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Estell MH, Whitford KJ, Ulrich AM, Larsen BE, Wood C, Bigelow ML, Dockter TJ, Schoonover KL, Stelpflug AJ, Strand JJ, Walton MP, Lapid MI. Music Therapy Intervention to Reduce Symptom Burden in Hospice Patients: A Descriptive Study. Am J Hosp Palliat Care 2024:10499091241237991. [PMID: 38501668 DOI: 10.1177/10499091241237991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
Background: Music therapy (MT) offers benefits of improved symptom relief and quality of life at the end of life, but its impact on hospice patients and caregivers needs more research. Objective: To assess the impact of MT intervention on symptom burden and well-being of hospice patients and caregivers. Methods: A total of 18 hospice patients, selected based on scores ≥4 on the revised Edmonton Symptom Assessment System (ESAS-r) items on pain, depression, anxiety, or well-being, participated in MT sessions provided by a board-certified music therapist. Over a period of 2-3 weeks, 3-4 MT sessions were conducted for each. Patient Quality of life (QOL) was assessed using the Linear Analogue Self-Assessment (LASA). Depression and anxiety were measured with the Patient Health Questionnaire-4 (PHQ-4). For the 7 caregivers enrolled, stress levels were measured using the Pearlin role overload measure and LASA. Results: Patients reported a reduction in symptom severity and emotional distress and an increase in QOL. All patients endorsed satisfaction with music therapy, describing it as particularly beneficial for stress relief, relaxation, spiritual support, emotional support, and well-being. Scores on overall QOL and stress were worse for caregivers. Conclusion: This study provides evidence that MT reduces symptom burden and enhances the quality of life for hospice patients. Hospice patients and their caregivers endorsed satisfaction with MT. Given the benefits observed, integrating MT into hospice care regimens could potentially improve patient and caregiver outcomes. Larger studies should be conducted to better assess the impact of MT in this population.
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Affiliation(s)
- Madison H Estell
- Medical School, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Kevin J Whitford
- Medical School, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Mayo Clinic Hospice, Mayo Clinic, Rochester, MN, USA
- Department of Medicine, Mayo Clinic Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Angela M Ulrich
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Travis J Dockter
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Kimberly L Schoonover
- Medical School, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Division of Community Internal Medicine, Geriatrics and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Jacob J Strand
- Medical School, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Monica P Walton
- Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Maria I Lapid
- Medical School, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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Wang Y, Ferreira E, Savageau J, Beitman A, Young M, Gabovitch E, Merriam G, Jozan A, Padgett K, Bateman S. Community-Based Pediatric Palliative Care: How Services Support Children's and Families' Quality of Life. J Palliat Med 2023; 26:1634-1643. [PMID: 37972058 DOI: 10.1089/jpm.2023.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Background: The Massachusetts Department of Public Health's Pediatric Palliative Care Network (PPCN) provides Community-Based Pediatric Palliative Care (CBPPC) to children with life-limiting conditions and their families. CBPPC services aim to improve children and families' quality of life (QOL). Objectives: To identify perceived domains of QOL important for children and families and to understand whether and how CBPPC supports QOL. Design: A community-based participatory research framework was used to develop recruitment and data collection materials for eight focus groups and seven interviews. Collected data were transcribed and analyzed with an inductive approach. Setting/Subjects: A convenience sample of 33 PPCN caregivers, 20 providers, and seven key informants, including policymakers, community organizations, and hospital-based clinicians, were interviewed virtually in the United States. Measurements: Perceived QOL domains for children and families, respectively, and perceived impact of CBPPC services on QOL. Results: Reported QOL domains described as important for children were socialization/community integration and accessibility; expression/play; and physical wellness. Control or autonomy, psycho-emotional wellness, and self-care were identified as important for families. Clinical services were described as "integral to mental health" through offered spiritual support; advocacy in the community; and education. PPCN's integrative services were noted as distractions from pain and helped improve communication and bonding. Sibling support and bereavement care were also mentioned as impactful on QOL. Conclusions: Family-centered CBPPC was described as supportive of children's and families' QOL. Future studies should consider using population-based QOL measures, leveraging the QOL domains identified through this analysis and other outcome measures in a cost-effectiveness analysis.
