An Overview of Systematic Reviews: Complementary Therapies for Cancer Patients

Experiences and Comfort of Young Cancer Patients Discussing Cannabis with Their Providers: Insights from a Survey at an NCI-Designated Cancer Center

Cannabis use among cancer patients for managing treatment-related symptoms is increasing, yet little is known about patterns in patient-provider communication. This study examines demographic differences in cannabis use communication at a National Cancer Institute-designated cancer center. The analysis included cancer patients aged ≥ 18 years who self-reported current cannabis use (past 30 days) and had visited Sylvester Comprehensive Cancer Center within the past 5 years (N = 226). Data were collected via an anonymous electronic survey on REDCap. Responses on patients' disclosure of cannabis use to cancer doctor/care team and their comfort in discussing cannabis were analyzed. Chi-squared/Fisher's exact tests and t-tests were applied. Logistic regression estimated the associations between age and stage of cancer treatment with patients' comfort in discussing cannabis use with cancer doctor (oncologist). The sample was 51.8% male and 39.4% Hispanic (mean age, 45.9 years (SD = 15.1)); 41.1% were aged 20-39 years, 43.8% were undergoing treatment, and 35.4% were in follow-up/had finished treatment. Over half (50.4%) did not disclose cannabis use to their cancer doctor/care team. Non-disclosers were more often younger (20-39 years) than disclosers (52.6% vs. 29.5%, p < 0.01). Most patients (72.5%) felt comfortable discussing cannabis use with their oncologist; however, younger patients (20-39 years) were more often uncomfortable (40.8%). Logistic regression showed newly diagnosed patients had lower odds (aOR, 0.41; 95% CI, 0.12-0.98) of comfort discussing cannabis compared to those in follow-up/finished treatment. Younger patients (20-39 years) also had lower odds (aOR, 0.11; 95% CI, 0.03-0.40) of feeling comfortable discussing cannabis compared to older patients (≥ 60 years). Age and treatment stage significantly impact the cannabis use disclosure and comfort in discussing it with cancer doctor/care team. These findings underscore the importance of considering age-related factors and treatment status when addressing cannabis use discussions within oncology setting.

The Effectiveness of Mind-Body Exercise on Health-Related Quality of Life and Mental Health During and After Breast Cancer Treatment: An Umbrella Review of Meta-Analyses for Randomized Controlled Trials

BACKGROUND

Previous studies regarding mind-body exercise among people with breast cancer mostly focused on one type of mind-body exercise and provided conflicting results.

AIMS

This paper aims to systematically synthesize the evidence hierarchy and examine the credibility of previous meta-analyses of different types of mind-body exercises.

METHODS

We searched PubMed, Embase, Cochrane Library, Web of Science, and Epitemonikos from database inception to February 2nd, 2024, for meta-analyses of randomized controlled trials. Included meta-analyses examined the effects of mind-body exercises on at least one outcome of health-related quality of life, cancer-related fatigue, depression, anxiety, and sleep quality in breast cancer patients. The random effects estimates (Hedges'G), 95% prediction interval, small study effect, and excess significance bias were calculated. Furthermore, we categorized meta-analyses based on the evidence credibility criteria and assessed quality using A Measurement Tool to Assess Systematic Reviews 2.

RESULTS

The umbrella review included a re-analysis of 16 meta-analyses of 9 articles including 134 randomized controlled trials involving 9469 breast cancer patients and survivors. We identified 3 articles as "low" quality and 6 articles as "critically low" quality. Convincing evidence supported the effectiveness of Yoga intervention in reducing depression symptoms (G = -0.77, 95% Confidence Interval [-0.93, -0.61]). However, 11 meta-analyses were supported by weak evidence (1 for Qigong alleviated depression, 4 for Qigong, Baduanjin, Tai Chi Chuan, and Yoga improved health-related quality of life, 3 for multiple mind-body exercises, Tai Chi Chuan, and Yoga reduced cancer-related fatigue, 2 of Baduanjin and Yoga reduced anxiety, as well as 1 of Yoga improved sleep quality).

LINKING EVIDENCE TO ACTION

Mind-body exercises, especially yoga, may be beneficial for improving health-related quality of life and mental health for breast cancer patients. Further high-quality interventions investigating diverse mind-body exercise interventions are warranted to ascertain the effectiveness of health-related quality of life and mental health outcomes.

Exploring the Landscape of Integrative Medicine in Pediatric Oncology: Characterization of an Outpatient Consultative Service

Background/Objectives: Symptoms from cancer and treatments often cause pediatric patients and their families to seek complementary and integrative medicine (IM) for relief. The aim of this study was to better describe the characteristics of pediatric patients at a tertiary cancer center who utilize an IM consultative service in the outpatient setting and the associated discussions with a pediatric-focused IM physician. Methods: A retrospective study was conducted on initial IM visits for patients aged less than 19 years old at the time of the visit from January 2019 through April 2022 at a tertiary cancer center. Patient demographics, clinical characteristics, and visit information were abstracted from electronic medical records, and discussions with the provider (presenting symptoms and recommendations) were described. Results: In total, 207 patients and their associated visit discussions met the criteria. About half (47%, n = 97) of the patients were female with a mean patient age of 10 years old (median age 11 years, range 0 to 18 years). The overall most common presenting symptoms were nausea (35%, n = 72), pain (30%, n = 62), and poor appetite (26%, n = 53) with variations between age groups. The most discussed topics were supplements (94%), diet (91%), stress management (82%), IM therapies (60%), and medical cannabis (54%). Conclusions: Priority symptoms reported by patients and referred to the IM outpatient consultative service included nausea, pain, and poor appetite. Concerns were addressed during tailored discussions with patients and their families. Having an outpatient consultative IM service may benefit providers, patients, and families to facilitate receiving evidence-informed recommendations in a dedicated, consolidated setting.

