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Barak M, Ben-Arye E. An Anthroposophic Medical Treatment in the Land of Salt and Gold. Curr Psychiatry Rep 2024:10.1007/s11920-024-01499-z. [PMID: 38647969 DOI: 10.1007/s11920-024-01499-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 04/25/2024]
Abstract
In this narrative, a general practitioner and psychotherapist trained in anthroposophic medicine presents the narrative and treatment of a 60-year-old woman who experienced the horrors of the "Dark Sabbath" attack in southern Israel on October 7, 2023. The patient's story is narrated by the physician, who shares his multi-disciplinary and multi-modal anthroposophic medicine approach to address the patient's acute stress disorder-related symptoms and concerns.
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Affiliation(s)
- Meron Barak
- Alumah Clinic for Anthroposophic and Integrative Medicine, Kiryat Tivon, Israel.
| | - Eran Ben-Arye
- Alumah Clinic for Anthroposophic and Integrative Medicine, Kiryat Tivon, Israel
- Integrative Oncology Program, The Oncology Service, Rappaport Faculty of Medicine, Lin Medical Center, Clalit Health Services, Technion-Israel Institute of Technology, Haifa, Israel
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Ben-Arye E, Samuels N, Keshet Y, Golan M, Baruch E, Dagash J. Exploring unmet concerns in home hospice cancer care: Perspectives of patients, informal caregivers, palliative care providers, and family physicians. Palliat Support Care 2024:1-9. [PMID: 38587040 DOI: 10.1017/s1478951524000567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
OBJECTIVES The study examines perspectives of patients in home hospice care; their informal caregivers; palliative health-care providers (HCPs); and family physicians, all regarding patients' unmet needs and quality of life (QoL)-related concerns. METHODS Participants from all 4 groups were approached within 2 months after the patient's admission to the home hospice care unit. Participants completed Edmonton Symptom Assessment Scale (ESAS) and Measure Yourself Concerns and Wellbeing (MYCAW) questionnaires, for patient's QoL-related concerns. Qualitative analysis of short narratives was conducted using ATLAS.ti software for systematic coding. RESULTS In total, 78 participants completed the study questionnaires: 24 patients, 22 informal caregivers, 22 palliative HCPs, and 11 family physicians. Informal caregivers gave higher scores (i.e., greater severity) than patients for fatigue on ESAS (p = 0.009); and family physicians lower scores than patients for ESAS drowsiness (p = 0.046). Compared with patients, palliative HCPs gave higher scores for patient emotional-spiritual concerns (77.2% vs. 41.7%, p = 0.02); lower scores for gastrointestinal concerns (p = 0.048); and higher scores for overall function (p = 0.049). Qualitative assessment identified a gap between how patients/informal caregivers vs. palliative HCPs/family physicians regard emotional-spiritual themes, including discussing issues related to death and dying. SIGNIFICANCE OF RESULTS The findings of the present study suggest that exploring a multifaceted cohort of home hospice patients, informal caregivers, palliative HCPs, and family physicians may provide insight on how to reduce communication gaps and address unmet needs of patients, particularly regarding emotional and spiritual concerns. CONCLUSIONS While the 4 groups were similar in their scoring of patient QoL-related concerns, there were discrepancies for some concerns (e.g., patient fatigue) and expectations regarding the need to discuss emotional and spiritual concerns, including on death and dying. Educational initiatives with programs providing training to all 4 groups may help bridge this gap, creating a more open and collaborative hospice care environment.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa, Israel
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yael Keshet
- Department of Sociology, Western Galilee College, Akko, Israel
| | - Miri Golan
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa, Israel
| | - Erez Baruch
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa, Israel
| | - Jamal Dagash
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa, Israel
- Palliative Care - Home Care Hospice, Clalit Health Services, Haifa, Israel
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Ben-Arye E, Lopez AM, Daoud N, Zoller L, Walker E, Davidescu M, Shulman K, Gressel O, Stein N, Brosh S, Schiff E, Samuels N. Identifying Factors Associated With Disparities in Access to Integrative Oncology Program. J Pain Symptom Manage 2024:S0885-3924(24)00673-0. [PMID: 38552747 DOI: 10.1016/j.jpainsymman.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/28/2024] [Accepted: 03/14/2024] [Indexed: 04/09/2024]
Abstract
CONTEXT AND OBJECTIVES Cancer centers are increasingly providing complementary medicine as part of an emerging discipline termed 'integrative oncology' (IO). The present study explored factors associated with disparities in referral and adherence to a freely-provided IO program. METHODS The databases of three oncology centers in northern Israel were searched retrospectively for chemotherapy-treated oncology patients eligible for referral by their oncology healthcare professionals to an integrative physician (IP) consultation. Demographic and cancer-related variables associated with the referral, and attendance by patients at the consultation were identified, as was adherence to the 6-week IO treatment program (high adherence, attending ≥4 IO treatment sessions; low adherence, 0-3 sessions). RESULTS Of 4988 eligible patients, 1694 (34%) were referred to the IP consultation, with 1331 (78.6%) attending the consultation of which 766 (57.6%) were adherent to IO treatments. Multivariate analysis revealed lower referral rates among patients speaking primarily Arabic and Russian vs. Hebrew (OR = 3.0, 95% CI = 2.0-4.6, P < 0.0001); males vs. females (OR = 1.94, CI = 1.3-2.9, P = 0.001); those not reporting emotional distress (OR = 1.5, CI = 1.02-2.16, P = 0.037); and older age (OR = 1.04, CI = 1.03-1.06, P < 0.0001). Arabic and Russian-speaking patients were less likely to adhere to IO treatments (OR = 0.52, 95% CI = 0.32-0.83, P = 0.006). CONCLUSION Patients' ethno-national origin and immigration status (primary language, Arabic and Russian), male gender and older age were associated with lower rates of referral to and attendance of the IP consultation, with reduced adherence to weekly IO treatments. These findings require further study to identify barriers toward diversity, equity and inclusion in IO care, increasing awareness among healthcare professionals regarding the benefits of these services for improving patient wellbeing.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program (E.B.A., M.D.), The Oncology Service, Lin, Zebulun, and Carmel Medical Centers, Clalit Health Services, Haifa, Israel; Rappaport Faculty of Medicine (E.B.A., K.S., E.S.), Technion-Israel Institute of Technology, Haifa, Israel.
| | - Ana Maria Lopez
- Sidney Kimmel Medical College and Sidney Kimmel Cancer Center (A.M.L.), Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nihaya Daoud
- School of Public health, Faculty of Health Sciences (N.D.), Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Lilach Zoller
- Haifa and Western Galilee District (L.Z.), Clalit Health Services, Haifa, Israel
| | | | - Michal Davidescu
- Integrative Oncology Program (E.B.A., M.D.), The Oncology Service, Lin, Zebulun, and Carmel Medical Centers, Clalit Health Services, Haifa, Israel
| | - Katerina Shulman
- Rappaport Faculty of Medicine (E.B.A., K.S., E.S.), Technion-Israel Institute of Technology, Haifa, Israel; The Oncology Service (K.S.), Lin and Zebulun Medical Centers, Clalit Health Services, Haifa, Israel
| | - Orit Gressel
- Integrative Oncology Program (E.B.A., M.D.), The Oncology Service, Lin, Zebulun, and Carmel Medical Centers, Clalit Health Services, Haifa, Israel
| | - Nili Stein
- Department of Community Medicine and Epidemiology (N.S.), Carmel Medical Center, Haifa, Israel
| | | | - Elad Schiff
- Rappaport Faculty of Medicine (E.B.A., K.S., E.S.), Technion-Israel Institute of Technology, Haifa, Israel; Department of Internal Medicine & Integrative Medicine Service (E.S.), Bnai-Zion, hospital, Haifa, Israel
| | - Noah Samuels
- Center for Integrative Complementary Medicine (N.S.), Shaarei Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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de Valois B, Young T, Zollman C, Appleyard I, Ben-Arye E, Cummings M, Green R, Hoffman C, Lacey J, Moir F, Peckham R, Stringer J, Veleber S, Weitzman M, Wode K. Acupuncture in cancer care: recommendations for safe practice (peer-reviewed expert opinion). Support Care Cancer 2024; 32:229. [PMID: 38483623 PMCID: PMC10940387 DOI: 10.1007/s00520-024-08386-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/16/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Up-to-date recommendations for the safe practice of acupuncture in integrative oncology are overdue with new cancer treatments and an increase in survivors with late effects of disease; 17 years have elapsed since Filshie and Hester's 2006 guidelines. During 2022/2023 an expert panel assembled to produce updated recommendations aiming to facilitate safe and appropriate care by acupuncturists working with people with cancer. METHODS A core development team comprising three integrative oncology professionals comprehensively updated pre-existing unpublished recommendations. Twelve invited international experts (senior acupuncturists with and without experience of working in oncology settings, oncologists, physicians and nurses trained in integrative oncology, researchers, academics, and professional body representatives) reviewed the recommendations. In multiple iterations, the core team harmonised comments for final ratification. To aid dissemination and uptake the panel represents national and international integrative oncology associations and major cancer treatment centres in Europe, USA, Australia, and the Middle East. RESULTS These recommendations facilitate safe care by articulating contra-indications, cautions, and risks for patients both on and off treatment (surgery, SACT, radiotherapy). Situations where acupuncture may be contra-indicated or practices need adapting are identified. "Red and Amber Flags" highlight where urgent referral is essential. CONCLUSION These are the first international, multidisciplinary peer-reviewed recommendations for safe acupuncture practice in integrative oncology. Concerns about safety remain a significant barrier to appropriate referral from oncology teams, to use by acupuncturists and to uptake by patients. Disseminating trustworthy, widely accessible guidance should facilitate informed, confident practice of acupuncture in and outside of oncology healthcare settings.
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Affiliation(s)
- Beverley de Valois
- Supportive Oncology Research Team (SORT), East and North Hertfordshire NHS Trust Incorporating Mount Vernon Cancer Centre, Northwood, Middlesex, UK.
| | - Teresa Young
- Supportive Oncology Research Team (SORT), East and North Hertfordshire NHS Trust Incorporating Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | | | | | | | - Mike Cummings
- British Medical Acupuncture Society, London Office, London, UK
| | - Ruth Green
- Imaging, Royal National Orthopaedic NHS Trust, Stanmore, Middlesex, UK
| | | | - Judith Lacey
- Supportive Care and Integrative Oncology, Chris O'Brien Lifehouse Comprehensive Cancer Hospital, Sydney, NSW, Australia
| | | | | | | | - Susan Veleber
- Integrative Medicine, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Matthew Weitzman
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kathrin Wode
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Samuels N, Ben-Arye E. Integrative Medicine for Cancer-Related Pain: A Narrative Review. Healthcare (Basel) 2024; 12:403. [PMID: 38338288 PMCID: PMC10855884 DOI: 10.3390/healthcare12030403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
Cancer-related pain (C-RP) is a prevalent and debilitating concern among patients with cancer, with conventional treatments limited in their ability to provide adequate relief, and by the adverse effects associated with their use. Complementary and integrative medicine (CIM) modalities have been shown to be potentially effective and safe for the treatment of pain and related symptoms, when used in conjunction with conventional medications and under medical supervision. An increasing number of oncology centers provide CIM within their conventional supportive and palliative care service, in an "Integrative Oncology" (IO) setting. A large body of clinical research, including systematic reviews and guidelines such as those published in 2022 by the Society for Integrative Oncology (SIO), in collaboration with the American Society for Clinical Oncology (ASCO), support the use of some CIM modalities for C-RP and related concerns. These include acupuncture for general and peri-operative/procedural pain, as well as aromatase inhibitor-associated arthralgia (AIA); reflexology or acupressure for pain during systemic therapy for cancer; hypnosis for procedural pain or pain due to diagnostic workup; and massage for pain experienced by patients during palliative and hospice care. Further research is needed, within both randomized control trials and pragmatic non-controlled studies which are more reflective of the real-life IO setting. This review summarizes the evidence supporting the use of CIM for C-RP; the analgesic mechanism of the modalities presented; and the challenges facing IO researchers, as well as the implementation of the 2022 SIO-ASCO guideline recommendations.
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Affiliation(s)
- Noah Samuels
- Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9103102, Israel
| | - Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin Carmel, and Zebulun Medical Centers, Clalit Health Services, Haifa 3535152, Israel;
- Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
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Andreazzoli F, Levy Yurkovski I, Ben-Arye E, Bonucci M. Conceptualizing an Integrative Multiple Myeloma Care: The Role of Nutrition, Supplements, and Complementary Modalities. Nutrients 2024; 16:237. [PMID: 38257130 PMCID: PMC10818534 DOI: 10.3390/nu16020237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Multiple Myeloma (MM) is the second most prevalent hematologic malignancy, and its incidence has been increasing enormously in recent years. The prognosis of MM has changed radically with the introduction of new drugs that have improved life expectancy; recurrences are a common occurrence during the course of the disease and are characterized by an increase in refractory to treatment. Moreover, MM patients are challenged by quality of life-related concerns while limited conventional therapy may be offered. This includes bone pain and dialysis due to the complications of acute renal failure. We, therefore, believe that it is very important to add new treatment modalities, including supplements, nutritional modifications, acupuncture, and mind-body therapies, with the goal of improving treatment tolerance, effectiveness, and patients' quality of life. Moreover, many patients use some of these supplements on their own, in the hope of reducing the side effects, so it is even more important to know their action and potential. The purpose of this review is to illustrate all these strategies potentially available to enrich our approach to this, to date, incurable disease.