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Affiliation(s)
- Ying Wang
- ForHealth Consulting, University of Massachusetts Chan Medical School, Shrewsbury, Massachusetts, USA
| | - Erica Ferreira
- ForHealth Consulting, University of Massachusetts Chan Medical School, Shrewsbury, Massachusetts, USA
| | - Judith Savageau
- Department of Family Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Aaron Beitman
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Megan Young
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Elaine Gabovitch
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Gail Merriam
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | | | - Kerri Padgett
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Scot Bateman
- Department of Pediatric Critical Care, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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Ahuja K, DeSena G, Lio PA. A response to "Steroid phobia on social media platforms". Pediatr Dermatol 2023; 40:968-969. [PMID: 37767650 DOI: 10.1111/pde.15373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/21/2023] [Indexed: 09/29/2023]
Affiliation(s)
- Kripa Ahuja
- Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Grace DeSena
- The University of Florida College of Medicine, Gainesville, Florida, USA
| | - Peter A Lio
- Department of Dermatology, Northwestern University, Chicago, Illinois, USA
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Gray E, Erickson M, Bindler R, Eti DU, Wilson M. Experiencing COMFORT: Perceptions of Virtually-delivered Nonpharmacologic Therapies in Adults Prescribed Opioids for Chronic Pain. Pain Manag Nurs 2023; 24:469-476. [PMID: 37179236 PMCID: PMC10524526 DOI: 10.1016/j.pmn.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND An opioid task force within an urban public health district sought to increase access to, and utilization of, non-opioid, nonpharmacologic alternatives for pain management. AIMS The COMFORT (Community-engaged Options to Maximize and Facilitate Opioid ReducTion) study was designed to provide virtual multidimensional integrated nonpharmacologic therapies via a cloud-based videoconferencing platform over six weeks to adults with chronic pain who were prescribed an opioid to investigate measurable health improvements. METHODS A qualitative descriptive analysis explored participants' experiences of a novel pain management intervention. A total of 19 participants consented to participate in the study and 15 completed six virtual consultations with either yoga, massage, chiropractic, or physical therapists. Semi-structured exit interviews were conducted, and data analyzed using content analysis. RESULTS Five main themes were identified, including unmet pain needs, self-care practices, incentive for participation, perception of a virtual environment, and benefits of the intervention. All participants reported at least minor benefits, with about half reporting improvement in pain levels, and some were able to reduce their opioid use. A virtual environment posed challenges for a few participants who found it more difficult to engage with than in-person therapy; others found the platform easy to navigate. CONCLUSIONS Participants with chronic pain were open and willing to try a novel way to access nonpharmacologic consultations to address unmet pain needs. Virtual consultations with pain management experts may increase access to, and utilization of, complementary and integrative treatment modalities.
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Affiliation(s)
- Emily Gray
- College of Nursing, Washington State University, Spokane, Washington.
| | - Morgan Erickson
- College of Nursing, Washington State University, Spokane, Washington
| | - Ross Bindler
- College of Nursing, Washington State University, Spokane, Washington
| | - Deborah U Eti
- College of Nursing, Washington State University, Spokane, Washington
| | - Marian Wilson
- College of Nursing, Washington State University, Spokane, Washington
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5
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Kaya MS. The Use of Dynamic Cognitive Behavioural Therapy (DCBT) in Social Anxiety Disorder (SAD): A Theoretical Integration Initiative. Medicina (B Aires) 2022; 58. [PMID: 36556961 DOI: 10.3390/medicina58121759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022] Open
Abstract
Psychotherapy theorists can often become fervent advocates of the schools they follow and place the doctrines of the theories they adopt above all else. This situation can sometimes turn into a war of theories between researchers as well. However, therapists should not aim to shape therapy sessions according to their methods but to use them in line with clients' needs. Although it is emphasised that the integration of both psychoanalytic and cognitive behavioural therapy techniques, which is going to be named dynamic cognitive behavioural therapy (DCBT) in this case report, will provide more effective and permanent treatment, a discernible gap exists regarding the integration of these theories and their use in psychotherapy. Taking into account this gap, it is considered important to use this approach with a client who has a social anxiety disorder (SAD). Therefore, this study aims to describe the almost forgotten DCBT approach step by step through a case report and reveal the effectiveness of this approach. As a result, DCBT seems to be effective in the treatment of SAD.
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DeVon HA, Uwizeye G, Cai HY, Shroff AR, Briller JE, Ardati A, Hoppensteadt D, Rountree L, Schlaeger JM. Feasibility and preliminary efficacy of acupuncture for angina in an underserved diverse population. Acupunct Med 2021; 40:152-159. [PMID: 34856826 DOI: 10.1177/09645284211055754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Stable angina is ischemic chest pain on exertion or with emotional stress. Despite guideline-directed therapy, up to 30% of patients have suboptimal pain relief. The aims of this study were to: (1) determine the feasibility and acceptability of a randomized controlled trial (RCT) of acupuncture; and (2) evaluate preliminary efficacy of acupuncture with respect to reduction of pain and increased functional status and health-related quality of life (HRQoL). METHODS Participants with stable angina for ⩾1 month received either a standardized acupuncture protocol, twice per week for 5 weeks, or an attention control protocol. Measures included the McGill Pain Questionnaire (average pain intensity (API), pain now) and the Seattle Angina Questionnaire-7 (functional status, symptoms, and HRQoL). Feasibility was defined as ⩾80% recruitment, ⩾75% retention following enrollment, and ⩾80% completion. Descriptive statistics and mixed-effects linear regression were used for analysis. RESULTS The sample (n = 24) had a mean age of 59 ± 12 years, was predominantly female (63%), and represented minority groups (8% White, 52% Black, 33% Hispanic, and 8% Other). Feasibility was supported by 79% retention and 89% completion rates. The recruitment rate (68%) was slightly lower than expected. Acceptability scores were 87.9% for the acupuncture group and 51.7% for the control group. Outcomes were significantly better for the acupuncture versus control groups (API, b = -2.1 (1.1), p = 0.047; functional status, b = 27.6 (7.2), p < 0.001; and HRQoL, b = 38.8 (11.9), p = 0.001). CONCLUSIONS AND IMPLICATIONS Acupuncture was feasible and acceptable in our diverse sample. We were slightly under the recruitment target of 80%, but participants who started the study had a high likelihood of completing it. Acupuncture shows promise for stable angina, but its effectiveness needs to be confirmed by a larger, adequately powered RCT. TRIAL REGISTRATION NUMBER NCT02914834 (ClinicalTrials.gov).