Yoga for Cancer Survivors (YOCAS): A Systematic Review of the YOCAS Program's Impact on Physical and Psychological Well-Being

Cancer survivors frequently experience prolonged physical and psychological symptoms including cancer-related fatigue (CRF), sleep disturbances, cognitive impairment, and musculoskeletal pain. Conventional treatments for these symptoms have demonstrated limited efficacy, emphasising the need for complementary therapies. The Yoga for Cancer Survivors (YOCAS) program is a structured mind-body intervention designed to address these challenges. This systematic review evaluated the efficacy of YOCAS in managing CRF, sleep quality, cognitive function, and musculoskeletal symptoms in cancer survivors using randomised controlled trials (RCTs). A comprehensive search was conducted across the Google Scholar, Scopus, Cochrane Library, and PubMed databases for RCTs published between January 2000 and September 2024. Eligible studies included adult cancer survivors who had completed primary treatment and compared YOCAS interventions to control groups. The primary outcomes were cancer-related fatigue, sleep quality, cognitive function, and musculoskeletal symptoms. The risk of bias was evaluated using the Cochrane Risk of Bias Tool, and the findings were synthesised. Six RCTs, involving 1,717 participants, met the inclusion criteria. The YOCAS program demonstrated significant improvements in the reduction of cancer-related fatigue and sleep quality. Cognitive function and memory were improved, particularly among breast cancer survivors, with reduced musculoskeletal pain reported in participants undergoing hormonal therapy. Despite variations in study design, the risk of bias was generally low. ​​​​​​​The YOCAS program effectively reduced cancer-related fatigue, improved sleep quality, and addressed the cognitive and musculoskeletal symptoms in cancer survivors. Given its low risk and broad applicability, YOCAS shows promise as a complementary therapy for cancer survivorship care. Future research should focus on the long-term sustainability of these benefits and explore the impact of the program across diverse cancer populations.

Combination of Brucea javanica oil emulsion and Aidi injection associated with the long‑term survival of a patient with colon cancer and lung metastases post‑chemotherapy: A case report

Colorectal cancer (CRC) ranks as the third most frequently diagnosed cancer and the fourth leading cause of cancer-related mortality worldwide. Treatment options for patients with advanced CRC recurrence and metastases remain limited, particularly for those unable to withstand chemotherapy. Bruscea javanica oil emulsion (BJOE) and Aidi injection (ADI) are two plant-derived products that have antitumor effects. The current report presents the case of a patient with colon cancer and resectable lung metastases. Despite the surgical removal of the metastatic lesions, tumor recurrence was not prevented. The patient underwent three chemotherapy regimens following lung metastasis surgery, namely XELOX, single-agent irinotecan and single-agent tegafur-gimeracil-oteracil potassium capsule, but experienced intolerable adverse reactions with each, and disease progression was observed during subsequent follow-up. Nonetheless, the patient achieved a progression-free survival of >5 years under BJOE + ADI treatment and continues to receive BJOE + ADI treatment to date. Although further research is required to understand the effectiveness of this treatment combination, the present case may instill hope in the treatment of future patients.

Effect of alternative and complementary medicine on male infertility: An umbrella review

Background and Aims

There is increasing interest worldwide in using alternative and complementary approaches for treating male infertility. This interest has spawned a multitude of published systematic reviews and meta-analyses. The aim of this Umbrella review was to consolidate the available evidence regarding the effect of complementary and alternative medicine on male infertility to inform clinical decision-making processes.

Methods

A comprehensive search was conducted to identify systematic reviews and meta-analyses pertaining to the effects of complementary and alternative medicine on male infertility. This search encompassed various databases including MEDLINE, CINAHL, PubMed, Scopus, Proquest, Google Scholar, SID, EMBASE, Magiran, Cochrane Library, Iranmedex, ScienceDirect, SAGE. Subsequently, two researchers independently extracted the data from the selected meta-analyses and systematic reviews, and evaluated their methodological quality using the assessment of multiple systematic reviews 2 (AMSTAR2).

Results

This analysis encompassed 11 studies, with four originating from Iran, two from Korea and five from China. The results regarding the effectiveness of complementary and alternative medicine are controversial, indicating a need for further research. The methodological quality of the systematic reviews and meta-analyses appraised by AMSTAR 2 was rated as low or critically low. This assessment is attributed to inadequate examination of publication biases in the reviews and a lack of discussion regarding the effect of risk of bias.

Conclusion

The existing evidence regarding the effectiveness of alternative and complementary medicine in addressing male infertility is limited. Furthermore, the overall methodological quality of the published systematic reviews and meta-analyses may have been underestimated as the use of AMSTAR2 appears to be a more precise appraisal instrument compared to its predecessor.