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Affiliation(s)
- Francesca Andreazzoli
- Department of Hematology, Versilia’s Hospital, Viale Aurelia, 335, 55049 Camaiore, Italy
| | - Ilana Levy Yurkovski
- Hematology Unit, Bnai Zion Medical Center, Haifa 3339419, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3109601, Israel;
- Complementary and Integrative Medicine Service, Bnai Zion Medical Center, Haifa 3339419, Israel
| | - Eran Ben-Arye
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3109601, Israel;
- Integrative Oncology Program, The Oncology Service, Lin Carmel, and Zebulun Medical Centers, Clalit Health Services, Haifa 3535152, Israel
| | - Massimo Bonucci
- Artoi Foundation, Via Ludovico Micara, 73, 00165 Rome, Italy;
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Ben-Arye E, Mao J, Bruera E, Samuels N, Keshet Y, Lee RT, Ben-Yehuda D, Eisenberg E, Bar-Sela G, Shvartzman P, Balneaves LG, Shani M, Ellis M, Tripathy D, Ash S, Elis A, Vaknin Z, Ofir R, Schiff E. Challenges in Implementing Guideline on Integrative Oncology and Pain: The Israeli Perspective. J Pain Symptom Manage 2024; 67:69-76. [PMID: 37769821 DOI: 10.1016/j.jpainsymman.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
CONTEXT AND OBJECTIVES To explore the feasibility of implementing the joint guideline on integrative medicine for pain management in oncology, published by the Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO), for integrative oncology (IO) services in supportive and palliative care. METHODS A qualitative research methodology was co-designed by the SIO-ASCO guideline committee, with the Society for Complementary Medicine, Israel Medical Association (IMA). A questionnaire with five open-ended questions exploring barriers and enablers to implementing the guideline was distributed to chairs and board members of nine IMA-affiliated medical societies; four deans of Israeli medical schools; and nurses from the Israeli Society for Oncology Nursing. Respondent narratives were qualitatively analyzed using ATLAS.Ti software for systematic coding. RESULTS Questionnaires were completed by 52 physicians and nurses from medical oncology, hematology, gynecological oncology, pediatric oncology, palliative medicine, pain, family medicine, internal medicine, and integrative medicine. The SIO-ASCO guidelines were endorsed by nine IMA-affiliated societies. The domains identified included the importance of guideline implementation in clinical practice; barriers and facilitators to implementation; practical aspects required for this implementation (e.g., IO training); clinical indications for referral; budget-related issues; and clinical and administrative models enabling practical implementation of the guideline. CONCLUSION We found across-the-board consensus among the nine IMA-affiliated societies supporting the current guideline. This, while identifying potential facilitators and barriers in order to address the implementation of the SIO-ASCO guideline recommendations.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program (E.B-A), The Oncology Service; Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, Haifa, Israel; Ruth and Bruch Rappaport Faculty of Medicine (E.B-A., E.E.), Technion-Israel Institute of Technology, Haifa, Israel.
| | - Jun Mao
- ASCO Guideline on Integrative Medicine for Pain Management (J.M.); Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eduardo Bruera
- ASCO Guideline on Integrative Medicine for Pain Management (E.B.); MD Anderson Cancer Center, Houston, Texas, USA
| | - Noah Samuels
- Center for Integrative Complementary Medicine (N.S.), Shaarei Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Yael Keshet
- Department of Sociology (Y.K.), The Western Galilee College, Acco, Israel
| | - Richard T Lee
- City of Hope Comprehensive Cancer Center (R.T.L.), Duarte, California, USA
| | - Dina Ben-Yehuda
- Hadassah-Hebrew University Medical School (D.B-Y.), Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Elon Eisenberg
- Ruth and Bruch Rappaport Faculty of Medicine (E.B-A., E.E.), Technion-Israel Institute of Technology, Haifa, Israel; The Israel Pain Society (E.E.), Israel Medical Association, Israel
| | - Gil Bar-Sela
- Israeli Society of Clinical Oncology & Radiation Therapy (ISCORT) (G.B-S.), Israel Medical Association; Cancer Center, Emek Medical Center, Afula, Israel
| | - Pesach Shvartzman
- Israel Society for Palliative Medicine (P.S.), Israel Medical Association; Siaal Center for Community Research, Pain and Palliative Care Unit, Kappy and Eric Flanders National Palliative Care Resource Centre, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lynda G Balneaves
- College of Nursing, Faculty of Health Sciences (L.G.B.), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michal Shani
- Israel Association of Family Physicians (M.S.), Israel Medical Association; Department of Family Medicine, Central District, Clalit Health Service, Rehovot, Israel; Sackler Faculty of Medicine (M.S.), Tel Aviv University, Tel Aviv, Israel
| | - Martin Ellis
- Israel Society of Hematology and Transfusion Medicine (M.E.), Israel Medical Association; Hematology Institute and Translational Hemato-Oncology Laboratory, Meir Medical Center, Israel
| | - Debu Tripathy
- Department of Breast Medical Oncology (D.T.), University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shifra Ash
- Israeli Society of Pediatric Hematology/Oncology (S.A.), Israel Medical Association; Department of Pediatric Hematology-Oncology, Rambam Medical Center, Haifa, Israel
| | - Avishay Elis
- Israel Society of Internal Medicine (A.E), Israel Medical Association; Department of Internal Medicine "C", Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel
| | - Zvi Vaknin
- Israeli Society of Gynecologic Oncology (Z.V.), Israel Medical Association; Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center, Zerifin, Israel; Affiliated to the Sackler Faculty of Medicine (Z.V.), Tel Aviv University, Tel Aviv, Israel
| | - Ruth Ofir
- Israeli Oncology Nursing Society (R.O.), Department of Pediatric Hematology-Oncology, Rambam Medical Center, Haifa, Israel
| | - Elad Schiff
- The Society of Complementary Medicine (E.S.), Israel Medical Association; Department of Internal Medicine & Integrative Medicine Service, Bnai-Zion Medical Center, Haifa, Israel
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Levy Yurkovski I, Andreazzoli F, Ben-Arye E, Attias S, Tadmor T. Integrative Approaches in the Treatment of Patients Affected by Lymphoma. Curr Oncol Rep 2023; 25:1523-1534. [PMID: 38060095 DOI: 10.1007/s11912-023-01476-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE OF REVIEW Lymphoma is the most frequent hematological malignancy with wide disease spectrum of watchful waiting period, active treatment, survivorship, and palliative care. All these steps impose unmet needs in terms of prevention, symptom alleviation, or prognosis. Complementary and integrative medicine (CIM) is widely used by patients with lymphoma to cope with such issues. Here, we describe the different CIM modalities that may be effective and safe for the management of patients with lymphoma. RECENT FINDINGS Low inflammatory diet and ginseng seem effective for lymphoma prevention. Pain and neuropathy may be improved using acupuncture, touch therapy and specific dietary supplements. Nausea/vomiting, fatigue, and insomnia may be relieved by acupuncture, mind-body, touch therapy, and certain dietary supplements. Vitamin D, curcumin, and some traditional medicine herbs may positively impact lymphoma prognosis. Finally, safety issues should be considered especially for the concomitant use of dietary supplements and lymphoma-directed therapies. CIM may be beneficial along the continuum of lymphoma management although safety concerns should be considered when used concomitantly with conventional therapy.
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Affiliation(s)
- Ilana Levy Yurkovski
- Hematology Unit, Bnai Zion Medical Center, Golomb 47, 33394, Haifa, Israel.
- Complementary Medicine Service, Bnai Zion Medical Center, Haifa, Israel.
- Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel.
| | | | - Eran Ben-Arye
- Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
- Integrative Oncology Program, The Oncology Service, Lin, Carmel & Zebulun Medical Centers, Clalit Health Services, Western Galilee District, Haifa, Israel
| | - Samuel Attias
- Complementary Medicine Service, Bnai Zion Medical Center, Haifa, Israel
| | - Tamar Tadmor
- Hematology Unit, Bnai Zion Medical Center, Golomb 47, 33394, Haifa, Israel
- Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
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Hauzer M, Grimberg R, Samuels N, Keshet Y, Mordechai A, Dagash J, Ben-Arye E. Exploring primary care physician feedback following an integrative oncology consultation. Support Care Cancer 2023; 31:606. [PMID: 37787815 DOI: 10.1007/s00520-023-08079-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE To explore responses from primary care physicians (PCPs) from an integrative physician (IP) consultation and recommended integrative oncology (IO) treatment program. METHODS Chemotherapy-treated patients were referred by their oncology healthcare professional to an IP, a physician dually trained in complementary medicine and supportive cancer care. The consultation summary and patient-centered IO treatment program was then sent to the patient's PCP, with PCP-to-IP responses analyzed qualitatively using ATLAS.Ti software for systematic coding and content analysis. Trial Registration Number NCT01860365 published May 22, 2013. RESULTS Of the 597 IP consultations conducted, 470 (78.7%) summaries were sent to patients' PCPs, with only 69 (14.7%) PCP-to-IP responses returned. PCPs were more likely to respond if the patient was Hebrew-speaking (78.3% vs. 65.1%, P = 0.032). Systematic coding identified four predominant themes among PCP narratives: addressing the patient's medical condition and leading QoL-related concerns; patient-centered reflections; available resources providing support and promoting resilience; and PCP attitudes to the IO treatment program. CONCLUSION PCP-IP communication can provide valuable insight into the patient's bio-psycho-social care, addressing the patient's health-belief model, emotional concerns, caregiver-related factors, preferences, and barriers to adherence to IO care. PRACTICE IMPLICATIONS Healthcare services should consider promoting IP-PCP communication in order to facilitate better patient outcomes from an IO treatment program.
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Affiliation(s)
- Michael Hauzer
- Department of Family Medicine, Haifa & Western Galilee District, Clalit Health Services Community Division, HaShahaf 6, Bat-Galim, Haifa, Israel.
- Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Ran Grimberg
- Department of Family Medicine, Haifa & Western Galilee District, Clalit Health Services Community Division, HaShahaf 6, Bat-Galim, Haifa, Israel
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yael Keshet
- Department of Sociology, Western Galilee Academic College, Galilee, Israel
| | - Alperin Mordechai
- Department of Family Medicine, Haifa & Western Galilee District, Clalit Health Services Community Division, HaShahaf 6, Bat-Galim, Haifa, Israel
| | - Jamal Dagash
- Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Palliative Care-Home Care Hospice, Clalit Health Services, Haifa and Western Galilee District, Jerusalem, Israel
| | - Eran Ben-Arye
- Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Integrative Oncology Program, The Oncology Service, Lin Carmel, and Zebulun Medical Centers, Clalit Health Services, Haifa, Israel
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Samuels N, Cohen N, Katz D, Ben-Arye E. Identifying cultural, demographic, personal health and cancer-related barriers to integrative oncology care: a retrospective case-cohort study. J Cancer Res Clin Oncol 2023; 149:10143-10148. [PMID: 37264264 DOI: 10.1007/s00432-023-04912-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/20/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE Integrative oncology (IO) provides complementary and integrative medicine within conventional supportive and palliative cancer care. The present study set out to identify barriers to attending an integrative physician (IP) consultation, provided without charge within an IO treatment program. STUDY METHODS Electronic files of adult oncology patients undergoing chemotherapy were studied. Patient-related characteristics were examined to identify factors associated with attendance at the IP consultation: socio-demographic (age, gender, country of birth, place of residence, primary language spoken); health- related (BMI, smoking, independent functioning); and cancer- related (primary tumor site, localized vs. metastatic). RESULTS Only 257 of the 1912 patients studied (13.4%) attended the IP consultation, with female patients more likely to attend (p < 0.001), as well as younger patients (p = 0.002); those residing outside the Jerusalem municipality (p = 0.008); and patients whose primary language was Hebrew (p < 0.001). Non-smokers and functionally independent patients were also more likely to attend (p = 0.007 and 0.008, respectively), as were those diagnosed with breast/gynecological (p = 0.005) or gastrointestinal tumors (p = 0.002). Multivariate analysis showed a significantly greater likelihood of attending the consultation among females (OR 1.619, 95% CI 1.065-2.460; p = 0.024); younger patients (OR 1.019, 95% CI 1.007-1.031; p = 0.001); non-Arabic speakers (OR 8.220, 95% CI 3.310-20.413; p < 0.001); and patients diagnosed with a tumor other than lung cancer (OR 2.954, 95% CI 1.259-6.933; p = 0.013). CONCLUSION Further prospective research addressing socio-demographic, personal health- and cancer-related characteristics of oncology patients is needed to address potential barriers to the provision of IO care within a diverse, equitable and inclusive setting of care.
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Affiliation(s)
- Noah Samuels
- Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, P.O.B. 3235, 9103102, Jerusalem, Israel.
| | - Neora Cohen
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Daniela Katz
- Integrated Oncology Institute, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin Carmel, and Zebulun Medical Centers, Clalit Health Services, Haifa, Israel
- Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Ben-Arye E, Hirsh I, Segev Y, Grach M, Master V, Eden A, Samuels N, Stein N, Gressel O, Ostrovsky L, Galil G, Schmidt M, Schiff E, Lavie O. A randomized-controlled trial assessing the effect of intraoperative acupuncture on anesthesia-related parameters during gynecological oncology surgery. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04758-3. [PMID: 37061627 PMCID: PMC10105534 DOI: 10.1007/s00432-023-04758-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/08/2023] [Indexed: 04/17/2023]
Abstract
CONTEXT AND OBJECTIVES The present study examined the impact of intraoperative acupuncture on anesthesia-related parameters in patients undergoing gynecological oncology surgery. METHODS Participants underwent preoperative integrative oncology (IO) touch/relaxation treatments, followed by intraoperative acupuncture (Group A); preoperative IO treatments without acupuncture (Group B); or standard care only (Group C). Mean arterial pressure (MAP), heart rate (HR), MAP variability (mean of MAP standard deviation), bispectral index (BIS), and calculated blood pressure Average Real Variability (ARV) were measured intraoperatively. RESULTS A total of 91 patients participated: Group A, 41; Group B, 24; Group C, 26. Among patients undergoing open laparotomy, Group A showed lower and more stable MAP and HR compared to Group B, (MAP, p = 0.026; HR, p = 0.029) and Group C (MAP, p = 0.025). Mean BIS, from incision to suture closing, was lower in Group A (vs. controls, p = 0.024). In patients undergoing laparoscopic surgery, MAP was elevated within Group A (p = 0.026) throughout surgery, with MAP variability significantly higher in Group A (P = 0.023) and Group B (P = 0.013) 10 min post-incision (vs. pre-incision). All groups showed similar intraoperative and post-anesthesia use of analgesic medication. CONCLUSION Intraoperative acupuncture was shown to reduce and stabilize MAP and HR, and reduce BIS in gynecology oncology patients undergoing laparotomy, with no impact on perioperative analgesic medication use. In the laparoscopic setting, intraoperative acupuncture was associated with elevated MAP. Further research is needed to explore the hemodynamic and BIS-associated benefits and risks of intraoperative acupuncture, and the impact on the use of analgesic drugs in response to these changes.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin, Zebulun, and Carmel Medical Centers, Clalit Health Services, 35 Rothschild St, Haifa, Israel.