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Affiliation(s)
- Holli A DeVon
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA
| | - Glorieuse Uwizeye
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Hui Yan Cai
- Department of Acupuncture and Oriental Medicine, National University of Health Sciences, Lombard, IL, USA
| | - Adhir R Shroff
- Department of Cardiology, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Joan E Briller
- Department of Cardiology, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Amer Ardati
- Department of Cardiology, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Debra Hoppensteadt
- Department of Pathology and Pharmacology, Loyola University Medical Center, Maywood, IL, USA
| | - Lauren Rountree
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA
| | - Judith M Schlaeger
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
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Shimizu M, Takayama S, Kikuchi A, Arita R, Ono R, Ishizawa K, Ishii T. Kampo Medicine Treatment for Advanced Pancreatic Cancer: A Case Series. Front Nutr 2021; 8:702812. [PMID: 34458306 PMCID: PMC8387656 DOI: 10.3389/fnut.2021.702812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/13/2021] [Indexed: 11/13/2022] Open
Abstract
Aims: The present report aims to investigate the use of Kampo medicine for advanced pancreatic cancer patients in order to prolong survival. Methods: We retrospectively reviewed medical records of patients with pancreatic cancer who presented to our Shimizu Clinic from 2000 to 2020. Patients who survived at least twice as long as the initial prognostic estimate were selected and their treatment was reviewed. The Kampo formula and crude drugs were selected according to the Kampo diagnosis and treatment strategy, which included qi and blood supplementation; qi, blood and water smoothing; and inflammation (termed "heat") and cancer suppression. Results: Ten patients aged 45-80 years (six males and four females) with stage IV advanced cancer were selected. All patients received hozai, which is a tonic formula, of juzentaihoto (JTT) or hochuekkito (HET) decoction. Anti-cancer crude drugs were included in the decoctions of nine patients. At the first visit, the estimated life expectancy for all patients was no more than 1 year; however, treatment with Western and Kampo medicine led to a relatively long survival period of over 2 years. Three patients were still living at the time of this writing, more than 2, 6, and 14 years after treatment initiation. Conclusion: Our results suggest that Kampo medicine may be useful for disease control and supportive care for patients with advanced pancreatic cancer.
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Affiliation(s)
- Masayuki Shimizu
- Shimizu Clinic, Sendai, Japan.,Department of Kampo Medicine, Tohoku University Hospital, Sendai, Japan
| | - Shin Takayama
- Department of Kampo Medicine, Tohoku University Hospital, Sendai, Japan.,Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan.,Department of Kampo and Integrative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akiko Kikuchi
- Department of Kampo Medicine, Tohoku University Hospital, Sendai, Japan.,Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan.,Department of Kampo and Integrative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryutaro Arita
- Department of Kampo Medicine, Tohoku University Hospital, Sendai, Japan.,Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Rie Ono
- Department of Kampo Medicine, Tohoku University Hospital, Sendai, Japan.,Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Kota Ishizawa
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Tadashi Ishii
- Department of Kampo Medicine, Tohoku University Hospital, Sendai, Japan.,Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan.,Department of Kampo and Integrative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Szőke H, Maródi M, Vagedes J, Székely B, Magyarosi I, Bedő A, Fellegi V, Somogyvári K, Móricz P. The P.E.A.N.U.T. Method: Update on an Integrative System Approach for the Treatment of Chronic Otitis Media with Effusion and Adenoid Hypertrophy in Children. Antibiotics (Basel) 2021; 10:134. [PMID: 33573118 DOI: 10.3390/antibiotics10020134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/18/2021] [Accepted: 01/26/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Based on our previous single-center study on optimization of treatment of chronic otitis media with effusion (COME) and adenoid hypertrophy (AH) in children using a noninvasive system approach to lower the necessity of antibiotics, analgesic use, and surgical interventions, we proceeded to perform a multicenter investigation in an outpatient setting. The purpose of the previous prospective study in 2013-2015 was to compare outcomes in the treatment of COME and AH using the noninvasive multimodal integrative method (IM) versus conventional treatment practice (COM). MATERIALS AND METHODS In this paper, we retrospectively analyze the data of patients treated with the integrative method between 2017 and 2020 in a multicenter setting and compared the outcomes with data from 2013-2015 in order to evaluate generalizability. In both periods, all eligible and willing participants were included and treated with the IM protocol under real-life conditions. The treatment involved pneumatization exercises, education, an antiallergic diet, nasal hygiene, useful constitutional therapy, and thermal interventions (P.E.A.N.U.T.). A total of 48 versus 28 patients, aged 1-8, were assessed, presenting with COME and AH, with moderate to severe hearing impairment at entry. RESULTS The significant improvement found in both audiometric measures (intact hearing) and tympanometric measures (normal A-type curve) was similar in both datasets with respect to conventional treatment. The new data confirms that the P.E.A.N.U.T. method results in a significant reduction of antibiotics, analgesic use, and surgical interventions. CONCLUSION In this multicenter trial, we confirm the effectiveness of the noninvasive system approach for the treatment of COME in lowering the need for antibiotics and analgesic use and elective surgery. This could be especially important with respect to a generally observed increase in antibiotic resistance. The method is easy to perform in different clinical settings and is effective, safe, and well-tolerated.
