1
|
Hesmert D, Klocke C, Stolz R, Huber R, Samstag Y, Hübner K, Simmet T, Syrovets T, Joos S, Valentini J. Exploring the gap: attitudes, knowledge, and training needs in complementary and integrative medicine among healthcare professionals at German university hospitals. Front Med (Lausanne) 2024; 11:1408653. [PMID: 38784234 PMCID: PMC11111851 DOI: 10.3389/fmed.2024.1408653] [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: 03/28/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction The use of Complementary and Integrative Medicine (CIM) is very popular among the general population in Germany. However, international studies show that nurses, physicians, and other health care professionals (HCPs) at hospitals often do not feel sufficiently informed about different CIM approaches. Moreover, they do not feel trained enough to counsel their patients appropriately. In the German-speaking context, particularly within university hospitals, research on this subject is scarce. Therefore, the aim of this explorative study was to evaluate attitudes, subjective knowledge, and needs regarding CIM among HCPs with direct patient interaction across all four university hospitals in the federal state of Baden-Württemberg, Germany (Tübingen, Ulm, Freiburg, Heidelberg). Methods The multicenter, cross-sectional, anonymous full survey was conducted online using a self-developed, semi-structured, web-based questionnaire. Recruitment took place via all-inclusive e-mail distribution lists of all four university hospitals. Results A total of n = 2,026 participants (response rate varied by location from about 5 to 14%) fully answered the questionnaire. Nurses constituted the largest professional group (n = 1,196; 59%), followed by physicians (n = 567; 28%), physiotherapists (n = 54), psychologists (n = 48), midwives (n = 37), and other professions (n = 124). More than two-thirds (71%, n = 1,437) of the participants were female and 14% (n = 286) reported additional training in CIM. The overall attitude toward CIM (10-point Likert scale, 10 = "very favorable") was clearly positive (M ± SD: 7.43 ± 2.33), with notable differences between professional groups: midwives (9.05 ± 1.18), physiotherapists (8.44 ± 1.74), and nurses (8.08 ± 1.95) expressed the highest support, whereas physicians (5.80 ± 2.39) the lowest. 42% of the participants incorporated CIM in patient care (from 33% of physicians to 86% of midwives). Overall, relaxation therapy (n = 1,951; 96%), external applications (n = 1,911; 94%), massage (n = 1,836; 91%), and meditation/mindfulness (n = 1,812; 89%) were rated as useful or rather useful for patients. The average self-assessed knowledge level about CIM was moderate (M ± SD: 5.83 ± 2.03). Most of the participants found CIM training at university hospitals important and saw research about CIM as one of the tasks of university hospitals. The participants expressed the highest interest in education for acupuncture/acupressure, relaxation therapies, and manual medicine. Discussion This comprehensive survey of health care professionals (HCPs) at university hospitals in Germany reveals a clearly positive disposition toward CIM, aligning with findings from other hospital-based surveys and highlighting differences among professional groups. While most therapies deemed beneficial for patient care are supported by positive evidence, further research is required for others. Given the average self-reported knowledge of CIM, targeted education is essential to meet the needs of both HCPs and patients and to ensure the provision of evidence-based information on the risks and benefits of CIM.
