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Braun IM, Bohlke K, Abrams DI, Anderson H, Balneaves LG, Bar-Sela G, Bowles DW, Chai PR, Damani A, Gupta A, Hallmeyer S, Subbiah IM, Twelves C, Wallace MS, Roeland EJ. Cannabis and Cannabinoids in Adults With Cancer: ASCO Guideline. J Clin Oncol 2024; 42:1575-1593. [PMID: 38478773 DOI: 10.1200/jco.23.02596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/20/2023] [Indexed: 04/28/2024] Open
Abstract
PURPOSE To guide clinicians, adults with cancer, caregivers, researchers, and oncology institutions on the medical use of cannabis and cannabinoids, including synthetic cannabinoids and herbal cannabis derivatives; single, purified cannabinoids; combinations of cannabis ingredients; and full-spectrum cannabis. METHODS A systematic literature review identified systematic reviews, randomized controlled trials (RCTs), and cohort studies on the efficacy and safety of cannabis and cannabinoids when used by adults with cancer. Outcomes of interest included antineoplastic effects, cancer treatment toxicity, symptoms, and quality of life. PubMed and the Cochrane Library were searched from database inception to January 27, 2023. ASCO convened an Expert Panel to review the evidence and formulate recommendations. RESULTS The evidence base consisted of 13 systematic reviews and five additional primary studies (four RCTs and one cohort study). The certainty of evidence for most outcomes was low or very low. RECOMMENDATIONS Cannabis and/or cannabinoid access and use by adults with cancer has outpaced the science supporting their clinical use. This guideline provides strategies for open, nonjudgmental communication between clinicians and adults with cancer about the use of cannabis and/or cannabinoids. Clinicians should recommend against using cannabis or cannabinoids as a cancer-directed treatment unless within the context of a clinical trial. Cannabis and/or cannabinoids may improve refractory, chemotherapy-induced nausea and vomiting when added to guideline-concordant antiemetic regimens. Whether cannabis and/or cannabinoids can improve other supportive care outcomes remains uncertain. This guideline also highlights the critical need for more cannabis and/or cannabinoid research.Additional information is available at www.asco.org/supportive-care-guidelines.
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Affiliation(s)
- Ilana M Braun
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Kari Bohlke
- American Society of Clinical Oncology, Alexandria, VA
| | - Donald I Abrams
- University of California San Francisco Osher Center for Integrative Health, San Francisco, CA
| | | | | | | | | | | | - Anuja Damani
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | | | | | | | - Chris Twelves
- University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Eric J Roeland
- Oregon Health and Science University, Knight Cancer Institute, Portland, OR
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Balneaves LG, Brown A, Green M, Prosk E, Rapin L, Monahan-Ellison M, McMillan E, Zaid J, Dworkind M, Watling CZ. Canadians' use of cannabis for therapeutic purposes since legalization of recreational cannabis: a cross-sectional analysis by medical authorization status. BMC Med 2024; 22:150. [PMID: 38589855 PMCID: PMC11003000 DOI: 10.1186/s12916-024-03370-7] [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: 10/14/2023] [Accepted: 03/26/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND There has been a precipitous decline in authorizations for medical cannabis since non-medical cannabis was legalized in Canada in 2018. This study examines the demographic and health- and medical cannabis-related factors associated with authorization as well as the differences in medical cannabis use, side effects, and sources of medical cannabis and information by authorization status. METHODS Individuals who were taking cannabis for therapeutic purposes completed an online survey in early 2022. Multivariable logistic regression was used to determine odds ratios (OR) and 95% confidence intervals (CI) of demographic and health- and medical cannabis-related variables associated with holding medical cannabis authorization. The differences in medical cannabis use, side effects, and sources of information by authorization status were determined via t-tests and chi-squared analysis. RESULTS A total of 5433 individuals who were currently taking cannabis for therapeutic purposes completed the study, of which 2941 (54.1%) currently held medical authorization. Individuals with authorization were more likely to be older (OR ≥ 70 years vs. < 30 years, 4.85 (95% CI, 3.49-6.76)), identify as a man (OR man vs. woman, 1.53 (1.34-1.74)), have a higher income (OR > $100,000/year vs. < $50,000 year, 1.55 (1.30-1.84)), and less likely to live in a small town (OR small town/rural vs. large city, 0.69 (0.59-0.81)). They were significantly more likely to report not experiencing any side effects (29.9% vs. 23.4%; p < 0.001), knowing the amount of cannabis they were taking (32.1% vs. 17.7%; p < 0.001), obtaining cannabis from regulated sources (74.1% vs. 47.5%; p < 0.001), and seeking information about medical cannabis from healthcare professionals (67.8% vs. 48.2%; p < 0.01) than individuals without authorization. CONCLUSIONS These findings offer insight into the possible issues regarding equitable access to medical cannabis and how authorization may support and influence individuals in a jurisdiction where recreational cannabis is legalized, highlighting the value of a formal medical cannabis authorization process.
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Affiliation(s)
- Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Ashleigh Brown
- SheCann Cannabis, Winnipeg, MB, Canada
- Medical Cannabis Canada, Toronto, ON, Canada
| | - Matthew Green
- Medical Cannabis Canada, Toronto, ON, Canada
- Department of Psychology, Brock University, St. Catharine's, ON, Canada
| | | | | | | | | | | | - Michael Dworkind
- Santé Cannabis, Montréal, QC, Canada
- Department of Medicine, McGill University, Montréal, QC, Canada
| | - Cody Z Watling
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Avery J, Bell JAH, Baryolay K, Rodin G, Nissim R, Balneaves LG. Decision-making and autonomy among participants in early-phase cancer immunotherapy trials: a qualitative study. BMC Cancer 2024; 24:373. [PMID: 38528488 DOI: 10.1186/s12885-024-12119-7] [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: 08/24/2023] [Accepted: 03/13/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Participants considering early-phase cancer clinical trials (CTs) need to understand the unique risks and benefits prior to providing informed consent. This qualitative study explored the factors that influence patients' decisions about participating in early-phase cancer immunotherapy CTs through the ethical lens of relational autonomy. METHODS Using an interpretive descriptive design, interviews were conducted with 21 adult patients with advanced cancer who had enrolled in an early-phase CT. Data was analyzed using relational autonomy ethical theory and constant comparative analysis. RESULTS The extent to which participants perceived themselves as having a choice to participate in early-phase cancer immunotherapy CTs was a central construct. Perceptions of choice varied according to whether participants characterized their experience as an act of desperation or as an opportunity to receive a novel treatment. Intersecting psychosocial and structural factors influenced participants' decision making about participating in early-phase cancer immunotherapy trials. These relational factors included: (1) being provided with hope; (2) having trust; (3) having the ability to withdraw; and (4) timing constraints. CONCLUSIONS Findings highlight the continuum of perceived choice that exists among patients with cancer when considering participation in early-phase cancer immunotherapy CTs. All participants were interpreted as exhibiting some degree of relational autonomy within the psychosocial and structural context of early-phase CT decision making. This study offers insights into the intersection of cancer care delivery, personal beliefs and values, and established CT processes and structures that can inform future practices and policies associated with early-phase cancer immunotherapy CTs to better support patients in making informed decisions.
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Affiliation(s)
- Jonathan Avery
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
- Department of Supportive Care Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jennifer A H Bell
- Department of Supportive Care Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
- Department of Clinical and Organizational Ethics, University Health Network, Toronto, ON, Canada.
- The Institute for Education Research, University Health Network, Toronto, ON, Canada.
- Department of Psychiatry and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Princess Margaret Cancer Centre, Department of Supportive Care, Research Division, 700 Bay St., 23rd Floor, Toronto, ON, M5G 1Z6, Canada.
| | - Khotira Baryolay
- Department of Supportive Care Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Gary Rodin
- Department of Supportive Care Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Cancer Experience, University Health Network Cancer Program, University Health Network, Toronto, ON, Canada
- Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Rinat Nissim
- Department of Supportive Care Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lynda G Balneaves
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, MB, Canada
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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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Balneaves LG, Watling CZ, Strus JA, Boscow M, Davis L, Graveline K, Harrigan T, Henriquez N, Mitchell K, Thompson G. Baccalaureate nursing students' knowledge, attitudes, educational needs, and use of medical and non-medical cannabis at five institutions in Manitoba, Canada: A cross-sectional analysis. Nurse Educ Today 2023; 130:105955. [PMID: 37677985 DOI: 10.1016/j.nedt.2023.105955] [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: 05/20/2023] [Revised: 08/15/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND With the legalization of non-medical cannabis in Canada, cannabis is commonly used in the community and nurses and nursing students are likely to engage in clinical practice discussions around cannabis use for both medical and non-medical purposes. However, whether having previous experience using cannabis influences nursing students' knowledge and attitudes towards cannabis remains unclear. OBJECTIVE The aim of this study was to describe nursing students' knowledge, attitudes, educational needs, and use of cannabis. DESIGN Cross-sectional survey. SETTING Five academic undergraduate nursing programs in Manitoba, Canada. PARTICIPANTS Nursing students in Manitoba. METHODS Students were asked about their use of cannabis, knowledge and attitudes regarding cannabis, clinical experiences and educational needs related to cannabis. Students' current knowledge was compared to their desired knowledge using paired t-tests. Using t-tests, attitudes towards cannabis were compared between students who had ever taken cannabis versus those with no experience. Descriptive statistics were utilized for all other questions. RESULTS A total of 327 nursing students participated in the survey with 220 students (67.3 %) reporting they had used cannabis in the past, and 123 students (37.6 %) reporting monthly use of cannabis. Students who previously used cannabis held more positive attitudes towards both medical and non-medical cannabis use in comparison to those with no experience. Students recognised that their current knowledge around cannabis was insufficient and indicated the need for greater knowledge on both medical and non-medical cannabis-related topics. Only 37.7 % of students reported receiving any education on cannabis in their nursing program. Nearly all students (92.2 %) agreed if they had more education on medical cannabis use that they would feel more comfortable discussing this in their clinical practice. CONCLUSION Education on both medical and non-medical cannabis is needed to support future nurses addressing cannabis use in their clinical practice. Nursing institutions must implement and evaluate curricula to ensure nursing students are adequately prepared to address cannabis use in their clinical practice and their own fitness to practice.
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Affiliation(s)
- Lynda G Balneaves
- 89 Curry Place, College of Nursing, University of Manitoba, Winnipeg, MB R3T 2N2, Canada.
| | - Cody Z Watling
- 89 Curry Place, College of Nursing, University of Manitoba, Winnipeg, MB R3T 2N2, Canada.
| | | | - Megan Boscow
- 436 7 St E, Faculty of Nursing, University College of the North, Thompson and The Pas, MB R9A 1T4, Canada.
| | - Lori Davis
- 89 Curry Place, College of Nursing, University of Manitoba, Winnipeg, MB R3T 2N2, Canada.
| | - Kellie Graveline
- 436 7 St E, Faculty of Nursing, University College of the North, Thompson and The Pas, MB R9A 1T4, Canada.
| | - Tom Harrigan
- 2055 Notre Dame Avenue, Nursing Department, Red River College Polytechnic, Winnipeg, MB R3H 0J9, Canada.
| | - Nadine Henriquez
- 270-18th Street, Faculty of Health Studies, Brandon University, Brandon, MB R7A 6A9, Canada.
| | - Kimberley Mitchell
- 89 Curry Place, College of Nursing, University of Manitoba, Winnipeg, MB R3T 2N2, Canada; 2055 Notre Dame Avenue, Nursing Department, Red River College Polytechnic, Winnipeg, MB R3H 0J9, Canada.
| | - Genevieve Thompson
- 89 Curry Place, College of Nursing, University of Manitoba, Winnipeg, MB R3T 2N2, Canada.