Understanding Placebo and Nocebo Responses Based on a Randomized Sham-Controlled Study on Acupuncture in Integrative Cancer Care

Objective: Since placebo and nocebo-responses during acupuncture therapy are rarely studied in clinical contexts, the objective was to investigate placebo and nocebo-responses in a clinical context through comparing positive and negative side-effects between genuine and sham acupuncture, and to identify factors modifying placebo and nocebo-responses. Methods: Patients reported positive side-effects (non-intended positive effects) or negative side-effects (non-intended negative effects) of genuine (penetrating; n = 109) or sham (telescopic non-penetrating; n = 106) acupuncture during 5 weeks of chemoradiation for cancer. Results: The genuine and the sham acupuncture group reported rather similar frequencies of positive (P-values .223-.800) or negative (P-values .072-1.0) side-effects: relaxation 59%/57% of the patients, improved mood 46%/38%, improved sleep 38%/38%, pain-reduction 36%/28%, tiredness 42%/42%, feeling cold 37%/31%, sweating 23%/21%, and dizziness 20%/12%. Positive side-effects occurred in 79% of patients who highly believed acupuncture to be effective, compared to in 0% of patients who did not believe. Other factors associated with placebo-response were female sex (P = .042), anxious mood (P = .007), depressed mood (P = .018), and blinding-success (P = .033). Factors associated with nocebo response were female sex (P = .049), younger age (P = .010), and needle-induced pain (P = .014). Sham-treated patients experiencing positive side-effects experienced better quality of life at the end of the treatment period (mean, m 64 on a scale 0-100 millimetres, Standard Deviation, SD, ±26.1 mm) than those who did not (m 48 ± 25.5 mm), P = .048 (adjusted for other characteristics). Conclusions: Clinically significant levels of placebo and nocebo effects commonly occurred during acupuncture therapy in integrative cancer care and this paper identified factors modifying these responses. This implicates that acupuncture-delivering therapists striving to maximize placebo-responses and minimize nocebo-responses may considering strengthen the patient's treatment expectations, and offer a pleasant, pain-free, acupuncture treatment.

Effect of a Single Live Group Music Therapy Intervention on Anxiety-State and Well-Being Levels During Chemotherapy: A Multicenter Randomized Clinical Trial Protocol

Introduction

Many cancer patients experience high levels of anxiety during chemotherapy, which can negatively impact their mental health and their physiological, emotional, and spiritual well-being. Different complementary therapies aim to attenuate these effects, including music therapy. Although there is preliminary evidence on the positive effects of music therapy and music-based interventions in chemotherapy wards, few studies report live group interventions delivered by accredited music therapists.

Objective

To determine the effect of a single live group music therapy intervention on state anxiety and well-being levels of adult cancer patients during chemotherapy.

Methodology

This study protocol follows the SPIRT guidelines and reports a two-arm multicenter randomized clinical trial (RCT). The intervention group will receive standard care + a live group music therapy session and the control group will receive standard care only. The primary outcome is state anxiety, measured with the six-item State-Trait Anxiety Inventory (STAI-6). The secondary outcome is well-being, measured with the Well-being Numerical Rating Scales (WB-NRSs). The scales will be applied before and after each intervention. Sample size calculation resulted in a total of 102 participants.

Conclusions

This study seeks to contribute to the improvement of psycho-emotional health and well-being of cancer patients during chemotherapy. It is the first multi-center RCT on music therapy with cancer patients in [country, de-identified for peer review] and aims to gather knowledge about music's role to improve patients' mental health during acute treatment.

Trial Registration

clinicaltrials.gov (NCT06577324, submission date August 21st, 2024).

Social representations of cancer in patients from Medellín, Colombia: a qualitative study

Background

Cancer has different explanatory theories that address its etiology and treatment. It is usually associated with pain and suffering. Recently, new technologies, knowledge, and therapies have been developed, which may have transformed the classic social representations of the disease. This study aimed to understand the social representations (SRs) of cancer in patients from Medellín, Colombia.

Methods

This study used a grounded theory in 16 patients with cancer. The information was collected between June 2020 and May 2021. Information was analyzed following the open, axial, and selective coding stages.

Results

SRs of cancer at the time of diagnosis evoke negative connotations. However, cancer is redefined as a positive event as the clinical course of the disease progresses, and patients interact with health professionals and respond to treatment. The resignification of the disease depends on the etiological models of the patients, which include genetic, socio-anthropological, psychosocial, and psychogenic factors. In line with the SRs of etiology, patients seek out treatments complementary to the biomedical ones that can be socio-anthropological and psychogenic.

Conclusion

In this group negative representations about cancer persist, this way of understanding the disease is determined by the convergence of cultural meanings and personal experiences. The causal representation is connected to the actions and willingness of the patients to face their diagnosis. In this sense, two categories stand out: the first expresses that cancer is the consequence of a body subjected to excessive productivity; the second subsumes a psychogenic predisposition caused by the context where the ideology of happiness appears to be a social norm. This double saturation in which an individual is immersed results in new burdens that are not visible to caregivers and healthcare workers.

