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Raiber L, Raff C, Thiele J, Kramer K. Integrative Nursing Interventions for Cancer-Related Symptoms in Oncology Inpatients: Results of a Descriptive Pilot Study. Integr Cancer Ther 2024; 23:15347354241239930. [PMID: 38680047 PMCID: PMC11057344 DOI: 10.1177/15347354241239930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/05/2024] [Accepted: 03/01/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Integrative nursing (IN) is an essential component of integrative medicine and integrative oncology. IN includes a range of external naturopathic, integrative nursing interventions, such as compresses, embrocation, and foot/hand baths, aimed at alleviating symptoms and side effects of conventional treatment. The project IMPLEMENT-UKU ("Implementation of IN at the University Hospital Ulm") was accompanied by a descriptive pilot study on the use of IN interventions on cancer-related symptoms in oncology inpatients, the characterization of these patients and the evaluation of the impact. METHODS A single-arm study was conducted using a paper-based questionnaire administered before the IN interventions (t0) and 24 hours after the IN interventions (t1). Topics included sociodemographic data, symptoms, quality of life, health status, psychological burden, attitudes, and experience and satisfaction with the IN interventions. Analyses were descriptive using absolute and relative frequencies. RESULTS During the 6-month study period out of 66 patients recommended for IN consultation by medical and nursing staff on 2 wards, 62 (93.9%) accepted the offer. Of those patients who received IN, 21 patients (33.9%) participated in the study. The number of IN interventions received per patient ranged from 1 to 3 during the 24-hour survey period. And a total of 36 IN interventions were performed: The most treated body region was the feet/legs (50.0%), followed by the back (25.0%), using oils such as solum oil (41.7%) and lavender oil (13.9%). Embrocation (77.8%) was the predominant type of IN intervention. For patients, the mean FACIT-F score was 29.2 ± 12.5. The mean PHQ-4 score was 3.0 ± 1.9. Regarding sleep quality in the last 4 weeks, 13 participants (61.9%) described it as rather or very poor. Satisfaction with the IN was high, with a large proportion of participants evaluating the IN interventions very positively. CONCLUSION The study's findings suggest that there is a great need for IN among oncology inpatients. These patients are open to and interested in IN interventions and evaluate them positively. IN provides a promising opportunity to provide non-pharmacological support to inpatients. The integration of IN in conventional oncology care settings may enhance patient-centered care and contribute to improved patient wellbeing.
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Affiliation(s)
- Lea Raiber
- University Hospital Ulm, Ulm, Germany
- Interprofessional Graduate School for Integrative Medicine and Health, Witten/Herdecke University, Germany
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Oei SL, Thronicke A, Grieb G, Schad F, Groß J. Evaluation of quality of life in breast cancer patients who underwent breast-conserving surgery or mastectomy using real-world data. Breast Cancer 2023; 30:1008-1017. [PMID: 37587322 DOI: 10.1007/s12282-023-01494-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/09/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Due to advances in the fight against breast cancer, aesthetic aspects and the prevention of breast deformities are playing an important role in surgical procedures. Currently the main form of breast cancer surgery is breast-conserving surgery (BCS), and even if mastectomy (MAS) is required, oncoplastic surgery and reconstruction options can improve outcomes, including health-related quality of life (QoL) of cancer patients. The purpose of this study was to assess whether surgery options induce different outcomes in self-reported QoL in guide-line treated breast cancer patients of the Network Oncology (NO). METHODS This prospective Real-World-Data (RWD) study was conducted using data from the NO-clinical registry. QoL was assessed by evaluation of the European Organization of Research and Treatment Health-Related Quality of Life Core Questionnaire scale (EORTC QLQ-C30). Association factors between type of surgery options, without or with immediate breast reconstructions the EORTC QLQ-C30-scales at baseline after surgery, 6, 12, and 24 months later were analyzed with adjusted multivariate regression analysis, considering age, cancer stage, and treatment regimens, using software R. RESULTS A total of 623 primary breast cancer patients (all tumor stages, median age 58 (ICR: 50-68) diagnosed and guide-line treated between 2013 and 2021), 524 BCS and 99 MAS, 24 of whom received immediate breast reconstruction (MBR), were eligible for analyses. Compared with BCS patients, MBR patients self-reported considerably lower global health, physical and social functioning, and higher burden of pain and financial difficulties at baseline. In later follow-up surveys, functional scales increased and symptoms decreased in all patients, and the differences between MAS and BCS equalized. Longitudinal analyses after 24 months were obtained from 258 patients and revealed that compared to 224 BCS, the 34 MAS patients reported increased social functioning (p = 0.04). CONCLUSIONS At 24 months after MAS, breast cancer patients' QoL improved compared with BCS, although impairments in QoL were reported immediately after MAS. A growing expertise in surgical procedures as well as supportive care is critical to optimizing patients' well-being. These findings may be considered when counseling breast cancer patients pre- and post-surgery. TRIAL REGISTRATION NUMBER DRKS00013335 on 27/11/2017 retrospectively registered.