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Carlson LE, Ismaila N, Addington EL, Asher GN, Atreya C, Balneaves LG, Bradt J, Fuller-Shavel N, Goodman J, Hoffman CJ, Huston A, Mehta A, Paller CJ, Richardson K, Seely D, Siwik CJ, Temel JS, Rowland JH. Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: Society for Integrative Oncology-ASCO Guideline. J Clin Oncol 2023; 41:4562-4591. [PMID: 37582238 DOI: 10.1200/jco.23.00857] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/13/2023] [Indexed: 08/17/2023] Open
Abstract
PURPOSE To provide evidence-based recommendations to health care providers on integrative approaches to managing anxiety and depression symptoms in adults living 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, methodology, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2023. Outcomes of interest included anxiety or depression symptoms as measured by validated psychometric tools, and adverse events. Expert panel members used this evidence and informal consensus with the Guidelines into Decision Support methodology to develop evidence-based guideline recommendations. RESULTS The literature search identified 110 relevant studies (30 systematic reviews and 80 randomized controlled trials) to inform the evidence base for this guideline. RECOMMENDATIONS Recommendations were made for mindfulness-based interventions (MBIs), yoga, relaxation, music therapy, reflexology, and aromatherapy (using inhalation) for treating symptoms of anxiety during active treatment; and MBIs, yoga, acupuncture, tai chi and/or qigong, and reflexology for treating anxiety symptoms after cancer treatment. For depression symptoms, MBIs, yoga, music therapy, relaxation, and reflexology were recommended during treatment, and MBIs, yoga, and tai chi and/or qigong were recommended post-treatment. DISCUSSION Issues of patient-health care provider communication, health disparities, comorbid medical conditions, cost implications, guideline implementation, provider training and credentialing, and quality assurance of natural health products are discussed. While several approaches such as MBIs and yoga appear effective, limitations of the evidence base including assessment of risk of bias, nonstandardization of therapies, lack of diversity in study samples, and lack of active control conditions as well as future research directions are discussed.Additional information is available at www.asco.org/survivorship-guidelines.
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Affiliation(s)
- Linda E Carlson
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | - Gary N Asher
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Chloe Atreya
- University of California San Francisco, San Francisco, CA
| | | | - Joke Bradt
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA
| | | | | | | | - Alissa Huston
- University of Rochester Medical Center, Rochester, NY
| | | | - Channing J Paller
- Sidney Kimmel Comprehensive Cancer Center, John Hopkins University, Baltimore, MD
| | | | - Dugald Seely
- University of Ottawa, Ottawa, ON, Canada
- Canadian College of Naturopathic Medicine, Toronto, ON, Canada
| | - Chelsea J Siwik
- Osher Center for Integrative Health, University of California, San Francisco, San Francisco, CA
| | - Jennifer S Temel
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Capler NR, Balneaves LG, Buxton JA, Kerr T. Reasonable access: important characteristics and perceived quality of legal and illegal sources of cannabis for medical purposes in Canada. J Cannabis Res 2023; 5:18. [PMID: 37291647 DOI: 10.1186/s42238-023-00185-w] [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: 10/07/2022] [Accepted: 04/30/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Throughout the past two decades of legal medical cannabis in Canada, individuals have experienced challenges related to accessing legal sources of cannabis for medical purposes. The objective of our study was to examine the sources of cannabis accessed by individuals authorized to use medical cannabis and to identify possible reasons for their use of illegal sources. METHODS Individuals who participated in the Cannabis Access Regulations Study (CANARY), a national cross-sectional survey launched in 2014, and indicated they were currently authorized to use cannabis for medical purposes in Canada were included in this study. We assessed differences between participants accessing cannabis from only legal sources versus from illegal sources in relation to sociodemographic characteristics, health-related factors, and characteristics of medical cannabis they considered important. A secondary analysis assessed differences in satisfaction with various dimensions of cannabis products and services provided by legal versus illegal sources. RESULTS Half of the 237 study participants accessed cannabis from illegal sources. Individuals accessing cannabis from illegal sources were significantly more likely to value pesticide-free products, access to a variety of strains, ability to select strain and dosage, ability to observe and smell cannabis, availability in a dispensary, and availability in small quantities than did individuals accessing cannabis from only legal sources (all p < 0.05). Additionally, participants gave significantly higher satisfaction scores to illegal sources than to legal sources on service-related dimensions of cannabis access (all p < 0.05). CONCLUSION Our findings contribute to an understanding of reasonable access to medical cannabis from a patient perspective and how to assess whether it has been achieved. Characteristics of cannabis products and services valued by patients and appropriate to their needs should be incorporated into legal medical cannabis programs to promote the use of legal medical sources. While pertaining specifically to medical use of cannabis in Canada, the findings of this study may also be instructive for understanding the use of illegal cannabis sources for non-medical purposes in Canada and provide insight for other jurisdictions implementing cannabis regulations for both medical and non-medical purposes.
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Affiliation(s)
- N Rielle Capler
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Musqueam Traditional Territory, Vancouver, BC, V6T 1Z3, Canada.
| | - Lynda G Balneaves
- College of Nursing, University of Manitoba, Room 495, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada
| | - Jane A Buxton
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Musqueam Traditional Territory, Vancouver, BC, V6T 1Z3, Canada
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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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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Oberoi S, Protudjer JLP, Rapoport A, Rassekh SR, Crooks B, Siden H, Decker K, Ananth P, Chapman S, Balneaves LG, Vanan MI, Kelly LE. Perspectives of pediatric oncologists and palliative care physicians on the therapeutic use of cannabis in children with cancer. Cancer Rep (Hoboken) 2022; 5:e1551. [PMID: 34672127 PMCID: PMC9458513 DOI: 10.1002/cnr2.1551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/29/2021] [Accepted: 08/23/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Children with cancer are increasingly using cannabis therapeutically. AIM The purpose of this study was to determine the perspectives and practices of pediatric oncologists and palliative care physicians regarding the use of cannabis for medical purposes among children with cancer. METHODS A self-administered, voluntary, cross-sectional, deidentified online survey was sent to all pediatric oncologists and palliative care physicians in Canada between June and August 2020. Survey domains included education, knowledge, and concerns about cannabis, views on its effectiveness, and the importance of cannabis-related research. Data were analyzed using descriptive statistics. RESULTS In total, 122/259 (47.1%) physicians completed the survey. Although 62.2% of the physicians completed some form of training about medical cannabis, nearly all (95.8%) desired to know more about the dosing, side effects, and safety of cannabis. Physicians identified a potential role of cannabis in the management of nausea and vomiting (85.7%), chronic pain (72.3%), cachexia/poor appetite (67.2%), and anxiety or depression (42.9%). Only four (0.3%) physicians recognized cannabis to be potentially useful as an anticancer agent. Nearly all physicians reported that cannabis-related research for symptom relief is essential (91.5%) in pediatric oncology, whereas 51.7% expressed that future studies are necessary to determine the anticancer effects of cannabis. CONCLUSIONS Our findings indicate that most pediatric oncologists and palliative care physicians recognize a potential role for cannabis in symptom control in children with cancer. Well-conducted studies are required to create evidence for cannabis use and promote shared decision making with pediatric oncology patients and their caregivers.
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Affiliation(s)
- Sapna Oberoi
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegCanada
- Department of Pediatric Hematology‐OncologyCancerCare ManitobaWinnipegCanada
- Children's Hospital Research Institute of ManitobaWinnipegManitobaCanada
| | - Jennifer L. P. Protudjer
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegCanada
- Children's Hospital Research Institute of ManitobaWinnipegManitobaCanada
- George and Fay Yee Centre for Healthcare InnovationWinnipegCanada
- Department Foods and Human Nutritional SciencesUniversity of ManitobaWinnipegCanada
| | - Adam Rapoport
- Paediatric Advanced Care TeamHospital for Sick ChildrenTorontoOntarioCanada
- Emily's House Children's HospiceTorontoOntarioCanada
- Department of PaediatricsFaculty of Medicine, University of TorontoTorontoOntarioCanada
- Department of Family & Community MedicineFaculty of Medicine, University of TorontoTorontoOntarioCanada
| | - Shahrad R. Rassekh
- Division of Oncology/Hematology/BMT, Department of PediatricsUniversity of British ColumbiaVancouverCanada
| | - Bruce Crooks
- Pediatric Hematology/Oncology & Medical EducationIWK Health CentreHalifaxCanada
| | - Harold Siden
- Department of Pediatrics, Faculty of MedicineUniversity of British ColumbiaVancouverCanada
| | - Kathleen Decker
- Department of Community Health SciencesUniversity of ManitobaWinnipegCanada
| | - Prasanna Ananth
- Section of Pediatric Hematology/Oncology, Department of PediatricsYale School of Medicine
| | - Stacy Chapman
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegCanada
- Department of Pediatric Hematology‐OncologyCancerCare ManitobaWinnipegCanada
| | | | - Magimairajan Issai Vanan
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegCanada
- Department of Pediatric Hematology‐OncologyCancerCare ManitobaWinnipegCanada
- Children's Hospital Research Institute of ManitobaWinnipegManitobaCanada
| | - Lauren E. Kelly
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegCanada
- Children's Hospital Research Institute of ManitobaWinnipegManitobaCanada
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10
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Witt CM, Balneaves LG, Carlson LE, Cohen M, Deng G, Fouladbakhsh JM, Kinney AY, Mehta A, Mailman J, Pole L, Rogge AA, O'Toole C, Zick SM, Helmer SM. Education Competencies for Integrative Oncology-Results of a Systematic Review and an International and Interprofessional Consensus Procedure. J Cancer Educ 2022; 37:499-507. [PMID: 32783117 PMCID: PMC7876161 DOI: 10.1007/s13187-020-01829-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Integrative oncology is a burgeoning field and typically provided by a multiprofessional team. To ensure cancer patients receive effective, appropriate, and safe care, health professionals providing integrative cancer care should have a certain set of competencies. The aim of this project was to define core competencies for different health professions involved in integrative oncology. The project consisted of two phases. A systematic literature review on published competencies was performed, and the results informed an international and interprofessional consensus procedure. The second phase consisted of three rounds of consensus procedure and included 28 experts representing 7 different professions (medical doctors, psychologists, nurses, naturopathic doctors, traditional Chinese medicine practitioners, yoga practitioners, patient navigators) as well as patient advocates, public health experts, and members of the Society for Integrative Oncology. A total of 40 integrative medicine competencies were identified in the literature review. These were further complemented by 18 core oncology competencies. The final round of the consensus procedure yielded 37 core competencies in the following categories: knowledge (n = 11), skills (n = 17), and abilities (n = 9). There was an agreement that these competencies are relevant for all participating professions. The integrative oncology core competencies combine both fundamental oncology knowledge and integrative medicine competencies that are necessary to provide effective and safe integrative oncology care for cancer patients. They can be used as a starting point for developing profession-specific learning objectives and to establish integrative oncology education and training programs to meet the needs of cancer patients and health professionals.
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Affiliation(s)
- Claudia M Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Sonneggstrasse 6, 8091, Zurich, Switzerland.