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Dilaveri CA, Croghan IT, Mallory MJ, Dion LJ, Fischer KM, Schroeder DR, Martinez-Jorge J, Nguyen MDT, Fokken SC, Bauer BA, Wahner-Roedler DL. Massage Compared with Massage Plus Acupuncture for Breast Cancer Patients Undergoing Reconstructive Surgery. J Altern Complement Med 2020; 26:602-609. [PMID: 32673082 DOI: 10.1089/acm.2019.0479] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objectives: Integrative therapies have been incorporated increasingly into health and wellness in the United States in recent decades. Their potential benefits are under evaluation in various situations, including pain and symptom relief for cancer patients and survivors. This pilot study evaluated whether combining two integrative complementary approaches augments a patient's benefit by reducing postoperative stress, pain, anxiety, muscle tension, and fatigue compared with one integrative complementary approach alone. Design: Patients undergoing autologous tissue breast reconstruction were randomly assigned to one of two postoperative complementary alternative therapies for three consecutive days. All participants were observed for up to 3 months. Subjects: Forty-two participants were recruited from January 29, 2016 to July 11, 2018. Interventions: Twenty-one participants were randomly assigned to massage alone and 21 to massage and acupuncture. Outcome measures: Stress, anxiety, relaxation, nausea, fatigue, pain, and mood (score 0-10) were measured at enrollment before surgery and postoperative days 1, 2, and 3 before and after the intervention. Patient satisfaction was evaluated. Results: Stress decreased from baseline for both Massage-Only Group and Massage+Acupuncture Group after each treatment intervention. Change in stress score from baseline decreased significantly more in the Massage-Only Group at pretreatment and posttreatment (p = 0.03 and p = 0.04). After adjustment for baseline values, change in fatigue, anxiety, relaxation, nausea, pain, and mood scores did not differ between groups. When patients were asked whether they would recommend the study, 100% (19/19) of Massage-Only Group and 94% (17/18) of Massage+Acupuncture Group responded yes (p = 0.49). Conclusion: No additive beneficial effects were observed with addition of acupuncture to massage for pain, anxiety, relaxation, nausea, fatigue, and mood. Combined massage and acupuncture was not as effective in reducing stress as massage alone, although both groups had significant stress reduction. These findings indicate a need for larger studies to explore these therapies further.
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Affiliation(s)
| | - Ivana T Croghan
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Department of Medicine Clinical Research Office, Mayo Clinic, Rochester, MN, USA
| | - Molly J Mallory
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Liza J Dion
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Karen M Fischer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | | | - Minh-Doan T Nguyen
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
| | - Shawn C Fokken
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Medicine Clinical Research Office, Mayo Clinic, Rochester, MN, USA
| | - Brent A Bauer
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
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10
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Lan XY, Chung TT, Huang CL, Lee YJ, Li WC. Traditional Herbal Medicine Mediated Regulations during Head and Neck Carcinogenesis. Biomolecules 2020; 10:E1321. [PMID: 32942674 DOI: 10.3390/biom10091321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 01/31/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is one of the most prevalent neoplasms worldwide. It is well recognized that environmental challenges such as smoking, viral infection and alcohol consumption are key factors underlying HNSCC pathogenesis. Other than major clinical interventions (e.g., surgical resection, chemical and radiotherapy) that have been routinely practiced over years, adjuvant anticancer agents from Traditional Herbal Medicine (THM) are proposed, either alone or together with conventional therapies, to be experimentally effective for improving treatment efficacy in different cancers including HNSCCs. At a cellular and molecular basis, THM extracts could modulate different malignant indices via distinct signaling pathways and provide better control in HNSCC malignancy and its clinical complications such as radiotherapy-induced xerostomia/oral mucositis. In this article, we aim to systemically review the impacts of THM in regulating HNSCC tumorous identities and its potential perspective for clinical use.