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Affiliation(s)
- Shiao Li Oei
- Research Institut Havelhöhe gGmbH at, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.
| | - Anja Thronicke
- Research Institut Havelhöhe gGmbH at, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Gerrit Grieb
- Department of Plastic Surgery and Hand Surgery, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Friedemann Schad
- Research Institut Havelhöhe gGmbH at, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
- Interdisciplinary Oncology and Supportive Cancer Medicine, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Jessica Groß
- Breast Cancer Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
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Steinhausen-Wachowsky A, Martin D, Rodrigues Recchia D, Büssing A. Stability of psychological wellbeing during the COVID-19 pandemic among people with an anthroposophical worldview: the influence of wondering awe and perception of nature as resources. Front Public Health 2023; 11:1200067. [PMID: 37546316 PMCID: PMC10400802 DOI: 10.3389/fpubh.2023.1200067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/21/2023] [Indexed: 08/08/2023] Open
Abstract
Background During the COVID-19 pandemic, differences in responses and behaviors were observed among specific groups. We aimed to address how people with an anthroposophical worldview behaved with respect to the perception of burden, fears, and wellbeing. As it is an integral part of their lifestyle and convictions, we addressed the influence of wondering awe and gratitude and perception of nature and times of mindful quietness as resources to cope. Methods In two cross-sectional surveys with standardized instruments, participants were recruited in 2020 (n = 1,252) and 2021 (n = 2,273). Results Psychological wellbeing was much higher than in other studied groups and populations, with slightly lower scores in 2021 compared to the 2020 sample (Eta2 = 0.020), while the perception of the COVID-19-related burden and fear of the future were low in 2020 with a slight increase in 2021 (Eta2 = 0.033 and 0.008, respectively). Their transcendence conviction was negatively related to fears of their own infection or the infection of others. Best predictors of their wellbeing were low burden and awe/gratitude, while the best predictors of their burden were low wellbeing and lack of social contacts. Conclusion Compared to the general population in Germany, the anthroposophical lifestyle and related convictions may have buffered some of the COVID-19-related burden and helped them to stabilize their psychological wellbeing.
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Affiliation(s)
- Anna Steinhausen-Wachowsky
- Professorship Quality of Life, Spirituality and Coping, Faculty of Health, Witten/Herdecke University, Herdecke, Germany
| | - David Martin
- Chair of Medical Theory, Integrative and Anthroposophic Medicine, Faculty of Health, Witten/Herdecke University, Herdecke, Germany
| | - Daniela Rodrigues Recchia
- Chair of Research Methods and Statistics in Psychology, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Arndt Büssing
- Professorship Quality of Life, Spirituality and Coping, Faculty of Health, Witten/Herdecke University, Herdecke, Germany
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Steigenberger C, Schnell-Inderst P, Flatscher-Thöni M, Plank LM, Siebert U. Patient' and social aspects related to complementary mistletoe therapy in patients with breast cancer: A systematic review commissioned by the German agency for Health Technology Assessment. Eur J Oncol Nurs 2023; 65:102338. [PMID: 37321128 DOI: 10.1016/j.ejon.2023.102338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/29/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE To mitigate side effects of conventional cancer care and improve quality of life, many patients with breast cancer in German-speaking countries opt for mistletoe therapy in addition to standard treatment. To understand the value for users, we evaluated the domain "Patient and Social aspects" in a health technology assessment on complementary mistletoe therapy in patients with breast cancer. METHODS A systematic review was conducted according to PRISMA guidelines. Fifteen electronic databases and the internet were searched. Qualitative studies were analyzed using qualitative content analysis; quantitative studies were systematically summarized in evidence tables. RESULTS Seventeen studies out of 1203 screened publications with 4765 patients and 869 healthcare professionals were included in the review. The median proportion of patients using mistletoe therapy was 26.7% (range: 7.3-46.3%). Predictors for use were younger age and higher educational level. Main reasons for patients' use of mistletoe therapy were to leave nothing untried and to be actively involved in the treatment process. Reasons against use were related to a lack of knowledge or uncertainty regarding effectiveness and safety. Physicians mainly aimed to support the patient's physical condition as main reason for use and a lack of resources and knowledge as main reason against use. CONCLUSION Mistletoe therapy was commonly used in the treatment of breast cancer despite a lack of scientific knowledge among patients and physicians. Transparent communication on motivation for use and its potential effect enables realistic expectations. Relatively small samples of mistletoe therapy users limit the representativeness and validity of our results.
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Affiliation(s)
- Caroline Steigenberger
- Institute for Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria.
| | - Petra Schnell-Inderst
- Institute for Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria
| | - Magdalena Flatscher-Thöni
- Institute for Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria
| | - Lisa-Maria Plank
- Institute for Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria
| | - Uwe Siebert
- Institute for Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria; Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 101 Merrimac Street, Boston, MA, 02114, USA; Center for Health Decision Science, Departments of Epidemiology and Health Policy & Management, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA; Division of Health Technology Assessment, ONCOTYROL - Center for Personalized Cancer Medicine, Karl-Kapferer-Str. 5, 6020, Innsbruck, Austria
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Schnell-Inderst P, Steigenberger C, Mertz M, Otto I, Flatscher-Thöni M, Siebert U. Additional treatment with mistletoe extracts for patients with breast cancer compared to conventional cancer therapy alone - efficacy and safety, costs and cost-effectiveness, patients and social aspects, and ethical assessment. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2022; 20:Doc10. [PMID: 36160875 PMCID: PMC9487779 DOI: 10.3205/000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Indexed: 11/07/2022]
Abstract
Background Chemotherapy is often used in the treatment of breast cancer in women. Side effects such as diarrhea, fatigue, hair loss, fever or disturbances in blood formation impair the women's quality of life. An essential treatment goal of the accompanying mistletoe therapy (MT) used in complementary medicine is to improve the health-related quality of life during cancer therapy. Aim and methods The HTA report on which this article is based examines the medical efficacy and safety, costs and cost-effectiveness, patient and social aspects, and ethical aspects of MT in women with breast cancer. Systematic reviews were conducted for this purpose. The search period of the literature search ranged from 2004 to October 2020. Results A total of 2 evidence-based medical guidelines, 3 randomized trials assessing efficacy and 1 additional non-randomized intervention trial, as well as 3 observational studies assessing safety, a cost analysis, 12 cross-sectional studies on patient aspects and 17 articles on ethical evaluation were included. Improvements in health-related quality of life compared to the control group were small to moderate. Due to the high risk of bias in the studies, it is possible that the difference is not caused by MT. One study with a small sample size showed no effect on progression-free survival after 5 years. Studies on the effect of MT on overall survival are lacking. In seven studies, local skin reactions of low and moderate severity were reported in a median of 25% (range 5 to 94%) of patients, and mild to moderate systemic reactions in a median of 2% (range 0 to 8%) of patients. A comparative cost analysis from Germany reported significantly lower medical costs within 5 years after surgery for patients with MT than for patients without MT, but the underlying observational study did not control for systematic bias. With regard to patient aspects, the frequency of use and the reasons for use from the patient's or practitioner's point of view were mainly investigated. A median of 25% (range 7 to 46%) of patients with breast cancer and 29% (range 29 to 79%) of treatment providers use MT. The main motivations of patients for use were to reduce side effects, strengthen the immune system and take an active role in the treatment process. Patients felt insufficiently advised. Studies on other aspects are lacking. The ethical evaluation was able to identify 6 overarching themes; the central challenge is the insufficient evidence on efficacy and safety.