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany.
| | - Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Linda E Carlson
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Misha Cohen
- Chicken Soup Chinese Medicine, San Francisco, CA, USA
- American College of Traditional Chinese Medicine at California Institute of Integral Studies, San Francisco, CA, USA
| | - Gary Deng
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Anita Y Kinney
- Department of Epidemiology, School of Public Health and Rutgers, Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | | | | | - Laura Pole
- Smith Center for Healing and the Arts, Institute for Integrative Oncology Navigation, Washington, DC, USA
| | - Alizé A Rogge
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany
| | - Carole O'Toole
- Smith Center for Healing and the Arts, Washington, DC, USA
| | - Suzanna M Zick
- Department of Family Medicine and Nutritional Sciences Schools of Medicine and Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Stefanie M Helmer
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany
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11
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Green J, Wright H, Seely D, Legacy M, Anderson M, Armstrong H, Martell C, Soles S, Balneaves LG. A survey of multidisciplinary healthcare providers utilizing the KNOWintegrativeoncology.org educational platform. BMC Complement Med Ther 2022; 22:118. [PMID: 35484545 PMCID: PMC9047465 DOI: 10.1186/s12906-022-03601-5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/13/2022] [Indexed: 12/03/2022] Open
Abstract
Background Although the vast majority of cancer patients use natural health products (NHPs), 59% of oncology healthcare providers (HCP) report not receiving any education on NHPs. KNOWintegrativeoncology.org (KNOW) is a web-based educational platform that provides up-to-date evidence on NHPs used in cancer care with a user-friendly interface. KNOW is a database of human studies systematically gathered from MEDLINE and EMBASE. We surveyed HCPs before and after accessing KNOW to identify their information needs regarding NHPs in cancer care, their preferred way to receive information, barriers they face accessing NHP information, and to obtain feedback on the website. Methods Recruitment was done through Beaumont Health Systems, the Society for Integrative Oncology, and the Andrew Weil Centre for Integrative Medicine, University of Arizona. HCPs who consented completed an initial survey and then a follow-up survey after being given access to KNOW for 4–6 weeks. Participants were required to access KNOW at least three times before completion of the follow-up survey. Results A total of 65 participants completed the initial survey, with 60% (n = 39) from the conventional medical community, 33% (n = 21) from the integrative medicine community, and 7% (n = 5) from the research community. The majority of participants (82%; n = 53) preferred educational websites to email updates, podcasts/webinars, in-house experts, PubMed searches and smartphone apps. The most common barriers identified to accessing information on NHPs were time, accessibility at point-of-care, and credibility of sources. A high number of participants were lost to follow up, with 18 participants demographically representative of the initial sample of 65 completing the follow-up survey. Half (n = 9) of participants stated accessing the KNOW website changed their clinical practice. Close to 90% (n = 16) reported they would recommend KNOW to a colleague. Conclusion Oncology HCPs reported preferring to use, and already relying on, numerous web-based educational platforms to gather information on NHPs, with time, accessibility, and credibility being common barriers to obtaining information. Our study findings highlight the promise of the KNOW web-based educational platform in reducing barriers to accessing up-to-date information on NHPs in busy cancer care settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-022-03601-5.
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Affiliation(s)
- Jen Green
- Emcura Integrative Clinic, Bloomfield Twp, Bloomfield Hills, MI, USA
| | | | - Dugald Seely
- Patterson Institute for Integrative Oncology Research, CCNM, Toronto, ON, Canada.,The Centre for Health Innovation, Ottawa, ON, Canada
| | - Mark Legacy
- Patterson Institute for Integrative Oncology Research, CCNM, Toronto, ON, Canada.,The Centre for Health Innovation, Ottawa, ON, Canada
| | | | | | | | - Sarah Soles
- Integrated Health Clinic, Fort Langley, Langley, BC, Canada
| | - Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada.
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12
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Donnelly L, Balneaves LG. Fact or Fiction? The Role of Regulated Body-Identical Hormone Therapy for Menopausal Women. Nurs Womens Health 2022; 26:143-151. [PMID: 35189118 DOI: 10.1016/j.nwh.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/15/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022]
Abstract
Many menopausal women use hormone therapy, including regulated body-identical hormone therapy (rBHT), to relieve vasomotor symptoms and prevent cardiovascular disease. Despite growing interest in rBHT, there is uncertainty regarding potential benefits and risks. With this narrative review, we aimed to synthesize the literature regarding the efficacy of these therapies for managing vasomotor symptoms and preventing cardiovascular disease. Thirteen articles were identified, with authors of several studies showing rBHT and combination therapy (rBHT with synthetic hormone therapy) to be efficacious in managing vasomotor symptoms when compared to placebo. Conflicting evidence exists regarding the efficacy of rBHT in the prevention of cardiovascular disease, with some studies demonstrating improved cardiovascular biomarkers, particularly among women who are at the beginning of the menopausal journey and experiencing symptoms. In summary, rBHT may have a role in the care of women trying to manage vasomotor symptoms and in protecting against cardiovascular disease among menopausal women; however, larger, more rigorously designed randomized controlled trials are required.
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13
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Balneaves LG, Watling CZ. "Part of the Conversation": A Qualitative Study of Oncology Healthcare Professionals' Experiences of Integrating Standardized Assessment and Documentation of Complementary Medicine. Integr Cancer Ther 2022; 21:15347354221077229. [PMID: 35130735 PMCID: PMC8829709 DOI: 10.1177/15347354221077229] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction: The use of complementary medicine (CM) among individuals with cancer is common, however, it is infrequently assessed or documented by oncology healthcare professionals (HCPs). A study implementing standardized assessment and documentation of CM was conducted at a provincial cancer agency. The purpose of this study was to understand the perspectives and experience of oncology HCPs who took part in the study, as well as withdrew, regarding the feasibility and the challenges associated with assessment and documentation of CM use. Methods: An interpretive descriptive study methodology was used. A total of 20 HCPs who participated, managed staff, or withdrew from the study were interviewed. Interviews were recorded and transcribed verbatim. Thematic, inductive analysis was used to code and analyse themes from the data. Results: Oncology HCPs who participated in the study felt that CM use was common among patients and recognized it went underreported and was poorly documented. Facilitating factors for the implementation of standardized assessment and documentation of CM use included having a standard assessment form, embedding assessment within existing screening processes, and leveraging self-report by patients. Barriers included limited time, perceived lack of knowledge regarding CM, hesitancy to engage patients in discussion about CM, and lack of institutional support and resources. Recommendations for future implementation included having explicit policies related to addressing CM at point-of-care, leveraging existing electronic patient reporting systems, including the electronic health record, and developing information resources and training for HCPs. Conclusions: With the high prevalence of CM use among individuals with cancer, oncology HCPs perceive addressing CM use to be feasible and an essential part of high-quality, person-centered cancer care. Institutional and professional challenges, however, must be overcome to support the assessment, documentation and discussion of CM in patient-HCP consultations.
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Affiliation(s)
- Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Cody Z Watling
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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14
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Gunning M, Rotenberg A, Anderson J, Balneaves LG, Brace T, Crooks B, Hall W, Kelly LE, Rassekh SR, Rieder M, Virani A, Ware MA, Zaslawski Z, Siden H, Illes J. Neither the “Devil’s Lettuce” nor a “Miracle Cure:” The Use of Medical Cannabis in the Care of Children and Youth. NEUROETHICS-NETH 2022. [DOI: 10.1007/s12152-022-09478-y] [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: 10/19/2022]
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15
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Baydoun M, Levin G, Balneaves LG, Oberoi D, Sidhu A, Carlson LE. Complementary and Alternative Medicine Online Learning Intervention for Oncology Healthcare Providers: A Mixed-Methods Study. Integr Cancer Ther 2022; 21:15347354221079280. [PMID: 35311375 PMCID: PMC8941705 DOI: 10.1177/15347354221079280] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Indexed: 11/17/2022] Open
Abstract
Introduction: With the increased usage of complementary approaches in oncology comes the
need for its integration into healthcare professional (HCP) education. The
purpose of this single-arm, mixed-methods study was to examine the
feasibility and benefits of a brief complementary and alternative medicine
(CAM) learning intervention for improving HCP knowledge, attitudes, and
practices regarding CAM use in cancer care, and explore the experiences of
participating HCPs. Methods: HCPs from the Tom Baker Cancer Centre in Alberta, Canada, were invited to
participate in 3 online interactive learning modules that reviewed: (1)
basic CAM information, (2) HCP-patient CAM communication, and (3)
evidence-based CAM decision support. The study survey consisted of attitude
(n = 14), knowledge (n = 31), and practice (n = 31) items, administered at
baseline and two-months post-intervention. Semi-structured interviews were
conducted with a subset of participants. Results: Approximately 300 HCPs were invited to participate, of which 105 expressed
interest in the study (35%), and 83 of them consented to participate (79%).
The intervention completion rate was 73% (61/83 HCPs). There was a
significant pre-post change in HCPs’ attitudes and, to a lesser extent,
knowledge and practices related to CAM (8/14 attitude items changed pre-post
compared to 13/31 knowledge items and 5/31 practice items), in which more
HCPs reported patients should be assisted in making complementary therapy
(CT) decisions, exhibited greater knowledge about CAM, and more often
engaged in a CAM-related clinical practice. Qualitative findings supported
the beneficial effects of the modules, with HCPs describing themselves as
being more likely to ask patients about their CAM use and referring them to
credible CAM resources. Nonetheless, the majority did not feel adequately
prepared to make recommendations about specific CTs, even after the
intervention. Conclusion: The current study suggests that online CAM learning offers a feasible and
potentially promising intervention for improving oncology HCP knowledge,
attitudes, and practices regarding CAM, warranting further investigation.
This study highlights a need for institutional resources to help HCPs fully
integrate CT decision support into cancer patient care. A coordinated
evidence-based CAM program at cancer centers may help ensure that all
patients’ CAM-related needs are properly attended to.
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Affiliation(s)
- Mohamad Baydoun
- University of Regina, Regina, Canada.,University of Calgary, Calgary, AB, Canada
| | | | | | | | - Aven Sidhu
- Fraser Health, Surrey, BC, Canada.,Veralife Health Centre, Surrey, BC, Canada
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16
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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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17
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Rieger KL, Mitchell KM, Bolianatz J, Rabbani R, Harder N, Balneaves LG, Armah N, Martin D. Evaluating the impact of an arts-based multimedia knowledge translation assignment on undergraduate nursing students. Nurse Educ Today 2021; 105:105030. [PMID: 34214948 DOI: 10.1016/j.nedt.2021.105030] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 10/24/2020] [Accepted: 06/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Despite the expectation that nurses utilize research to provide excellent patient care, students often fail to recognize the value of learning about evidence-informed practice. Experiential, creative pedagogical approaches are needed to engage undergraduate nursing students in evidence-informed practice. In two undergraduate courses, we implemented an innovative assignment in which students created an arts-based multimedia knowledge translation presentation to communicate systematic review findings to patients. OBJECTIVE To evaluate how the assignment affected nursing students' satisfaction, learning, and anticipated behaviour changes regarding evidence-informed practice and to assess what factors influenced their evaluation of the assignment. DESIGN AND METHODS Kirkpatrick's Evaluation Model and Groff's Theory of Whole-Mindedness informed our study, incorporating an observational cross-sectional survey design. We recruited a convenience sample of nursing students (N = 242) from two baccalaureate programs. We collected data with an online survey comprised of closed- and open-ended questions. Quantitative data were analyzed with descriptive statistics, univariate analysis, and general linear models, and qualitative data with content analysis. RESULTS Most students were satisfied (68%) and reported learning (77%) and benefits for their future practice (75%). Age, enjoyment of and experience with the arts, type of motivation, and valuing evidence-informed practice were significant predictors (p < 0.01) and the model predicted 59% of the variance in positive student perceptions of the assignment. Students reported experiencing relational and engaged learning, translating research findings creatively and clearly, understanding complex research concepts through experiential learning, and having frustrations and pragmatic concerns. CONCLUSION Creative approaches that contextualize research findings hold potential to deepen students' understanding of evidence-informed practice. This study identified key factors that influenced students' evaluation and experience of the assignment. These results provide valuable insights to inform effective implementation of arts-based assignments in nursing education.
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Affiliation(s)
- Kendra L Rieger
- School of Nursing, Trinity Western University, Langley, BC, Canada; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Canada.
| | - Kim M Mitchell
- Nursing Department, School of Health Sciences and Community Services, Red River College, Canada
| | - Josie Bolianatz
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Rasheda Rabbani
- Biostatistician, George & Fay Yee Centre for Healthcare Innovation, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Nicole Harder
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Naomi Armah
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Donna Martin
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Canada
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18
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Lambert LK, Balneaves LG, Howard AF. It's not an easy fix: Adherence to adjuvant endocrine therapy after breast cancer. Can Oncol Nurs J 2021; 31:221-227. [PMID: 34036161 PMCID: PMC8128422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Adjuvant endocrine therapy (AET) is a highly efficacious treatment that significantly reduces breast cancer recurrence and mortality for women with hormone-receptor positive breast cancer. Yet, many women do not adhere to prescribed AET. The overarching aim of this research was to gain a better understanding of why a significant number of women diagnosed with breast cancer have suboptimal adherence to AET. A mixed-methods approach was used to explore the personal, social, and structural factors influencing breast cancer survivors' AET adherence, including: (1) an integrative review of patient-reported factors associated with AET adherence; and (2) interviews with breast cancer survivors prescribed AET. In this paper, we summarize and discuss the key contributions of both phases of this research, implication for clinical practice, and how we might leverage the expertise of nurses in practicing to full scope to address the complex needs of breast cancer survivors prescribed AET.