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11
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Polak K, Meyer BL, Neale ZE, Reisweber J. Program Evaluation of Group Transcending Self Therapy: An Integrative Modular Cognitive-Behavioral Therapy for Substance Use Disorders. Subst Abuse 2020; 14:1178221820947653. [PMID: 32874092 PMCID: PMC7436794 DOI: 10.1177/1178221820947653] [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] [Received: 03/03/2020] [Accepted: 07/03/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Substance Use Disorders (SUDs) are increasingly prevalent among Veterans. Effective interventions for SUDs that also meet the clinical reality of open treatment groups are needed. Transcending Self Therapy: Group Integrative Cognitive Behavioral Treatment (Group TST-I-CBT) was developed to address this need. Group TST-I-CBT is a four-module, 20-session treatment designed so that a person can enter at any point in the treatment. We conducted a program evaluation of Group TST-I-CBT for veterans with SUDs. METHODS Participants were N = 68 veterans enrolled in the 28-day Substance Abuse Residential Rehabilitation Treatment Program at an urban Veterans Administration Medical Center who received either Group TST-I-CBT (N = 34) or treatment-as-usual (TAU; N = 34). Medical records were reviewed and participant treatment outcome data was retrieved. Group TST-I-CBT clients completed a knowledge and feedback form at treatment completion. RESULTS Compared to TAU participants, Group TST-I-CBT participants were significantly less likely to have a positive urine drug screen (UDS) during treatment (17.6% versus 0%; P = .01) and within one month post-discharge (50% versus 17.6%; P = .04). Among Group TST-I-CBT clients, Quality of Life Inventory scores significantly increased by an average of 14 points from pre- to post-treatment, t(15) = -3.31, P = .005, d = 0.83. Group TST-I-CBT clients displayed cognitive-behavioral therapy knowledge (mean correct answers ranged from 92%-100%) and rated Group TST-I-CBT as helpful, understandable, and useful (mean scores ranged from 9.3-9.6 out of 10). CONCLUSIONS These preliminary data indicate that Group TST-I-CBT may be an effective group therapy as part of SUD treatment. A formal randomized controlled trial of Group TST-I-CBT may be warranted.
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Affiliation(s)
- Kathryn Polak
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Brian L Meyer
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Hunter Holmes McGuire Veterans Administration Medical Center, Richmond, VA, USA
- Department of Psychiatry, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Zoe E Neale
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Jarrod Reisweber
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Hunter Holmes McGuire Veterans Administration Medical Center, Richmond, VA, USA
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12
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Liu Y, Li Y, Wang X, Huang Y, Zhang Q, Shi K, Ran C, Hou J, Wang X. Fufang Banmao Capsule, a Traditional Chinese Medicinal Formulation, Enhances the Survival of Patients with Hepatocellular Carcinoma and Vp3-4 Portal Vein Tumor Thrombosis Undergoing Supportive Treatment. J Altern Complement Med 2020; 26:956-965. [PMID: 32614605 DOI: 10.1089/acm.2019.0334] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objectives: Fufang Banmao (FFBM) capsule, a type of Chinese medicinal formulation, has decades of history in treating hepatocellular carcinoma (HCC). This retrospective study aimed to observe the effect of FFBM capsules on the 6-month survival of patients with advanced HCC and Vp3-4 portal vein tumor thrombosis (PVTT) who received supportive therapy alone. Design: In total, 320 HCC/Vp3-4 PVTT patients underwent treatment with supportive therapy, of whom 95 took FFBM capsules and were treated with supportive therapy (FFBM group) and 225 received supportive therapy alone (control group). Comparisons of the 6-month overall survival (OS) rate of the two groups were performed. Propensity score matching (PSM) was used to match the characteristics between individuals in the two groups. A nomogram was built based on independent predictive factors for OS. Results: Cox multivariate analysis revealed that hepatic encephalopathy, aspartate transaminase (AST) and γ-glutamyl transpeptidase levels, Child-Pugh class, prothrombin time, α-fetoprotein level, largest tumor diameter, and use of FFBM capsules were independent predictive factors of OS. Variceal bleeding, alanine transaminase, AST, total bilirubin, and Barcelona Clinic for Liver Cancer stage were different at baseline in the FFBM and control groups. Analysis revealed no significant adverse effects or toxicities relevant to the medications. After PSM (1:1), 95 patient pairs were analyzed as FFBM versus control. The OS probability was remarkably higher for patients in the FFBM group than in those in the control group at 6 months (p < 0.0001). The median survival time was 4 months in the FFBM group and 2.2 months in the control group. Kaplan-Meier analysis showed significant statistical differences in the 6-month OS rates in the patients with total nomogram scores ≥84 (p < 0.0001). Conclusions: Given the satisfying survival outcomes, the results suggested that FFBM capsules should be administered to patients with HCC/Vp3-4 PVTT in the high-risk group (score ≥84). FFBM capsules have the potential for improving patient survival time in those with advanced HCC and Vp3-4 PVTT who receive supportive therapy alone, especially those in the high-risk group (score ≥84).