Collapse
Affiliation(s)
- Daniela Hesmert
- Institute of General Practice and Interprofessional Care, University Hospital and Faculty of Medicine, Tübingen, Germany
| | - Carina Klocke
- Institute of General Practice and Interprofessional Care, University Hospital and Faculty of Medicine, Tübingen, Germany
| | - Regina Stolz
- Institute of General Practice and Interprofessional Care, University Hospital and Faculty of Medicine, Tübingen, Germany
| | - Roman Huber
- Center for Complementary Medicine, Department of Medicine II, Medical Center, Faculty of Medicine – University of Freiburg, Freiburg im Breisgau, Germany
| | - Yvonne Samstag
- Section of Molecular Immunology, Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Katrin Hübner
- Section of Molecular Immunology, Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Simmet
- Institute of Experimental and Clinical Pharmacology, Toxicology, and Pharmacology of Natural Products, Ulm University, Ulm, Germany
| | - Tatiana Syrovets
- Institute of Experimental and Clinical Pharmacology, Toxicology, and Pharmacology of Natural Products, Ulm University, Ulm, Germany
| | - Stefanie Joos
- Institute of General Practice and Interprofessional Care, University Hospital and Faculty of Medicine, Tübingen, Germany
| | - Jan Valentini
- Institute of General Practice and Interprofessional Care, University Hospital and Faculty of Medicine, Tübingen, Germany
| |
Collapse
|
2
|
Ammar A, Soua A, Ezzi O, Chelly S, Ammar N, Ezzairi F, Khenissi N, Chabchoub I, Ben Ahmed S, Mahjoub M, Njah M. Complementary and alternative medicine in oncology: knowledge, attitude and practice among Tunisian healthcare workers. J Cancer Res Clin Oncol 2023; 149:11585-11594. [PMID: 37401941 DOI: 10.1007/s00432-023-05040-2] [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: 04/15/2023] [Accepted: 06/28/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE Over the past years, there has been a considerable increase in complementary and alternative medicine (CAM) use among cancer patients. However, guidance from health care workers (HCWs) is not always provided. We aimed to determine the knowledge, attitude and practice of Tunisian HCWs regarding the use of CAM in cancer patients. METHODS We conducted a multicenter cross-sectional study over 5 months from February to June 2022 among HCWs caring for cancer patients in the Tunisian center region. Data were collected using a self-administered questionnaire developed by our investigators. RESULTS The level of knowledge about CAM was declared limited by 78.4% of our population. The best known CAM therapies were herbal medicine and homeopathy while chiropractic and hypnosis where the least. HCWs who had sought information on CAM represented 54.3% of our sample and the main source of information was the Internet (37.1%). A positive attitude towards the use of CAM was found in 56% of HCWs. The integration of CAM into supportive care in oncology was approved by 78% of HCWs. Concerning training on CAM, 78% declared its necessity for HCWs and 73.3% expressed a desire to have it. A personal use of CAM was found in 53% of HCWs while 38.8% had previously used CAM in the treatment of their cancer patients. CONCLUSION The majority of HCWs had a positive attitude towards the use of CAM in oncology despite their poor knowledge about it. Our study emphasizes the need to train HCWs dealing with cancer patients on CAM.
Collapse
Affiliation(s)
- Asma Ammar
- Department of Hospital Hygiene, Farhat Hached University Hospital, Sousse, Tunisia
| | - Asma Soua
- Department of Hospital Hygiene, Farhat Hached University Hospital, Sousse, Tunisia.
| | - Olfa Ezzi
- Department of Hospital Hygiene, Farhat Hached University Hospital, Sousse, Tunisia
| | - Souhir Chelly
- Department of Hospital Hygiene, Farhat Hached University Hospital, Sousse, Tunisia
| | - Nouha Ammar
- Department of Medical Oncology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Faten Ezzairi
- Department of Medical Oncology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Nouha Khenissi
- Higher Institute of Nursing Sciences of Sousse, Sousse, Tunisia
| | - Imene Chabchoub
- Department of Medical Oncology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Slim Ben Ahmed
- Department of Medical Oncology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Mohamed Mahjoub
- Department of Hospital Hygiene, Farhat Hached University Hospital, Sousse, Tunisia
| | - Mansour Njah
- Department of Hospital Hygiene, Farhat Hached University Hospital, Sousse, Tunisia
| |
Collapse
|
3
|
Debes AM, Koenig A, Strobach D, Schinkoethe T, Forster M, Harbeck N, Wuerstlein R. Biologically Based Complementary and Alternative Medicine Use in Breast Cancer Patients and Possible Drug-Drug Interactions. Breast Care (Basel) 2023; 18:327-335. [PMID: 37901050 PMCID: PMC10601661 DOI: 10.1159/000531346] [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: 11/13/2022] [Accepted: 05/24/2023] [Indexed: 10/31/2023] Open
Abstract