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Affiliation(s)
- Leah K Lambert
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5; British Columbia Cancer, 600 W 10th Ave, Vancouver, BC V5Z 4E6
| | - Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Helen Glass Centre for Nursing, Winnipeg, MB R3T 2N2
| | - A Fuchsia Howard
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5
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19
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Lambert LK, Balneaves LG, Howard AF. [Not Available]. Can Oncol Nurs J 2021; 31:228-234. [PMID: 34036162 PMCID: PMC8128429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Chez les femmes atteintes d’un cancer du sein à récepteurs hormonaux positifs, l’endocrinothérapie adjuvante est très efficace pour réduire le risque de récidive et de mortalité. Pourtant, ce ne sont pas toutes les femmes qui se conforment au traitement. L’objectif principal de cette recherche était de mieux comprendre pourquoi de nombreuses femmes ayant reçu un diagnostic de cancer du sein n’adhèrent pas au traitement adjuvant. Une approche méthodologique mixte a été utilisée afin d’explorer les facteurs personnels, sociaux et structurels qui influencent l’adhésion à l’endocrinothérapie adjuvante chez les survivantes du cancer du sein. L’approche comprend: 1) une revue intégrative des facteurs mentionnés par les patientes pour expliquer l’adhésion au traitement endocrinien; et 2) des entretiens avec des survivantes du cancer du sein à qui on a prescrit le traitement adjuvant. Le présent article résume et présente les principales contributions des deux phases de cette recherche, les implications pour la pratique clinique et la manière dont nous pourrons tirer parti de l’expertise des infirmières en les amenant à exercer pleinement leur pratique pour répondre aux besoins complexes des survivantes du cancer du sein à qui l’on prescrit l’endocrinothérapie adjuvante.
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Affiliation(s)
- Leah K Lambert
- École des sciences infirmières, Université de la Colombie-Britannique, T201-221 Wesbrook Mall, Vancouver, C.-B. V6T 2B5 ; British Columbia Cancer, 600 West 10th Ave, Vancouver, C.-B. V5Z 4E6
| | - Lynda G Balneaves
- Collège des sciences infirmières, Faculté des sciences de la santé Rady, Université du Manitoba, 89 Curry Place, Helen Glass Centre for Nursing, Winnipeg, MB R3T 2N2
| | - A Fuchsia Howard
- École des sciences infirmières, Université de la Colombie-Britannique, T201-221 Wesbrook Mall, Vancouver, C.-B. V6T 2B5
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20
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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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21
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Balneaves LG, Watling CZ, Hayward EN, Ross B, Taylor-Brown J, Porcino A, Truant TLO. Addressing Complementary and Alternative Medicine Use Among Individuals With Cancer: an Integrative Review and Clinical Practice Guideline. J Natl Cancer Inst 2021; 114:25-37. [PMID: 33769512 DOI: 10.1093/jnci/djab048] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 01/19/2021] [Revised: 02/22/2021] [Accepted: 03/19/2021] [Indexed: 01/07/2023] Open
Abstract
Complementary and alternative medicine (CAM) use is common among individuals with cancer, but many choose not to discuss CAM with healthcare providers (HCPs). Moreover, there is variability in the provision of evidence-informed decision making about CAM use. A clinical practice guideline was developed to standardize how oncology HCPs address CAM use as well as to inform how individuals with cancer can be supported in making evidence-informed decisions about CAM. An integrative review of the literature, from inception to December 31st, 2018, was conducted in MEDLINE, EMBASE, PsychINFO, CINAHL, and AMED databases. Eligible articles included oncology HCPs' practice related to discussing, assessing, documenting, providing decision support, or offering information about CAM. Two authors independently searched the literature and selected articles were summarised. Recommendations for clinical practice were formulated from the appraised evidence and clinical experiences of the research team. An expert panel reviewed the guideline for usability and appropriateness and recommendations were finalised. The majority of the 30 studies eligible for inclusion were either observational or qualitative, with only three being reviews and three being experimental. From the literature, seven practice recommendations were formulated for oncology HCPs regarding how to address CAM use by individuals with cancer, including communicating, assessing, educating, decision-coaching, documenting, active monitoring, and adverse event reporting. It is imperative for safe and comprehensive care that oncology HCPs address CAM use as part of standard practice. This clinical practice guideline offers directions on how to support evidence-informed decision making about CAM among individuals with cancer.
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Affiliation(s)
- Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Cody Z Watling
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Emilie N Hayward
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | | | - Antony Porcino
- BC Cancer, Vancouver, Canada.,School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, Canada
| | - Tracy L O Truant
- School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, Canada
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Allen Searson N, Balneaves LG, Thorne SE, Gotay C, Truant TLO, Porcino A, Kelly MT. The Effect of a Complementary Therapy Education Seminar on Support Persons of Individuals with Cancer. J Altern Complement Med 2021; 27:365-372. [PMID: 33601933 DOI: 10.1089/acm.2020.0443] [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] [Indexed: 01/12/2023] Open
Abstract
Objectives: Complementary therapy (CT) use is prevalent among individuals living with cancer, who often consult family and friends (i.e., support persons) in making decisions about CT. This study examines the effect of an education seminar for adult cancer patients and support persons on the support persons' use, knowledge, and decision-making processes related to CT. Design: A patient education seminar that included support persons was developed and evaluated as part of a CT decision support research program. Survey data were collected before and after the education seminar to examine its impact on support persons' knowledge and use of CT, as well as their engagement in the CT decision-making process. Setting: The study was conducted in Western Canada. Subjects: 62 adult support persons. Interventions: Participants attended a 4-h CT education seminar at one in four provincial cancer centers. The seminar provided recommendations regarding how to make informed decisions about CT, where to find credible information, and key issues to consider to avoid potential risks of CT use. The evidence related to popular CT was also reviewed. Outcome Measures: The primary outcome was support persons' CT knowledge. Secondary outcomes included CT use, information-seeking behavior, decision self-efficacy, decision conflict, and distress. Results: A significant increase in support persons' CT knowledge was observed, as well as improved confidence in CT decision making. There was no significant difference in participants' CT use following the education seminar. Most indicated they would continue to locate information about CT using the Internet. A significant decrease in support persons' decisional conflict was reported; however, there were no significant change in distress related to CT decision making. Conclusions: This study demonstrates the importance of including support persons in patient education related to CT and the positive impact on their knowledge and treatment decision-making processes. No significant change in CT use, information seeking behavior and distress related to CT decisions, however, was observed in the study.
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Affiliation(s)
| | | | - Sally E Thorne
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Carolyn Gotay
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Tracy L O Truant
- School of Nursing, University of British Columbia, Vancouver, Canada
| | | | - Mary T Kelly
- School of Nursing, University of British Columbia, Vancouver, Canada
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23
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Balneaves LG, Truant TLO, Van Patten C, Kirkham AA, Waters E, Campbell KL. Patient and Medical Oncologists' Perspectives on Prescribed Lifestyle Intervention-Experiences of Women with Breast Cancer and Providers. J Clin Med 2020; 9:jcm9092815. [PMID: 32878120 PMCID: PMC7564717 DOI: 10.3390/jcm9092815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/30/2020] [Revised: 08/18/2020] [Accepted: 08/27/2020] [Indexed: 01/16/2023] Open
Abstract
This study explored the perspectives and experiences of breast cancer patients and medical oncologists with regards to participation in a lifestyle intervention at a tertiary cancer treatment center. A thematic approach was used to understand the context within which a lifestyle intervention was recommended and experienced, to inform future lifestyle programming and promote uptake. Twelve women with breast cancer receiving adjuvant chemotherapy and eight medical oncologists completed interviews. Findings suggest receiving a prescription for a lifestyle intervention from a trusted health professional was influential to women with breast cancer. The intervention offered physical, psychological, emotional, social, and informational benefits to the women and oncologists perceived both physiological and relational benefit to prescribing the intervention. Challenges focused on program access and tailored interventions. Lifestyle prescriptions are perceived by women with breast cancer to have numerous benefits and may promote lifestyle interventions and build rapport between oncologists and women. Oncology healthcare professionals play a pivotal role in motivating women’s participation in lifestyle interventions during breast cancer treatment. Maintenance programs that transition patients into community settings and provide on-going information and follow-up are needed.
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Affiliation(s)
- Lynda G. Balneaves
- College of Nursing, University of Manitoba, Winnipeg, MB R3T 2N2, Canada;
| | | | | | - Amy A. Kirkham
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2W6, Canada;
| | - Erin Waters
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
| | - Kristin L. Campbell
- BC Cancer, Vancouver, BC V5Z 1G1, Canada; (T.L.O.T.); (C.V.P.)
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212, 2177 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada
- Correspondence: ; Tel.: +1-604-827-4704; Fax: +1-604-822-1870
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Ng B, Chapman GE, Levy-Milne R, Balneaves LG. Exploring the dietary choices of Chinese women living with breast cancer in Vancouver, Canada. Support Care Cancer 2020; 29:1675-1681. [PMID: 32772197 PMCID: PMC7843472 DOI: 10.1007/s00520-020-05666-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/09/2019] [Accepted: 07/31/2020] [Indexed: 11/26/2022]
Abstract
Purpose To explore how Chinese Canadian patients with breast cancer make dietary choices and to understand their nutritional information needs in order to inform oncology healthcare providers about provision of optimal supportive care for this population. Methods Using interpretive description methodology, semi-structured interviews were conducted with first- and second-generation Chinese Canadian women aged 41–73 years living in Vancouver, Canada, who were diagnosed with breast cancer within the last 5 years. A follow-up focus group was held to validate emergent themes. Results Nineteen women were interviewed; 6 participated in the focus group. Their accounts of dietary experiences following diagnosis focused on three areas: dietary change (including desired and implemented changes that participants believed would benefit their health), facilitators and barriers to dietary change, and information and resource needs. Dietary changes reported included avoiding or consuming greater amounts of certain foods, and taking traditional Chinese medicine (TCM) and natural health products. Barriers to desired dietary change included the interplay between food preferences and family and social life, work-life balance, and cost and availability of specialty foods. Support from family members, however, facilitated participants’ consumption of more whole and natural foods after their cancer diagnosis. Participants obtained food and nutrition information from a variety of sources but had difficulty determining the reliability and accuracy of information. They requested timely, credible, culturally-relevant, and easily accessible dietary information. Conclusions Oncology healthcare providers would benefit from increased understanding of the dietary practices, including TCM, of Chinese women living with breast cancer. To facilitate communication and improve quality of care, healthcare professionals should provide credible and culturally relevant diet-related information in a variety of forms.