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Affiliation(s)
- Yao Liu
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yuxin Li
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiaojing Wang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yunyi Huang
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qun Zhang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ke Shi
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chongping Ran
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jie Hou
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xianbo Wang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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Weaver MS, Robinson J, Wichman C. Aromatherapy improves nausea, pain, and mood for patients receiving pediatric palliative care symptom-based consults: A pilot design trial. Palliat Support Care 2020; 18:158-63. [PMID: 31423959 DOI: 10.1017/S1478951519000555] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The role of aromatherapy in supportive symptom management for pediatric patients receiving palliative care has been underexplored. This pilot study aimed to measure the impact of aromatherapy using validated child-reported nausea, pain, and mood scales 5 minutes and 60 minutes after aromatherapy exposure. METHODS The 3 intervention arms included use of a symptom-specific aromatherapy sachet scent involving deep breathing. The parallel default control arm (for those children with medical exclusion criteria to aromatherapy) included use of a visual imagery picture envelope and deep breathing. Symptom burden was sequentially assessed at 5 and 60 minutes using the Baxter Retching Faces scale for nausea, the Wong-Baker FACES scale for pain, and the Children's Anxiety and Pain Scale (CAPS) for anxious mood. Ninety children or adolescents (mean age 9.4 years) at a free-standing children's hospital in the United States were included in each arm (total n = 180). RESULTS At 5 minutes, there was a mean improvement of 3/10 (standard deviation [SD] 2.21) on the nausea scale; 2.6/10 (SD 1.83) on the pain scale; and 1.6/5 (SD 0.93) on the mood scale for the aromatherapy cohort (p < 0.0001). Symptom burden remained improved at 60 minutes post-intervention (<0.0001). Visual imagery with deep breathing improved self-reports of symptoms but was not as consistently sustained at 60 minutes. SIGNIFICANCE OF RESULTS Aromatherapy represents an implementable supportive care intervention for pediatric patients receiving palliative care consults for symptom burden. The high number of children disqualified from the aromatherapy arm because of pulmonary or allergy indications warrants further attention to outcomes for additional breathing-based integrative modalities.
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Sun L, Fahey P, Zhu X, Ng W, Chen ZP, Qiu Y, Lai H, Lin J, Lin L. A Cohort Study to Examine the Use of Chinese Herbal Medicine in Combination With Conventional Therapies for Patients With Hepatocellular Carcinoma in China. Integr Cancer Ther 2018; 17:902-911. [PMID: 29775121 PMCID: PMC6142107 DOI: 10.1177/1534735418775819] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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] [Indexed: 01/27/2023] Open
Abstract
Background. Hepatocellular carcinoma (HCC) is one of the major
malignancies associated with high mortality rates. Chinese herbal medicine (CHM)
alone, or in combination with conventional therapies (CT), has been widely used
for patients with HCC in China. This study aims to explore how integrative
therapy (IT) through the combination of CHM and CT affects the survival of
patients with intermediate-advanced HCC. Methods. A retrospective
cohort study was performed at the First Affiliated Hospital of Guangzhou
University of Chinese Medicine, Guangzhou, China. Data of consecutive patients
diagnosed with intermediate-advanced HCC and a specific traditional Chinese
medicine diagnostic pattern between January 2006 and December 2013 were
retrieved from the electronic medical record system at the hospital. Patients
were divided into 3 groups based on the therapies used, that is, IT, CHM alone,
and CT alone, and the survival times of these patients was compared.
Results. A total of 328 patients were included in this study.
Median follow-up period was 26.4 months (95% confidence interval [CI] =
22.7-38.9). Median overall survival was 11.0 months for IT, 8.6 months for CHM,
and 9.4 months for CT groups (P < .001). The adjusted hazard
ratio (HR) of death for the IT group was 0.55 (95% CI = 0.38-0.79,
P = .001) relative to the CT group and 0.68 (95% CI =
0.52-0.90, P = .007) relative to the CHM group, after adjusting
for the factors that impact prognosis. Stratified analysis shows that IT can
significantly lower the risk of death, especially for patients with good
performance status (PS) and Child-Pugh class A. Conclusions. It was
indicated that the integrative approach with combination of CHM and CT might
improve survival for patients with intermediate-advanced HCC, especially for
patients with good PS and Child-Pugh class A. However, a randomized controlled
trial is warranted for a conclusive statement.
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Affiliation(s)
- Lingling Sun
- 1 Guangzhou University of Chinese Medicine First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Paul Fahey
- 2 Western Sydney University, Campbelltown, New South Wales, Australia
| | - Xiaoshu Zhu
- 2 Western Sydney University, Campbelltown, New South Wales, Australia
| | - Weng Ng
- 3 South West Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Zhuo Ping Chen
- 1 Guangzhou University of Chinese Medicine First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Yiwen Qiu
- 1 Guangzhou University of Chinese Medicine First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Hezheng Lai
- 2 Western Sydney University, Campbelltown, New South Wales, Australia
| | - Jietao Lin
- 1 Guangzhou University of Chinese Medicine First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Lizhu Lin
- 1 Guangzhou University of Chinese Medicine First Affiliated Hospital, Guangzhou, Guangdong, China
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Bonucci M, Pastore C, Ferrera V, Fiorentini C, Fabbri A. Integrated Cancer Treatment in the Course of Metastatic Pancreatic Cancer: Complete Resolution in 2 Cases. Integr Cancer Ther 2018; 17:994-999. [PMID: 29478350 PMCID: PMC6142071 DOI: 10.1177/1534735418755479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/21/2022] Open
Abstract
Pancreatic cancer (PC) has a very low average survival, but its prognosis is
further reduced in the case of metastatic spread. Medical therapy in these cases
is the only applicable methodology in the international guidelines. During
anticancer treatments, common side effects are nausea, vomiting, arthralgia,
neuropathy, and alopecia as well as a myelosuppressive effect. The toxicity of
various drugs not only affects the quality of life of the patient, but often its
severity requires a reduction in if not the termination of drug administration.