Purpose Biologically based complementary and alternative medicine (BB-CAM) is gaining importance. Cancer patients in particular are at risk of interactions between the prescribed medications (intravenous or oral anticancer therapy, concomitant medication, medication for pre-existing illnesses) and BB-CAM. This investigation aims to identify potentially clinically relevant interactions between both BB-CAM and conventional medicine and two BB-CAM products in breast cancer patients (n = 47). Methods From March 2020 to January 2021, consecutive breast cancer patients (n = 47) completed a questionnaire about their medication and BB-CAM intake at the beginning of a new intravenous or oral tumor therapy (time point 1) and again after 10 to 12 weeks (time point 2) at the LMU Breast Center in Munich. The collective was divided into two subgroups based on the time after initial diagnosis; a cutoff of 6 months was used. The survey was available through an eHealth application called CANKADO as electronic patient-reported outcome only. Lexicomp® and AiD Klinik® databases were used for evaluating potentially clinically relevant interactions. As part of routine care, the collected data were evaluated and cross-checked in interdisciplinary cooperation with the University Hospital Pharmacy LMU. Results 43 of the 47 included breast cancer patients (91%) used BB-CAM at some point during their treatment period. We found a significant increase from time point 1 (n = 27) to time point 2 (n = 40) (p = 0.004). Moreover, in the subgroup of newly diagnosed patients, the number significant rose from 17 at time point 1 to 28 at time point 2 (p = 0.007). Overall, we found potentially clinically relevant interactions in 30 of 43 patients (70%). Sixty interactions were detected at both times of investigations. Twenty-three different kinds of BB-CAM-to-BB-CAM (time point 1 [n = 12], time point 2 [n = 11]) or conventional medicine-to-BB-CAM interactions (time point 1 [n = 15], time point 2 [n = 22]) were discovered. Importantly, there was not a single interaction between BB-CAM and an anticancer drug. Conclusion Breast cancer patients frequently use BB-CAM. Interactions were detected at both time points of investigation (time point 1 [n = 27], time point 2 [n = 33]). Interactions were particularly evident between BB-CAM substances as well as between BB-CAM and the patients' medication for pre-existing illnesses. Although no interaction between BB-CAM and an anticancer therapy was found, the use of BB-CAM should be evaluated at the beginning and regularly during therapy in view of the substantial number of interactions detected and the large number of upcoming targeted therapies.
Collapse
Affiliation(s)
- Anna Marie Debes
- Breast Center, Department of Gynecology and Obstetrics CCC Munich, LMU University Hospital, Munich, Germany
| | - Alexander Koenig
- Breast Center, Department of Gynecology and Obstetrics CCC Munich, LMU University Hospital, Munich, Germany
| | - Dorothea Strobach
- Hospital Pharmacy and Doctoral Program Clinical Pharmacy, University Hospital Munich, Munich, Germany
| | - Timo Schinkoethe
- Breast Center, Department of Gynecology and Obstetrics CCC Munich, LMU University Hospital, Munich, Germany
- CANKADO Service GmbH, Cologne, Germany
| | - Marie Forster
- Breast Center, Department of Gynecology and Obstetrics CCC Munich, LMU University Hospital, Munich, Germany
| | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics CCC Munich, LMU University Hospital, Munich, Germany
| | - Rachel Wuerstlein
- Breast Center, Department of Gynecology and Obstetrics CCC Munich, LMU University Hospital, Munich, Germany
| |
Collapse
|
4
|
Dietary supplement use and recommendations for discontinuation in an integrative oncology clinic. Support Care Cancer 2023; 31:40. [DOI: 10.1007/s00520-022-07504-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
|
5
|
Open dialogue about complementary and alternative medicine early in the oncology treatment trajectory. A qualitative study of patients’ lived experiences. Eur J Integr Med 2023. [DOI: 10.1016/j.eujim.2023.102228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
6
|
Lam CS, Koon HK, Ma CT, Au KY, Zuo Z, Chung VCH, Cheung YT. Real-world data on herb-drug interactions in oncology: A scoping review of pharmacoepidemiological studies. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 103:154247. [PMID: 35716539 DOI: 10.1016/j.phymed.2022.154247] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 05/14/2022] [Accepted: 06/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The concurrent use of conventional drugs and herbal medicines is becoming popular among patients with cancer. However, the potential risk of herb-drug interactions (HDI) remains under-addressed in the literature. Previous reviews have mainly focused on the prevalence of interactions, with less attention paid to the methods used by pharmacoepidemiological studies on evaluating HDI. This scoping review aims to summarize the existing pharmacoepidemiological studies that evaluate HDI using real-world data and to