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Irena Hirsh
- Department of Anesthesiology, Critical Care and Pain Medicine, Carmel Medical Center, Haifa, Israel
| | - Yakir Segev
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
| | - Michael Grach
- Department of Anesthesiology, Critical Care and Pain Medicine, Carmel Medical Center, Haifa, Israel
| | - Viraj Master
- Department of Urology and Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Arie Eden
- Department of Anesthesiology, Critical Care and Pain Medicine, Carmel Medical Center, Haifa, Israel
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Faculty of Medicine, Shaarei Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nili Stein
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Orit Gressel
- Integrative Oncology Program, The Oncology Service, Lin, Zebulun, and Carmel Medical Centers, Clalit Health Services, 35 Rothschild St, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ludmila Ostrovsky
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
| | - Galit Galil
- Integrative Oncology Program, The Oncology Service, Lin, Zebulun, and Carmel Medical Centers, Clalit Health Services, 35 Rothschild St, Haifa, Israel
| | - Meirav Schmidt
- Department of Anesthesiology, Critical Care and Pain Medicine, Carmel Medical Center, Haifa, Israel
| | - Elad Schiff
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Internal Medicine & Integrative Medicine Service, Bnai-Zion, Hospital, Haifa, Israel
| | - Ofer Lavie
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
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12
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Ben-Arye E, Lavie O, Segev Y, Samuels N. Reply to "Assessing the impacts of integrative therapies on pain and anxiety after gynecological oncology surgery". Cancer 2023; 129:1941-1942. [PMID: 37056036 DOI: 10.1002/cncr.34803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin, Zebulun, and Carmel Medical Centers, Clalit Health Services, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ofer Lavie
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
| | - Yakir Segev
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Shaarei Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Ben-Arye E, Balneaves LG, Yaguda S, Shulman B, Gressel O, Tapiro Y, Sharabi IS, Samuels N. Nurse-guided patient self-treatment in integrative oncology: a randomized controlled trial. Support Care Cancer 2023; 31:233. [PMID: 36964801 PMCID: PMC10039353 DOI: 10.1007/s00520-023-07689-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 03/13/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE Nurses are increasingly becoming involved in integrative oncology (IO) programs. This study examined the additive effect of nurse-provided guidance for self-administered IO therapies on cancer-related fatigue and quality of life (QoL). METHODS The study was randomized and controlled, enrolling patients undergoing active oncology treatment with IO interventions for fatigue and other QoL-related outcomes. IO practitioner guidance on self-treatment with manual, relaxation, and/or traditional herbal therapies was provided to patients in both the intervention and control arms. However, patients in the intervention arms also received additional guidance on self-treatment by IO-trained palliative care nurses. All participants were assessed for fatigue and QoL at baseline and at 24-h follow-up, using the Edmonton Symptom Assessment Scale (ESAS) and the Measure Yourself Concerns and Wellbeing (MYCAW) questionnaire tools. RESULTS Of 353 patients recruited, 187 were randomized to the intervention and 166 to the control group. Both groups had similar demographic and oncology-related characteristics. Patients in the intervention arm reported significantly greater improvement in ESAS scores for fatigue (p = 0.026) and appetite (p = 0.003) when compared to controls. CONCLUSION The addition of nurse-provided guidance on self-administration of IO treatments to that provided by IO practitioners further reduced short-term scores for fatigue and improved appetite. The relationship between palliative and IO-supportive cancer care requires further study.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service; Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, 35 Rothschild St, Haifa, Israel.
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Lynda G Balneaves
- College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Susan Yaguda
- Department of Supportive Oncology, Levine Cancer Institute, Charlotte, NC, USA
| | - Bella Shulman
- Integrative Oncology Program, The Oncology Service; Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, 35 Rothschild St, Haifa, Israel
| | - Orit Gressel
- Integrative Oncology Program, The Oncology Service; Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, 35 Rothschild St, Haifa, Israel
| | - Yehudit Tapiro
- Integrative Oncology Program, The Oncology Service; Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, 35 Rothschild St, Haifa, Israel
| | - Ilanit Shalom Sharabi
- Integrative Oncology Program, The Oncology Service; Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, 35 Rothschild St, Haifa, Israel
| | - Noah Samuels
- Department of Supportive Oncology, Levine Cancer Institute, Charlotte, NC, USA
- Center for Integrative Complementary Medicine, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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Abstract
PURPOSE OF REVIEW Integrative oncology (IO) services provide a wide range of complementary medicine therapies, many of which can augment the beneficial effects of conventional supportive and palliative care for patients with ovarian cancer. This study aims to assess the current state of integrative oncology research in ovarian cancer care. RECENT FINDINGS We review the clinical research both supporting the effectiveness of leading IO modalities in ovarian cancer care as well as addressing potential safety-related concerns. There is growing amount of clinical research supporting the use of IO and implementation of integrative gynecological oncology models of care within the conventional supportive cancer care setting. Additional research is still needed in order to create clinical guidelines for IO interventions for the treatment of female patients with ovarian cancer. These guidelines need to address both effectiveness and safety-related issues, providing oncology healthcare professionals with indications for which these patients can be referred to the IO treatment program.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin, Carmel & Zebulun Medical Centers, Clalit Health Services, Haifa, Western Galilee District, Israel. .,Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel and Clalit Health Services, Haifa, Western Galilee District, Israel.
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Gynecologic Oncology Service, Carmel Medical Center, Haifa, Israel
| | - Wolfgang Heyl
- Department of Obstetrics and Gynecology, Cancer Center North Wurttemberg, Ludwigsburg, Germany
| | - Lois Ramondetta
- Department of Gynecologic Oncology and Reproductive Medicine And Department of Palliative, Rehabilitation, & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tara Berman
- Department of Medical Oncology, Inova Schar Cancer Institute, Fairfax, VA, USA
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Faculty of Medicine, Shaarei Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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15
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Ben-Arye E, Segev Y, Galil G, Marom I, Gressel O, Stein N, Hirsh I, Samuels N, Schmidt M, Schiff E, Lurie I, Lavie O. Acupuncture during gynecological oncology surgery: A randomized controlled trial assessing the impact of integrative therapies on perioperative pain and anxiety. Cancer 2023; 129:908-919. [PMID: 36647622 DOI: 10.1002/cncr.34542] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/28/2022] [Accepted: 05/12/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND In this study, the impact of a multimodal integrative oncology pre- and intraoperative intervention on pain and anxiety among patients undergoing gynecological oncology surgery was explored. METHODS Study participants were randomized to three groups: Group A received preoperative touch/relaxation techniques, followed by intraoperative acupuncture; Group B received preoperative touch/relaxation only; and a control group (Group C) received standard care. Pain and anxiety were scored before and after surgery using the Measure Yourself Concerns and Wellbeing (MYCAW) and Quality of Recovery (QOR-15) questionnaires, using Part B of the QOR to assess pain, anxiety, and other quality-of-life parameters. RESULTS A total of 99 patients participated in the study: 45 in Group A, 25 in Group B, and 29 in Group C. The three groups had similar baseline demographic and surgery-related characteristics. Postoperative QOR-Part B scores were significantly higher in the treatment groups (A and B) when compared with controls (p = .005), including for severe pain (p = .011) and anxiety (p = .007). Between-group improvement for severe pain was observed in Group A compared with controls (p = .011). Within-group improvement for QOR depression subscales was observed in only the intervention groups (p <0.0001). Compared with Group B, Group A had better improvement of MYCAW-reported concerns (p = .025). CONCLUSIONS A preoperative touch/relaxation intervention may significantly reduce postoperative anxiety, possibly depression, in patients undergoing gynecological oncology surgery. The addition of intraoperative acupuncture significantly reduced severe pain when compared with controls. Further research is needed to confirm these findings and better understand the impact of intraoperative acupuncture on postoperative pain. PLAIN LANGUAGE SUMMARY Integrative oncology programs are increasingly becoming part of supportive/palliative care, with many working within the Society for Integrative Oncology. This study examined the impact of a multimodal integrative oncology program on pain and anxiety among 99 patients undergoing gynecological oncology surgery. Participants were randomized to three groups: preoperative touch/relaxation treatments, followed by intraoperative acupuncture; preoperative touch/relaxation without acupuncture; and a control group receiving standard care only. The preoperative touch/relaxation intervention significantly reduced perioperative anxiety, with the addition of intraoperative acupuncture significantly reducing severe pain as well, when compared with controls. Further research is needed to confirm these findings.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin, Zebulun, and Carmel Medical Centers, Clalit Health Services, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yakir Segev
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
| | - Galit Galil
- Integrative Oncology Program, The Oncology Service, Lin, Zebulun, and Carmel Medical Centers, Clalit Health Services, Haifa, Israel
| | - Inbal Marom
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
| | - Orit Gressel
- Integrative Oncology Program, The Oncology Service, Lin, Zebulun, and Carmel Medical Centers, Clalit Health Services, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nili Stein
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Irena Hirsh
- Department of Anesthesiology, Critical Care and Pain Medicine, Carmel Medical Center, Haifa, Israel
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Shaarei Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Meirav Schmidt
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
| | - Elad Schiff
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Internal Medicine & Integrative Medicine Service, Bnai-Zion, Hospital, Haifa, Israel
| | - Irina Lurie
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
| | - Ofer Lavie
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
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16
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Kruger D, Samuels N, Lacey J, Keshet Y, Gressel O, Dodiuk-Gad RP, Shulman K, Tapiro Y, Golan M, Ben-Arye E. Exploring a multi-disciplinary model of supportive cancer care for monoclonal antibody treatment-related dermatological symptoms. Support Care Cancer 2023; 31:185. [PMID: 36821054 PMCID: PMC9947431 DOI: 10.1007/s00520-023-07642-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
CONTEXT AND OBJECTIVES The present study examined the perspectives of healthcare providers (HCPs) in designing a multi-disciplinary model of supportive cancer care for the relief of dermatology-related symptoms caused by monoclonal antibody therapies. METHODS The study employed a mixed research methodology, with qualitative research embedded within a pragmatic prospective study of a registry protocol study. Patients undergoing oncology therapy with MoAB, anti-HER2, and anti-PD-L1 monoclonal antibodies were identified among a cohort of patients referred to an integrative oncology (IO) consultation for symptom relief and improved quality of life (QoL). Case studies with significant dermatology-related concerns were selected and presented to a panel of 6 HCPs trained in medical oncology, oncology nursing, family medicine, supportive cancer care, and IO. HCP narratives were qualitatively analyzed and assessed using ATLAS.Ti software for systematic coding. RESULTS Of the 924 patients referred to the IO consultation, 208 were treated with monoclonal antibodies, from which 50 were selected for further evaluation. Of these, 7 cases were presented to the HCP team who were asked to identify treatment gaps requiring a multi-disciplinary approach. Qualitative analysis identified 3 major themes: a biophysical perspective; a psycho-social-spiritual perspective; and the implementation of integrated care. DISCUSSION There is a need for a multi-disciplinary approach when treating patients suffering from monoclonal antibody treatment-related skin toxicities. HCP-reported themes highlight the need to identify patients for whom such an approach is warranted; conditions in which a psycho-social-spiritual perspective should be considered, in addition to a bio-physical approach; and considerations of who should be designated as the patient's primary case manager.
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Affiliation(s)
- Dikla Kruger
- Integrative Oncology Program, Oncology Service; Lin, Carmel, and Zebulon Medical Centers, Clalit Health Services, Haifa, Israel.,Department of Family Medicine, Clalit Health Services, Haifa and Western Galilee District, Haifa, Israel
| | - Noah Samuels
- The Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Judith Lacey
- Supportive Care and Integrative Oncology, Chris O'Brien Lifehouse, Sydney, NSW, Australia.,Clinical School of Medicine, University of Sydney, Camperdown, Australia.,NICM Health Research Institute, Western Sydney University, Sydney, Australia
| | - Yael Keshet
- Department of Sociology and Anthropology, Western Galilee Academic College, Akko, Israel
| | - Orit Gressel
- Integrative Oncology Program, Oncology Service; Lin, Carmel, and Zebulon Medical Centers, Clalit Health Services, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Roni P Dodiuk-Gad
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Department of Dermatology, Emek Medical Center, Afula, Israel.,Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Katerina Shulman
- The Oncology Service, Lin and Zebulon Medical Centers, Clalit Health Services, Haifa, Israel.,Carmel Medical Center, Haifa, Israel
| | - Yehudit Tapiro
- The Oncology Service, Lin and Zebulon Medical Centers, Clalit Health Services, Haifa, Israel
| | - Miri Golan
- Integrative Oncology Program, Oncology Service; Lin, Carmel, and Zebulon Medical Centers, Clalit Health Services, Haifa, Israel
| | - Eran Ben-Arye
- Integrative Oncology Program, Oncology Service; Lin, Carmel, and Zebulon Medical Centers, Clalit Health Services, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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17
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Ben-Arye E, Tapiro Y, Baruch R, Tal A, Shulman B, Gressel O, Israeli P, Dagash J, Yosipovich A, Shalom Sharabi I, Zimmermann P, Samuels N. Integrative oncology for palliative care nurses: pre-post training evaluation. BMJ Support Palliat Care 2023:spcare-2022-004117. [PMID: 36690415 DOI: 10.1136/spcare-2022-004117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/09/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Integrative oncology (IO) is increasingly being incorporated in supportive and palliative cancer care. This study examined an IO-palliative care training programme for nurses from community and hospital settings. METHODS A 120-hour course, attended by 24 palliative care nurses without IO training, included precourse/postcourse questionnaires examining knowledge, attitudes and level of IO-palliative care skills. Qualitative analysis examined precourse and postcourse narratives. RESULTS Most (18; 75%) completed study questionnaires, with knowledge and attitudes towards IO changing only modestly and IO-related skills significantly for guidance on herbal medicine and lifestyle changes, manual-movement and mind-body modalities. Greater consultation skills were reported for fatigue, stomatitis, nausea, appetite, constipation/diarrhoea, insomnia, peripheral neuropathy and hot flashes. Trainees reported improved skills for pain (p=0.003), emotional (p<0.001) and informal caregiver-related concerns (p<0.001), with no change in palliative care-related skills. Qualitative analysis found both personal and professional attitude changes, with enhanced mindfulness and an expressed intent to implement the learnt skills in daily practice. CONCLUSIONS The IO-palliative care nurse training programme increased IO-related and palliative care-related consultation skills for a wide range of quality of life-related concerns. Further research is needed to explore both short-term and long-term effects and the implementation of the learnt skills in clinical practice. TRIAL REGISTRATION NUMBER NCT03676153.