Scientific studies have shown that a combined use of chemotherapy and certain
natural substances, in the form of standardized extracts, can lead to an
enhancement of the action of the chemotherapy. Here, we describe 2 cases of
metastatic PC. The first case concerns the integrated treatment of a patient
with cancer of the pancreas tail with metastatic involvement ab initio of
peripancreatic lymph nodes and liver parenchyma, with numerous secondary lesions
greater than 9.5 cm. The second case concerns the integrated treatment of a
patient with cancer of the pancreatic body with metastatic involvement of the
liver parenchyma, with a small secondary lesion. In both cases, an integrated
cancer treatment approach, combining chemotherapy with natural remedies,
extracts, and hyperthermia, induced a notable remission of primary and
metastatic lesions.
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Abstract
Approximately 350 million people worldwide are chronically infected with hepatitis B virus (HBV), representing a significant public health challenge. Nucleos/tide analogues (NUCs) and interferon alpha (IFNα), the current standard of care for chronic infection, aim at preventing progression of the disease to cirrhosis, hepatocellular carcinoma (HCC) and death. However, in contrast to the case of hepatitis C virus infection, in which novel antiviral drugs cure the vast majority of treated patients, in regard to HBV, cure is rare due to the unusual persistence of viral DNA in the form of covalently closed circular DNA (cccDNA) within the nucleus of infected cells. Available therapies for HBV require lifelong treatment and surveillance, as reactivation frequently occurs following medication cessation and the occurrence of HCC is decreased but not eliminated, even after years of successful viral suppression. Progress has been made in the development of new therapeutics, and it is likely that only a combination of immune modulators, inhibitors of gene expression and replication and cccDNA-targeting drugs will eradicate chronic infection. This review aims to summarize the state of the art in HBV drug research highlighting those agents with the greatest potential for success based on in vitro as well as on data from clinical studies.
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Affiliation(s)
- Maya Bitton Alaluf
- Department of Medicine D, Beilinson Hospital Rabin Medical Center, Petah Tikva, Israel
| | - Amir Shlomai
- Department of Medicine D, Beilinson Hospital Rabin Medical Center, Petah Tikva, Israel.,The Liver Institute, Beilinson Hospital Rabin Medical Center, Petah Tikva, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Abstract
Background. Breast cancer patients may experience various symptoms that affect the quality of life significantly and they seek complementary and alternative medicine (CAM). To meet the needs of patients, we developed an integrative outpatient care program. Methods. This program provided CAM consultation and acupuncture for breast cancer patients at Taipei Veterans General Hospital. The outcome measures included Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12) and patient satisfaction questionnaires on the first visit (baseline) and at 6 months. Results. Forty-five breast cancer patients were enrolled. All patients completed the study. The median age was 53.3 (±8.3). The symptoms most often experienced during previous cancer treatments were fatigue (35.6%), arthralgia (20%), nausea (6.7%), and insomnia (6.7%). The symptoms most wished to be diminished by the patients were arthralgia (22.2%), insomnia (17.8%), and fatigue (15.6%). Thirty-four patients (75.6%) had sought CAM therapy to reduce these symptoms. Fifteen patients (33.3%) received CAM consultation only and 30 (66.7%) received acupuncture in addition. Sixteen patients completed at least 6 sessions of acupuncture. No serious adverse effect was reported. In the SF-12 Questionnaire on all the patients, physical component summary (PCS) was 49.6 (±5.6) at baseline and 44.9 (±7.6) at 6 months (P = .001); the mental component summary (MCS) was 44.7 (±6.1) at baseline and 52.3 (±9.3) at 6 months (P < .001). For patients who had completed acupuncture, PCS was 49.2 (±4.9) at baseline and 41.4 (±7.6) at 6 months (P = .148); the MCS was 45.6 (±6.2) at baseline and 49.7 (±11) at 6 months (P = .07). Thirty-eight (84.4%) patients were satisfied with this program. Conclusions. Our results demonstrated that an integrative outpatient care program of conventional and Chinese medicine is feasible. Most patients were satisfied with this program and the quality of life was improved. It is important to conduct more research to build a model that integrates CAM with conventional medicine in Taiwan.
