Evidence-based Integrative Medicine in Clinical Veterinary Oncology

Homeopathy, Acupuncture and Phytotherapy in the Veterinary Treatment or Prophylaxis of Diseases in Animals: An Overview of Systematic Reviews

INTRODUCTION

 Complementary and alternative veterinary medicine (CAVM) has been intensively used, and there is currently an increasing demand for a more rigorous approach regarding its clinical effectiveness.

AIMS

 The objectives of this overview were: first, to identify systematic reviews on homeopathy, acupuncture and phytotherapy in veterinary medicine and assess their methodological quality; and second, to map interventions and findings in the treatment or prophylaxis of any medical conditions in any animal species for which high-quality systematic reviews had identified reliable evidence of efficacy or effectiveness in randomized controlled trials (RCTs) or controlled clinical trials (CCTs).

METHOD

 The study was an overview of systematic reviews published in the years 2000 to 2022 inclusive. The following databases were used: CAB Abstracts, PubMed and Vet Index, from which the abstracts of 173 articles were extracted, 22 of which were initially included for complete analysis. After excluding 15 studies according to the exclusion/inclusion criteria, 7 review papers were comprehensively analyzed. The review quality was assessed by the Measurement Tool to Assess Systematic Reviews (AMSTAR 2) method. The reported RCTs/CCTs in these reviews were analyzed for their reliability, and the results were classified according to statistical significance and risk of bias.

RESULTS

 Seven eligible systematic reviews reported studies on dogs, horses, cats, cattle, sheep, goats, swine, rabbits and poultry. The number of primary RCTs/CCTs was 38 for homeopathy, 35 for acupuncture, and 171 for phytotherapy. The AMSTAR 2 evaluation ranked two reviews of veterinary homeopathy as high-quality, in which two placebo-controlled RCTs comprised reliable evidence, one of which reported efficacy of homeopathy as prophylaxis for diarrhea in pigs. The systematic reviews of acupuncture and phytotherapy were all of low quality, preventing formal assessment of their reviewed RCTs/CCTs.

CONCLUSION

 Only the systematic reviews of homeopathy were rated of sufficient quality to enable the assessment of reliable evidence within their reviewed RCTs. Contemporary high-quality systematic reviews of clinical trials in each of the three areas of CAVM are required.

Identifying the Risk Factors for Malignant Mammary Tumors in Dogs: A Retrospective Study

Mammary cancer is one of the main causes of death in female dogs worldwide, considering that many risk factors are involved in its development. This study aimed to elucidate the relationship between epidemiological and clinical risk factors with the histopathological diagnosis of malignant mammary tumors in dogs treated at the Veterinary Hospital of the Federal University of Uberlândia, which has one of the first veterinary oncology services in Brazil. A retrospective matched case-control study was conducted to identify risk factors for the development of malignant mammary tumors in dogs. The variables analyzed were size dog, breed, housing, type of diet, and body score. Potential risk factors were selected by univariate analysis (p < 0.25) before multivariate forward binary logistic regression. The most frequent benign tumor was the benign mixed tumor (35.2%), and the most frequent malignant tumor was the mixed carcinoma (27.4%). Size dog, breed, housing, and overweight are predictors of malignant mammary tumors in dogs. The highest risk of developing malignant mammary tumors is associated with large female dogs, Yorkshire or Poodle breeds, living outside the home, or being overweight.

Neutrophil to lymphocyte ratio and principal component analysis offer prognostic advantage for dogs with mammary tumors

Introduction

In veterinary medicine, cancer is the leading cause of death in companion animals, and mammary gland tumors represent the most common neoplasm in female dogs. Several epidemiological risk factors, such as age, breed, hormones, diet, and obesity have been reported to be relevant for canine mammary tumors. Nowadays, the gold standard for diagnosis of canine mammary tumors is the pathological examination of the suspected tissue. However, tumor grade can only be assessed after surgical removal or biopsy of the altered tissue. Therefore, in cases of tumors that could be surgically removed, it would be very helpful to be able to predict the biological behavior of the tumor, before performing any surgery. Since, inflammation constitutes part of the tumor microenvironment and it influences each step of tumorigenesis, cellular and biochemical blood markers of systemic inflammation, such as the neutrophil to lymphocyte ratio (NLR) and the albumin to globulin ratio (AGR) have been proposed as prognostic factors for human cancer development. The NLR and the AGR have not been explored enough as prognostic factors for cancer development in veterinary medicine.