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Affiliation(s)
- Petra Schnell-Inderst
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences, Medical Informatics and Technology, Hall i. T., Austria
| | - Caroline Steigenberger
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences, Medical Informatics and Technology, Hall i. T., Austria
| | - Marcel Mertz
- Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Ilvie Otto
- Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Magdalena Flatscher-Thöni
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences, Medical Informatics and Technology, Hall i. T., Austria
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences, Medical Informatics and Technology, Hall i. T., Austria
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, USA
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Zimmermann-Klemd AM, Reinhardt JK, Winker M, Gründemann C. Phytotherapy in Integrative Oncology-An Update of Promising Treatment Options. Molecules 2022; 27:3209. [PMID: 35630688 PMCID: PMC9143079 DOI: 10.3390/molecules27103209] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/02/2022] [Accepted: 05/10/2022] [Indexed: 02/06/2023] Open
Abstract
Modern phytotherapy is part of today's conventional evidence-based medicine and the use of phytopharmaceuticals in integrative oncology is becoming increasingly popular. Approximately 40% of users of such phytopharmaceuticals are tumour patients. The present review provides an overview of the most important plants and nature-based compounds used in integrative oncology and illustrates their pharmacological potential in preclinical and clinical settings. A selection of promising anti-tumour plants and ingredients was made on the basis of scientific evidence and therapeutic practical relevance and included Boswellia, gingko, ginseng, ginger, and curcumin. In addition to these nominees, there is a large number of other interesting plants and plant ingredients that can be considered for the treatment of cancer diseases or for the treatment of tumour or tumour therapy-associated symptoms. Side effects and interactions are included in the discussion. However, with the regular and intended use of phytopharmaceuticals, the occurrence of adverse side effects is rather rare. Overall, the use of defined phytopharmaceuticals is recommended in the context of a rational integrative oncology approach.
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Affiliation(s)
- Amy M. Zimmermann-Klemd
- Translational Complementary Medicine, Department of Pharmaceutical Sciences, University of Basel, Klingelbergstrasse 80, CH-4056 Basel, Switzerland; (A.M.Z.-K.); (M.W.)
| | - Jakob K. Reinhardt
- Pharmaceutical Biology, Department of Pharmaceutical Sciences, University of Basel, Klingelbergstrasse 50, CH-4056 Basel, Switzerland;
| | - Moritz Winker
- Translational Complementary Medicine, Department of Pharmaceutical Sciences, University of Basel, Klingelbergstrasse 80, CH-4056 Basel, Switzerland; (A.M.Z.-K.); (M.W.)
| | - Carsten Gründemann
- Translational Complementary Medicine, Department of Pharmaceutical Sciences, University of Basel, Klingelbergstrasse 80, CH-4056 Basel, Switzerland; (A.M.Z.-K.); (M.W.)
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Oei SL, Rieser T, Becker S, Groß J, Matthes H, Schad F, Thronicke A. TANGO: effect of tango Argentino on cancer-associated fatigue in breast cancer patients-study protocol for a randomized controlled trial. Trials 2021; 22:866. [PMID: 34857031 PMCID: PMC8637025 DOI: 10.1186/s13063-021-05869-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/23/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The majority of breast cancer patients suffer from persistent impairments after completion of their primary oncological therapy. Cancer-related fatigue (CRF) in particular is a multidimensional syndrome having a profound negative impact on the quality of life. To counter CRF symptoms, physical activities are suggested as first-line interventions, mind-body therapies have been shown to be effective, and music therapy can also reduce anxiety and stress in breast cancer patients. Tango therapy that combines various elements can have an impact on physical, psychological, and cognitive abilities and could therefore have a beneficial effect on breast cancer patients. The purpose of this study is to investigate whether a 6-week tango module is suited as a therapeutic approach for people after primary breast cancer therapy to favorably influence their quality of life, especially CRF levels. METHODS Sixty patients with a diagnosis for stage I-III breast cancer 12-48 months before enrollment and with CRF (age > 18) will be recruited and randomized 1:1 to a tango or a waiting-list group. Movement concepts using elements of Argentine tango (self-awareness, musical and spatial perception, self-perception, playfulness, shared experience) will be examined with the participants during six consecutive weekly 1-h tango sessions. The primary outcome will be the improvement of CRF (German version of the Cancer Fatigue Scale), and the secondary outcomes will be the improvement in sleep quality (Pittsburgh Sleep Quality Index) and quality of life (EORTC-QLQ-C30). Patient-reported outcomes will be measured at baseline and 6 weeks later; follow-up will be performed 6, 12, and 24 months after baseline. An evaluation will be performed by means of descriptive data analyses. DISCUSSION Argentine tango, as a music-based movement therapy, can influence different skills and may improve several outcomes. The therapeutic use of Argentine tango in the care of breast cancer patients has not yet been reported. It is anticipated that participants receiving the tango module will have improved CRF, sleep, and quality of life scores compared to a waitlist control. TRIAL REGISTRATION German Clinical Trials Registry (DRKS) DRKS00021601 . Retrospectively registered on 21 August 2020.