identify gaps to be addressed in future research. METHODS A comprehensive search was performed in nine English- and Chinese-language databases from their inception to May 2021. Gray literature and manual searches were conducted to identify additional studies. The recommended components of the pharmacoepidemiological studies and key findings related to HDI were summarized. The proportion (%) of patients with cancer at risk of HDI was estimated by combining data from eligible studies. RESULTS Twenty-eight studies were included in the review. More than half of these studies were cross-sectional studies (n = 18, 64.3%), followed by retrospective cohort studies (n = 5, 17.9%) and prospective cohort studies (n = 2, 7.1%). The three cancer drugs most commonly studied for their interaction potential with herbs were tamoxifen (n = 11, 39.3%), cyclophosphamide (n = 6, 21.4%), and paclitaxel (n = 6, 21.4%). Most cross-sectional studies identified potential HDI using tertiary databases and primary literature searches. Conversely, prospective and retrospective studies mainly investigated actual clinical outcomes, such as adverse events and secondary cancer occurrences. Most interaction outcomes identified using real-world data did not lead to negative clinical consequences. Collectively, 45.4% of herbal medicine users of the included studies were found to be at risk of HDI. We infer from this review that the common limitations of these studies were limited sample size, lack of data on herbal medicine use and details of HDI, and lack of evidence of HDI. Based on the study limitations, several recommendations to enrich the data sources and optimize the study designs were proposed. CONCLUSIONS There is a high demand for pharmacoepidemiological research on HDI, considering the increasing popularity of herbal medicine among patients with cancer. It is anticipated that emerging real-world data in this field can guide the development of safe and effective approaches to integrative oncology.
Collapse
Affiliation(s)
- Chun Sing Lam
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Area 39, Shatin, NT, Hong Kong
| | - Ho Kee Koon
- School of Chinese Medicine, Faculty of Medicine, Chung Chi College, The Chinese University of Hong Kong, Room 101, Li Wai Chun Building, Shatin, NT, Hong Kong
| | - Chung Tin Ma
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Area 39, Shatin, NT, Hong Kong
| | - Kwok Yin Au
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, 4L, 4/F, Day Treatment Block, Shatin, NT, Hong Kong
| | - Zhong Zuo
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Area 39, Shatin, NT, Hong Kong
| | - Vincent Chi-Ho Chung
- School of Chinese Medicine, Faculty of Medicine, Chung Chi College, The Chinese University of Hong Kong, Room 101, Li Wai Chun Building, Shatin, NT, Hong Kong; Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Room 202, School of Public Health Building, Shatin, NT, Hong Kong
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Area 39, Shatin, NT, Hong Kong.
| |
Collapse
|
7
|
The Use of Complementary and Alternative Medicine in Thai Gynecologic Oncology Patients: Influencing Factors. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:1322390. [PMID: 34804172 PMCID: PMC8598354 DOI: 10.1155/2021/1322390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/26/2021] [Indexed: 01/22/2023]
Abstract
Background To determine the factors influencing the use of complementary and alternative medicine (CAM) in gynecologic cancer patients and the prevalence and pattern of CAM use. Methods This was a cross-sectional study of 370 gynecologic cancer patients conducted at the outpatient clinic, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. After obtaining informed consent, participants were asked to complete a standardized questionnaire including sociodemographic and clinical characteristics, detail of CAM use, attitude of CAM use, and quality of life using EORTC-QLQ-C30. Results The prevalence of CAM use was 25.13%. The most common type was herbal medicine (55.90%). The participants who resided or had a birthplace in rural areas presented with a higher proportion of CAM use than those in urban areas (P=0.470 and P=0.004, respectively). Participants who received multiple modalities of cancer treatment reported a significantly higher proportion of CAM use (P=0.024). Most CAM users agreed that the CAM could be used in combination with standard treatment, and some rather disagreed that CAM could interrupt the treatment effect of the conventional treatment. CAM users had significantly higher role functioning in quality-of-life scores. Conclusion Factors influencing CAM use in gynecologic cancer patients were rural area birthplace or residency, receiving multiple modalities of cancer treatment, having positive attitude toward CAM use. CAM users had better performance in role functioning in the quality-of-life score. Therefore, gynecologic oncologists should pay attention to these factors in order to communicate with gynecologic cancer patients about CAM use.