Methods

To determine the prognostic value of NLR in canine mammary tumors, clinical records including biochemistry and hematological studies of female dogs with mammary tumors and of control healthy dogs, were used to determine the pre-treatment NLR and AGR. Other clinical data included age, breed, tumor size, histological tumor grade, and survival time after surgery.

Results and discussion

It was found that a higher pre-treatment NLR value (NLR > 5) associates with less survival rate. In contrast, the AGR did not show any predictive value on the malignancy of the tumor. However, by combining the NLR with AGR, age of the dog, and tumor size in a principal component analysis (PCA), the grade of the tumor and survival after surgery could be appropriately predicted. These data strongly suggest that pre-treatment NLR values have a prognostic value for the survival rate after surgery of dogs with mammary tumors.

Surveying dog owners' use and understanding of, and communication with veterinarians about, complementary and alternative veterinary medicine

BACKGROUND

Complementary and alternative veterinary medicine (CAVM) seems to be gaining acceptance by pet owners. Client-veterinarian communication about CAVM is important to explore client perceptions and facilitate open exchange of ideas between owners and veterinarians.

METHODS

This study includes an online, cross-sectional survey of dog owners to evaluate CAVM use and client-veterinarian communication about CAVM. Based on the extended theory of planned behaviour, factors influencing the intention to use CAVM were evaluated.

RESULTS

Past CAVM use was reported by 45.3% clients based on 1000 valid surveys. The attitude towards CAVM was generally positive. Perceived knowledge about CAVM positively predicted perceived behavioural control and attitude towards CAVM. Both were the strongest predictors of future CAVM use. Around 45.7% of clients had already talked to their veterinarian about CAVM. This conversation was mainly initiated by the owner (66.3%). Owners expected the veterinarian to have knowledge about CAVM (91.5%) and offer referral (71.5%).

LIMITATIONS

The limitation is difficulty in classifying and defining CAVM modalities.

CONCLUSIONS

Owners' perceived behavioural control and attitude towards CAVM predict CAVM use. Failure to engage in a conversation about CAVM hampers clients to partner with veterinarians to discuss the treatment approach and maximise patient outcome. The veterinarian plays an essential role in providing objective accurate information about CAVM.

[Naturopathy and complementary medicine in small animal science - definitions and contents]

Naturopathic and complementary procedures attain increasing popularity in veterinary medicine. A common understanding of definitions and contents of these fields is crucial for communication between pet owners and veterinarians. This paper reviews the existing definitions and the various contents of naturopathy and complementary veterinary medicine as well as their assigned treatment options. Naturopathy includes phytotherapy, hydro-therapy, thermotherapy, electrotherapy, manual therapy/chiropractic/osteopathy, and dietetic treatment. Homeopathy, homotoxicology, Traditional Chinese Medicine including acu-puncture and Chinese herbal medicine, neural therapy, organotherapy and Bach flower remedies are known as complementary treatments. The level of evidence based on scientific literature and the opportunity for certification procedures differ between treatment modalities. In the area of small animal medicine, the most extensive body of literature is available on the subject of acupuncture, in part comprising high evidence levels.

Ethnoveterinary for food-producing animals and related food safety issues: A comprehensive overview about terpenes

Alternatives to the use of conventional veterinary drugs in food-producing animals have gained attention, such as the use of natural products (NPs), mainly to soften the risks to the animal, the environment, and consumer's health. Although NPs have consistent advantages over conventional drugs, they cannot be considered risk free under food safety matters. In this way, this document presents a comprehensive overview of the importance of considering both the pharmacological and toxicological properties of the constituents of a NP from plants intending the standardization and regulation of its use in food-producing animals. Terpenes are the most diverse class of natural substances present in NP of vegetal origin with a broad range of biological activities that can be explored in veterinary science; however, certain plants and terpenes also have significant toxic effects, a fact that can harm the health of animals and consequently generate economic losses and risks for humans. In this context, this review gathered scientific data of vegetal species of importance to ethnoveterinary for food-producing animals, which produce terpenes, its biological effects, and their implications on food safety issues for consumers. For this, more than 300 documents were selected from different online scientific databases. The present data and discussion may contribute to the rational commercial exploration of this class of NPs in veterinary medicine.