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Affiliation(s)
| | - Gwen E. Chapman
- College of Social and Applied Human Sciences, University of Guelph, Guelph, ON Canada
| | | | - Lynda G. Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
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25
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Bell JAH, Kelly MT, Gelmon K, Chi K, Ho A, Rodney P, Balneaves LG. Gatekeeping in cancer clinical trials in Canada: The ethics of recruiting the "ideal" patient. Cancer Med 2020; 9:4107-4113. [PMID: 32314549 PMCID: PMC7300392 DOI: 10.1002/cam4.3031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 01/06/2020] [Revised: 02/28/2020] [Accepted: 03/12/2020] [Indexed: 01/11/2023] Open
Abstract
Background Perspectives of clinical trial (CT) personnel on accrual to oncology CTs are relatively absent from the literature. This study explores CT personnel's experience recruiting patients to oncology CTs. Methods A qualitative study design was utilized. In‐depth, individual interviews with 12 oncology CT personnel were conducted, including six CT nurses and six physician‐investigators. Interviews were digitally recorded and transcribed verbatim. Data were subjected to thematic and ethical analysis to identify key concepts and themes. Results CT personnel reported considering two ethical commitments in CT recruitment: maintaining trial integrity and ensuring patient autonomy through obtaining informed consent. The process of gatekeeping emerged as a way to navigate these ethical commitments during CT accrual. Gatekeeping was influenced by: (a) perceptions of patients’ personal suitability for a trial, and (b) healthcare resources and infrastructure. CT personnel's discernment of personal suitability was influenced by patients’ cognitive and mental health status, language and cultural background, geographic location, family support, and disease status. Three structural factors impacted gatekeeping: complexity of CTs, consent process, and time limitations in the healthcare system. CT personnel experienced most factors as constraints to accrual and gaining patients’ informed consent. Conclusion CT personnel discussed navigating ethical challenges in CT recruitment by offering enrollment to specific patient populations, exacerbating other ethical tensions. Systems‐level strategies are needed to address barriers to ethical CT recruitment. Future research should investigate the role of policies and/or tools (eg, decision aids) to support patients and CT personnel's discussions about CT participation, promote more ethical recruitment, and potentially increase accrual.
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Affiliation(s)
- Jennifer A H Bell
- University of Toronto, Toronto, ON, Canada.,Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Karen Gelmon
- University of British Columbia, Vancouver, BC, Canada
| | - Kim Chi
- University of British Columbia, Vancouver, BC, Canada
| | - Anita Ho
- University of British Columbia, Vancouver, BC, Canada.,University of California, Oakland, CA, USA.,Centre for Health Evaluation & Outcomes Sciences, University of British Columbia, Vancouver, BC, Canada
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Abstract
Interest in integrative oncology (IO) is growing globally. Patients with cancer are actively using traditional complementary and integrative medicine (TCIM) as part of their cancer and survivorship care. Published studies from around the world report increasing use of TCIM by people living with cancer. This article summarizes the presentations that took place during a symposium titled, "Integrative Oncology: International Perspectives" at the International Research Congress on Integrative Medicine and Health in Baltimore, 2018. The purpose of the presentations was to examine whether cancer services across a variety of geographical regions, including Australia, Canada, the United States, and the European Union, were actively responding to cancer survivors' demand for TCIM. The presenters highlighted utilization rates and both facilitators and barriers to the provision of IO services in their respective countries and regions. The audience discussion following the presentations drew out many noteworthy perspectives.
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Affiliation(s)
- Suzanne J Grant
- 1 Western Sydney University, Penrith, NSW, Australia.,2 Chris O'Brien Lifehouse Comprehensive Cancer Centre, Camperdown, NSW, Australia
| | - Jennifer Hunter
- 1 Western Sydney University, Penrith, NSW, Australia.,3 The University of Sydney, Australia
| | - Dugald Seely
- 4 Ottawa Integrative Cancer Centre, Ottawa, ON, Canada.,5 Canadian College of Naturopathic Medicine, Toronto, ON, Canada
| | | | - Elio Rossi
- 7 Coordinating Center of Complementary Medicine-Local Health Unit Tuscany North West, Lucca, Italy
| | - Ting Bao
- 8 Memorial Sloan Kettering Cancer Center, NY, USA
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27
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Balneaves LG, Alraja AA. "Guarding their practice": a descriptive study of Canadian nursing policies and education related to medical cannabis. BMC Nurs 2019; 18:66. [PMID: 31827392 PMCID: PMC6902327 DOI: 10.1186/s12912-019-0390-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 04/24/2019] [Accepted: 11/26/2019] [Indexed: 11/10/2022] Open
Abstract
Background In Canada, federal regulations allow Nurse Practitioners (NPs) to authorize medical cannabis. Nursing regulatory bodies, however, have been hesitant to include medical cannabis within NPs' scope of practice. As the interest in cannabis increases, NPs have the potential to play a pivotal role in promoting the safe and appropriate use of cannabis. This study aimed to: summarize nursing policies in Canada related to medical cannabis; explore the perspective of nursing regulatory bodies regarding practice and policy issues related to medical cannabis; and examine the inclusion of medical cannabis content within Canadian NP curricula. Methods A descriptive study was conducted that comprised three phases. The first phase reviewed nursing regulatory bodies' existing policies related to medical cannabis. In the second phase, practice consultants from nursing regulatory bodies were interviewed regarding policies and practices issues related to medical cannabis. The interviews were analyzed using thematic analysis. The third phase was a national survey of NP program coordinators regarding inclusion of cannabis in curricula. Descriptive statistics summarized survey responses. Results Of the 12 nursing regulatory bodies in Canada, only 7 had policies or statements related to cannabis, with only Ontario allowing NPs to authorize medical cannabis. There was confusion among practice consultants regarding the role of nurses in the administration of medical cannabis and several barriers were identified regarding nursing engagement in care related to medical cannabis, including lack of knowledge and clinical guidelines. 60% of NP programs included cannabis in their curricula, however, less than half addressed the risks and benefits of medical cannabis and dosing and administration protocols. Limited faculty expertise was a barrier to including cannabis content in NP curricula. Conclusion Nursing regulatory bodies must be proactive in developing policies and educational resources that will support nurses in providing safe and informed care related to cannabis. To ensure patients using medical cannabis receive consistent and safe care from nurses, harmonized regulations and policies are needed across all jurisdictions. Education programs must also provide updated knowledge and training for both registered nurses and NPs that will support them in providing non-judgemental and evidence-based care to the growing number of individuals using cannabis.
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Affiliation(s)
- Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, Manitoba R3T 2N2 Canada
| | - Abeer A Alraja
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, Manitoba R3T 2N2 Canada
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28
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Wong CHL, Wu IXY, Balneaves LG, Lo RSK, Witt CM, Wu JCY, Leung TH, Chung VCH. Prioritizing Chinese Medicine Clinical Research Questions in Cancer Palliative Care: International Delphi Survey. J Pain Symptom Manage 2019; 58:1002-1014.e7. [PMID: 31404640 DOI: 10.1016/j.jpainsymman.2019.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 06/24/2019] [Revised: 07/31/2019] [Accepted: 08/02/2019] [Indexed: 01/09/2023]
Abstract
CONTEXT Chinese medicine modalities, including acupuncture and Chinese herbal medicine (CHM), have been used as palliative interventions among cancer patients. More research should be conducted to confirm their effectiveness. OBJECTIVES The objective of this study was to prioritize Chinese medicine clinical research questions for cancer palliative care. METHODS Twelve international experts, including physicians, Chinese medicine practitioners, nurses, and clinical research methodologists (n = 3 from each category), from Asia, North America, Australia, and Europe participated in a two-round Delphi survey for prioritizing 29 research questions identified from existing systematic reviews. The experts were asked to 1) rate clinical importance of answering the questions on a nine-point Likert scale; 2) provide qualitative comments on their ratings; and 3) suggest outcome measurement approaches. RESULTS Eight research priorities reached positive consensus after the two-round Delphi survey. Six of the priorities focused on acupuncture and related therapies, of which median ratings on importance ranged from 7.0 to 8.0 (interquartile range: 1.00 to 2.50), and the percentage agreement ranged from 75.0% to 91.7%. The remaining two priorities related to CHM, with median ratings ranged from 7.0 to 8.0 (interquartile range: 1.00 to 1.50) and percentage agreement ranged from 75.0% to 83.3%. Neither positive nor negative consensus was established among the remaining 21 questions. CONCLUSION The findings will inform rational allocation of scarce research funding for evaluating the effectiveness of Chinese medicine for cancer palliative care, especially on acupuncture and related therapies. Further research on herb safety and herb-drug interaction should be performed before conducting international trials on CHM.
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Affiliation(s)
- Charlene H L Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong; Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Irene X Y Wu
- Xiang-Ya School of Public Health, Central South University, Changsha, China
| | - Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Raymond S K Lo
- Hospice and Palliative Care, New Territories East Cluster, Hospital Authority, Kowloon, Hong Kong
| | - Claudia M Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University Zurich, Zurich, Switzerland
| | - Justin C Y Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong; Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ting Hung Leung
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vincent C H Chung
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong; Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Smith CA, Chang E, Gallego G, Khan A, Armour M, Balneaves LG. An education intervention to improve decision making and health literacy among older Australians: a randomised controlled trial. BMC Geriatr 2019; 19:129. [PMID: 31064336 PMCID: PMC6505289 DOI: 10.1186/s12877-019-1143-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 11/14/2017] [Accepted: 04/22/2019] [Indexed: 11/24/2022] Open
Abstract
Background National policies seek to involve older Australian’s in decisions regarding their care; however, research has found varying levels of decision self-efficacy and health literacy skills. An increasing number of older Australians use complementary medicine (CM). We examined the effectiveness of a CM educational intervention delivered using a web or DVD plus booklet format to increase older adults’ decision self-efficacy and health literacy. Methods A randomised controlled trial was conducted. We recruited individuals aged over 65 years living in retirement villages or participating in community groups, in Sydney Australia. Participants were randomly allocated to receive a CM education intervention delivered using a website or DVD plus booklet versus booklet only. The primary outcome was decision self-efficacy. A secondary outcome included the Preparation for Decision-Making scale and health literacy. Outcomes were collected at 3 weeks, and 2 months from baseline, and analysed using an adjusted ANOVA, or repeated measures ANOVA. Result We randomised 153 participants. Follow up at 3 weeks and 2 months was completed by 131 participants. There was a 14% (n = 22) attrition rate. At the end of the intervention, we found no significant differences between groups for decision self-efficacy (mean difference (MD) 3.8, 95% confidence interval (CI) -2.0 to 9.6 p = 0.20), there were no differences between groups on nine health literacy domains, and the Preparation for Decision-Making scale. Over 80% of participants in both groups rated the content as excellent or good. Conclusion Decision self-efficacy improved for participants, but did not differ between groups. Decision self-efficacy and health literacy outcomes were not influenced by the delivery of education using a website, DVD or booklet. Participants found the resources useful, and rated the content as good or excellent. CM Web or DVD and booklet resources have the potential for wider application. Trial registration The trial was registered with the Australian New Zealand Clinical Trials Registry: ACTRN (ACTRN12616000135415). The trial was registered on 5 February 2016.
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Affiliation(s)
- Caroline A Smith
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2571, Australia.
| | - Esther Chang
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Gisselle Gallego
- School of Medicine, The University of Notre Dame, Sydney, NSW, Australia
| | - Afshan Khan
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2571, Australia
| | - Mike Armour
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2571, Australia
| | - Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, Canada
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30
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Affiliation(s)
- Linda E Carlson
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ting Bao
- Integrative Breast Oncology, Integrative Medicine and Breast Medicine Services, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Lynda G Balneaves
- College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
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31
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Cyr C, Arboleda MF, Aggarwal SK, Balneaves LG, Daeninck P, Néron A, Prosk E, Vigano A. Erratum to cannabis in palliative care: current challenges and practical recommendations. Ann Palliat Med 2019; 8:215-217. [PMID: 30823840 DOI: 10.21037/apm.2019.01.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/07/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Claude Cyr
- Department of Family Medicine, McGill University, Montreal, Canada.
| | - Maria Fernanda Arboleda
- Department of Oncology, McGill University, Montreal, Canada; Clinique Santé Cannabis, Montreal, Canada
| | - Sunil Kumar Aggarwal
- Department of Rehabilitation Medicine, Department of Geography, University of Washington, Seattle, WA, USA
| | - Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Paul Daeninck
- Department of Family Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Andrée Néron
- Pharmacy Department, CHUM (Centre Hospitalier de l'Université de Montréal), Montreal, Canada
| | - Erin Prosk
- Clinique Santé Cannabis, Montreal, Canada
| | - Antonio Vigano
- Department of Oncology, McGill University, Montreal, Canada; Clinique Santé Cannabis, Montreal, Canada
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32
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Hippman C, Balneaves LG. Women's decision making about antidepressant use during pregnancy: A narrative review. Depress Anxiety 2018; 35:1158-1167. [PMID: 30099817 DOI: 10.1002/da.22821] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 01/02/2018] [Revised: 04/27/2018] [Accepted: 07/11/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Depression is common, particularly among women of childbearing age, and can have far-reaching negative consequences if untreated. Efficacious treatments are available, but little is known about how women make depression treatment decisions during pregnancy. The purpose of this narrative review is to interpretively synthesize literature on women's decision making (DM) regarding antidepressant use during pregnancy. METHODS The databases PubMed, CINAHL, and PsycINFO were searched between May 2015 and August 2017 for peer-reviewed, English-language papers using terms such as "depression," "pregnancy," and "DM." The literature matrix abstraction method was used to systematically abstract data from full articles that met criteria for inclusion. RESULTS Of the articles abstracted (N = 10), half did not cite a DM theory on which the work was based. Key aspects of DM for this population were need for information and decision support, desire for active participation in DM, reflection on beliefs and values, evaluation of treatment option sequelae, and societal expectations. Treatment DM for depression during pregnancy is particularly impacted by the stigma associated with depression and societal expectations of pregnant women related to medication use during pregnancy. These findings, however, were based on studies of predominantly Caucasian and well-educated women. CONCLUSIONS Women require a nonjudgmental environment, in which shared DM feels safe, to foster positive DM experiences and outcomes. Future research is needed to define how to best support women to make depression treatment decisions in pregnancy, with particular attention to DM in the second and third trimesters of pregnancy.