Collapse
|
8
|
Theuser AK, Hack CC, Fasching PA, Antoniadis S, Grasruck K, Wasner S, Knoll S, Sievers H, Beckmann MW, Thiel FC. Patterns and Trends of Herbal Medicine Use among Patients with Gynecologic Cancer. Geburtshilfe Frauenheilkd 2021; 81:699-707. [PMID: 34168382 PMCID: PMC8216777 DOI: 10.1055/a-1487-6284] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/20/2021] [Indexed: 11/03/2022] Open
Abstract
Background More and more information about complementary and integrative medicine is becoming available, especially among cancer patients. However, little is known about the use of herbal medicine by patients with gynecologic cancers. This study aimed to assess the use of herbal products by gynecologic cancer patients compared with healthy controls. Methods This cross-sectional study was conducted at the Department for Gynecology and Obstetrics of Erlangen University Hospital and included 201 patients with gynecologic cancer and 212 healthy controls. Use of herbal medicines was evaluated using a standardized questionnaire. Medical information on cancer patients was collected from hospital records. Group comparisons were done using a logistic regression model. Risk ratios were assessed using a Poisson regression model. Results Gynecologic cancer patients used herbal medicine significantly less often than healthy persons. 69% of gynecologic cancer patients and 81% of healthy participants reported using herbal products. 40% of cancer patients and 56% of healthy persons reported using plants for medicinal purposes. Motives of cancer patients for using herbal medicine included treatment of cancer-related symptoms. The major source of information for both groups was family and friends. Conclusions Although herbal medicine was used less by patients with gynecologic cancer, herbal products were used by both cancer patients and healthy individuals. To provide cancer patients with optimal therapy, oncologists should be informed about the herbal products used by their patients as this will allow them to take their patients' self-medication with herbal medicine into account. Counseling by oncologists on the use of herbal medicine should be encouraged.
Collapse
Affiliation(s)
| | - Carolin C Hack
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen - European Metropolitan Area Nuremberg (CCC ER-EMN), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen - European Metropolitan Area Nuremberg (CCC ER-EMN), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sophia Antoniadis
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen - European Metropolitan Area Nuremberg (CCC ER-EMN), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Katharina Grasruck
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen - European Metropolitan Area Nuremberg (CCC ER-EMN), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sonja Wasner
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen - European Metropolitan Area Nuremberg (CCC ER-EMN), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stefanie Knoll
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen - European Metropolitan Area Nuremberg (CCC ER-EMN), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen - European Metropolitan Area Nuremberg (CCC ER-EMN), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Falk C Thiel
- Department of Gynecology and Obstetrics, Alb Fils Kliniken, Klinik am Eichert, Göppingen, Germany
| |
Collapse
|
9
|
Jazieh AR, Abuelgasim KA, Ardah HI, Alkaiyat M, Da'ar OB. The trends of complementary alternative medicine use among cancer patients. BMC Complement Med Ther 2021; 21:167. [PMID: 34103037 PMCID: PMC8188662 DOI: 10.1186/s12906-021-03338-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of complementary and alternative medicine (CAM) is common among cancer patients and it may reflect the individual and societal beliefs on cancer therapy. Our study aimed to evaluate the trends of CAM use among patients with cancer between 2006 and 2018. METHODS We included 2 Cohorts of patients with cancer who were recruited for Cohort 1 between 2006 and 2008 and for Cohort 2 between 2016 and 2018. The study is a cross-sectional study obtaining demographic and clinical information and inquiring about the types of CAM used, the reasons to use them and the perceived benefits. We compared the changes in the patterns of CAM use and other variables between the two cohorts. RESULTS A total of 1416 patients were included in the study, with 464 patients in Cohort 1 and 952 patients in Cohort 2. Patients in Cohort 2 used less CAM (78.9%) than Cohort 1 (96.8%). Cohort 1 was more likely to use CAM to treat cancer compared to Cohort 2 (84.4% vs. 73%, respectively, p < 0.0001,); while Cohort 2 used CAM for symptom management such as pain control and improving appetite among others. Disclosure of CAM use did not change significantly over time and remains low (31.6% in Cohort 1 and 35.7% for Cohort 2). However, physicians were more likely to express an opposing opinion against CAM use in Cohort 2 compared to Cohort 1 (48.7% vs. 19.1%, p < 0.001, respectively). CONCLUSION There is a significant change in CAM use among cancer patients over the decade, which reflects major societal and cultural changes in this population. Further studies and interventions are needed to improve the disclosure to physicians and to improve other aspects of care to these patients.