Anticancer assessment and antibiofilm potential of Laetiporus sulphureus mushroom originated from Serbia

Laetiporus sulphureus (Bull.) Murrill is a well-known edible mushroom consumed in nutrition as delicacy. It has been used in traditional medicine because of its beneficial effects on human wellness, such as antimicrobial, antioxidant, and anticancer potential. The present study determined the phenolic profile of Laetiporus sulphureus ethanolic extract (LSE) by high-performance liquid chromatographic method. Tolerance of two probiotic bacterial strains Lactiplantibacillus plantarum 229v, Bifidobacterium animalis subsp. lactis and probiotic yeast Saccharomyces boulardii on LSE was analyzed in terms of viability and biofilm formation. Effects of extract on colorectal (HCT-116) and cervical (HeLa) cancer cells viability was determined using MTT test in concentration range: 1-500 μg/mL after 24 and 72 h. Redox parameters (superoxide anion radicals, nitrites, and reduced glutathione) were evaluated using NBT, Griess, and GSH assays in the concentration range of 1-500 μg/mL after 24 and 72 h. Antimigratory activity was determined by wound healing method using selected concentrations of 10 and 50 μg/mL after 24 h. Untreated cells were considered as control. As control cell line, we used healthy fibroblasts (MRC-5). Our results demonstrated abundance of LSE in phenolics, with rosmarinic acid as the main component. LSE induced low tolerance of tested planktonic probiotic strains, with no affection on their ability to form biofilm. No significant cytotoxicity on tested cancer cells was observed, with prooxidative and antimigratory effects noticed. Extract exerted significant antimigratory activity on cancer cells without effect on planktonic and probiotic cultures in biofilm. These results indicate potential application of Laetiporus sulphureus ethanolic extract as natural protector of probiotics with prominent ability to suppress cancer cell motility.

The Effects of Complementary Therapies on Patient-Reported Outcomes: An Overview of Recent Systematic Reviews in Oncology

Many patients with cancer make use of complementary medicine alongside conventional medicine, but clinicians in oncology often lack the knowledge to adequately advise patients on the evidence base for complementary therapies. This study aims to provide an overview of recently published systematic reviews that assess the effects of complementary therapies on patient-reported health outcomes in patients with cancer. Systematic reviews, including a meta-analysis of at least two randomized controlled trials, were identified from the PubMed, Embase, Cochrane Library, CINAHL and PsycINFO databases. The methodological quality was assessed with AMSTAR 2. One hundred systematic reviews were included. The results suggest that several complementary therapies can improve health outcomes reported by patients with cancer, such as acupuncture to relieve pain, music interventions to reduce anxiety and yoga to improve cancer-related fatigue. The side effects related to complementary therapy use are generally mild. The results remain inconclusive for some intervention-outcome combinations. Many of the included systematic reviews insufficiently assessed the causes and impact of bias in their interpretation of the results. This overview of systematic reviews can support clinicians in counselling their patients on this topic and provide directions for future research and clinical practice guidelines in the field of complementary medicine.

Effectiveness of immersive virtual reality on anxiety, fatigue and pain in patients with cancer undergoing chemotherapy: A systematic review and meta-analysis

PURPOSE

This Systematic review and meta-analysis aimed to assess the effectiveness of Virtual Reality on anxiety, fatigue and pain in patients with cancer during chemotherapy and provide evidence for decision-making in clinical practice.

METHODS

A systematic literature search was performed in the databases PubMed, Web of Science, Scopus, Cumulative Index of Nursing and Allied Health Literature and the Cochrane Library. Risk of Bias was used to assess the quality of individual studies, and Grading of Recommendations Assessment, Development and Evaluation was used to assess confidence for each individual outcome. A random-effects model was used to examine the overall effect.

RESULTS

Four randomized controlled trials and four crossover studies were included, with an overall sample of 459 patients. Results showed that Virtual Reality compared with standard care had a significant reduction of anxiety only (MD = -6.57, 95% CI: -11.59 to -1.54, p = 0.01) but with considerable heterogeneity (I² = 92%), while Virtual Reality was not significantly different from integrative interventions. The trials included showed small sample sizes, lack of statistical power, low methodological quality, high heterogeneity, and different Virtual Reality technology types, lengths and frequencies.

CONCLUSION

The quality of evidence is very low and the strength of recommendation is weak. Further research has large potential for reducing uncertainty about the effects of Virtual Reality in patients with cancer receiving chemotherapy. This study was registered with PROSPERO as CRD42020223375.

A Systematic Review of Systematic Reviews and a Pooled Meta-Analysis on Complementary and Integrative Medicine for Improving Cancer-Related Fatigue

PURPOSE

Evidence supporting complementary and integrative medicine (CIM) for improving cancer-related fatigue (CRF) is still fragmented. This study therefore critically appraised all the systematic reviews (SRs) regarding the effectiveness of CIM in mitigating CRF in adults.

METHODS

A systematic review of SRs and a meta-analysis were conducted in 4 databases. The effect sizes of the included SRs were quantitatively pooled (standardized mean difference [SMD]; 95% CI) using a random-effects model. Heterogeneity was tested by using χ² (Q) tests and I² statistics.

FINDINGS

Twenty-two SRs met the inclusion criteria, and results from 20 SRs underwent meta-analysis. The pooled significant estimate of fatigue reduction was as follows: SMD, -0.50; 95% CI, -0.67 to -0.32; P < 0.001. The subgroup analysis based on the type of CIM intervention revealed that the approach showing higher effects in reducing fatigue thus far is acupuncture: SMD, -0.99; 95% CI = -1.37 to -0.62, P < 0.001; I² = 84%. CIM therapies showed a significant reduction of fatigue in patients with breast cancer: SMD, -0.46; 95% CI, -0.69 to -0.23; P < 0.001; I² = 82%.

