrated telehealth intervention to improve MBCT for cancer patients.


Xiang DB, Zhang KQ, Zeng YL, Yan QZ, Shi Z, Tuo QH, et al. Curcumin: From a controversial "panacea" to effective antineoplastic products. Medicine (Baltimore) 2020 Jan;99(2):e18467 PMID 31914018

BACKGROUND: Curcumin, a controversial "panacea," has been broadly studied. Its bioactivities including antioxidant, anti-inflammatory, and especially antineoplastic activities have been documented. However, due to its extensive bioactivities, some scientists hold a skeptical point of view toward curcumin and described curcumin as a "deceiver" to chemists. The objective of this study was to explore curcumin's another possibility as a potential supplementary leading compound to cancer treatments. METHODS: Literature searches were conducted using electronic databases. Search terms such as "curcumin," "curcumin analogues," and so on were used. The literatures were collected and summarized. In this article, reported targets of curcumin are reviewed. The limitations of a curcumin as a therapeutic anticancer product including low bioavailability and poor targeting are mentioned. Furthermore, modified curcumin analogues and antitumor mechanisms are listed and discussed in the aspects of cell death and tumor microenvironment including angiogenesis, tissue hypoxia status, and energy metabolism. RESULTS: Several possible modification strategies were presented by analyzing the relationships between the antitumor activity of curcumin analogues and their structural characteristics, including the introduction of hydrophilic group, shortening of redundant hydrocarbon chain, the introduction of extra chemical group, and so on. CONCLUSIONS: From our perspective, after structural modification curcumin could be more effective complementary product for cancer therapies by the enhancement of targeting abilities and the improvement of bioavailability.