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Affiliation(s)
- Shiao Li Oei
- Research Institute Havelhöhe at the Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Thomas Rieser
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Sarah Becker
- Breast Cancer Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Jessica Groß
- Breast Cancer Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Harald Matthes
- Research Institute Havelhöhe at the Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Medical Clinic for Gastroenterology, Infectiology and Rheumatology CBF Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Friedemann Schad
- Research Institute Havelhöhe at the Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
- Institute for Gastroenterology, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Anja Thronicke
- Research Institute Havelhöhe at the Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany.
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
- Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany.
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Oei SL, Thronicke A, Kröz M, von Trott P, Schad F, Matthes H. Impact of Oncological Therapy and Viscum album L Treatment on Cancer-Related Fatigue and Internal Coherence in Nonmetastasized Breast Cancer Patients. Integr Cancer Ther 2021; 19:1534735420917211. [PMID: 32478590 PMCID: PMC7273755 DOI: 10.1177/1534735420917211] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction:Viscum album L extracts (VA) are frequently used in integrative
oncology. Aim of this study was to evaluate the impact of add-on VA applications
on various patient-reported outcome measures. Methods: A
longitudinal real-world study was conducted, using data from the Network
Oncology clinical registry. Primary, nonmetastasized breast cancer patients
treated with oncological standard therapy partly combined with VA applications
were included. Internal Coherence Cancer-related Fatigue, and EORTC QLQ-C30
questionnaires were assessed at baseline and 6, 12, and 24 months later.
Results: A total of 319 patients received standard oncological
therapy and 40% of them additionally VA applications. After 6 and 12 months for
patients treated with chemotherapy (Ctx) only a significant decline of the
thermo-coherence, and worsening of fatigue was observed. For patients receiving
VA applications but no Ctx, significant beneficial effects on thermo-coherence,
fatigue, and seven EORTC QLQ-C30 scales were observed 24 months later. Adjusted
multivariable long-term subgroup (n = 106) regression analysis
revealed that Ctx, immuno-, and endocrine therapies had a worsening of 17, 17,
and 6 point changes, respectively, for EORTC QLQ-C30 fatigue (P
= .0004), while VA applications showed an improvement of 12 point change. A
similar impact of improvement (add-on VA) and worsening (standard oncological
treatment regimens) on EORTC QLQ-C30 insomnia (P = .009) and
physical functioning (P = .005) were observed.
Conclusions: In the present real-world study, add-on VA
applications had a supportive effect on cancer-related fatigue, insomnia,
physical functioning, and thermo-coherence. Thus, VA applications might be
suited to alleviate symptom burden during anticancer therapy in breast cancer
patients.
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Affiliation(s)
| | | | - Matthias Kröz
- Research Institute Havelhöhe, Berlin, Germany.,Institute for Integrative Medicine, Witten/Herdecke, Germany
| | - Philipp von Trott
- Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Friedemann Schad
- Research Institute Havelhöhe, Berlin, Germany.,Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Harald Matthes
- Research Institute Havelhöhe, Berlin, Germany.,Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany.,Medical Clinic for Gastroenterology, CBF, Charité Universitätsmedizin Berlin, Berlin, Germany
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Megas IF, Tolzmann DS, Bastiaanse J, Fuchs PC, Kim BS, Kröz M, Schad F, Matthes H, Grieb G. Integrative Medicine and Plastic Surgery: A Synergy-Not an Antonym. ACTA ACUST UNITED AC 2021; 57:medicina57040326. [PMID: 33915729 PMCID: PMC8066838 DOI: 10.3390/medicina57040326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/09/2021] [Accepted: 03/25/2021] [Indexed: 01/25/2023]
Abstract
Background: Integrative medicine focuses on the human being as a whole—on the body, mind, and spirit—to achieve optimal health and healing. As a synthesis of conventional and complementary treatment options, integrative medicine combines the pathological with the salutogenetic approach of therapy. The aim is to create a holistic system of medicine for the individual. So far, little is known about its role in plastic surgery. Hypothesis: We hypothesize that integrative medicine based on a conventional therapy with additional anthroposophic therapies is very potent and beneficial for plastic surgery patients. Evaluation and consequence of the hypothesis: Additional anthroposophic pharmacological and non-pharmacological treatments are promising for all areas of plastic surgery. We are convinced that our specific approach will induce further clinical trials to underline its therapeutic potential.
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Affiliation(s)
- Ioannis-Fivos Megas
- Department of Plastic Surgery and Hand Surgery, Gemeinschaftskrankenhaus Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany; (I.-F.M.); (D.S.T.); (J.B.)
| | - Dascha Sophie Tolzmann
- Department of Plastic Surgery and Hand Surgery, Gemeinschaftskrankenhaus Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany; (I.-F.M.); (D.S.T.); (J.B.)
| | - Jacqueline Bastiaanse
- Department of Plastic Surgery and Hand Surgery, Gemeinschaftskrankenhaus Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany; (I.-F.M.); (D.S.T.); (J.B.)
| | - Paul Christian Fuchs
- Department of Plastic Surgery and Hand Surgery, Burn Center, University of Witten/Herdecke, Kliniken der Stadt Köln, Ostmerheimer Str. 200, 51109 Köln, Germany;
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland;
| | - Matthias Kröz
- Institute of Integrative Medicine, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany;
- Research Department Klinik Arlesheim, Pfeffingerweg 1, 4144 Arlesheim, Switzerland
- Research Institute Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany; (F.S.); (H.M.)
| | - Friedemann Schad
- Research Institute Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany; (F.S.); (H.M.)
| | - Harald Matthes
- Research Institute Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany; (F.S.); (H.M.)