IMPLICATIONS

CIM interventions showed effectiveness in reducing CRF. Subgroup analysis suggested some potential influencing, such as tumor type and specific CIM therapy factors, that require in-depth assessment in future research. Study protocol registration: PROSPERO CRD42020194254.

Effectiveness of Acupuncture, Mind and Body Practices, and Natural Products for Insomnia: an overview of systematic reviews

Objectives

This overview summarizes the evidence for the effectiveness and safety of complementary therapies for insomnia through systematic reviews (SRs) and meta-analyses (MAs).

Methods

A comprehensive literature search on SRs and MAs for complementary therapies for insomnia was conducted using six databases.

Results

This overview included 30 SRs/MAs. The Pittsburgh Sleep Quality Index (PSQI) analysis of insomnia included 383 randomized controlled trials and 31,748 participants. Twenty-four SRs/MAs (80%) out of 30 SRs/MAs reported a positive result, and six SRs/MAs reported a partially positive result. The most frequently used form of acupuncture reported a positive effect in 89.5% (17/19) of SRs/MAs and a superior effect to western medicine, sham/placebo, and no treatment. The lack of protocol registration and the excluded studies list resulted in generally poor methodological and reporting quality in SRs/MAs with AMSTAR 2.

Conclusion

This overview confirmed that complementary therapies positively affected the PSQI scores in patients with insomnia. However, better-designed primary studies are needed to strengthen the relevant evidence in the future. A more stringent assessment of multiple systematic reviews 2 must be followed when performing SR and MA.

The effect of cancer on traditional, complementary and alternative medicine utilization in Korea: a fixed effect analysis using Korea Health Panel data

BACKGROUND

Cancer-related incidence and mortality rates are rapidly increasing worldwide. However, no studies have examined the effect of cancer as a single factor on the use of traditional, complementary, and alternative medicine (T&CAM). We aimed to determine the effect of cancer occurrence on T&CAM utilization using Korea Health Panel (KHP) data.

METHODS

We analyzed longitudinal data (49,380 observations) derived from 12,975 Korean adult participants with complete KHP data from 2011 to 2014 and 2016, and divided them into two groups based on cancer diagnosis. A panel multinomial logit model was used to assess whether the participants used T&CAM or conventional medicine or both in outpatient settings. Additionally, a negative binomial regression model was used to examine the effect of cancer on the number of outpatient visits for T&CAM.

RESULTS

In total, 25.54% of the study participants in the cancer group used T&CAM, which was higher than that in the non-cancer group (18.37%, p < 0.0001). A panel multinomial logistic regression analysis using KHP data showed that cancer occurrence was significantly more likely to be associated with 'Using both Korean medicine and conventional medicine' (Coef. = 0.80, p = 0.017) and 'Not using Korean medicine but using conventional medicine' (Coef. = 0.85, p = 0.008) than 'Not using Korean medicine and conventional medicine.' A panel negative binomial regression showed a significant effect of cancer on increasing the number of T&CAM outpatient visits (Coef. = 0.11, p = 0.040).

CONCLUSIONS

Our findings showed that cancer occurrence within an individual led to the simultaneous use of conventional medicine and T&CAM. In addition, the occurrence of cancer significantly increased the number of T&CAM outpatient visits among participants already using T&CAM. It was also found that T&CAM has been utilized more often by the most vulnerable people, such as medical beneficiaries and those with a low level of education.

Methodological quality of systematic reviews on Chinese herbal medicine: a methodological survey

BACKGROUND

Systematic reviews (SRs) synthesise the best evidence of effectiveness and safety on Chinese herbal medicine (CHM). Decision-making should be supported by the high-quality evidence of prudently conducted SRs, but the trustworthiness of conclusions may be limited by poor methodological rigour.

METHODS

This survey aimed to examine the methodological quality of a representative sample of SRs on CHM published during January 2018 to March 2020. We conducted literature search in Cochrane Database of Systematic Reviews, MEDLINE via Ovid, and EMBASE via Ovid. Eligible SRs must be in Chinese or English with at least one meta-analysis on the treatment effect of any CHM documented in the 2015 Chinese Pharmacopoeia. Two reviewers extracted the bibliographical characteristics of SRs and appraised their methodological quality using AMSTAR 2 (Assessing the Methodological Quality of Systematic Reviews 2). The associations between bibliographical characteristics and methodological quality were investigated using Kruskal-Wallis tests and Spearman's rank correlation coefficients.

RESULTS

We sampled and appraised one hundred forty-eight SRs. Overall, one (0.7%) was of high methodological quality; zero (0%), four (2.7%), and one-hundred forty-three (96.6%) SRs were of moderate, low, and critically-low quality. Only thirteen SRs (8.8%) provided a pre-defined protocol; none (0%) provided justifications for including particular primary study designs; six (4.1%) conducted a comprehensive literature search; two (1.4%) provided a list of excluded studies; nine (6.1%) undertook meta-analysis with appropriate methods; and seven (4.7%) reported funding sources of included primary studies. Cochrane reviews had higher overall quality than non-Cochrane reviews (P < 0.001). SRs with European funding support were less likely to have critically-low quality when compared with their counterparts (P = 0.020). SRs conducted by more authors (rs = 0.23; P = 0.006) and published in higher impact factor journals (rs = 0.20; P = 0.044) were associated with higher methodological quality.