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Affiliation(s)
- Catriona Hippman
- Translational Psychiatric Genetics Group, BC Mental Health & Addictions Research Institute, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Lynda G Balneaves
- College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
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33
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Affiliation(s)
- Moshe Frenkel
- Department of Family Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX
- Medical Director, Integrative Medicine Program, Institute of Oncology Meir Medical Center, Kfar Saba, Israel
| | - Lynda G. Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Lambert LK, Balneaves LG, Howard AF, Chia SK, Gotay CC. Understanding adjuvant endocrine therapy persistence in breast Cancer survivors. BMC Cancer 2018; 18:732. [PMID: 29996816 PMCID: PMC6042363 DOI: 10.1186/s12885-018-4644-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [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: 01/03/2018] [Accepted: 06/28/2018] [Indexed: 01/13/2023] Open
Abstract
Background Adjuvant endocrine therapy (AET) significantly decreases the risk of breast cancer recurrence and mortality. Notwithstanding the demonstrated efficacy of AET, 31–73% of breast cancer survivors do not persist with AET. The purpose of this study was to explore breast cancer survivors’ experiences and perspectives of persisting with AET and to identify the psychosocial and healthcare system factors that influence AET persistence. Methods Informed by interpretive descriptive methodology and relational autonomy theory, individual interviews were conducted with 22 women diagnosed with early-stage breast cancer who had been prescribed AET. These participants also completed a demographic form and a survey that assessed their perceived risk of recurrence. Interviews were analysed using inductive thematic and constant comparative analysis to iteratively compare data and develop conceptualizations of the relationships among data. Descriptive statistics were used to summarize the quantitative data. Results The personal, social, and structural factors found to influence AET persistence included AET side effects, perception of breast cancer recurrence risk, medication and necessity beliefs, social support, the patient-provider relationship, and the continuity and frequency of follow-up care. For most women, over time, the decision-making process around AET persistence became a balancing act between quality of life and quantity of life. The interplay between the personal, social, and structural factors was complex and the weight women placed on some factors over others influenced their AET persistence or non-persistence. Conclusion Expanding our understanding of the factors affecting breast cancer survivors’ AET persistence from their perspective is the first step in developing efficacious, patient-centered interventions aimed at improving AET persistence. In order to improve AET persistence, enhanced symptom management is required, as well as the development of supportive care strategies that acknowledge the values and beliefs held by breast cancer survivors while reinforcing the benefits of AET, and addressing women’s reasons for non-persistence. Improved continuity of health care and patient-healthcare provider communication across oncology and primary care settings is also required. The development and evaluation of supportive care strategies that address the challenges associated with AET experienced by breast cancer survivors hold the potential to increase both women’s quality and quantity of life. Electronic supplementary material The online version of this article (10.1186/s12885-018-4644-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leah K Lambert
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Helen Glass Centre for Nursing, Winnipeg, MB, R3T 2N2, Canada.
| | - A Fuchsia Howard
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Stephen K Chia
- British Columbia Cancer Agency, 600 W 10th Ave, Vancouver, BC, V5Z 4E6, Canada
| | - Carolyn C Gotay
- School of Population and Public Health, University of British Columbia, V2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
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Cyr C, Arboleda MF, Aggarwal SK, Balneaves LG, Daeninck P, Néron A, Prosk E, Vigano A. Cannabis in palliative care: current challenges and practical recommendations. Ann Palliat Med 2018; 7:463-477. [PMID: 30180728 DOI: 10.21037/apm.2018.06.04] [Citation(s) in RCA: 38] [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] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/06/2018] [Indexed: 11/06/2022]
Abstract
Pain and symptom control challenges are common in palliative care, and the search for other therapeutic strategies is ongoing. Unfortunately, patients and their caregivers are receiving little information or support from healthcare providers regarding the increasingly popular cannabinoid-based medicines (CBM). Clinicians, meanwhile, feel understandably perplexed by the discrepancy between the available evidence and the rapid interest in which patients and their families have demonstrated for CBM. There is an urgent need to address the many challenges that are delaying the appropriate integration of CBM into clinical practice, notwithstanding the obvious need for a solid general knowledge of pharmacology, mechanism of action and available clinical evidence supporting its use. The authors will address these challenges and provide practical recommendations regarding patient assessment for the use of CBM. The authors will also make suggestions regarding patient expectations in order to define clear objectives, review the necessary precautions prior to initiating treatment, aid in selecting the appropriate strain and route of administration as well as establishing proper titration and monitoring protocols. The authors will also discuss the lesser known but potentially therapeutic psychoactive effects of cannabis. As this class of therapeutic agents are likely to play a major role in palliative medicine in the near future, clinicians would benefit from familiarizing themselves with CBM and we can expect that patients and their caregivers will appreciate receiving support in their search for safe and effective therapeutic alternatives.
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Affiliation(s)
- Claude Cyr
- Department of Family Medicine, McGill University, Montreal, Canada.
| | - Maria Fernanda Arboleda
- Department of Oncology, McGill University, Montreal, Canada; Clinique Santé Cannabis, Montreal, Canada
| | - Sunil Kumar Aggarwal
- Department of Rehabilitation Medicine, Department of Geography, University of Washington, Seattle, WA, USA
| | - Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Paul Daeninck
- Department of Family Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Andrée Néron
- Pharmacy Department, CHUM (Centre Hospitalier de l'Université de Montréal), Montreal, Canada
| | - Erin Prosk
- Clinique Santé Cannabis, Montreal, Canada
| | - Antonio Vigano
- Department of Oncology, McGill University, Montreal, Canada; Clinique Santé Cannabis, Montreal, Canada
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Witt CM, Balneaves LG, Cardoso MJ, Cohen L, Greenlee H, Johnstone P, Kücük Ö, Mailman J, Mao JJ. A Comprehensive Definition for Integrative Oncology. J Natl Cancer Inst Monogr 2018; 2017:4617827. [PMID: 29140493 DOI: 10.1093/jncimonographs/lgx012] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 08/14/2017] [Indexed: 11/12/2022] Open
Abstract
Background Integrative oncology, which is generally understood to refer to the use of a combination of complementary medicine therapies in conjunction with conventional cancer treatments, has been defined in different ways, but there is no widely accepted definition. We sought to develop and establish a consensus for a comprehensive definition of the field of integrative oncology. Methods We used a mixed-methods approach that included a literature analysis and a consensus procedure, including an interdisciplinary expert panel and surveys, to develop a comprehensive and acceptable definition for the term "integrative oncology." Results The themes identified in the literature and from the expert discussion were condensed into a two-sentence definition. Survey respondents had very positive views on the draft definition, and their comments helped to shape the final version. The final definition for integrative oncology is: "Integrative oncology is a patient-centered, evidence-informed field of cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside conventional cancer treatments. Integrative oncology aims to optimize health, quality of life, and clinical outcomes across the cancer care continuum and to empower people to prevent cancer and become active participants before,during, and beyond cancer treatment." Conclusions This short and comprehensive definition for the term integrative oncology will facilitate a better understanding and communication of this emerging field. This definition will also drive focused and cohesive effort to advance the field of integrative oncology.
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Affiliation(s)
- Claudia M Witt
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lynda G Balneaves
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maria J Cardoso
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lorenzo Cohen
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heather Greenlee
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Peter Johnstone
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ömer Kücük
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Josh Mailman
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jun J Mao
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
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Balneaves LG. Moving Evidence to the Bedside: Natural Products in Cancer Care. Am J Transl Res 2018. [DOI: 10.1055/s-0038-1644923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- LG Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Balneaves LG, Alraja A, Ziemianski D, McCuaig F, Ware M. A National Needs Assessment of Canadian Nurse Practitioners Regarding Cannabis for Therapeutic Purposes. Cannabis Cannabinoid Res 2018; 3:66-73. [PMID: 29588917 PMCID: PMC5868330 DOI: 10.1089/can.2018.0002] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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] [Indexed: 11/21/2022] Open
Abstract
Introduction: In Canada, the Access to Cannabis for Medical Purposes Regulations (ACMPR) has given nurse practitioners (NPs) the power to authorize cannabis for therapeutic purposes (CTP) to eligible patients. This expansion in NPs' scope of practice underscores the importance of delivering balanced, evidence-based education on cannabis to NPs. The aim of this national study was to assess NPs' knowledge and practice gaps related to CTP to inform the development of future education resources that increase NPs' clinical competence and improve patient care related to medical cannabis. Methods: This is a quantitative, descriptive exploratory design study. A national online survey of NPs was conducted from August 2013 to June 2014. NPs were recruited through email lists held by numerous Canadian nursing organizations. The survey was adapted from a previous national survey that assessed CTP educational needs among Canadian physicians. The survey assessed NPs' knowledge, experience, barriers, and attitudes related to CTP as well as preferred format for future CTP education. Results: The sample consisted of 182 NPs from across Canada. The largest knowledge gap was related to dosing and creating effective treatment plans for patients using CTP. The majority of respondents (76.3%) ranked the need for education on CTP to be either strong or very strong. Over half (57%) reported that they would be comfortable authorizing medical cannabis through the ACMPR; this number increased to 64% if they were to receive appropriate education. Conclusion: Nursing regulatory organizations, in partnership with academic institutions and government agencies, must work toward the development of educational and clinical competencies specific to CTP. Tailored education programs are needed to address the knowledge gaps held by NPs and the clinical barriers they face to including CTP as part of their care.
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Affiliation(s)
- Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Abeer Alraja
- Manitoba Centre for Nursing and Health Research, University of Manitoba, Winnipeg, Canada
| | - Daniel Ziemianski
- Canadian Consortium for the Investigation of Cannabinoids, Montreal, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Fairleth McCuaig
- School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, Canada
| | - Mark Ware
- Canadian Consortium for the Investigation of Cannabinoids, Montreal, Canada.,Department of Anesthesia, McGill University, Montreal, Canada.,Department of Family Medicine, McGill University, Montreal, Canada.,Alan Edwards Pain Management Unit, McGill University, Montreal, Canada
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Ravindran AV, Balneaves LG, Faulkner G, Ortiz A, McIntosh D, Morehouse RL, Ravindran L, Yatham LN, Kennedy SH, Lam RW, MacQueen GM, Milev RV, Parikh SV. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 5. Complementary and Alternative Medicine Treatments. Focus (Am Psychiatr Publ) 2018; 16:85-94. [PMID: 32015703 DOI: 10.1176/appi.focus.16106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
(Reprinted by permission of SAGE Publications, Inc., from The Canadian Journal of Psychiatry 2016; 61:576-587. Copyright © 2016 by the Authors [https://doi.org/10.1177/0706743716660290]).