- Institute of Social Medicine, Epidemiology and Health Economics CCM, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Gerrit Grieb
- Department of Plastic Surgery and Hand Surgery, Gemeinschaftskrankenhaus Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany; (I.-F.M.); (D.S.T.); (J.B.)
- Department of Plastic Surgery and Hand Surgery, Burn Center, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
- Correspondence:
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10
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Oei SL, Thronicke A, Matthes H, Schad F. Assessment of integrative non-pharmacological interventions and quality of life in breast cancer patients using real-world data. Breast Cancer 2021; 28:608-617. [PMID: 33393018 DOI: 10.1007/s12282-020-01193-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/19/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Treatments with non-pharmacological interventions (NPIs), comprising art and exercise therapies, nursing interventions, and educational components, are considered to improve quality of life of cancer patients. The aim of this study was to assess the longitudinal changes in self-reported quality of life of breast cancer patients receiving an integrative medicine program consisting of hospital-based NPIs and standard oncological treatments. METHODS This real-world data study was conducted using data from the Network Oncology clinical registry of the Gemeinschaftskrankenhaus Havelhöhe. Primary breast cancer patients of all tumor stages, who answered the European Organization of Research and Treatment Health-Related Quality of Life Core Questionnaire scale (EORTC QLQ-C30) at first diagnosis and 12 months later, were included. Association factors between received NPIs and longitudinal EORTC QLQ-C30-changes were analyzed with additive non-parametric regression tests, considering treatment regimens and demographic variables, using the software R. RESULTS A total of 231 primary breast cancer patients were enrolled and separate regression analyses were carried out. Significant associations between the received NPIs elaborate consultations and life review, nursing compresses, music and eurythmy therapy and improvements of 8-13 points for global health, all five functional EORTC-scales, and symptoms fatigue, dyspnea, insomnia, and financial difficulties were observed. CONCLUSION Our findings support the beneficial impact of NPIs for breast cancer patients. Further research could be directed towards synergistic effects of multimodal applied NPIs. TRIAL REGISTRATION Trial registration number DRKS00013335 on 27/11/2017 retrospectively registered.
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Affiliation(s)
- Shiao Li Oei
- Research Institute Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.
| | - Anja Thronicke
- Research Institute Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.,Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Harald Matthes
- Research Institute Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.,Medical Clinic for Gastroenterology, Infectiology and Rheumatology CBF, Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Friedemann Schad
- Research Institute Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.,Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
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Schad F, Thronicke A, von Trott P, Oei SL. Analysis of Changes in Cancer-Related Fatigue of Breast Cancer Patients Receiving an Integrative Medicine Program. Integr Cancer Ther 2020; 19:1534735420963780. [PMID: 33040629 PMCID: PMC7585890 DOI: 10.1177/1534735420963780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction: Cancer-related fatigue (CRF) occurs frequently in breast cancer patients. The
aim of this real-world study was to analyze the longitudinal changes of CRF
in breast cancer patients receiving an integrative medicine program, which
includes the application of non-pharmacological interventions (NPIs) and
Viscum album L. (VA) extracts. Methods: All data were collected from the clinical register of the Network Oncology of
a German certified breast cancer center of the Gemeinschaftskrankenhaus
Havelhöhe (GKH). Primary breast cancer patients, treated upon initial
diagnosis with integrated NPIs, comprising art and exercise therapy, nursing
interventions, and educational components, during their hospital stay, and
who had answered the German Cancer-Fatigue Scale (CFS-D) questionnaire at
first diagnosis and 12 months later, were included. The associations between
NPIs and CFS-D changes were analyzed with adjusted multivariable regression
analyses, considering received treatment regimens and demographic variables,
using the software R. Results: 231 female breast cancer patients of all tumor stages were evaluated. While
chemotherapy exhibited significant severe deterioration, add-on VA
applications seem to partially mitigate this impairment on CRF. 36 separate
multivariable regression analyses for all NPIs showed that in particular
significant associations between CFS-D improvements and the interventions
nursing compresses (6 point change; P = .0002;
R² = 28%) or elaborate consultations and life review
(ECLR) (4 point change; P = .0002;
R² = 25%) were observed. Conclusions: Breast cancer patients benefit from a hospital-based integrative medicine
program. To alleviate fatigue symptoms during oncological therapy, an
expansion of this concept should be developed in the future.
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Affiliation(s)
- Friedemann Schad
- Research Institute Havelhöhe, Berlin, Germany.,Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | | | - Phillipp von Trott
- Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
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12
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Schmidt G, Mathes S, Klein E, Kiechle M, Paepke D. Evaluation of an Expert Guided Integrative Therapy Concept in Patients With Breast or Gynecological Cancer During Systemic Therapy. J Evid Based Integr Med 2020; 25:2515690X20949444. [PMID: 32808558 PMCID: PMC7436788 DOI: 10.1177/2515690x20949444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose. Breast and gynecological cancer patients undergoing systemic therapy frequently request integrative therapy concepts. The potential of integrative therapy (IM) lies in minimizing side effects of conventional cancer treatments and therefore decreasing treatment delays. IM can help to improve patients’ physical and emotional well-being, optimizing health and quality of life as IM involves patients in their own treatment. A counseling service for integrative medicine concepts as an outpatient program was implemented in our cancer center in 2013. Methods. In 2016 and 2017 144 breast and gynecological cancer patients were included into our specific IM program. The program comprises biological based complementary and alternative medicines (BB-CAM), a structured exercise therapy, manipulative and body-based practices, nutritional counseling, psycho-oncological and relaxing therapies. Therapists with additional specialization for IM, guide the treatment units. The program was evaluated via self-administered questionnaire. Results. 78% of the participating patients noticed an improvement by using BB-CAMs. 86% stated to feel better through participation in the structured exercise program. 74% profited from nutritional counseling and 91% from manual therapy. 93% of the patients treated with body compresses considered the application as soothing. The Bio-Frequency Sound Color Bed led to a relaxation in 96%. Psychological therapy improved coping with the disease in 70% of the patients. Conclusion. Integrative oncology combines the best practices of conventional and complementary therapy, uniting them in a holistic concept. Data show that our integrative therapy concept is well accepted by the patients and that therapy- and disease-related side effects can be reduced.