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Affiliation(s)
- Eran Ben-Arye
- Technion Israel Institute of Technology, Haifa, Israel
- Integrative Oncology Program, Oncology Service, Lin Medical Center, Haifa, Israel
| | | | - Ruth Baruch
- Nursing, Clalit Health Services, Tel Aviv, Israel
| | - Ahuva Tal
- Carmel Medical Center, Haifa, Israel
| | - Bella Shulman
- Integrative Oncology Program, Oncology Service, Lin Medical Center, Haifa, Israel
| | - Orit Gressel
- Integrative Oncology Program, Oncology Service, Lin Medical Center, Haifa, Israel
| | | | | | | | | | | | - Noah Samuels
- Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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18
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Ben-Arye E, Gamus D, Samuels N, Schiff E, Hausner D, Gressel O, Attias S, Lavie O, David A, Shulman K, Agbarya A. Acupuncture and integrative oncology for taxane-induced peripheral neuropathy: a randomized multicentered study. Int J Gynecol Cancer 2022; 33:792-801. [PMID: 36600535 DOI: 10.1136/ijgc-2022-004004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To compare the effectiveness of acupuncture alone or with additional integrative oncology modalities for taxane-induced peripheral neuropathy-related symptoms in patients with gynecological and breast cancer. METHODS The study was a prospective evaluation of patients undergoing twice-weekly treatments with either acupuncture alone (single-modality, group A) or with additional manual-movement and mind-body therapies (multimodality, group B), for 6 weeks. Symptom severity was assessed at baseline, 6 weeks, and 9 weeks using the Functional Assessment of Cancer Therapy-Taxane (FACT-Tax) tool; and von Frey perception thresholds. Additional symptoms were also assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the Measure Yourself Concerns and Wellbeing (MYCaW) study tool. RESULTS For the 120 participants (60 in each study arm), baseline to 6-week scores were similar in both groups for improved FACT-Tax physical wellbeing and scores for hand numbness/tingling; EORTC physical functioning and global health status; and MYCaW scores. FACT-Tax taxane subscales and scores for foot numbness/tingling improved only in group A (p=0.038), while emotional wellbeing FACT-Tax (p=0.02) and EORTC pain (p=0.005) improved only in group B. Group B showed greater improvement for FACT-Tax neuropathy-related concerns than group A at 24 hours (p=0.043) and 7 days (p=0.009) after the first treatment. CONCLUSION Acupuncture alone or with additional integrative oncology modalities may help reduce neuropathy-related symptoms. The single-modality group demonstrated greater improvement for foot numbness/tingling, and the multimodality group demonstrated improvement for pain and improved emotional wellbeing and neuropathy-related concerns in the first week of treatment. TRIAL REGISTRATION NUMBER NCT03290976.
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Affiliation(s)
- Eran Ben-Arye
- The Oncology Service; Lin Medical Center, Clalit Health Services; Haifa and Western Galilee District, Haifa, Israel .,Technion Israel Institute of Technology, Haifa, Israel
| | | | | | - Elad Schiff
- Technion Israel Institute of Technology, Haifa, Israel.,Department of Internal Medicine, Hospital, Haifa, Israel.,Bnai Zion Medical Center, Haifa, Israel
| | | | - Orit Gressel
- The Oncology Service; Lin Medical Center, Clalit Health Services; Haifa and Western Galilee District, Haifa, Israel
| | | | - Ofer Lavie
- Technion Israel Institute of Technology, Haifa, Israel.,Lady Davies Carmel Medical Center, Haifa, Israel
| | - Adi David
- Sheba Medical Center, Tel Hashomer, Israel
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Mao JJ, Ismaila N, Bao T, Barton D, Ben-Arye E, Garland EL, Greenlee H, Leblanc T, Lee RT, Lopez AM, Loprinzi C, Lyman GH, MacLeod J, Master VA, Ramchandran K, Wagner LI, Walker EM, Bruner DW, Witt CM, Bruera E. Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline. J Clin Oncol 2022; 40:3998-4024. [PMID: 36122322 DOI: 10.1200/jco.22.01357] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The aim of this joint guideline is to provide evidence-based recommendations to practicing physicians and other health care providers on integrative approaches to managing pain in patients with cancer. METHODS The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2021. Outcomes of interest included pain intensity, symptom relief, and adverse events. Expert panel members used this evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 227 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Among adult patients, acupuncture should be recommended for aromatase inhibitor-related joint pain. Acupuncture or reflexology or acupressure may be recommended for general cancer pain or musculoskeletal pain. Hypnosis may be recommended to patients who experience procedural pain. Massage may be recommended to patients experiencing pain during palliative or hospice care. These recommendations are based on an intermediate level of evidence, benefit outweighing risk, and with moderate strength of recommendation. The quality of evidence for other mind-body interventions or natural products for pain is either low or inconclusive. There is insufficient or inconclusive evidence to make recommendations for pediatric patients. More research is needed to better characterize the role of integrative medicine interventions in the care of patients with cancer.Additional information is available at https://integrativeonc.org/practice-guidelines/guidelines and www.asco.org/survivorship-guidelines.
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Affiliation(s)
- Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Ting Bao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Debra Barton
- University of Michigan School of Nursing, Ann Arbor, MI
| | - Eran Ben-Arye
- Lin & Carmel Medical Centers, Clalit Health Services; Technion Faculty of Medicine, Haifa, Israel
| | - Eric L Garland
- College of Social Work, University of Utah, Salt Lake City, UT
| | | | | | - Richard T Lee
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Ana Maria Lopez
- Thomas Jefferson. Sidney Kimmel Cancer Center, Philadelphia, PA
| | | | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jodi MacLeod
- Patient Representative, Memorial Sloan Kettering Integrative Medicine Service, New York, NY
| | - Viraj A Master
- Winship Cancer Institute of Emory University, Atlanta, GA
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20
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Ben-Arye E, Samuels N, Kassem S. On Being a Stranger in a Foreign Land: Providing Integrative Oncology Therapies to COVID-19 Medical Professionals. Oncologist 2022; 27:e973-e975. [PMID: 36200861 PMCID: PMC9732254 DOI: 10.1093/oncolo/oyac201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 07/18/2022] [Indexed: 01/05/2023] Open
Abstract
This narrative describes an innovative program using integrative medicine therapies to improve the well-being of patients and providers in a hospital’s COVID-19 departments.
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Affiliation(s)
- Eran Ben-Arye
- Corresponding author: Eran Ben-Arye, MD, Integrative Oncology Program, Oncology Service, Lin Medical Center, 35 Rothschild Street, Haifa, Israel. Tel: +972 (5) 28709282; Fax: +972 (4) 8568249;
| | - Noah Samuels
- The Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sameer Kassem
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel,Internal Medicine Ward A, Carmel Medical Center, Haifa, Israel
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21
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Ben-Arye E, Hausner D, Samuels N, Gamus D, Lavie O, Tadmor T, Gressel O, Agbarya A, Attias S, David A, Schiff E. Impact of acupuncture and integrative therapies on chemotherapy-induced peripheral neuropathy: A multicentered, randomized controlled trial. Cancer 2022; 128:3641-3652. [PMID: 35960141 DOI: 10.1002/cncr.34422] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND To explore the impact of acupuncture with other complementary and integrative medicine (CIM) modalities on chemotherapy-induced peripheral neuropathy (CIPN) and quality of life (QoL) in oncology patients. METHODS In this prospective, pragmatic, and patient-preference study, patients with CIPN were treated with acupuncture and CIM therapies (intervention group) or standard care alone (controls) for 6 weeks. Patients in the intervention arm were randomized to twice-weekly acupuncture-only (group A) or acupuncture with additional manual-movement or mind-body CIM therapies (group B). Severity of CIPN was assessed at baseline and at 6 weeks using the Functional Assessment of Cancer Therapy-Taxane (FACT-Tax) tool. Other QoL-related outcomes were assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC); and the Measure Yourself Concerns and Well-being questionnaire. Von Frey measurements examined perception thresholds. RESULTS Of 168 participants, 136 underwent the study intervention (group A, 69; group B, 67), with 32 controls. Baseline-to-6-week assessment scores improved significantly in the intervention arm (vs controls) on FACT-Tax (p = .038) and emotional well-being (p = .04) scores; FACT-TAX scores for hand numbness/tingling (p = .007) and discomfort (p < .0001); and EORTC physical functioning (p = .045). Intervention groups A and B showed improved FACT-Tax physical well-being (p < .001), FACT-TAX total score (p < .001), FACT-TAX feet discomfort (p = .003), and EORTC pain (p = .017) scores. CONCLUSIONS Acupuncture, with or without CIM modalities, can relieve CIPN-related symptoms during oncology treatment. This is most pronounced for hand numbness, tingling, pain, discomfort, and for physical functioning.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin, Zebulun, and Carmel Medical Centers, Clalit Health Services, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - David Hausner
- Tal Center for Integrative Medicine, Institute of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel.,Palliative Care Service, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Shaarei Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dorit Gamus
- Tal Center for Integrative Medicine, Institute of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel.,Complementary and Integrative Medicine Service, Sheba Medical Center, Ramat-Gan, Israel
| | - Ofer Lavie
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
| | - Tamar Tadmor
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Unit of Hematology, Bnai Zion Medical Center, Haifa, Israel
| | - Orit Gressel
- Integrative Oncology Program, The Oncology Service, Lin, Zebulun, and Carmel Medical Centers, Clalit Health Services, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Abed Agbarya
- Integrative Oncology Program, The Oncology Service, Lin, Zebulun, and Carmel Medical Centers, Clalit Health Services, Haifa, Israel.,Institute of Oncology, Bnai Zion Medical Center, Haifa, Israel
| | - Samuel Attias
- Department of Internal Medicine & Integrative Medicine Service, Bnai-Zion, Medical Center, Haifa, Israel
| | - Adi David
- Palliative Care Service, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Elad Schiff
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Internal Medicine & Integrative Medicine Service, Bnai-Zion, Medical Center, Haifa, Israel
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22
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Samuels N, Shaham D, Schiff E, Ben-Yehuda D, Finkelstein A, Lesser L, Bergel M, Reis S, Ben-Arye E. From the "what" to the "how": Teaching integrative medicine-related skills to medical students during COVID-19. Patient Educ Couns 2022; 105:2256-2263. [PMID: 34756637 PMCID: PMC9180628 DOI: 10.1016/j.pec.2021.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/08/2021] [Accepted: 10/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To examine the impact of an integrative medicine (IM) course on self-perceived IM-related communication and research skills. METHODS A 3-day mandatory "hybrid" (online and in-person) IM course was held within COVID-19 restrictions for 161 pre-clerkship medical students, with workshops facilitated by mentor healthcare professionals (IM and non-IM) and student-directed tasks. Self-perceived levels of 6 IM-related skills were scored (from 1 to 5) for history-taking; communicating with patients with "alternative" health-beliefs; referral to IM consultations; assessing risks/benefits; and working with non-medical IM practitioners. RESULTS 137 students (85.1%) completed pre-/post-course questionnaires, with overall scores improving from pre-course (1.98 ± 0.92) to post-course (3.31 ± 0.63; p < 0.0001), for the entire group and student subgroups (with vs. without prior IM experience). Multivariate analysis found no association between age, gender, primary language or prior experience with IM and improvement in skill scores. CONCLUSIONS The IM course increased self-perceived skill levels, reflecting the course curriculum and workshops. Further research needs to explore the application of these skills during clinical training. PRACTICE IMPLICATIONS Teaching medical students about IM in a course comprising communication and research skills was shown to be feasible and effective. The application of IM-related skills needs to be evaluated during the clinical clerkship.