CONCLUSIONS

Our results indicated that the methodological quality of SRs on CHM is low. Future authors should enhance the methodological quality through registering a priori protocols, justifying selection of study designs, conducting comprehensive literature search, providing a list of excluded studies with rationales, using appropriate method for meta-analyses, and reporting funding sources among primary studies.

East Asian Herbal Medicine to Reduce Primary Pain and Adverse Events in Cancer Patients : A Systematic Review and Meta-Analysis With Association Rule Mining to Identify Core Herb Combination

Objective: Cancer pain is an important factor in cancer management that affects a patient’s quality of life and survival-related outcomes. The aim of this review was to systematically evaluate the efficacy and safety of oral administration of East Asian herbal medicine (EAHM) for primary cancer pain and to explore core herb patterns based on the collected data.

Methods: A comprehensive literature search was conducted in 11 electronic databases, namely, PubMed, Cochrane Library, Cumulative Index to Nursing & Allied Health Literature, EMBASE, Korean Studies Information Service System, Research Information Service System, Oriental Medicine Advanced Searching Integrated System, Korea Citation Index, Chinese National Knowledge Infrastructure Database (CNKI), Wanfang Data, and CiNii for randomized controlled trials from their inception until August 19, 2021. Statistical analysis was performed in R version 4.1.1 and R studio program using the default settings of the meta-package. When heterogeneity in studies was detected, the cause was identified through meta-regression and subgroup analysis. Methodological quality was independently assessed using the revised tool for risk of bias in randomized trials (Rob 2.0).

Results: A total of 38 trials with 3,434 cancer pain patients met the selection criteria. Meta-analysis favored EAHM-combined conventional medicine on response rate (risk ratio: 1.06; 95% CI: 1.04 to 1.09, p < 0.0001), continuous pain intensity (standardized mean difference: −1.74; 95% CI: −2.17 to −1.30, p < 0.0001), duration of pain relief (standardized mean difference: 0.96, 95% CI: 0.69 to 1.22, p < 0.0001), performance status (weighted mean difference: 10.71; 95% CI: 4.89 to 16.53, p = 0.0003), and opioid usage (weighted mean difference: −20.66 mg/day; 95% CI: −30.22 to −11.10, p < 0.0001). No significant difference was observed between EAHM and conventional medicine on response rate and other outcomes. Patients treated with EAHM had significantly reduced adverse event (AE) incidence rates. In addition, based on the ingredients of herb data in this meta-analysis, four combinations of herb pairs, which were frequently used together for cancer pain, were derived.

Conclusion: EAHM monotherapy can decrease adverse events associated with pain management in cancer patients. Additionally, EAHM-combined conventional medicine therapy may be beneficial for patients with cancer pain in increasing the response rate, relieving pain intensity, improving pain-related performance status, and regulating opioid usage. However, the efficacy and safety of EAHM monotherapy are difficult to conclude due to the lack of methodological quality and quantity of studies. More well-designed, multicenter, double-blind, and placebo-controlled randomized clinical trials are needed in the future. In terms of the core herb combination patterns derived from the present review, four combinations of herb pairs might be promising for cancer pain because they have been often distinctly used for cancer patients in East Asia. Thus, they are considered to be worth a follow-up study to elucidate their actions and effects.

Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier CRD42021265804

"Is the Pain a Sign of Healing?": Cancer Patients' Experiences of Energy Healing in a Pragmatic Trial

The use of complementary and alternative medicine has increased, most markedly among cancer patients. Previous research on energy healing is inconclusive, but qualitative studies have mainly reported positive healing experiences, whereas positive results from trials are scarce. Considering the apparent discrepancy between qualitative and quantitative studies, we aimed to describe the interpretation processes of the patients receiving energy healing. We followed the interpretation processes of a subsection of cancer patients who participated in a pragmatic trial on energy healing, including patients in the control groups. No significant differences between the groups were found in the quantitative part of the trial, but the majority of patients in both the intervention and control groups reported subjective improvements. A subset of 32 patients from the trial was selected for this qualitative sub-study to gain insight into their interpretation processes. These 32 patients recruited from the trial were followed with qualitative interviews before, during, and after the treatment period, using a cultural-phenomenological approach. Most patients who received energy healing changed their perception of bodily experiences, and they perceived a wider variety of signs as indicative of healing than the patients in the control groups. After receiving energy healing, the patients also perceived signs that from a medical perspective are regarded as symptoms, as signs of healing. The changes in perception of illness and healing affected decision-making dynamics and should be considered when producing information and communication strategies for health promotion.

East Asian herbal medicine for cancer pain: A protocol for systematic review and meta-analysis with using association rule analysis to identify core herb pattern

BACKGROUND

Cancer pain is an important factor in cancer management that affects a patient's quality of life and survival-related outcomes. The aim of this review is to systematically evaluate the efficacy and safety of oral administration East Asian herbal medicine (EAHM) for primary cancer pain, and to explore core herb patterns based on collected data.