Collapse
Affiliation(s)
- Abdul Rahman Jazieh
- Department of Oncology, Ministry of National Guard Health Affairs, King Abdulaziz Medical City, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. .,Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. .,King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.
| | - Khadega A Abuelgasim
- Department of Oncology, Ministry of National Guard Health Affairs, King Abdulaziz Medical City, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.,Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia
| | - Husam I Ardah
- Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.,Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Mohammad Alkaiyat
- Department of Oncology, Ministry of National Guard Health Affairs, King Abdulaziz Medical City, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.,Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia
| | - Omar B Da'ar
- Department of Health Systems, College of Public Health, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Goetz K, Kalder M, Albert US, Jacke CO. The usage of over-the-counter products by private insured patients in Germany - a claims data analysis with focus on complementary medicine. BMC Health Serv Res 2020; 20:651. [PMID: 32660646 PMCID: PMC7359243 DOI: 10.1186/s12913-020-05501-1] [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] [Received: 01/18/2020] [Accepted: 07/02/2020] [Indexed: 12/12/2022] Open
Abstract
Background An important contribution to well-being of human beings can be observed by the use of self-medication products that is reflected in the constantly growing volume of over-the-counter (OTC) drugs. The aim of the current study was to extend the measurement concept for OTCs by exploring the relevance of the peripheral assortment provided by the widely accepted framework of the Anatomical Therapeutical and Chemical (ATC) classification of the WHO. Methods The focus was on the prescriptions and drug-related receipts submitted by privately insured persons to 18 private health insurers (PHIs) in Germany from the year 2016. The age- and gender-specific average claims amount per risks of outpatient drug expenditure were used as weights to scale up the relative distributions of the item amounts. The ATC-classification defines the commodity groups and discriminates between the main and the peripheral assortment. A descriptive analysis assessed the OTC frequencies and sum scores of the product groups within the main and peripheral assortment whereby the study group explored and assessed the relevance of each category independently according to the OTCs and integrative medicines. Results The analysis included 22.1 Mio. packages from the main assortment and examined 10.1 Mio. packages from the peripheral assortment. The latter was examined thoroughly and the commodity groups “Pharmaceutical food products”, “Medicinal products for special therapy options” and particular “Hygiene and body care products” meet the defined requirements for OTCs relevant for integrative medicines. A high proportion of OTC products from the peripheral assortment was associated with the categories “medicinal products for special therapy options”. Homeopathy and anthroposophy present two special therapy options, which are relevant for the extended OTC measurement. Conclusions The analysis of OTC drugs is feasible when the main and the peripheral assortment is available and enable to integrate about 18% of all OTCs, which are neglected by the common ATC-based approach. The presented extended approach may help to identify potential users of OTCs or people in need of OTC use. In case of the highly disputed homeopathy and anthroposophy products, more research among interactions with prescriptions drugs (Rx), nutrition’s and other potentially harmful exposures is recommended.
Collapse
Affiliation(s)
- Katja Goetz
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 16, Building 50, 23538, Lübeck, Germany.