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Affiliation(s)
- Georg Schmidt
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
| | - Sofia Mathes
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
| | - Evelyn Klein
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
| | - Marion Kiechle
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
| | - Daniela Paepke
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
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Oei SL, Thronicke A, Matthes H, Schad F. Evaluation of the effects of integrative non-pharmacological interventions on the internal coherence and resilience of breast cancer patients. Support Care Cancer 2020; 29:1413-1421. [PMID: 32671562 DOI: 10.1007/s00520-020-05617-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/07/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE In the breast cancer center at the Gemeinschaftskrankenhaus Havelhöhe (GKH), integrative strategies are implemented in the routine care of breast cancer patients. The aim of this breast cancer real-world study was to systematically evaluate changes in patients' internal coherence and resilience, associated with the use of non-pharmacological interventions (NPIs). METHODS This study included 231 primary breast cancer patients treated with standard oncological therapy and NPIs, which comprise art and movement therapies, nursing interventions, and educational components, and had answered the internal coherence scale (ICS) questionnaire at first diagnosis and 12 months later. Data were collected from the Network Oncology clinical registry of the GKH, and effects of NPIs on ICS changes were analyzed with adjusted linear multivariable regression analyses, using the software R. RESULTS Two hundred twenty breast cancer patients of all tumor stages were eligible for a total of 27 separate adjusted multivariable linear regression analyses. The NPIs elaborate consultations and life review (ECLR); nursing compresses, music therapy, and rhythmic massages were significantly associated with increases of about 2-point changes in inner resilience and coherence (p < 0.05). Furthermore, a significant association with an elevation of the thermo coherence was observed for the application of nursing compresses. CONCLUSIONS The evaluation of real-world data carried out here shows that the application of the multimodal treatment concept can lead to an enhancement of the internal coherence and resilience in breast cancer patients. To improve the care of cancer patients, this multimodal program should be further expanded into routine clinical practices. TRIAL REGISTRATION Trial registration number DRKS00013335 on 27/11/2017 retrospectively registered.
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Affiliation(s)
- Shiao Li Oei
- Research Institute Havelhöhe, Forschungsinstitut Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.
| | - Anja Thronicke
- Research Institute Havelhöhe, Forschungsinstitut Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Harald Matthes
- Research Institute Havelhöhe, Forschungsinstitut Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.,Institute of Social Medicine, Epidemiology and Health Economics and Medical Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Friedemann Schad
- Research Institute Havelhöhe, Forschungsinstitut Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.,Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
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Health-Related Quality of Life in Patients with Lung Cancer Applying Integrative Oncology Concepts in a Certified Cancer Centre. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:5917382. [PMID: 32454866 PMCID: PMC7238336 DOI: 10.1155/2020/5917382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 03/02/2020] [Accepted: 04/22/2020] [Indexed: 11/25/2022]
Abstract
Background Pretreatment health-related quality of life (HRQOL) is associated with survival outcome in lung cancer patients. There is a lack of systematic research on pretreatment HRQOL in lung cancer patients who receive integrative oncology (IO). We evaluated patient-reported outcomes in these patients at time of diagnosis at a certified oncology and lung cancer centre. Methods The present analysis is a prospective real-world data study. Clinical and demographic data were obtained from the accredited Network Oncology cancer registry. Pretreatment HRQOL was evaluated (international standardized questionnaires) for people with all-stage lung cancer at first diagnosis that received IO consisting of standard therapy and multimodal add-on complementary concepts. Univariate and adjusted multivariate regression analyses were performed with R. Results. Eighty seven patients with all-stage lung cancer were eligible for the questionnaire analysis (median age 68.0 years, IQR 59.0–74.4). Thirty percent of the total cohort reported financial difficulties. Self-reported pretreatment financial difficulty was associated with younger age (p=0.007), pretreatment pain (p=0.006), anxiety (p=0.04), and low mood (p=0.03). Pain (p=0.03) and young age (p=0.02) in the early- and late-stage lung cancer were associated with financial difficulties. Conclusion We suggest physicians screen lung cancer patients at working age (broadly aged ≤65 years) and/or who report increased pain at the time of diagnosis as they might be at particular risk for emotional, physical, and financial problems. Our results emphasize to address emotional and physical needs before and during early treatment in lung cancer patients as suggested in integrative and supportive cancer concepts.
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Matthes H, Thronicke A, Hofheinz RD, Baars E, Martin D, Huber R, Breitkreuz T, Bar-Sela G, Galun D, Schad F. Statement to an Insufficient Systematic Review on Viscum album L. Therapy. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:7091039. [PMID: 32148549 PMCID: PMC7049420 DOI: 10.1155/2020/7091039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/24/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Up to 88% of oncological patients apply complementary therapies and up to 77% apply complementary mistletoe therapy in the context of integrative oncological approaches. An evidence-based consultation of oncological health professionals regarding complementary therapies used in Germany is missing. Therefore, a new S3-Guideline for Complementary Medicine in the Treatment of Oncological Patients is under development and is anticipated to be finalized in November 2020. It will be based on evidence-based publications and systematic reviews on complementary therapies in oncology. A recently published two-part systematic review on mistletoe treatment in oncology has been reevaluated. METHODS The latest published systematic two-part review on mistletoe has been systematically proofread and checked in compliance with the Cochrane Handbook for Systematic Reviews of Intervention and the AMSTAR 2 (A MeaSurement Tool to Assess Systematic Reviews) tool. RESULTS The here discussed two-part review is incomplete, lacks sound accuracy including insufficient assessment of the risk of bias, and contains imprecise statements. In addition, it does not sufficiently comply with the Cochrane Handbook for Systematic Reviews of Intervention and the AMSTAR 2 tool. CONCLUSION In view of the approaching release of a new guideline in the field of complementary therapies in oncology, the present statement draws attention to a lack of profound methodology of conductance of a recently released systematic review on mistletoe. In consequence, a comprehensive overview of published mistletoe studies, i.e., a meta-analysis with a sound methodology of conductance, is necessary.