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Affiliation(s)
- Noah Samuels
- Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel.
| | - Dorith Shaham
- Hadassah Medical Center and Hebrew University Faculty of Medicine, Jerusalem, Israel; Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Elad Schiff
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Complementary Medicine Department, Bnai Zion Medical Center, Haifa, Israel
| | - Dina Ben-Yehuda
- Hadassah Medical Center and Hebrew University Faculty of Medicine, Jerusalem, Israel; Department of Hematology, Hadassah Medical Center, Jerusalem, Israel
| | - Adi Finkelstein
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
| | - Lior Lesser
- Center for Dignified End of Life, Hebrew University Hadassah School of Medicine, Jerusalem, Israel
| | - Michael Bergel
- Hebrew University Hadassah School of Medicine, Jerusalem, Israel
| | - Shmuel Reis
- Center for Medical Education, Hebrew University Hadassah School of Medicine, Jerusalem, Israel
| | - Eran Ben-Arye
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Lin, Carmel, and Zebulun Medical centers, Clalit Health Services, Haifa, Israel; Integrative Oncology Program, The Oncology Service, Carmel, and Zebulun Medical centers, Clalit Health Services, Haifa, Israel
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23
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Kassem S, Ben-Arye E. [CARING FOR HEALTHCARE PROVIDERS: A GLIMPSE INTO THE SOUL OF BATTLE LEADERS AT THE COVID-19 FRONTIER]. Harefuah 2022; 161:458-460. [PMID: 35833434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Sameer Kassem
- Department of Internal Medicine, Lady Davis Carmel Medical Center
- Rappport faculty of medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Eran Ben-Arye
- Rappport faculty of medicine, Technion, Israel Institute of Technology, Haifa, Israel
- Integrative Oncology Program, The oncology Service, Lin, Carmel, and Zebulon Medical Centers, Israel
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24
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Gentile D, Beeler D, Wang XS, Ben-Arye E, Zick SM, Bao T, Carlson LE, Ghelman R, Master V, Tripathy D, Zhi WI. Cancer-Related Fatigue Outcome Measures in Integrative Oncology: Evidence for Practice and Research Recommendations. Oncology (Williston Park) 2022; 36:276-287. [PMID: 35576178 DOI: 10.46883/2022.25920958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Cancer-related fatigue (CRF) is one of the most common symptoms across the cancer continuum and is often underreported and undertreated. Defined as a distressing, persistent, subjective sense of tiredness or exhaustion related to cancer or its treatment, CRF includes physical, emotional, cognitive, and spiritual dimensions. Patient-reported outcome (PRO) measures are the most widely used tool to screen for and assess fatigue and the associated negative impacts on quality of life. However, selecting subjective CRF measures can be complex. This has resulted in the availability of and inconsistent use of numerous PROs, limiting the ability to cross-compare outcomes clinically and within research. To address this, the PROs that are most widely reported in the literature are recommended to support the standardization of a core set of validated measures. The National Comprehensive Cancer Network single-item tool for clinical significance is recommended for quick use in clinical environments; the Brief Fatigue Inventory allows for fast, easy, helpful cutoffs on severity threshold for triage, and measures both severity and interference with daily functioning; while the MD Anderson Symptom Inventory allows for multisymptomatic assessment. In addition, a fundamental consideration for any PRO use is the administrative burden on the patient and clinician. In this review, we aim to summarize current, validated PROs specific to CRF to aid clinicians and researchers in patient care and in study design and implementation. We conclude with suggestions for future directions in CRF research that can increase the possibility for long-term impact on future guidelines of fatigue management.
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25
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Ben-Arye E, Gressel O, Samuels N, Stein N, Eden A, Vagedes J, Kassem S. Complementary and integrative medicine intervention in front-line COVID-19 clinicians. BMJ Support Palliat Care 2022:bmjspcare-2021-003333. [PMID: 35383045 PMCID: PMC9002254 DOI: 10.1136/bmjspcare-2021-003333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/08/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the impact of a multidisciplinary complementary and integrative medicine (CIM) intervention on physical and emotional concerns among front-line COVID-19 healthcare providers (HCPs). METHODS A multimodality CIM treatment intervention was provided by integrative practitioners to HCPs in three isolated COVID-19 departments. HCPs' two main concerns were scored (from 0 to 6) before and following the CIM intervention using the Measure Yourself Concerns and Wellbeing questionnaire. Postintervention narratives identified reflective narratives specifying emotional and/or spiritual keywords. RESULTS Of 181 HCPs undergoing at least one CIM treatment, 119 (65.7%) completed post-treatment questionnaires. While HCPs listing baseline emotional-related concerns benefited from the CIM intervention, those who did not express emotional or spiritual concerns improved even more significantly following the first session, for both leading concerns (p=0.038) and emotional-related concerns (p=0.023). Nevertheless, it was shown that following subsequent treatments HCPs who expressed emotional and spiritual concerns improved more significantly than those who did not for emotional-related concerns (p=0.017). CONCLUSIONS A CIM intervention for front-line HCPs working in isolated COVID-19 departments can significantly impact emotional-related concerns, more so after the first treatment and among HCPs not using emotional-spiritual keywords in post-treatment narratives. Referral of HCPs to CIM programmes for improved well-being should avoid referral bias to those not expressing emotional/spiritual concerns.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical centers, Clalit Health Services, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Orit Gressel
- Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical centers, Clalit Health Services, Haifa, Israel
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Shaarei Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nili Stein
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Arieh Eden
- Lady Davis Carmel Medical Center, Haifa, Israel
| | - Jan Vagedes
- Department of Pediatrics, University Hospital Tubingen, Tubingen, Germany
| | - Sameer Kassem
- Department of Internal Medicine, Lady Davis Carmel Medical Center, Haifa, Israel
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26
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Ben-Arye E, Nijk N, Lavie O, Gressel O, MD ES, Samuels N. Can integrative oncology increase adherence to chemotherapy in advanced gynecologic cancer? Support Care Cancer 2022; 30:4345-4354. [DOI: 10.1007/s00520-022-06865-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/24/2022] [Indexed: 11/30/2022]
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27
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Ben-Arye E, Finkelstein A, Samuels N, Ben-Yehuda D, Schiff E, Reis S, Lesser L, Bergel M, Shaham D. From skepticism to openness: a qualitative narrative analysis of medical students' attitudes following an integrative medicine course. Support Care Cancer 2022; 30:4789-4795. [PMID: 35142910 PMCID: PMC9046550 DOI: 10.1007/s00520-022-06888-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/30/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The present study aimed to explore attitudes of medical students following a course in integrative medicine (IM) focused on palliative and supportive cancer. METHOD Attitudes to IM among pre-clerkship medical students were assessed following a 3-day required course, which included interviews with international experts in IM and "hands-on" workshops mentored by IM and non-IM healthcare professionals. Student reflections were analyzed qualitatively, and written narratives were examined thematically. RESULTS Of 161 students, 102 (63.4%) provided post-course reflections. The main narrative themes included pre-course attitudes, attitude changes and influencing factors, and insights on implementing IM in clinical practice. Pre-course attitudes were predominantly skeptical, with post-course attitudes more open and non-judgmental, addressing research on IM effectiveness and safety. Students looked favorably on the implementation of IM in clinical practice and felt the course enhanced communication with patients. CONCLUSIONS Student attitudes to IM shifted following the course, from a skeptical to a more non-judgmental and accepting approach. IM course may facilitate a better understanding of the limitations and risks of IM practices, particularly in the supportive cancer care setting, as well as implications regarding students' own resilience and professional growth.
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Affiliation(s)
- Eran Ben-Arye
- grid.6451.60000000121102151Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel ,grid.414553.20000 0004 0575 3597Integrative Oncology Program, Clalit Health Services, & Carmel Medical Centers, LinHaifa, Zebulun Israel
| | - Adi Finkelstein
- grid.419646.80000 0001 0040 8485Faculty of Life and Health Sciences, Jerusalem College of Technology, Jerusalem, Israel ,grid.9619.70000 0004 1937 0538Faculty of Medicine, Hadassah-Hebrew University Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Noah Samuels
- grid.414505.10000 0004 0631 3825Center for Integrative Complementary Medicine, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dina Ben-Yehuda
- grid.9619.70000 0004 1937 0538Faculty of Medicine, Hadassah-Hebrew University Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Elad Schiff
- grid.6451.60000000121102151Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel ,grid.414529.fDepartment of Internal Medicine & Integrative Medicine Service, Bnai Zion Medical Center, Haifa, Israel
| | - Shmuel Reis
- grid.9619.70000 0004 1937 0538Faculty of Medicine, Hadassah-Hebrew University Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lior Lesser
- grid.9619.70000 0004 1937 0538Faculty of Medicine, Hadassah-Hebrew University Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Bergel
- grid.9619.70000 0004 1937 0538Faculty of Medicine, Hadassah-Hebrew University Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dorith Shaham
- grid.9619.70000 0004 1937 0538Faculty of Medicine, Hadassah-Hebrew University Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
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28
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Balneaves L, Ben-Arye E, Balneaves LG, Paller CJ, Lopez AM. The Society for Integrative Oncology Practice Recommendations for online consultation and treatment. Eur J Integr Med 2021. [DOI: 10.1016/j.eujim.2021.102028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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29
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Ben-Arye E, Zohar S, Keshet Y, Gressel O, Samuels N, Eden A, Vagedes J, Kassem S. Sensing the lightness: a narrative analysis of an integrative medicine program for healthcare providers in the COVID-19 department. Support Care Cancer 2021; 30:1419-1426. [PMID: 34528124 PMCID: PMC8442644 DOI: 10.1007/s00520-021-06546-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/03/2021] [Indexed: 02/13/2023]
Abstract
Objectives
The research addressing physical and emotional exhaustion among healthcare providers (HCPs) in COVID-19 departments is limited. We examined the impact of integrative medicine (IM) intervention for HCPs working in isolated COVID-19 in-patient departments, addressing concerns and well-being. Methods HCPs working in 3 isolated COVID-19 in-patient departments underwent 40-min IM treatment sessions (including acupuncture, manual movement, and/or mind–body modalities) provided by integrative oncology practitioners. The MYCAW (Measure Yourself Concerns and Well-being) questionnaire examined HCP concerns and free-text narratives following IM treatments. Data were qualitatively analyzed using ATLAS.Ti software for systematic coding. Results A total of 181 HCPs underwent 305 IM treatments. Narrative themes focused on physical symptoms (primarily pain and fatigue) and emotional concerns, including perceived communication barriers with patients, and reflections on well-being and insights following IM treatments. HCPs reported feeling a sense of “relief” which was likely related to the 3 main effects of the IM intervention: a sense of “being cared for” and treated; experiencing emotional, sometimes spiritual effects of the treatment; and the feeling of relaxation, combined with the relief of pain. Qualitative analysis identified clusters of emotional and spiritual-related keywords such as “calming,” “release,” “relaxation,” and “disengagement” following the first IM session (119 of 181 narratives, 65.7%). Conclusions HCPs working in isolated COVID-19 departments reported improved well-being and the addressing of their concerns following IM treatment sessions provided during their work shift. Further research is needed to explore the impact of IM on HCP burnout and resilience in palliative care settings.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, 35 Rothschild St., Haifa, Israel. .,Ruth and Bruch Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Shaked Zohar
- Ruth and Bruch Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yael Keshet
- Department of Sociology, Western Galilee Academic College, Galilee, Israel
| | - Orit Gressel
- Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, 35 Rothschild St., Haifa, Israel.,Ruth and Bruch Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Shaarei Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Arieh Eden
- Ruth and Bruch Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Depatment of Anesthesiology, Critical Care and Pain Medicine, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Jan Vagedes
- ARCIM Institute, Research Institute, Filderstadt, Germany.,Department of Neonatology, University Hospital Tuebingen, University Tuebingen, Tuebingen, Germany
| | - Sameer Kassem
- Ruth and Bruch Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Internal Medicine, Lady Davis Carmel Medical Center, Haifa, Israel
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30
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Ben-Arye E, Elly M, Gressel O, Reshef A, Shani Md M, Stein N, Saliba W, Samuels N. Exploring the effectiveness of a patient-tailored integrative oncology program on emotional distress during chemotherapy for localized cancer. Psychooncology 2021; 31:207-218. [PMID: 34435403 DOI: 10.1002/pon.5794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/25/2021] [Accepted: 08/11/2021] [Indexed: 01/06/2023]
Abstract
STUDY OBJECTIVE There is a need to explore how patient-tailored integrative oncology (IO) programs reduce emotional distress. This study set out to bridge the IO research gap between non-specific, quality of life-related and specific emotional-related concerns in chemotherapy-treated patients. METHODS This pragmatic, prospective and preference-controlled study examined patients attending an integrative-physician consultation and weekly IO treatments during adjuvant/neo-adjuvant chemotherapy for localized cancer. Patients choosing to attend ≥4 IO sessions (highly adherent to integrative care, AIC) were compared to low AIC patients using the ESAS (Edmonton Symptom Assessment Scale) anxiety, depression and sleep; and the EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) emotional functioning scale, at baseline, 6 and 12 weeks. Emotional distress was assessed by ESAS anxiety and depression, considered as the primary study outcomes. RESULTS Of 439 participants, 260 (59%) were high-AIC and 179 low-AIC, both with similar baseline demographic and cancer-related characteristics. At 6 weeks, high-AIC patients reported greater improvement on ESAS sleep (p = 0.044); within-group improvement on ESAS anxiety and; and EORTC emotional functioning. Compared with low-AIC, high-AIC patients showed greater improvement on ESAS depression (p = 0.022) and sleep (p = 0.015) in those with high baseline ESAS anxiety scores (≥7); and ESAS anxiety (p = 0.049) for patients moderately anxious (4-6) at baseline. CONCLUSIONS High-AIC was associated with significantly reduced anxiety, depression and sleep severity at 6 weeks, especially those with high-to-moderate baseline anxiety levels. These findings reduce the research gap, suggesting specific emotional-related effects of IO.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, Haifa, Israel.,Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Maya Elly