METHODS

A comprehensive literature search will be conducted in 10 electronic databases including PubMed, Cochrane Library, Cumulative Index to Nursing & Allied Health Literature, EMBASE, Korean Studies Information Service System, Research Information Service System Oriental Medicine Advanced Searching Integrated System, Korea Citation Index, Chinese National Knowledge Infrastructure Database (CNKI), CiNii for randomized controlled trials from their inception until August 19, 2021. Statistical analysis will be performed in the software R version 4.1.1. and R studio program using the default settings of the 'meta' package. When heterogeneity in studies is detected, the cause will be identified through meta regression and subgroup analysis. Methodological quality will be assessed independently using the revised tool for risk of bias in randomized trials (Rob 2.0).

RESULTS

This study will provide more comprehensive and specific evidence of EAHM for cancer pain management.

CONCLUSIONS

Based on the results of this review, it is expected that the efficacy and safety of East Asian herbal medicine for cancer pain may be confirmed. In addition, it will be possible to derivation of a core herb pattern related to this research topic through additional association rule mining analysis.

Self-Efficacy of Older People Using Technology to Self-Manage COPD, Hypertension, Heart Failure, or Dementia at Home: An Overview of Systematic Reviews

BACKGROUND AND OBJECTIVES

Although telehealth research among the general population is voluminous, the quality of studies is low and results are mixed. Little is known specifically concerning older people and their self-efficacy to engage with and benefit from such technologies. This article reviews the evidence for which self-care telehealth technology supports the self-efficacy of older people with long-term conditions (LTCs) living at home.

RESEARCH DESIGN AND METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA) guidelines, this overview of systematic reviews focused on four LTCs and the concept of "self-efficacy." Quality was appraised using R-AMSTAR and study evaluation was guided by the PRISMS taxonomy for reporting of self-management support. Heterogeneous data evidencing technology-enhanced self-efficacy were narratively synthesized.

RESULTS

Five included articles contained 74 primary studies involving 9,004 participants with chronic obstructive pulmonary disease, hypertension, heart failure, or dementia. Evidence for self-care telehealth technology supporting the self-efficacy of older people with LTCs living at home was limited. Self-efficacy was rarely an outcome, also attrition and dropout rates and mediators of support or education. The pathway from telehealth to self-efficacy depended on telehealth modes and techniques promoting healthy lifestyles. Increased self-care and self-monitoring empowered self-efficacy, patient activation, or mastery.

DISCUSSION AND IMPLICATIONS

Future research needs to focus on the process by which the intervention works and the effects of mediating variables and mechanisms through which self-management is achieved. Self-efficacy, patient activation, and motivation are critical components to telehealth's adoption by the patient and hence to the success of self-care in self-management of LTCs. Their invisibility as outcomes is a limitation.

Out-of-Pocket Costs of Complementary Medicine Following Cancer and the Financial Impact in a Setting With Universal Health Coverage: Findings From a Prospective Cohort Study

PURPOSE

To determine household spending patterns on complementary medicine following cancer and the financial impact in a setting with universal health coverage.

METHODS

Country-specific data from a multinational prospective cohort study, Association of Southeast Asian Nations Costs in Oncology Study, comprising 1,249 cancer survivors were included. Household costs of complementary medicine (healthcare practices or products that are not considered as part of conventional medicine) throughout the first year after cancer diagnosis were measured using cost diaries. Study outcomes comprised (1) shares of household expenditures on complementary medicine from total out-of-pocket costs and health costs that were respectively incurred in relation to cancer, (2) incidence of financial catastrophe (out-of-pocket costs related to cancer ≥ 30% of annual household income), and (3) economic hardship (inability to pay for essential household items or services).

RESULTS

One third of patients reported out-of-pocket household expenditures on complementary medicine in the immediate year after cancer diagnosis, accounting to 20% of the total out-of-pocket costs and 35% of the health costs. Risk of financial catastrophe was higher in households reporting out-of-pocket expenditures on complementary medicine (adjusted odds ratio: 1.39 [95% CI, 1.05 to 1.86]). Corresponding odds ratio within patients from low-income households showed that they were substantially more vulnerable: 2.28 (95% CI, 1.41 to 3.68). Expenditures on complementary medicine were, however, not associated with economic hardship in the immediate year after cancer diagnosis.

CONCLUSION

In settings with universal health coverage, integration of subsidized evidence-based complementary medicine into mainstream cancer care may alleviate catastrophic expenditures. However, this must go hand in hand with interventions to reduce the use of nonevidence-based complementary therapies following cancer.

Active Participation, Mind-Body Stabilization, and Coping Strategies with Integrative Medicine in Breast Cancer Patients

PURPOSE

Increasing numbers of breast cancer survivors have led to a growing demand for integrative medicine. When patients have completed treatments associated with severe side effects, attention turns to reducing psychological symptoms, coping behavior, and self-care. The aim of this study was to assess patient-reported benefits in relation to active participation, mind-body stabilization, and coping strategies in breast cancer patients receiving integrative medicine.

METHODS

In a cross-sectional study, health counseling and treatment provided by a standardized integrative medicine consultancy service at the University Breast Center of Franconia were evaluated in 75 breast cancer patients over a 15-month period. At the baseline, the patients answered a questionnaire on their medical history, symptoms, and the treatment goals they were hoping to achieve with integrative medicine. Patient-reported outcomes relative to active participation, mind-body stabilization, and coping strategies were analyzed.