Canine and Feline Patients Referred Exclusively for Acupuncture and Herbs: A Two-Year Retrospective Analysis

Acupuncture and the administration of herbal supplements are increasingly used in veterinary practice, but no retrospective studies have examined patient characteristics and treatment interventions in a population of dogs and cats presenting exclusively for such therapies. This two-year retrospective analysis of 161 referrals to an integrative medicine service at an academic teaching hospital found that dogs were more frequently treated than cats (91.9% vs. 8.1%, respectively) and that small animal patients most frequently were presented for musculoskeletal (26.7%), neurologic (16.8%), oncologic (14.9%), and dermatologic (10.6%) conditions. Cats were older than treated dogs (12.7 ± 3.7 vs. 9.5 ± 4.3 years) and more likely to be treated for oncologic complaints (odds ratio = 5.6). Patients received acupuncture (95.4%), herbal supplements (76.4%), acupuncture with percutaneous electrical nerve stimulation (electroacupuncture, 26.1%), and/or cyanocobalamin injections in acupuncture points (pharmacopuncture, 23.6%). Some differences were detected between treatment groups. This retrospective analysis provides a foundation for designing future prospective studies using acupuncture and herbs in dogs and cats.

Integrative veterinary medical education and consensus guidelines for an integrative veterinary medicine curriculum within veterinary colleges

Integrative veterinary medicine (IVM) describes the combination of complementary and alternative therapies with conventional care and is guided by the best available evidence. Veterinarians frequently encounter questions about complementary and alternative veterinary medicine (CAVM) in practice, and the general public has demonstrated increased interest in these areas for both human and animal health. Consequently, veterinary students should receive adequate exposure to the principles, theories, and current knowledge supporting or refuting such techniques. A proposed curriculum guideline would broadly introduce students to the objective evaluation of new veterinary treatments while increasing their preparation for responding to questions about IVM in clinical practice. Such a course should be evidence-based, unbiased, and unaffiliated with any particular CAVM advocacy or training group. All IVM courses require routine updating as new information becomes available. Controversies regarding IVM and CAVM must be addressed within the course and throughout the entire curriculum. Instructional honesty regarding the uncertainties in this emerging field is critical. Increased training of future veterinary professionals in IVM may produce an openness to new ideas that characterizes the scientific method and a willingness to pursue and incorporate evidence-based medicine in clinical practice with all therapies, including those presently regarded as integrative, complementary, or alternative.

A Retrospective Analysis of 5,195 Patient Treatment Sessions in an Integrative Veterinary Medicine Service: Patient Characteristics, Presenting Complaints, and Therapeutic Interventions

Integrative veterinary medicine, the combination of complementary and alternative therapies with conventional care, is increasingly prevalent in veterinary practice and a focus of clinical instruction in many academic teaching institutions. However, the presenting complaints, therapeutic modalities, and patient population in an integrative medicine service have not been described. A retrospective analysis of 5,195 integrative patient treatment sessions in a veterinary academic teaching hospital demonstrated that patients most commonly received a combination of therapeutic modalities (39% of all treatment sessions). The 274 patients receiving multiple modalities were most frequently treated for neurologic and orthopedic disease (50.7% versus 49.6% of all presenting complaints, resp.). Older neutered or spayed dogs (mean age = 9.0 years) and Dachshunds were treated more often than expected based on general population statistics. Acupuncture, laser therapy, electroacupuncture, and hydrotherapy were frequently administered (>50% patients). Neurologic patients were more likely to receive acupuncture, electroacupuncture, and therapeutic exercises but less likely than orthopedic patients to receive laser, hydrotherapy, or therapeutic ultrasound treatments (P < 0.05). The results suggest that the application of these specific modalities to orthopedic and neurologic diseases should be subjected to increased evidence-based investigations. A review of current knowledge in core areas is presented.