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Smith CA, Chang E, Gallego G, Balneaves LG. An education intervention to improve health literacy and decision making about supporting self-care among older Australians: a study protocol for a randomised controlled trial. Trials 2017; 18:441. [PMID: 28950888 PMCID: PMC5615792 DOI: 10.1186/s13063-017-2182-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older Australians are high consumers of complementary and alternative medicines (CM). To help older people to take an active role in their health, we will develop and evaluate a novel educational intervention to support decision self-efficacy, and improve health literacy skills. METHODS The primary hypothesis is that participants receiving a web/DVD plus booklet intervention compared with a booklet-only group will demonstrate an increase in decision self-efficacy. This study is a randomised controlled trial. One hundred and sixty-eight people aged 65 years and older will be recruited from community settings comprising retirement villages and community groups, based in Sydney, Australia. Participants will be randomly allocated to either the education intervention delivered by the Internet or a DVD plus booklet versus a control group (booklet only). The primary outcome measure is CM decision self-efficacy. Secondary outcomes are health literacy, knowledge and attitudes, and change in health-seeking behaviour. Participants' views on the ease of using the resources, the length of the modules, the amount of information, and participant understanding of the modules will be assessed. Outcomes will be collected on completion of the intervention at 3 weeks, and at a 2-month follow up from trial entry. DISCUSSION This trial has the potential to improve CM health literacy in older Australians. There are no educational resources designed to support decision self-efficacy and improve health literacy amongst older people related to CM. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12616000135415 . Registered on 5 February 2016.
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Affiliation(s)
- Caroline A. Smith
- National Institute of Complementary Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - Esther Chang
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - Gisselle Gallego
- School of Medicine, The University of Notre Dame, Sydney, Australia
| | - Lynda G. Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, Manitoba R3T 2N2 Canada
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Carlson LE, Zelinski EL, Speca M, Balneaves LG, Jones JM, Santa Mina D, Wayne PM, Campbell TS, Giese-Davis J, Faris P, Zwicker J, Patel K, Beattie TL, Cole S, Toivonen K, Nation J, Peng P, Thong B, Wong R, Vohra S. Protocol for the MATCH study (Mindfulness and Tai Chi for cancer health): A preference-based multi-site randomized comparative effectiveness trial (CET) of Mindfulness-Based Cancer Recovery (MBCR) vs. Tai Chi/Qigong (TCQ) for cancer survivors. Contemp Clin Trials 2017; 59:64-76. [PMID: 28576734 PMCID: PMC5639905 DOI: 10.1016/j.cct.2017.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 01/16/2017] [Revised: 05/26/2017] [Accepted: 05/29/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE A growing number of cancer survivors suffer high levels of distress, depression and stress, as well as sleep disturbance, pain and fatigue. Two different mind-body interventions helpful for treating these problems are Mindfulness-Based Cancer Recovery (MBCR) and Tai Chi/Qigong (TCQ). However, while both interventions show efficacy compared to usual care, they have never been evaluated in the same study or directly compared. This study will be the first to incorporate innovative design features including patient choice while evaluating two interventions to treat distressed cancer survivors. It will also allow for secondary analyses of which program best targets specific symptoms in particular groups of survivors, based on preferences and baseline characteristics. METHODS AND SIGNIFICANCE The design is a preference-based multi-site randomized comparative effectiveness trial. Participants (N=600) with a preference for either MBCR or TCQ will receive their preferred intervention; while those without a preference will be randomized into either intervention. Further, within the preference and non-preference groups, participants will be randomized into immediate intervention or wait-list control. Total mood disturbance on the Profile of mood states (POMS) post-intervention is the primary outcome. Other measures taken pre- and post-intervention and at 6-month follow-up include quality of life, psychological functioning, cancer-related symptoms and physical functioning. Exploratory analyses investigate biomarkers (cortisol, cytokines, blood pressure/Heart Rate Variability, telomere length, gene expression), which may uncover potentially important effects on key biological regulatory and antineoplastic functions. Health economic measures will determine potential savings to the health system.
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Affiliation(s)
- Linda E Carlson
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Cancer Control Board, Alberta Health Services, AB, Canada.
| | - Erin L Zelinski
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Cancer Control Board, Alberta Health Services, AB, Canada
| | - Michael Speca
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Cancer Control Board, Alberta Health Services, AB, Canada
| | - Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jennifer M Jones
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Peter M Wayne
- Osher Center for Integrative Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Janine Giese-Davis
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Cancer Control Board, Alberta Health Services, AB, Canada
| | - Peter Faris
- Centre for Advancement of Health, Alberta Health Services, AB, Canada
| | - Jennifer Zwicker
- School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Kamala Patel
- Department of Immunology, University of Calgary, Calgary, AB, Canada
| | - Tara L Beattie
- Department of Biochemistry and Molecular Biology, University of Calgary, Calgary, AB, Canada
| | - Steve Cole
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kirsti Toivonen
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Jill Nation
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Philip Peng
- Department of Anesthesia, University of Toronto, ON, Canada
| | - Bruce Thong
- Department of Athletics and Recreation, McMaster University, Hamilton, ON, Canada
| | - Raimond Wong
- Department of Oncology, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sunita Vohra
- Department of Pediatrics, Faculty of Medicine and Dentistry, Integrative Health Institute, University of Alberta, Edmonton, AB, Canada
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Greenlee H, DuPont-Reyes MJ, Balneaves LG, Carlson LE, Cohen MR, Deng G, Johnson JA, Mumber M, Seely D, Zick SM, Boyce LM, Tripathy D. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin 2017; 67:194-232. [PMID: 28436999 PMCID: PMC5892208 DOI: 10.3322/caac.21397] [Citation(s) in RCA: 381] [Impact Index Per Article: 54.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Answer questions and earn CME/CNE Patients with breast cancer commonly use complementary and integrative therapies as supportive care during cancer treatment and to manage treatment-related side effects. However, evidence supporting the use of such therapies in the oncology setting is limited. This report provides updated clinical practice guidelines from the Society for Integrative Oncology on the use of integrative therapies for specific clinical indications during and after breast cancer treatment, including anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Clinical practice guidelines are based on a systematic literature review from 1990 through 2015. Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-L-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy due to a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related side effects. In summary, there is a growing body of evidence supporting the use of integrative therapies, especially mind-body therapies, as effective supportive care strategies during breast cancer treatment. Many integrative practices, however, remain understudied, with insufficient evidence to be definitively recommended or avoided. CA Cancer J Clin 2017;67:194-232. © 2017 American Cancer Society.
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Affiliation(s)
- Heather Greenlee
- Assistant Professor, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
- Member, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY
| | - Melissa J DuPont-Reyes
- Doctoral Fellow, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Lynda G Balneaves
- Associate Professor, College of Nursing, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
| | - Linda E Carlson
- Professor, Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Misha R Cohen
- Adjunct Professor, American College of Traditional Chinese Medicine at California Institute of Integral Studies, San Francisco, CA
- Clinic Director, Chicken Soup Chinese Medicine, San Francisco, CA
| | - Gary Deng
- Medical Director, Integrative Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jillian A Johnson
- Post-Doctoral Scholar, Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA
| | | | - Dugald Seely
- Executive Director, Ottawa Integrative Cancer Center, Ottawa, ON, Canada
- Executive Director of Research, Canadian College of Naturopathic Medicine, Toronto, ON, Canada
| | - Suzanna M Zick
- Research Associate Professor, Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI
- Research Associate Professor, Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Lindsay M Boyce
- Research Informationist, Memorial Sloan Kettering Library, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Debu Tripathy
- Professor, Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Aucoin M, Cooley K, Knee C, Fritz H, Balneaves LG, Breau R, Fergusson D, Skidmore B, Wong R, Seely D. Fish-Derived Omega-3 Fatty Acids and Prostate Cancer: A Systematic Review. Integr Cancer Ther 2017; 16:32-62. [PMID: 27365385 PMCID: PMC5736071 DOI: 10.1177/1534735416656052] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/16/2016] [Accepted: 05/18/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The use of natural health products in prostate cancer (PrCa) is high despite a lack of evidence with respect to safety and efficacy. Fish-derived omega-3 fatty acids possess anti-inflammatory effects and preclinical data suggest a protective effect on PrCa incidence and progression; however, human studies have yielded conflicting results. METHODS A search of OVID MEDLINE, Pre-MEDLINE, Embase, and the Allied and Complementary Medicine Database (AMED) was completed for human interventional or observational data assessing the safety and efficacy of fish-derived omega-3 fatty acids in the incidence and progression of PrCa. RESULTS Of 1776 citations screened, 54 publications reporting on 44 studies were included for review and analysis: 4 reports of 3 randomized controlled trials, 1 nonrandomized clinical trial, 20 reports of 14 cohort studies, 26 reports of 23 case-control studies, and 3 case-cohort studies. The interventional studies using fish oil supplements in patients with PrCa showed no impact on prostate-specific antigen levels; however, 2 studies showed a decrease in inflammatory or other cancer markers. A small number of mild adverse events were reported and interactions with other interventions were not assessed. Cohort and case-control studies assessing the relationship between dietary fish intake and the risk of PrCa were equivocal. Cohort studies assessing the risk of PrCa mortality suggested an association between higher intake of fish and decreased risk of prostate cancer-related death. CONCLUSIONS Current evidence is insufficient to suggest a relationship between fish-derived omega-3 fatty acid and risk of PrCa. An association between higher omega-3 intake and decreased PrCa mortality may be present but more research is needed. More intervention trials or observational studies with precisely measured exposure are needed to assess the impact of fish oil supplements and dietary fish-derived omega-3 fatty acid intake on safety, PrCa incidence, treatment, and progression.
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Affiliation(s)
- Monique Aucoin
- Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
| | - Kieran Cooley
- Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
| | - Christopher Knee
- Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
| | - Heidi Fritz
- Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
| | | | - Rodney Breau
- Ottawa Hospital General Campus, Ottawa, Ontario, Canada
| | - Dean Fergusson
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Becky Skidmore
- Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
| | | | - Dugald Seely
- Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Ottawa Integrative Cancer Centre, Ottawa, Ontario, Canada
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Boon H, Gaboury I, Balneaves LG, Tsui T, Ng JY, Bozinovski N. 2016 INCAM Research Symposium: Expanding Person-Centred Care through Integrative Health Research. J Complement Integr Med 2016; 13:eA1-eA27. [PMID: 27783560 DOI: 10.1515/jcim-2016-0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The following are abstracts of research presentations given at the 9th INCAM Research Symposium. The theme for this year's conference was "Expanding Person-Centred Care through Integrative Health Research", which was held on November 18 and 19, 2016 at the Toronto Marriott Bloor Yorkville Hotel in Ontario, Canada. The abstracts are grouped under the categories of oral or poster presentation based on their presentation at the Symposium. For more information, please visit: http://www.iscmr.org/content/canadian-chapter---public.
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Mulkins AL, McKenzie E, Balneaves LG, Salamonsen A, Verhoef MJ. From the conventional to the alternative: exploring patients' pathways of cancer treatment and care. J Complement Integr Med 2016; 13:51-64. [PMID: 26259233 DOI: 10.1515/jcim-2014-0070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 07/23/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Complementary and alternative medicine (CAM) use is widespread and on the increase among cancer patients. Most research to date has involved a cross-sectional snapshot of CAM use rather than an exploration into the longitudinal, nonlinear treatment trajectories that cancer patients develop. Our aim is to explore and describe different treatment and decision-making pathways that individuals develop after receipt of a diagnosis of either breast, colorectal, or prostate cancer. METHODS The study was part of a larger mixed-methods pilot project to explore the feasibility of conducting a five-year international study to assess cancer patients' treatment pathways, including health care use and the perceived impact of different patterns of use on health outcomes over the course of one year. The results presented in this paper are based on the analysis of personal interviews that were conducted over the course of 12 months with 30 participants. RESULTS Five pathways emerged from the data: passive conventional, self-directed conventional, cautious integrative, aggressive integrative, and aggressive alternative. Factors that shaped each pathway included health beliefs, decision-making role, illness characteristics, and the patient-practitioner relationship. CONCLUSIONS The results of this examination of the longitudinal treatment and decision-making trajectory provide important information to support health care professionals in their quest for individualized, targeted support at each stage of the patient pathway.