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Orit Gressel
- Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, Haifa, Israel.,Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Alon Reshef
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Psychiatry Department, Ha'Emek Medical Center, Haifa, Israel
| | - Michal Shani Md
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Clalit Health Service, Rehovot, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nili Stein
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Walid Saliba
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Noah Samuels
- The Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Ben-Arye E, Keshet Y, Schiff A, Zollman C, Portalupi E, Nave R, Shaham D, Samuels N, Schiff E. From COVID-19 adversity comes opportunity: teaching an online integrative medicine course. BMJ Support Palliat Care 2021:bmjspcare-2020-002713. [PMID: 34266910 DOI: 10.1136/bmjspcare-2020-002713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 06/22/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND We examine the impact of a 5-day online elective course in integrative medicine (IM) taking place during the COVID-19 pandemic, attended by 18 medical students from two faculties of medicine in Israel. METHODS The course curriculum addressed effectiveness and safety of IM practices highlighting supportive and palliative care, demonstrated the work of integrative physicians (IPs) in designing patient-tailored treatments and taught practical skills in communication regarding IM. Group discussions were conducted via Zoom with 32 physicians, healthcare practitioners and IM practitioners working in integrative academic, community and hospital-based settings, in Israel, Italy, UK and Germany. An 18-item questionnaire examined student attitudes and perceived acquisition of skills for implementing what was learned in clinical practice. Student narratives were analysed using ATLAS.Ti software for systematic coding, identifying barriers and advantages of the online learning methodology. RESULTS Students reported a better understanding of the benefits of IM for specific outcomes (p=0.012) and of potential risks associated with these therapies (p=0.048). They also perceived the acquisition of skills related to the IM-focused history (p=0.006), learnt to identify effectiveness and safety of IM treatments (p=0.001), and internalised the referral to IPs for consultation (p=0.001). Student narratives included reflections on the tools provided during the course for assessing effectiveness and safety, enhancing communication with patients, enriching their patient-centred perspective, raising awareness of available therapeutic options, and personal and professional growth. CONCLUSIONS Online clinical electives in IM are feasible and can significantly increase students' awareness and modify attitudes towards acquirement of patient-centred perspectives.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, Oncology Service, Clalit Health Services, Haifa, Israel
- Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Yael Keshet
- Department of Sociology and Anthropology, Western Galilee College, Akko, Israel
| | - Ariel Schiff
- Ben-Gurion University of the Negev, Beer Sheba, Israel
| | | | - Emanuela Portalupi
- Associazione Italiana di Ricerche e Studi per la Medicina Antroposofica (ARESMA), Milano, Italy
| | - Rachel Nave
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Dorith Shaham
- Hadassah Medical Center and Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Elad Schiff
- Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Department of Internal Medicine, Bnei Zion Medical Centre, Haifa, Israel
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Ben-Arye E, Yakubov Y, Samuels N, Gressel O, Yosipovich A, Schiff E, Ophir M, Saliba W, Dagash J. Impact of a combined integrative oncology and palliative care program on quality of life of patients with advanced cancer. Med Oncol 2021; 38:93. [PMID: 34241706 DOI: 10.1007/s12032-021-01544-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Abstract
Many oncology centers provide integrative oncology (IO) care, many within palliative care settings. The primary study objective was to examine the impact of IO-palliative patient-tailored program on quality of life (QoL) among patients with advanced cancer. In this pragmatic prospective controlled study, patients with advanced cancer undergoing chemotherapy/palliative care were referred by their oncology healthcare providers to an integrative physician (IP) consultation and weekly IO treatments. Patients with high adherence to integrative care (AIC; ≥ 4 IO sessions/6 weeks) were compared with moderate (2-3 sessions) or low AIC patients (regarded as control group). Outcomes were assessed at 6- and 12-week follow-up with Edmonton Symptom Assessment Scale (ESAS) and EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) tools. Change in QoL scores (ESAS fatigue in particular) was considered a primary study outcome. Of 225 eligible patients, 153 underwent baseline and 6-week optimal assessment (high AIC, 100; moderate AIC, 22; low AIC, 31). High AIC patients reported greater improvement on ESAS scores for fatigue (vs. low-moderate AIC, P < 0.001), depression (vs. moderate AIC, P = 0.01) at 6 weeks, and sleep (P = 0.007) at 12 weeks. High AIC patients had significantly improved EORTC global health status/QoL at 6 weeks (vs. moderate-low AIC, P = 0.01), cognitive functioning (vs. moderate AIC, P = 0.043), and social functioning (vs. moderate AIC, P = 0.032). High AIC patients had lower rates of hospitalizations at 12 weeks (19% vs. 35% in low AIC, P = 0.02; 44% in moderate AIC, P = 0.003), hospitalization days (vs. low AIC, P = 0.003), and opioid use (vs. low AIC, P < 0.001). High adherence to integrative care was associated with a significant effect on fatigue, depression, global QoL at 6 weeks, and need for hospitalizations at 12 weeks.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, 35 Rothschild St., Haifa, Israel. .,Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Yonatan Yakubov
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Orit Gressel
- Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, 35 Rothschild St., Haifa, Israel.,Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Elad Schiff
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Internal Medicine & Integrative Medicine Service, Bnai-Zion Hospital, Haifa, Israel
| | - Mattan Ophir
- Palliative Care Service, Carmel Medical Center, Haifa, Israel
| | - Walid Saliba
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Jamal Dagash
- Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, 35 Rothschild St., Haifa, Israel.,Palliative Care - Home Care Hospice, Clalit Health Services, Haifa and Western Galilee District, Haifa, Israel
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Ben-Arye E, Paller CJ, Lopez AM, White S, Pendleton E, Kienle GS, Samuels N, Abbawaajii N, Balneaves LG. The Society for Integrative Oncology Practice Recommendations for online consultation and treatment during the COVID-19 pandemic. Support Care Cancer 2021; 29:6155-6165. [PMID: 33852088 PMCID: PMC8044504 DOI: 10.1007/s00520-021-06205-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/05/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The Society for Integrative Oncology (SIO) Online Task Force was created in response to the challenges facing continuity of integrative oncology care resulting from the COVID-19 pandemic. The Task Force set out to guide integrative oncology practitioners in providing effective and safe online consultations and treatments for quality-of-life-concerns and symptom management. Online treatments include manual, acupuncture, movement, mind-body, herbal, and expressive art therapies. METHODS The SIO Online Practice Recommendations employed a four-phase consensus process: (1) literature review and discussion among an international panel of SIO members, identifying key elements essential in an integrative oncology visit; (2) development, testing, and refinement of a questionnaire defining challenges and strategies; (3) refinement input from integrative oncology experts from 19 countries; and (4) SIO Executive Committee review identifying the most high-priority challenges and strategies. RESULTS The SIO Online Practice Recommendations address ten challenges, providing practical suggestions for online treatment/consultation. These include overcoming unfamiliarity, addressing resistance among patients and healthcare practitioners to online consultation/treatment, exploring ethical and medical-legal aspects, solving technological issues, preparing the online treatment setting, starting the online treatment session, maintaining effective communication, promoting specific treatment effects, involving the caregiver, concluding the session, and ensuring continuity of care. CONCLUSIONS The SIO Online Practice Recommendations are relevant for ensuring continuity of care beyond the present pandemic. They can be implemented for patients with limited accessibility to integrative oncology treatments due to geographic constraints, financial difficulties, physical disability, or an unsupportive caregiver. These recommendations require further study in practice settings.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, Lin, Zebulon, & Carmel Medical Centers, Clalit Health Services; Faculty of Medicine, Technion - Israel Institute of Technology, 35 Rothschild St, Haifa, Israel.
| | | | - Ana Maria Lopez
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Shelley White
- Wellness and Integrative Health Center, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Eva Pendleton
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gunver S Kienle
- Center for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.,Institute for Applied Epistemology and Medical Methodology, University of Witten/Herdecke, Freiburg, Germany
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Shaarei Zedek Medical Center, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nuria Abbawaajii
- College of Nursing, University of Manitoba, Winnipeg, MB, Canada
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Dan A, Attias S, Woitiz R, Arnon Z, Keshet Y, Ben-Arye E, Schiff E. Patterns of patient reluctance to receive complementary-medicine treatments in a hospital setting: A cross-sectional study. Complement Ther Med 2021; 58:102694. [PMID: 33639252 DOI: 10.1016/j.ctim.2021.102694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/03/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE We aim to characterize the patient population that exhibits reluctance to undergo complementary medicine (CM) treatments in a hospital setting. METHODS We conducted a cross-sectional prospective study among patients prior to hospitalization using structured questionnaires in a single center in Israel. Participants were asked to rate their degree of consent to receiving CM treatments during hospitalization. RESULTS The CM-reluctant group was 7.1 % of the study cohort. The CM modalities most commonly refused were spiritual guidance, acupuncture, and energy and healing therapies. The CM-reluctant population showed a weaker relation to spiritual content and tended to value complementary medicine's effectiveness less in comparison to the CM-consenting group. The main reason for reluctance was skepticism of the perceived effectiveness of CM. CONCLUSIONS With skepticism playing a major role in decision making, we should question whether the Stakeholders in the field of CM and public health services are succeeding in explaining the benefits and risks of CM treatments.
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Affiliation(s)
- Asaf Dan
- Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel; Complementary and Integrative Medicine Service, Bnai-Zion Medical Center, Haifa, Israel.
| | - Samuel Attias
- Complementary and Integrative Medicine Service, Bnai-Zion Medical Center, Haifa, Israel; School of Public Health, University of Haifa, Haifa, Israel.
| | - Rachel Woitiz
- Complementary and Integrative Medicine Service, Bnai-Zion Medical Center, Haifa, Israel.
| | - Zahi Arnon
- Complementary and Integrative Medicine Service, Bnai-Zion Medical Center, Haifa, Israel; Yezreel Valley Academic College, Emek Yezreel, Israel.
| | - Yael Keshet
- Yezreel Valley Academic College, Emek Yezreel, Israel.
| | - Eran Ben-Arye
- Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel; Integrative Oncology Program, Haifa and Western Galilee Oncology Service, Lin and Carmel Medical Centers, Clalit Health Services.
| | - Elad Schiff
- Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel; Complementary and Integrative Medicine Service, Bnai-Zion Medical Center, Haifa, Israel; Internal Medicine Department B, Bnai-Zion Medical Center, Haifa, Israel.
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Abstract
Integrative physicians (IPs) working in supportive and palliative care are often consulted about the use of herbal medicine for disease-related outcomes. We examined 150 electronic files of oncology patients referred to an IP consultation for demographic and cancer-related data; use of herbal medicine for disease-related outcomes; and narratives of patients and informal caregivers describing their expectations from the IP consultation. Over half (51.3%) of patients reported using herbal medicine for disease-related outcomes, more so among those adopting dietary changes for this goal (P < .005). Most (53.3%) were accompanied by an informal caregiver, especially those using herbal medicine (66.2%, P = .002) or adopting dietary changes (69.8%, P < .001). The majority of patients (84.4%) expected the IP to provide guidance on the use of herbal medicine for disease-related outcomes (e.g., "curing," "shrinking," "eradicating" and "cleansing"). Most caregivers (88.8%) expressed a similar expectation, with some having additional questions not mentioned by the patient. IPs need to identify and understand expectations of oncology patients and their informal caregivers, helping them make informed decisions on the effective and safe use of herbal medicine. The IP may need to "reframe" expectations regarding the ability of herbal medicine to treat cancer and immunity, to more realistic quality of life-focused goals.
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Affiliation(s)
- Noah Samuels
- Shaare Zedek Medical Center, Jerusalem, Israel.,Tel Aviv University, Tel Aviv, Israel
| | | | - Eran Ben-Arye
- Clalit Health Services, Haifa, Israel.,Technion-Israel Institute of Technology, Haifa, Israel
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Ben-Arye E, Keshet Y, Gressel O, Tapiro Y, Lavie O, Samuels N. Being in touch: narrative assessment of patients receiving online integrative oncology treatments during COVID-19. Support Care Cancer 2021; 29:4819-4825. [PMID: 33538895 PMCID: PMC7859467 DOI: 10.1007/s00520-021-06026-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/21/2021] [Indexed: 11/26/2022]
Abstract
Objective We examined the qualitative impact of an online integrative oncology (IO) treatment program, designed in response to the restrictions created by the current COVID-19 pandemic. Methods Patients undergoing chemotherapy were seen by an integrative physician (IP), together co-designing an IO treatment program of ≥ 6 weekly treatments to alleviate symptoms and improve quality of life (QoL). IO practitioners guided patients and their caregivers online in self-treatment with manual/touch, movement, and/or mind-body modalities. Narratives of both patients and IO practitioners were analyzed for systematic coding, identifying barriers and advantages of the online treatment program. Results Narratives obtained from 30 patients and eight IO-trained practitioners were examined. The patients had undergone 169 online IO sessions with a total of 327 IO interventions during the 3-month study period. Patient narratives included reflections on both non-specific effects (e.g., less of a “sense of isolation”) and specific QoL-related outcomes with the online intervention. IO practitioner narratives focused on barriers to providing manual-movement and mind-body modalities, suggesting practical recommendations on how to address specific QoL-related outcomes using the online IO “toolbox.” Conclusions Effective online IO practitioner-guided treatments are feasible and may induce both specific and non-specific QoL-related effects. Future research needs to explore online IO interventions for additional situations in which access to IO care is limited.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, 35 Rothschild St, Haifa, Israel.