| | - Matthias Kalder
- Department of Gynecology and Obstetrics, Philipps University of Marburg, Baldingerstr., 35043, Marburg, Germany
| | - Ute-Susann Albert
- Department for Obstetrics and Gynecology, University Hospital Würzburg, Josef-Schneider-Straße 4, 97080, Würzburg, Germany
| | - Christian O Jacke
- Scientific Institute of Private Health Insurance (WIP), Gustav-Heinemann-Ufer 74c, 50968, Köln, Germany
| |
Collapse
|
12
|
Renet S, de Chevigny A, Hoacoglu S, Belkarfa AL, Jardin-Szucs M, Bezie Y, Jouveshomme S. Risk evaluation of the use of complementary and alternative medicines in cancer. ANNALES PHARMACEUTIQUES FRANÇAISES 2020; 79:44-52. [PMID: 32485144 DOI: 10.1016/j.pharma.2020.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/06/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Cancer patients use complementary and alternative medicines (CAM) to improve their well-being. Little is known about real risks. OBJECTIVE To highlight 3 different types of axes: 1/cancer patients' perceptions concerning CAM; 2/misinformation/miscommunication about CAM; 3/CAM toxicity (direct toxicity, CAM-anticancer drugs, CAM-cancer interactions). METHOD A questionnaire was proposed to cancer patients for 2 months. The CAM toxicity was analyzed if patients documented their drugs and CAM. RESULTS Eighty-five patients responded: 72/85 were taking≥1CAM. In total, 95% patients were satisfied. There was an increasing CAM intake after cancer diagnosis. One hundred and seventeen different CAM were identified (63 herbs, 24 essential oils, 28 food supplements, 2 homeopathic specialities). Only 30/85 were aware CAM could interact with anticancer drugs. No other type of risk was perceived. INFORMATION SOURCES 43/85 Internet, 38/85 general practitioner, 38/85 community pharmacist, 32/85 entourage, 25/85 other patients, 22/85 oncologist. In total, 81.3% questioned healthcare professionals (HCP) about CAM. Twelve patients noticed HCP lacked knowledge regarding CAM. The toxicity analysis was carried out for 24 patients who consumed 1 to 24CAM. In total, 133CAM were reported, including 87 different CAM. For only 43CAM/87, studies were found. All patients presented≥1risk: 14 at risk of CAM-cancer interactions, 15 of CAM-anticancer drug interactions, 21 of CAM direct toxicities. CONCLUSION Many CAM are used by patients. The diagnosis of cancer favors their use. The risks are manifold: low perception of risk that can be induced by CAM, diverse and insecure sources of information and many potential toxicities that are not scientifically documented.
Collapse
Affiliation(s)
- S Renet
- Pharmacy department, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France; Education and Training Research Center (ED 139 - EA 1589), University of Paris Nanterre, Nanterre, France; Faculty of Pharmacy, Paris-Sud University, 5, rue Jean-Baptiste-Clément, 92290 Châtenay-Malabry, France.
| | - A de Chevigny
- Pharmacy department, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - S Hoacoglu
- Pharmacy department, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - A-L Belkarfa
- Pharmacy department, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - M Jardin-Szucs
- Pharmacy department, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - Y Bezie
- Pharmacy department, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - S Jouveshomme
- Pneumology and Thoracic department, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
| |
Collapse
|
13
|
Knecht K, Kinder D, Stockert A. Biologically-Based Complementary and Alternative Medicine (CAM) Use in Cancer Patients: The Good, the Bad, the Misunderstood. Front Nutr 2020; 6:196. [PMID: 32039227 PMCID: PMC6992534 DOI: 10.3389/fnut.2019.00196] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/20/2019] [Indexed: 12/12/2022] Open
Abstract
As complementary and alternative medicine (CAM) becomes more popular, it is being used in cancer patients to aid in recovery or to treat symptoms associated with the current chemotherapy. Numerous papers exist that discuss patients using CAM with cancer chemotherapy and their outcomes-both positive and negative. However, in the case of the negative outcomes, the reason for the dangers or interactions with drugs are not made clear. Indeed, many chemotherapy regimens are rendered less effective by the well-meaning but uninformed patient or their family members and friends. Similarly, reports of positive outcomes with CAM and chemotherapy provide a strong basis for further research, but do not identify specific mechanisms of action. These small clinical studies and in vitro studies identify a necessary area for further research and provide a much needed, although often rejected, alternative look at whole treatment plans. Careful review of the available information and evaluation of the nature of the CAM effects are necessary to combat the misunderstanding and sometimes unwarranted claims over CAM use. This mini review will explore some of the commonly used CAM agents and their mechanisms of interactions with other treatments. Suggestions as to which agents can be safe and when to use them will be an integral part of this review.
Collapse
Affiliation(s)
- Kathryn Knecht
- Loma Linda University School of Pharmacy, Loma Linda University, Loma Linda, CA, United States
| | - David Kinder
- Department of Pharmaceutical and Biomedical Sciences, Raabe College of Pharmacy, Ohio Northern University, Ada, OH, United States
| | - Amy Stockert
- Department of Pharmaceutical and Biomedical Sciences, Raabe College of Pharmacy, Ohio Northern University, Ada, OH, United States
| |
Collapse
|