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Affiliation(s)
- Harald Matthes
- Oncological Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
- Institute of Social Medicine, Epidemiology and Health Economics and Medical Department of Gastroenterology, Infectiology and Rheumatology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Research Institute Havelhöhe, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Anja Thronicke
- Research Institute Havelhöhe, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Ralf-Dieter Hofheinz
- Interdisciplinary Tumour Centre Mannheim, University Medicine of Mannheim, Mannheim, Germany
| | - Erik Baars
- Louis Bolk Institute, Bunnik, Netherlands
| | - David Martin
- Gerhard Kienle Chair for Medical Theory, Integrative and Anthroposophical Medicine, Department of Human Medicine, Faculty of Health, University of Witten/Herdecke, Witten/Herdecke, Germany
| | - Roman Huber
- Center for Complementary Medicine, Institute for Infection, Prevention and Hospital Epidemiology, University Freiburg, Freiburg, Germany
| | - Thomas Breitkreuz
- Hospital Filderklinik, Stuttgart, Germany
- Hospital Paracelsus Krankenhaus, Bad Liebenzell, Germany
| | | | - Daniel Galun
- Clinical Center of Serbia, Belgrade and Medical School, University of Belgrade, Belgrade, Serbia
| | - Friedemann Schad
- Oncological Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
- Research Institute Havelhöhe, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
- Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
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Belt-van Zoen E, De Bruin AM, Ponstein AS, Ephraïm MP, Baars EW. First Steps in the Development of an Expertise-Based Anthroposophic Complex Intervention for Oncological Treatment in Primary Care: A Qualitative Study. Integr Cancer Ther 2020. [PMCID: PMC7716074 DOI: 10.1177/1534735420969825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: The aim of this study was to develop a prototype of an anthroposophic complex intervention (CI) for oncological patients in primary care. Methods: Standardized methods for the development of CIs were used. Qualitative data were collected among professionals (n = 44) working in 3 Dutch anthroposophic primary care centers. The following topics were discussed in interviews and panel discussions (n = 12): treatment phases, treatment dimensions, treatment goals, and content of the indicated treatments and therapies. In a multidisciplinary focus group (n = 23) completeness and comprehensibility of the CI, and integration in daily practice were addressed. Subsequently, the developed CI was tested on face validity (n = 21) and compared with conventional guidelines. Results: Professionals reached consensus about 4 oncological treatment phases, 4 anthroposophic treatment dimensions, and twelve general treatment goals. The following anthroposophic therapies were found to be suited for oncological patients in primary care: medication (eg, mistletoe preparations); nursing (eg, external embrocation); physiotherapy (eg, rhythmic massage); eurythmy therapy; dietetics; art therapy; and counseling. The content of each therapy must be tailored to the individual. Comparison with existing guidelines demonstrated added value and the ability to fit with conventional care. Discussion: Strengths of the developed CI prototype are its focus on primary care, its practical applicability, the use of validated research methods, and the check on face validity in 2 other Dutch anthroposophic primary care centers. Limitations are that no systematic literature review was done and patient experiences were not collected. Conclusions: An applicable prototype of an anthroposophic CI for oncological patients in primary care was developed. To complete the development of this CI, a systematic review of the literature is needed, feasibility should be tested, patient experiences need to be collected, and implementation should be initiated and monitored. Finally, development of a patient decision aid (PtDA) and a decision-making tool (DMT) are recommended.
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Affiliation(s)
- E. Belt-van Zoen
- University of Applied Sciences Leiden, Leiden, South Holland, The Netherlands
| | - A. M. De Bruin
- University of Applied Sciences Leiden, Leiden, South Holland, The Netherlands
| | - A. S. Ponstein
- University of Applied Sciences Leiden, Leiden, South Holland, The Netherlands
| | - M. P. Ephraïm
- Primary Care Center ‘Therapeuticum Aurum’, Zoetermeer, The Netherlands
| | - E. W. Baars
- University of Applied Sciences Leiden, Leiden, South Holland, The Netherlands
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Rodondi PY, Lüthi E, Dubois J, Roy E, Burnand B, Grass G. Complementary Medicine Provision in an Academic Hospital: Evaluation and Structuring Project. J Altern Complement Med 2019; 25:606-612. [DOI: 10.1089/acm.2019.0062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Pierre-Yves Rodondi
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Institute of Family Medicine, University of Fribourg, Fribourg, Switzerland
| | - Emmanuelle Lüthi
- Institute of Family Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Anesthesiology, Center for Integrative and Complementary Medicine, Pain Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Julie Dubois
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Institute of Family Medicine, University of Fribourg, Fribourg, Switzerland
| | - Edith Roy
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Bernard Burnand
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Geneviève Grass
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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Supportive effect of Viscum album L. extracts on the sense of coherence in non-metastasized breast cancer patients. Eur J Integr Med 2019. [DOI: 10.1016/j.eujim.2019.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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The Internal Coherence of Breast Cancer Patients Is Associated with the Decision-Making for Chemotherapy and Viscum album L. Treatment. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:1065271. [PMID: 30363769 PMCID: PMC6181006 DOI: 10.1155/2018/1065271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 09/05/2018] [Indexed: 01/10/2023]
Abstract
Objective In the present observational study, the influence of internal coherence on shared decision-making for chemotherapy (CTX) and Viscum album L. extracts (VA) treatment in breast cancer patients was evaluated. Methods Breast cancer patients with a guideline-oriented advice from the tumor board for CTX were included in the study. At first diagnosis (T0) and 6 months later (T1), a questionnaire, the internal coherence scale (ICS), was administered and evaluated. Prior to analysis, patients were classified retrospectively depending on their treatment decision. Results 64 primary nonmetastasized breast cancer patients (median age 54.8 years, IQR: 46.3-65.3) were analyzed in this study. At T0, adjusted multivariable linear regression analyses revealed significant low ICS scores in patients rejecting CTX, especially in the ICS subscale “thermo coherence” (p = 0.006). The decision for add-on VA-therapy was associated with low scores for the ICS subscale “inner resilience coherence”, in particular low for the item “courage”. At T1, in the CTX+VA-group the thermo coherence increased significantly (p(d) < 0.01), while in contrast, in the CTX-only group the thermo coherence decreased significantly (p(d) = 0.02). Conclusion Add-on VA-applications in CTX treatment support the thermo coherence of breast cancer patients, revealing a decision option to encourage patients to undergo CTX in combination with additional VA-treatments.