RESULTS

A large majority of the patients had previous experience with integrative medicine (91%). Most reported that they achieved their treatment goals with integrative medicine. Ninety-one percent achieved active participation in cancer treatment, 90% mind-body stabilization, and 79% improvement in coping strategies. Besides active participation, which was greatest in patients with stable disease, the success of integrative therapy was independent of age, concomitant diseases, previous integrative medicine experience, treatment state, and systemic cancer therapy.

CONCLUSION

Breast cancer patients benefit from the counseling and treatment provided with integrative medicine in mind-body stabilization and coping with cancer. Active participation in cancer treatment is important for the patients. Integrative treatment services should form part of routine patient care.

Dynamic Effects of CAM Techniques on Inflammation and Emotional States: An Integrative Single-Case Study on a Breast Cancer Survivor

BACKGROUND

This study on a breast cancer survivor investigated how episodic practice of various complementary and alternative medicine (CAM) techniques affected the dynamics of emotional states and urinary neopterin-an inflammation marker.

METHODS

The 49-year-old female patient (diagnosis: ductal breast carcinoma 5 years before study start, suffering from chronic fatigue and depression) collected her entire urine in 12-hour intervals (from about 8 a.m. to 8 p.m. and from about 8 p.m. to 8 a.m.) for 28 days. The resulting 55 consecutive urine samples were analyzed for neopterin and creatinine levels using HPLC. Also in 12-hour intervals, the patient filled out questionnaires on emotional states and everyday routine, including CAM practice. Weekly, she was interviewed to identify emotionally meaningful everyday incidents, including use of CAM techniques. Time series analysis consisted of ARIMA modeling and cross-correlational analyses.

RESULTS

Qualitative evaluation revealed that, with the exception of Tai Chi, all CAM techniques, that is, Jin Shin Jyutsu, music, physiotherapy and energy healing, were experienced as positive. Cross-correlational analyses showed that practice of such CAM techniques was followed first by significant (P < .05) increases in positive mood and mental activity on the same day (lag 0) and then by decreases in positive mood after a total of 72 to 84 hours (+lag 6) and in mental activity after a total of 84 to 96 hours (+lag 7). Negative mood, by contrast, first decreased on the day of CAM practice (lag 0) and then increased after a total of 84 to 96 hours (+lag 7) following CAM. Moreover, urinary neopterin levels first increased on the day of CAM practice (lag 0) and then decreased after a total of 36 to 48 hours (+lag 3). Similar biphasic effects were also detected for irritation in response to CAM, although only partly significant.

CONCLUSION

Cyclic psychophysiological response patterns following CAM practice were attributable to biopsychosocial feedback mechanisms involving personally meaningful experiences. As lower neopterin levels following CAM point to a health-promoting effect, the patient of this study may have actively contributed to her healing process through episodic CAM practice.

Acupuncture and herbal medicine for female infertility: an overview of systematic reviews

Background

Acupuncture and herbal medicine have been used as additional treatments for infertility or as an adjuvant treatment of assisted reproductive technology (ART) in infertility. Many systematic reviews (SRs) and meta-analyses (MA) have been published. This paper reviews the SRs and MA of acupuncture and herbal medicine on infertility to provide evidence for clinical decision making.

Methods

A comprehensive literature search of SRs and MA for the effects of acupuncture and herbal medicine on infertility was conducted using nine databases. Two independent reviewers extracted the data of the selected SR and MA and evaluated their methodological quality using the ‘Assessment of multiple systematic reviews 2 (AMSTAR2)’.

Results

Twenty-one studies were included in this analysis. Eight studies were published in China, and three studies each were published in the USA, UK, and Australia. Conflicting evidence on the efficacy of acupuncture for infertile women has been reported. Herbal medicine for infertile women undergoing ART, women with anovulation, and women with polycystic ovary syndrome helped improve the clinical pregnancy rate. The methodological quality of SRs and MAs evaluated by AMSTAR 2 was low or very low because the protocol or list of excluded studies were omitted.

Conclusion

Herbal medicine tended to be effective in infertility, but acupuncture had low evidence of an effect on infertility. The methodological quality of the published SRs and MAs was underestimated because AMSTAR2 is a more rigorous assessment tool than the previous version.

Knowledge and use of complementary therapies in a tertiary care hospital in France: A preliminary study

Few studies have clarified the use of complementary therapies (CTs) in France. The main objective of this preliminary study was to evaluate knowledge of CTs in 4 representative groups of patients: patients suffering from cancer, patients presenting with a chronic noncancerous disease, chronic dialysis patients and nonchronic or cancerous patients needing surgery.A formalized questionnaire was designed by 2 psychologists, an oncologist and an anesthesiologist in charge of the Pain Clinic and Support Care Unit. One-hundred eleven patients were enrolled, and all agreed to complete the questionnaire.Eighty (72%) patients did not know the term "complementary therapies" (patients who were "not aware of CTs"), and 24 (21.6%) patients knew the term "complementary therapies" (patients who were "aware of CTs"), while 7 patients were not sure of the meaning. There were no differences between aware and unaware patients in gender (P = .27), age (P = .24), level of education (p = 0.24) or professional occupation (P = .06). Knowledge about CTs was significantly different among the different categories of patients (P = .03), with the only statistically significant difference between groups being between oncologic patients receiving ambulatory chemotherapy and patients presenting with a chronic noncancerous disease (P = .004).This preliminary study clearly highlights that patients and health caregivers are not aware of CTs and that there is a need for better communication about CTs.