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Yael Keshet
- Department of Sociology and Anthropology, Western Galilee Academic College, Galilee, Israel
| | - Orit Gressel
- Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, 35 Rothschild St, Haifa, Israel
| | - Yehudit Tapiro
- Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, 35 Rothschild St, Haifa, Israel
| | - Ofer Lavie
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Obstetrics and Gynecology Carmel Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Shaarei Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Ben-Arye E, Portalupi E, Keshet Y, Bonucci M, Can G, Kading Y, Samuels N, Livas M, Gressel O, Silbermann M, Breitkreuz T. Enhancing Palliative Care With Mindful Touch: Impact of a Manual and Movement Therapy Training Program in an International Multidisciplinary Integrative Oncology Setting. J Pain Symptom Manage 2021; 61:229-236. [PMID: 32795608 DOI: 10.1016/j.jpainsymman.2020.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/01/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
CONTEXT Manual and movement therapies (MMTs) play a central role in the integrative oncology setting, significantly improving patients' quality of life (QOL). Despite research supporting the effectiveness and safety of these modalities, most oncology health care providers (HCPs) lack any MMT training. OBJECTIVES In this study, we examine the impact of an MMT-based integrative oncology training program with the participation of an international and multidisciplinary group of oncology HCPs. The feasibility of implementing these skills in palliative cancer care is examined. METHODS A three-day evidence-based hands-on teaching program was designed to train oncology HCPs working in supportive cancer care MMT modalities from traditional Chinese and anthroposophic medicine. Prequalitative and postqualitative assessments of the trainees' narratives were analyzed using ATLAS.Ti software (Scientific Software Development GmbH, Berlin, Germany) for systematic coding. RESULTS The training program was attended by 30 participants from Israel (15), Germany (7), Italy (6), Turkey (1), and Cyprus (1). The group included 13 nurses, 10 physicians, 6 complementary/integrative HCPs, and 1 psycho-oncologist. The pretraining expectations that were met at post-training included gaining knowledge and practical QOL-oriented skills, which could be implemented in the palliative and supportive care setting. A significant change in the attitude of trainees to touch therapy was also identified, with respondents seeing MMTs promoting patient-centered palliative care, including nonverbal communication. CONCLUSION An MMT training program for oncology HCPs for QOL-related indications is both feasible and likely to be implemented in palliative and supportive cancer care. Nonspecific effects of MMTs were also recognized for their ability to facilitate patient-centered care.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, Lin, Zebulon & Carmel Medical Centers, Clalit Health Services, Haifa, Israel; Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Middle East Research Group in Integrative Oncology (MERGIO), Middle East Cancer Consortium, Haifa, Israel.
| | - Emanuela Portalupi
- Associazione Italiana di Ricerche e Studi per la Medicina Antroposofica (ARESMA), Milan, Italy; Association Research on Integrative Oncology Therapies (A.R.T.O.I.), Rome, Italy
| | - Yael Keshet
- Department of Sociology and Anthropology, Western Galilee Academic College, Galilee, Israel
| | - Massimo Bonucci
- Association Research on Integrative Oncology Therapies (A.R.T.O.I.), Rome, Italy
| | - Gulbeyaz Can
- Florence Nightingale Nursing Faculty, Istanbul University, Cerrahpasa, Istanbul, Turkey
| | - Yolanda Kading
- Cyprus Association of Cancer Patients and Friends (PASYKAF), Nicosia, Cyprus
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Shaarei Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Maria Livas
- Staedtisches Klinikum Karlsruhe and Paracelsus-Krankenhaus, Bad Liebenzell, Germany
| | - Orit Gressel
- Integrative Oncology Program, Lin, Zebulon & Carmel Medical Centers, Clalit Health Services, Haifa, Israel
| | - Michael Silbermann
- Middle East Research Group in Integrative Oncology (MERGIO), Middle East Cancer Consortium, Haifa, Israel
| | - Thomas Breitkreuz
- Staedtisches Klinikum Karlsruhe and Paracelsus-Krankenhaus, Bad Liebenzell, Germany; Die Filderklinik, Stuttgart/Paracelsus-Krankenhaus, Bad Liebenzell, Germany; International Federation of Anthroposophic Medical Associations (IVAA), Brussels, Belgium
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Ben-Arye E, Gressel O, Ben-Arye E, Samuels N. Feasibility of an Online Integrative Oncology Treatment Program During COVID-19. J Pain Symptom Manage 2021; 61:e1-e3. [PMID: 33189855 PMCID: PMC7659922 DOI: 10.1016/j.jpainsymman.2020.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service; Lin, Carmel, and Zebulun Medical centers, Clalit Health Services, Haifa, Israel
| | - Orit Gressel
- Integrative Oncology Program, The Oncology Service; Lin, Carmel, and Zebulun Medical centers, Clalit Health Services, Haifa, Israel.
| | - Eran Ben-Arye
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Shaarei Zedek Medical Center, Israel; Faculty of Medicine, Tel-Aviv University, Israel
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Ben-Arye E, Elly D, Samuels N, Gressel O, Shulman K, Schiff E, Lavie O, Minerbi A. Effects of a patient-tailored integrative oncology intervention in the relief of pain in palliative and supportive cancer care. J Cancer Res Clin Oncol 2021; 147:2361-2372. [PMID: 33433656 DOI: 10.1007/s00432-020-03506-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/14/2020] [Indexed: 12/29/2022]
Abstract
CONTEXT AND OBJECTIVES The present study examined the impact of an integrative oncology treatment program in the relief of pain in patients undergoing chemotherapy and/or palliative care. METHODS In this pragmatic prospective controlled study, patients undergoing chemotherapy and/or palliative care were referred by their oncology healthcare providers to an integrative physician (IP) consultation, followed by weekly integrative treatments. Patients attending ≥ 4 sessions during the first 6 weeks of the study were considered to be highly adherent to integrative care (AIC). Pain was assessed at baseline and at 6 and 12 weeks using the ESAS (Edmonton Symptom Assessment Scale) and EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) tools. RESULTS Of 815 eligible patients, 484 (59.4%) were high-AIC and 331 low-AIC. Mean pain scores decreased significantly from baseline to 6 and 12 weeks in both groups. However, ESAS and EORTC pain scores improved significantly more in the high-AIC group at 6 weeks (p= 0.008), though not at 12 weeks. Between-group analysis of participants undergoing adjuvant/neo-adjuvant chemotherapy showed higher pain reduction in the high-AIC group at 6 weeks (ESAS, p = 0.006; EORTC, p = 0.046), as was the case with patients receiving palliative care (ESAS p = 0.04; EORTC p = 0.056). CONCLUSIONS High adherence to integrative care was found to be associated with a greater effect on pain relief at 6 weeks but not at 12 weeks in patients undergoing chemotherapy and/or palliative care.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, 35 Rothschild St, Haifa, Israel.
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Dana Elly
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Shaarei Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Orit Gressel
- Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, 35 Rothschild St, Haifa, Israel
| | - Katerina Shulman
- The Oncology Service, Lin and Zebulun Medical Centers, Clalit Health Services, Haifa, Israel
| | - Elad Schiff
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Internal Medicine and Integrative Medicine Service, Bnai-Zion, Hospital, Haifa, Israel
| | - Ofer Lavie
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Obstetrics and Gynecology Carmel Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Amir Minerbi
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Institute for Pain Medicine, Rambam Health Campus, Haifa, Israel
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Gressel Raz O, Samuels N, Levy M, Leviov M, Lavie O, Ben-Arye E. Association Between Physical Activity and Use of Complementary Medicine by Female Oncology Patients in an Integrative Palliative Care Setting. J Altern Complement Med 2020; 26:721-728. [DOI: 10.1089/acm.2019.0437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Orit Gressel Raz
- Integrative Oncology Program, The Oncology Service, Lin and Carmel Medical Centers, Clalit Health Services, Haifa, Israel
- Clalit Complementary Medicine, Haifa, Israel
| | - Noah Samuels
- The Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moti Levy
- Clalit Complementary Medicine, Haifa, Israel
| | - Michelle Leviov
- Integrative Oncology Program, The Oncology Service, Lin and Carmel Medical Centers, Clalit Health Services, Haifa, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Gynecologic Oncology Service, Carmel Medical Center, Haifa, Israel
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin and Carmel Medical Centers, Clalit Health Services, Haifa, Israel
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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41
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Ben-Sasson M, Levy I, Ben-Arye E, Attias S, Schiff E. Dietary and herbal supplements use among patients hospitalized in internal medicine departments. Complement Ther Med 2020; 50:102345. [PMID: 32444039 DOI: 10.1016/j.ctim.2020.102345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/22/2020] [Accepted: 02/11/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To assess consumption of dietary and herbal supplements (DHS) among patients in internal medicine departments and determine whether such use is documented in their medical files. METHODS 267 patients from three internal medicine departments of an academic medical center in Haifa, Israel were assessed prospectively with questionnaires about their DHS use in the month preceding hospitalization. DHS were categorized into vitamins & minerals, herbal supplements and others. Further data was then collected from patients' medical records on socio-demographic and medical characteristics, as well as documentation of DHS use. RESULTS 123 patients (50.6 %) used DHS on a daily basis. Most of them (53.7 %) were using more than one DHS. DHS use was more prevalent in older (OR = 1.02 [1.001-1.036], p = 0.034) and educated (OR = 0.482 [0.252-0.923], p = 0.028) patients. Vitamins & minerals were used mainly to enhance vitality and address laboratory abnormalities, whereas herbal supplements were used mainly for gastrointestinal problems (p < 0.001). DHS use was reported to the physicians by 42 % of the patients, mostly at the patients' initiative [92 (82.1 %), p < 0.001)]. Vitamins and minerals were the most reported category of DHS (94 (57.3 %), p < 0.001). The use of DHS was reported to physicians for 112 DHS (41.8 %) but only 32 DHS (11.9 %) were documented in their medical files. The documentation of vitamins and minerals was significantly higher compared to herbal supplements documentation (29 (17.7 %) & 3 (2.9 %) respectively, P < 0.001). CONCLUSIONS DHS are commonly used by patients hospitalized in the internal medicine departments. Many patients do not report such use to the physicians, and more strikingly, physicians do not document DHS use in patient medical files. This communication gap may have serious medico-legal ramifications due to DHS side effects and DHS interactions with other DHS and with conventional drugs.
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Affiliation(s)
- M Ben-Sasson
- Internal B Medicine Department, Israel; Complementary Medicine Service, BnaiZion Medical Center, Haifa, Israel; Faculty of Medicine, Technion- IsraelInstitute of Technology, Haifa, Israel.
| | - I Levy
- Internal B Medicine Department, Israel; Complementary Medicine Service, BnaiZion Medical Center, Haifa, Israel; Faculty of Medicine, Technion- IsraelInstitute of Technology, Haifa, Israel
| | - E Ben-Arye
- Faculty of Medicine, Technion- IsraelInstitute of Technology, Haifa, Israel; Integrative Oncology Program, Oncology Service, Lin Medical Center, ClalitHealth Services, Haifa, Israel
| | - S Attias
- Complementary Medicine Service, BnaiZion Medical Center, Haifa, Israel; School of Public Health, University of Haifa, Israel
| | - E Schiff
- Internal B Medicine Department, Israel; Complementary Medicine Service, BnaiZion Medical Center, Haifa, Israel; Faculty of Medicine, Technion- IsraelInstitute of Technology, Haifa, Israel
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Abstract
PURPOSE OF REVIEW Chemotherapy-induced peripheral neuropathy (CIPN) is a common complication of cancer treatment, with conventional treatment limited in its ability for prevention or treatment of symptoms. This review addresses the research assessing the effectiveness and safety of complementary and integrative medicine (CIM) in preventing and treating CIPN-related symptoms. RECENT FINDINGS The CIM modalities acupuncture, classical massage, omega-3 fatty acids, and the Japanese Kampo medicine Goshanjishen may be of benefit in preventing or treating CIPN. Vitamin E (alpha-tocopherol), glutamine/glutamate, alpha-lipoic acid, and acetyl-L-carnitine (ALCAR) are not, with ALCAR increasing symptom severity and vitamin E the risk for developing prostate cancer. CIM therapies with a potential for preventing or treating CIPN-related symptoms should be further investigated. CIM is considered safe when provided within an integrative oncology setting, under the guidance and supervision of an integrative physician.
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Affiliation(s)
- Noah Samuels
- Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, 12 Shmuel Bait St., PO Box 3235, 9103102, Jerusalem, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Eran Ben-Arye
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Integrative Oncology Program, The Oncology Service, Lin, Zebulun and Carmel Medical Centers, Clalit Health Services, Haifa and Western Galilee District, Haifa, Israel
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Mühlenpfordt I, Stritter W, Bertram M, Ben-Arye E, Seifert G. The power of touch: external applications from whole medical systems in the care of cancer patients (literature review). Support Care Cancer 2020; 28:461-471. [PMID: 31781950 DOI: 10.1007/s00520-019-05172-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 11/05/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE In the context of whole medical systems (WMSs), external applications are manual treatments that stem from complementary medicine and are performed by practitioners, nurses and caregivers through the application of interpersonal touch. These applications work via physiological, psychological and social processes and are intended for holistic healing. In integrative oncology, these applications are used to improve patients' wellbeing. The purpose of the review is to collect and compare research results concerning external applications from WMSs applied to patients with cancer. METHODS We conducted a literature review to explore the effects of external applications on patients undergoing cancer treatment. Inclusion criteria were external applications from Anthroposophic Medicine, Traditional Chinese Medicine (TCM) and Ayurvedic Medicine, examined detached from the effect interdependencies of their respective WMSs. RESULTS Searches identified 111 publications. Final inclusions were four Shiatsu studies (from TCM), supplemented by two case reports exploring anthroposophic external applications. The literature review suggests that external applications may improve patients' wellbeing during cancer treatment and are associated with physical and psychological effects that potentially enhance supportive cancer care. The number and quality of published studies in the field is limited. CONCLUSIONS Future empirical investigations should assess the effectiveness and underlying effects in patients with cancer, adhere to a patient-tailored approach, and investigate the systemic complexity of touch-based applications from WMSs.
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Affiliation(s)
- Inga Mühlenpfordt
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Wiebke Stritter
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Mathias Bertram
- Doerthe-Krause-Institute for Nursing Science and Education, Gemeinschaftskrankenhaus Herdecke gGmbH, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany
| | - Eran Ben-Arye
- Integrative Oncology Program, Haifa and Western Galilee Oncology Service, Lin and Carmel Medical Centers, Clalit Health Services, Tel Aviv-Yafo, Israel.,The Bruce Rappaport Faculty of Medicine, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Georg Seifert
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Bar-Sela G, Schultz MJ, Elshamy K, Rassouli M, Ben-Arye E, Doumit M, Gafer N, Albashayreh A, Ghrayeb I, Turker I, Ozalp G, Kav S, Fahmi R, Nestoros S, Ghali H, Mula-Hussain L, Shazar I, Obeidat R, Punjwani R, Khleif M, Can G, Tuncel G, Charalambous H, Faraj S, Keoppi N, Al-Jadiry M, Postovsky S, Al-Omari M, Razzaq S, Ayyash H, Khader K, Kebudi R, Omran S, Rasheed O, Qadire M, Ozet A, Silbermann M. Correction to: Human Development Index and its association with staff spiritual care provision: a Middle Eastern oncology study. Support Care Cancer 2019; 27:3611-3612. [PMID: 31016423 DOI: 10.1007/s00520-019-04798-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Incorrect family name of Layth Mula-Hussain.