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Thronicke A, Kröz M, Merkle A, Matthes H, Herbstreit C, Schad F. Psychosocial, Cognitive, and Physical Impact of Elaborate Consultations and Life Review in Female Patients with Non-Metastasized Breast Cancer. Complement Med Res 2018; 25:92-101. [DOI: 10.1159/000486672] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Elaborate consultations and life review (ECLR) has been regularly applied in patients of various cancer entities and stages within Anthroposophic-integrative oncology concepts. However, a lack of systematic research in this field has been detected. To close this gap of knowledge, we evaluated the impact of ECLR in patients with non-metastasized breast cancer before, during, and after primary oncological treatment. Methods: Patient-reported outcome measures were evaluated by analyzing European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ-C30) in patients with non-metastasized breast cancer who had received either oncological standard therapy alone or in combination with ECLR. Results: 95 female patients were eligible for questionnaire analysis (median age 58 years). Adjusted multivariable linear regression analysis revealed that ECLR was associated with significant improvements in medium-term global health/quality of life and emotional, social, and cognitive functioning. Furthermore, ECLR was associated with significant reductions of short-term appetite loss burden, pain, and short- and medium-term financial difficulties. Subgroup analyses revealed significant improvements in pivotal quality-of-life aspects including fatigue (p = 0.002) in chemotherapy-treated patients after ECLR. Conclusions: 12 months of surveillance of breast cancer patients reveals medium-term recovery of the global health status/quality of life and cognitive and psychosocial well-being associated with ECLR. In addition, our data indicate a possible association between ECLR and reduced short-term fatigue burden, which has to be re-confirmed prospectively in a larger study cohort. As long-term cancer survivors develop psychological symptoms similar to patients with chronic diseases, prospective studies should evaluate the impact of ECLR on the psychosocial well-being in these patients.
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Thronicke A, Oei SL, Merkle A, Herbstreit C, Lemmens HP, Grah C, Kröz M, Matthes H, Schad F. Integrative cancer care in a certified Cancer Centre of a German Anthroposophic hospital. Complement Ther Med 2018; 40:151-157. [PMID: 30219441 DOI: 10.1016/j.ctim.2018.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/19/2018] [Accepted: 03/31/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The concept of integrative oncology (IO) comprising guideline-oriented standard and add-on complementary medicine has gained growing importance. The Anthroposophic-integrative Cancer Centre (CC) at the hospital Gemeinschaftskrankenhaus (GKH) in Berlin has been implementing IO concepts during recent years. Furthermore, it is a certified CC and has been annually audited by national cancer authorities since 2012. The objective of the present study was to evaluate IO concepts of the certified CC GKH. METHODS Clinical, demographic, integrative treatment and follow-up data were analyzed between 2011 and 2016. In addition, CC GKH quality measures were compared with those of nationwide benchmarking CCs. RESULTS Between 2011 and 2016, 2.382 primary cancer patients, median age 66 years, were treated at the CC GKH. 70.1% of the patients showed either Union for International Cancer Control (UICC) stage 0, I, II or III and 25.6% were in UICC stage IV. IO therapies included surgery (64.4% of patients), radiation (41.2%), and application of cytostatic drugs (53.9%), add-on mistletoe therapy (30.5%), and non-pharmacological interventions (87.3%). Regarding psycho-oncological support and quota of patient's enrollment in studies the CC GKH performs above nationwide benchmarks. Research outcomes including safety issues, clinical impact as well as patient's health-related quality of life are continuously evaluated and integrated into hospital's decision-management. CONCLUSION This analysis reveals that IO concepts are applied to a high proportion of male and female primary cancer patients of all age groups, indicating a successful implementation at the certified CC GKH. Ongoing clinical evaluations have been initiated and cost-effectiveness comparisons are under analyses.
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Affiliation(s)
| | - Shiao Li Oei
- Research Institute Havelhöhe, 14089 Berlin, Germany.
| | - Antje Merkle
- Research Institute Havelhöhe, 14089 Berlin, Germany; Oncological Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany.
| | - Cornelia Herbstreit
- Oncological Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany; Breast Cancer Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany.
| | - Hans-Peter Lemmens
- Oncological Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany; Colon and Rectum Cancer Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany.
| | - Christian Grah
- Oncological Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany; Lung Cancer Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany.
| | - Matthias Kröz
- Research Institute Havelhöhe, 14089 Berlin, Germany; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, 10098 Berlin, Germany; Institute for Integrative Medicine, University of Witten/Herdecke, 58313 Witten, Herdecke, Germany.
| | - Harald Matthes
- Oncological Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany; Medical Department, Division of Gastroenterology, Infectiology and Rheumatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany.
| | - Friedemann Schad
- Research Institute Havelhöhe, 14089 Berlin, Germany; Oncological Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany.
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