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Ravindran AV, Balneaves LG, Faulkner G, Ortiz A, McIntosh D, Morehouse RL, Ravindran L, Yatham LN, Kennedy SH, Lam RW, MacQueen GM, Milev RV, Parikh SV. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 5. Complementary and Alternative Medicine Treatments. Can J Psychiatry 2016; 61:576-87. [PMID: 27486153 PMCID: PMC4994794 DOI: 10.1177/0706743716660290] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. METHODS Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. "Complementary and Alternative Medicine Treatments" is the fifth of six sections of the 2016 guidelines. RESULTS Evidence-informed responses were developed for 12 questions for 2 broad categories of complementary and alternative medicine (CAM) interventions: 1) physical and meditative treatments (light therapy, sleep deprivation, exercise, yoga, and acupuncture) and 2) natural health products (St. John's wort, omega-3 fatty acids; S-adenosyl-L-methionine [SAM-e], dehydroepiandrosterone, folate, Crocus sativus, and others). Recommendations were based on available data on efficacy, tolerability, and safety. CONCLUSIONS For MDD of mild to moderate severity, exercise, light therapy, St. John's wort, omega-3 fatty acids, SAM-e, and yoga are recommended as first- or second-line treatments. Adjunctive exercise and adjunctive St. John's wort are second-line recommendations for moderate to severe MDD. Other physical treatments and natural health products have less evidence but may be considered as third-line treatments. CAM treatments are generally well tolerated. Caveats include methodological limitations of studies and paucity of data on long-term outcomes and drug interactions.
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Affiliation(s)
- Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | - Guy Faulkner
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia
| | - Abigail Ortiz
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario
| | - Diane McIntosh
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | | | | | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | | | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario
| | - Sagar V Parikh
- Department of Psychiatry, University of Toronto, Toronto, Ontario Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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Wu X, Chung VCH, Lu P, Poon SK, Hui EP, Lau AYL, Balneaves LG, Wong SYS, Wu JCY. Chinese Herbal Medicine for Improving Quality of Life Among Nonsmall Cell Lung Cancer Patients: Overview of Systematic Reviews and Network Meta-Analysis. Medicine (Baltimore) 2016; 95:e2410. [PMID: 26735544 PMCID: PMC4706264 DOI: 10.1097/md.0000000000002410] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
For patients with nonsmall cell lung cancer (NSCLC) receiving chemotherapy, current clinical evidence has indicated add-on benefit of Chinese herbal medicine (CHM) in improving quality of life (QoL). However, the relative performance among different CHM is unknown. The aim of this overview of systematic reviews (SRs) and network meta-analyses (NMA) is to evaluate the comparative effectiveness of different CHM. Seven electronic databases including both international databases and Chinese databases were searched. SRs focus on randomized controlled trials (RCTs) with comparison of CHM plus chemotherapy against chemotherapy alone on QoL among NSCLC patients were considered eligible. Data from RCTs were extracted for random effect pairwise meta-analyses. Pooled relative risk (RR) with 95% confidence interval (CI) was used to quantify the impact of CHM on QoL. NMA was used to explore the most effective CHM for improving QoL when used with chemotherapy. From 14 SRs, 61 RCTs (n = 4247) assessing 11 different CHM were included. Result from pairwise meta-analyses showed 6 CHM (Kang-lai-te injection, Shei-qi-fu-zheng injection, Compound ku-shen injection, Kang-ai injection, Zi-jin-long tablet, and Shen-fu injection) has significant beneficial effect on QoL among NSCLC patients when used with chemotherapy, even after adjustment for publication bias. Pooled RR varied from 1.38 (95% CI: 1.11-1.72, I2 = 0.0%, Kang-lai-te injection) to 3.36 (95% CI: 1.30-8.66, I2 = 0.0%, Zi-jin-long tablet). One trial comparing Hai-shen-su (a protein extract from Tegillarca granosa L.) plus chemotherapy with chemotherapy also demonstrated beneficial effect of combined treatment (RR = 3.13, 95% CI: 1.41-6.98). Results from NMA showed no differences on the comparative effectiveness among CHM, but Hai-shen-su plus chemotherapy has the highest probability (62.3%) of being the best option for improving QoL. Use of CHM on top of chemotherapy can significantly improve QoL in NSCLC patients. Although Hai-shen-su showed the highest probability of being the best add-on to chemotherapy, the effectiveness of all 11 CHM reviewed appeared to be similar. In the future, rigorous placebo controlled trials with proper blinding are needed to confirm the effectiveness of CHM.
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Affiliation(s)
- Xinyin Wu
- From the Hong Kong Institute of Integrative Medicine (XW, VCHC, LP, SYSW), Jockey Club School of Public Health and Primary Care (XW, VCHC, EPH, AYLL, SYSW, JCYW), Comprehensive Cancer Trials Unit (EPH), and Department of Medicine and Therapeutics (AYLL, JCYW), The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong; School of Information Technologies, The University of Sydney, Sydney, Australia (SKP); and Centre for Integrative Medicine, University of Toronto, Toronto, ON, Canada (LGB)
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Greenlee H, Balneaves LG, Carlson LE, Cohen M, Deng G, Hershman D, Mumber M, Perlmutter J, Seely D, Sen A, Zick SM, Tripathy D. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr 2015; 2014:346-58. [PMID: 25749602 DOI: 10.1093/jncimonographs/lgu041] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The majority of breast cancer patients use complementary and/or integrative therapies during and beyond cancer treatment to manage symptoms, prevent toxicities, and improve quality of life. Practice guidelines are needed to inform clinicians and patients about safe and effective therapies. METHODS Following the Institute of Medicine's guideline development process, a systematic review identified randomized controlled trials testing the use of integrative therapies for supportive care in patients receiving breast cancer treatment. Trials were included if the majority of participants had breast cancer and/or breast cancer patient results were reported separately, and outcomes were clinically relevant. Recommendations were organized by outcome and graded based upon a modified version of the US Preventive Services Task Force grading system. RESULTS The search (January 1, 1990-December 31, 2013) identified 4900 articles, of which 203 were eligible for analysis. Meditation, yoga, and relaxation with imagery are recommended for routine use for common conditions, including anxiety and mood disorders (Grade A). Stress management, yoga, massage, music therapy, energy conservation, and meditation are recommended for stress reduction, anxiety, depression, fatigue, and quality of life (Grade B). Many interventions (n = 32) had weaker evidence of benefit (Grade C). Some interventions (n = 7) were deemed unlikely to provide any benefit (Grade D). Notably, only one intervention, acetyl-l-carnitine for the prevention of taxane-induced neuropathy, was identified as likely harmful (Grade H) as it was found to increase neuropathy. The majority of intervention/modality combinations (n = 138) did not have sufficient evidence to form specific recommendations (Grade I). CONCLUSIONS Specific integrative therapies can be recommended as evidence-based supportive care options during breast cancer treatment. Most integrative therapies require further investigation via well-designed controlled trials with meaningful outcomes.
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Affiliation(s)
- Heather Greenlee
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT).
| | - Lynda G Balneaves
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Linda E Carlson
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Misha Cohen
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Gary Deng
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Dawn Hershman
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Matthew Mumber
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Jane Perlmutter
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Dugald Seely
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Ananda Sen
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Suzanna M Zick
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Debu Tripathy
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
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Lee RT, Yang P, Greenlee H, Bauer-Wu S, Balneaves LG, Zick S. Personalized integrative oncology: targeted approaches for optimal outcomes: the 11th International Conference of the Society for Integrative Oncology. Integr Cancer Ther 2015; 14:98-105. [PMID: 25505022 DOI: 10.1177/1534735414563603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 12/22/2022] Open
Abstract
The 11th International Conference of the Society for Integrative Oncology (SIO) brought together more than 300 clinicians, researchers, patients, and advocates to hear and interact with world-leading experts about the latest research in the areas of nutrition, exercise, acupuncture, health services research, meditation, and other integrative disciplines. The conference theme, "Personalized Integrative Oncology: Targeted Approaches for Optimal Outcomes," highlighted innovations in personalized medicine and ways this growing field will advance the evolution of individualized integrative cancer care to the next level. This year's conference also featured a clinical track focusing on clinical information for the practicing health care professional. The conference's rigorous schedule included 3 keynotes, 4 plenary sessions, 2 interdisciplinary tumor boards, 5 workshops, 45 concurrent oral sessions, and 106 posters. In addition to the conference theme, keynote and plenary sessions presented topics on stress and cancer, the importance of sleep for cancer patients, epigenetic mechanisms of lifestyle and natural products, recently published Journal of the National Cancer Institute monograph on integrative oncology, SIO's clinical practice guidelines for breast cancer survivors, and a joint session of the American Academy of Hospice and Palliative Medicine and SIO about supportive care and symptom management. This highly successful conference helped further the mission of the SIO to advance evidence-based, comprehensive, integrative health care to improve the lives of people affected by cancer.
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Affiliation(s)
- Richard T Lee
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peiying Yang
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Lynda G Balneaves
- University of Toronto, Princess Margaret Cancer Center, Toronto, Ontario, Canada
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King N, Balneaves LG, Levin GT, Nguyen T, Nation JG, Card C, Truant T, Carlson LE. Surveys of Cancer Patients and Cancer Health Care Providers Regarding Complementary Therapy Use, Communication, and Information Needs. Integr Cancer Ther 2015; 14:515-24. [PMID: 26069277 DOI: 10.1177/1534735415589984] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [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: 01/07/2023] Open
Abstract
BACKGROUND Complementary therapies (CTs) are increasingly utilized by cancer patients. Nonetheless, patients report insufficient support from health care practitioners (HCPs) and there is a general lack of patient-practitioner communication about CT use. Best care practices suggest that HCPs should address the needs of patients, including CT use. This study examined current practices of patients and HCPs as well as their interactions relating to CTs. METHODS A total of 481 cancer outpatients and 100 HCPs completed questionnaires. Patient questions addressed CT use and information needs; HCP questions addressed knowledge, opinions and beliefs about complementary and alternative medicine. Patient-practitioner communication around CT was also examined. RESULTS 47% of patients reported using CTs since diagnosis. Many commenced CT use to improve quality of life (65%) based on recommendations from family or friends. Patients acknowledged the need for trusted sources of information and would attend a hospital-based education program (72%). HCPs reported limited training about CTs but most (90%) expressed interested in receiving more training. The majority of HCPs (>80%) reported limited knowledge about the role of CTs in cancer care or evidence to support CT use. Questions about communication and interactions revealed that 80% of patients reported not having had an HCP speak to them about CTs. However, 63% of HCPs reported addressing CT use. CONCLUSION Results demonstrate a need for improved CT education and training for patients and HCPs. increasing HCP knowledge and clinical skills will ensure patients' information needs about CTs are acknowledged and attended to, thereby providing safer and comprehensive cancer care.
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Affiliation(s)
- Ngaire King
- University of Calgary, Calgary, Alberta, Canada
| | - Lynda G Balneaves
- University of British Columbia, Vancouver, British Columbia, Canada University of Toronto, Toronto, Ontario, Canada
| | - Gregory T Levin
- University of Calgary, Calgary, Alberta, Canada Edith Cowan University, Perth, Western Australia, Australia
| | - Thao Nguyen
- Tom Baker Cancer Centre, Alberta Health Services, Alberta, Canada
| | - Jill G Nation
- Tom Baker Cancer Centre, Alberta Health Services, Alberta, Canada
| | - Cynthia Card
- University of Calgary, Calgary, Alberta, Canada Tom Baker Cancer Centre, Alberta Health Services, Alberta, Canada
| | - Tracy Truant
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda E Carlson
- University of Calgary, Calgary, Alberta, Canada Tom Baker Cancer Centre, Alberta Health Services, Alberta, Canada
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