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Affiliation(s)
- Gil Bar-Sela
- Cancer Center, Emek Medical Center, Afula, Israel.
| | | | - Karima Elshamy
- Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Maryam Rassouli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Eran Ben-Arye
- The Oncology Service, Lin Medical Center, Haifa, Israel
| | - Myrna Doumit
- Alice Ramez Chagoury School of Nursing, Lebanese American University, Beirut, Lebanon
| | - Nahla Gafer
- Radiation and Isotope Center, Khartoum, Sudan
| | - Alaa Albashayreh
- College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Ibtisam Ghrayeb
- Makassed Charitable Hospital, Bethlehem, West Bank, Palestine
| | - Ibrahim Turker
- Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Gulcin Ozalp
- Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Sultan Kav
- Faculty of Health Sciences, Department of Nursing, Baskent University, Ankara, Turkey
| | | | - Sophia Nestoros
- Cyprus Anti-Cancer Society, Avodaphnousa Hospice, Nicosia, Cyprus
| | - Hasanein Ghali
- Children's Welfare Teaching Hospital, Baghdad College of Medicine, Baghdad, Iraq
| | | | - Ilana Shazar
- Department of Hematology, Rambam Health Care Campus, Haifa, Israel
| | - Rana Obeidat
- Faculty of Nursing, Zarqa University, Zarqa, Jordan
| | | | - Mohamad Khleif
- Al-Sadeel Society for Palliative Care, Bethlehem, West Bank, Palestine
| | - Gulbeyaz Can
- Florence Nightingale Faculty of Nursing, Istanbul University, Istanbul, Turkey
| | - Gonca Tuncel
- Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | | | - Safa Faraj
- Children's Welfare Teaching Hospital, Baghdad College of Medicine, Baghdad, Iraq
| | | | - Mazin Al-Jadiry
- Children's Welfare Teaching Hospital, Baghdad College of Medicine, Baghdad, Iraq
| | - Sergey Postovsky
- Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | | | - Samaher Razzaq
- Children's Welfare Teaching Hospital, Baghdad College of Medicine, Baghdad, Iraq
| | - Hani Ayyash
- European Khan Yunis Hospital, Khan Yunis, Gaza Strip, Palestine
| | | | - Rejin Kebudi
- Cerrahpasa Medical Faculty & Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Suha Omran
- Faculty of Nursing, Jordan University for Science and Technology, Irbid, Jordan
| | - Osaid Rasheed
- Abu Dis and Al-Ahli Hospital, Al Quds University, Hebron, West Bank, Palestine
| | | | - Ahmet Ozet
- Tibbi Onkoloji Bilim Dali, Gazi Universitesi Tip Fakultesi, Ankara, Turkey
| | - Michael Silbermann
- Middle East Cancer Consortium and Technion-Israel Institute of Technology, Haifa, Israel
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Levy I, Attias S, Gavrieli S, Oliven R, Neerland BE, Devlin JW, Ben-Arye E, Greenberg D, Schiff E. The study protocol for a randomized, controlled trial of acupuncture versus a sham procedure versus standard care alone for the treatment of delirium in acutely hospitalized older adults with a medical illness. Maturitas 2019; 124:72-80. [PMID: 31097183 DOI: 10.1016/j.maturitas.2019.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/13/2019] [Accepted: 03/02/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Many hospitalized older adults experience delirium, but treatment options are limited. Acupuncture has been shown to improve cognitive function and reduce agitation in dementia. We hypothesize that acupuncture, when compared with a sham intervention, will reduce the duration and severity of delirium, normalize delirium biomarkers, and improve clinical outcomes related to delirium in acutely hospitalized older adults with a medical illness. METHODS This three-arm, prospective, randomized, clinical trial will evaluate adults aged over 65 years who are acutely hospitalized to an internal-medicine ward and diagnosed with delirium or subsyndromal delirium. The 288 patients (96 in each of three groups) will be randomly allocated to receive either daily true acupuncture with usual care, a daily sham procedure with usual care, or usual care only in a 1:1:1 distribution for up to one week or until the patient is delirium-free for over 48 h. Other delirium and clinical interventions will remain unchanged. Delirium will be diagnosed using DSM-5 criteria and its severity will be assessed using the long Confusion Assessment Method Severity (CAM-S) tool. OUTCOMES The primary study outcome will be the daily CAM-S score over 7 days between the three groups. Secondary outcomes will include time to first resolution of the delirium (over 7 days), the proportion of days spent delirium-free, daily antipsychotic use, daily pain scores, sleep quality, morning serum cortisol and T3 levels, and midnight urinary cortisol/creatinine ratio, all determined twice a week, and delirium-related complications. Hospital mortality, duration of hospital stay and functional status at discharge will also be compared between the three groups. Adverse events potentially related to acupuncture will be evaluated daily. The cost-effectiveness of acupuncture will be estimated. CONCLUSION This novel randomized study will evaluate both the specific and the non-specific effects of acupuncture on delirium, and related outcomes, and its safety. Potential mechanism(s) of action for acupuncture in reducing delirium will be explored and healthcare-related costs estimated. Positive study results may prove pivotal in facilitating a multimodal, non-pharmacologic, integrative approach to delirium treatment among older, medical inpatients.
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Affiliation(s)
- Ilana Levy
- Internal Medicine B Department, Bnai Zion Medical Center, Haifa, Israel.
| | - Samuel Attias
- Complementary Medicine Department, Bnai Zion Medical Center, Haifa, Israel; School of Public Health, University of Haifa, Haifa, Israel
| | - Sagi Gavrieli
- Complementary Medicine Department, Bnai Zion Medical Center, Haifa, Israel
| | - Ron Oliven
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Internal Medicine C Department, Bnai Zion Medical Center, Haifa, Israel; Geriatric Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Bjorn E Neerland
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - John W Devlin
- Northeastern University, School of Pharmacy, Boston, MA, United States; Tufts Medical Center, 1867, Boston, MA, United States
| | - Eran Ben-Arye
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa, Israel
| | - Dan Greenberg
- Department of Health Systems Management, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Elad Schiff
- Internal Medicine B Department, Bnai Zion Medical Center, Haifa, Israel; Complementary Medicine Department, Bnai Zion Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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46
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Ortiz M, Teut M, Ben-Arye E, Reshef A, Kaffman M, Arnon Z, Stöckigt B, Bähr V, Meoded-Danon L, Brinkhaus B, Schiff E. Can complementary medicine enhance doctor-patient communication skills? Insights from an international medical student project. Complement Ther Med 2018; 41:283-286. [DOI: 10.1016/j.ctim.2018.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/16/2018] [Indexed: 11/27/2022] Open
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47
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Jolliffe RC, Durrant JR, Seers HE, Churchward SF, Griffiths M, Naidoo M, Ben-Arye E, Polley MJ, Zollman C. Impact of Penny Brohn UK's Living Well Course on Informal Caregivers of People with Cancer. J Altern Complement Med 2018; 24:974-980. [PMID: 30247959 DOI: 10.1089/acm.2018.0195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES This study evaluated the change in the concerns, wellbeing, and lifestyle behaviors of informal caregivers of people with cancer attending Penny Brohn UK's Living Well Course (LWC), a self-management education intervention. DESIGN A pre-postcourse design collected self-reported quantitative and qualitative data from informal caregivers attending a LWC. SETTING/LOCATION Penny Brohn UK is a United Kingdom-based charity (not-for-profit) providing specialist integrative, whole person support, free of charge, to people affected by cancer. SUBJECTS Informal caregivers taking part in a Penny Brohn UK LWC between June 2014 and May 2016 attending alongside the person with cancer. INTERVENTION The LWC is a structured 15 h, multimodal group self-management educational course, designed to help people affected by cancer learn tools and techniques to help build resilience. Trained facilitators deliver LWCs to around 12 people with various types and stages of cancer and their informal caregivers. OUTCOME MEASURES Measure Yourself Concern and Wellbeing (MYCaW) completed precourse and at 6 weeks postcourse; and bespoke 6-week follow-up Patient Reported Experience Measure. RESULTS Four hundred eighty informal caregivers attended a LWC June 2014 to May 2016. One hundred eighteen completed a 6-week follow-up MYCaW: MYCaW Concerns 1 and 2 showed statistically significant improvements (p < 0.0001), there was no significant improvement in wellbeing. Informal caregivers' most reported concerns relating to themselves were psychological and emotional issues (59%). The primary concern of the caregiver for the care recipient was related to the physical health of the person with cancer (40%). Eighty-seven percent of responding informal caregivers stated that the LWC enabled health self-management. CONCLUSIONS The LWC was followed by an improvement in informal caregivers' concerns, and increased self-management of their own health needs. More studies, with larger sample size, are needed to explore if better self-management by informal caregivers may also lead to improvements in patients' health and wellbeing.
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Affiliation(s)
| | | | | | | | | | | | - Eran Ben-Arye
- 2 Integrative Oncology Program, The Oncology Service and Lin Medical Center , Clalit Health Services, Haifa, Israel .,3 Faculty of Medicine, Technion-Israel Institute of Technology , Haifa, Israel
| | - Marie J Polley
- 4 Department of Life Sciences, Faculty of Science and Technology, University of Westminster , London, United Kingdom
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Levy I, Attias S, Cohen L, Stoppelmann N, Steinberger D, Grimberg O, Ben-Arye E, Matter I, Sroka G, Somri M, Schiff E. Postoperative analgesia by adding acupuncture to conventional therapy, a non-randomized controlled trial. J Complement Integr Med 2018; 16:/j/jcim.ahead-of-print/jcim-2018-0028/jcim-2018-0028.xml. [PMID: 30312162 DOI: 10.1515/jcim-2018-0028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/19/2018] [Indexed: 11/15/2022]
Abstract
Background Postoperative pain is common in patients hospitalized in surgical departments, yet it is currently not sufficiently controlled by analgesics. Acupuncture, a complementary medical practice, has been evaluated for its benefits in postoperative pain with heterogeneous results. We tested the feasibility of a controlled study comparing the postoperative analgesic effect of acupuncture together with standard-of-care to standard-of-care only. Methods In this pilot non-randomized controlled study conducted at a tertiary medical center in Israel, patients received either acupuncture with standard-of-care pain treatment (acupuncture group) or standard-of-care treatment only (control group) following surgery. Visual Analogue Scale (VAS) ratings for pain level at rest and in motion were evaluated both at recruitment and two hours after treatment. Acupuncture-related side effects were reported as well. Results We recruited 425 patients; 336 were assigned to the acupuncture group and 89 to the control group. The acupuncture group exhibited a decrease of at least 40% in average level of pain both at rest (1.8±2.4, p<0.0001) and in motion (2.1±2.8, p<0.0001) following acupuncture, whereas the control group exhibited no significant decrease (p=0.92 at rest, p=0.98 in motion). Acupuncture's analgesic effect was even more prominent in reducing moderate to severe pain at baseline (VAS ≥4), with a decrease of 49% and 45% of pain level at rest and in motion respectively (p<0.001), compared with no significant amelioration in the control group (p=0.20 at rest, p=0.12 in motion). No major side effects were reported. Conclusion Integrating acupuncture with standard care may improve pain control in the postoperative setting.
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Affiliation(s)
- Ilana Levy
- Internal Medicine Department B, Bnai Zion Medical Center, Haifa, Israel
| | - Samuel Attias
- Complementary Medicine Department, Bnai Zion Medical Center, Haifa, Israel.,School of Public Health, University of Haifa, Haifa, Israel
| | - Lior Cohen
- Ruth Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Nadav Stoppelmann
- Complementary Medicine Department, Bnai Zion Medical Center, Haifa, Israel
| | - Dan Steinberger
- Complementary Medicine Department, Bnai Zion Medical Center, Haifa, Israel
| | - Ofra Grimberg
- General Surgery Department, Bnai Zion Medical Center, Haifa, Israel
| | - Eran Ben-Arye
- Ruth Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,Integrative Oncology Program, Oncology Service, Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel
| | - Ibrahim Matter
- Ruth Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,General Surgery Department, Bnai Zion Medical Center, Haifa, Israel
| | - Gideon Sroka
- Ruth Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,General Surgery Department, Bnai Zion Medical Center, Haifa, Israel
| | - Mostafa Somri
- Ruth Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,Anesthesiology Department, Bnai Zion Medical Center, Haifa, Israel
| | - Elad Schiff
- Internal Medicine Department B, Bnai Zion Medical Center, Haifa, Israel.,Complementary Medicine Department, Bnai Zion Medical Center, Haifa, Israel.,Ruth Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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49
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin and Carmel Medical Centers, Clalit Health Services, Haifa, Israel
- Complementary and Traditional Medicine Unit, Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Clalit Health Services, Haifa, Israel
| | - Noah Samuels
- Tal Center for Integrative Medicine, Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Gynecologic Oncology Service, Carmel Medical Center, Haifa, Israel
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50
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Attias S, Sivan K, Avneri O, Sagee A, Ben-Arye E, Grinberg O, Sroka G, Matter I, Schiff E. Analgesic Effects of Reflexology in Patients Undergoing Surgical Procedures: A Randomized Controlled Trial. J Altern Complement Med 2018; 24:809-815. [DOI: 10.1089/acm.2017.0167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Samuel Attias
- Complementary and Integrative Surgery Service, and the Surgery Department, Bnai-Zion Medical Center, Haifa, Israel
- School of Public Health, University of Haifa, Haifa, Israel
| | - Keren Sivan
- Internal Medicine Department, Bnai Zion Medical Center, Haifa, Israel
| | - Ofri Avneri
- Complementary and Integrative Surgery Service, and the Surgery Department, Bnai-Zion Medical Center, Haifa, Israel
| | - Avigail Sagee
- Complementary and Integrative Surgery Service, and the Surgery Department, Bnai-Zion Medical Center, Haifa, Israel
| | - Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa, Israel
- Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel
| | - Ofra Grinberg
- Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel
| | - Gideon Sroka
- Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel
- Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel
| | - Ibrahim Matter
- Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel
- Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel
| | - Elad Schiff
- Complementary and Integrative Surgery Service, and the Surgery Department, Bnai-Zion Medical Center, Haifa, Israel
- Internal Medicine Department, Bnai Zion Medical Center, Haifa, Israel
- The International Center for Health, Law and Ethics, Haifa, Israel
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