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Affiliation(s)
- Yi-Hsien Lin
- Cheng Hsin General Hospital, Taipei, Taiwan National Yang-Ming University, Taipei, Taiwan
| | | | - Fang-Pey Chen
- National Yang-Ming University, Taipei, Taiwan Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jen-Hwey Chiu
- Cheng Hsin General Hospital, Taipei, Taiwan National Yang-Ming University, Taipei, Taiwan Taipei Veterans General Hospital, Taipei, Taiwan
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Abstract
As an older woman therapist, I find that my life experience grounds me in my work with people of all ages and backgrounds as they deal with life crises, aging issues, and loss. People with whom I work in therapy appreciate the fact that I am older and have had varied life experiences. Gender issues are still central to my work with clients whether I am working with a man or a woman. I am an integrative therapist, with a background in cognitive-behavioral therapy and gestalt therapy. Therapists need to help clients to identify less with their aging bodies and our culture's view of attractiveness, shifting instead to a paradigm that values life experience and the cultivation of wisdom. We need to find ways of embracing what we have learned about life instead of extolling youthful values. As I get older, I more fully appreciate a constructivism framework and life-cycle perspective, focusing on making sense of clients' life narratives. Storytelling and memoirs have both provided a framework for working with clients on coping with the many changes and challenges of life that bring them to therapy and added another layer to my integrative therapeutic work.
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Thrane S. Effectiveness of integrative modalities for pain and anxiety in children and adolescents with cancer: a systematic review. J Pediatr Oncol Nurs 2015; 30:320-32. [PMID: 24371260 DOI: 10.1177/1043454213511538] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [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: 11/15/2022] Open
Abstract
Throughout the trajectory of the cancer experience, children and adolescents will likely face pain and anxiety in a variety of circumstances. Integrative therapies may be used either alone or as an adjunct to standard analgesics. Children are often very receptive to integrative therapies such as music, art, guided imagery, massage, therapeutic play, distraction, and other modalities. The effect of integrative modalities on pain and anxiety in children with cancer has not been systematically examined across the entire cancer experience. An in-depth search of PubMed, CINAHL, MedLine, PsychInfo, and Web of Science, integrative medicine journals, and the reference lists of review articles using the search terms pain, anxiety, pediatric, child*, oncology, cancer, neoplasm, complementary, integrative, nonconventional, and unconventional yielded 164 articles. Of these, 25 warranted full-text review. Cohen's d calculations show medium (d = 0.70) to extremely large (8.57) effect sizes indicating that integrative interventions may be very effective for pain and anxiety in children undergoing cancer treatment. Integrative modalities warrant further study with larger sample sizes to better determine their effectiveness in this population.
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KAWANAMI KATSUHISA, WAKAO NORIMITSU, KAMIYA MITSUHIRO, TAKEUCHI MIKINOBU, HIRASAWA ATSUHIKO, TAKAHASHI EMIKO, SATO KEIJI. A case of mediastinal embryonal carcinoma successfully treated by integrative therapy. Nagoya J Med Sci 2014; 76:225-33. [PMID: 25130010 PMCID: PMC4345714] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mediastinal embryonal carcinoma is rare, and the life prognosis of this disease is assumed to be relatively short. We encountered a case of mediastinal embryonal carcinoma for which we could perform radical surgical resection. The patient was male, aged 16 years, and acutely aware of back pain. Because the pain increased during the same year, he visited a local doctor, and an expanding neoplastic lesion was detected in the right thoracic wall by computed tomography (CT). Then he was referred to our institution. Magnetic resonance imaging (MRI) showed a dumbbell type tumor (Eden type 3) at the Th7/8 level. Malignant disease was suspected, so the authors planned and performed CT-guided biopsy. The result showed that this tumor pathologically corresponded to malignant peripheral nerve sheath tumor (MPNST). Therefore, chemotherapy was considered the main treatment. After 2 courses of chemotherapy, the tumor size decreased dramatically. The authors thought that radical resection is possible if there is no intrathoracic tumor dissemination as a result of a favorable response to chemotherapy. We thus perfomed surgical resection after we confirmed by a thoracoscopic exploratory thoracotomy that there was no intrathoracic tumor dissemination. Pathological findings were consistent with an embryonal carcinoma. Both the cutting ends of the thoracic wall and the epidural lateral sides of the excised lesion were negative for tumor cells. There is no image finding from the MRI and PET-CT suggesting metastasis or recurrence in the MRI and PET-CT 18 months after surgical resection. Therefore, the long-term vital prognosis can be expected in this patient.
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Affiliation(s)
- KATSUHISA KAWANAMI
- Department of Spine Center, Aichi Medical University, Nagakute, Aichi, Japan,Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - NORIMITSU WAKAO
- Department of Spine Center, Aichi Medical University, Nagakute, Aichi, Japan,Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - MITSUHIRO KAMIYA
- Department of Spine Center, Aichi Medical University, Nagakute, Aichi, Japan,Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - MIKINOBU TAKEUCHI
- Department of Spine Center, Aichi Medical University, Nagakute, Aichi, Japan
| | - ATSUHIKO HIRASAWA
- Department of Spine Center, Aichi Medical University, Nagakute, Aichi, Japan,Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - EMIKO TAKAHASHI
- Department of pathology, Aichi Medical University, Nagakute, Aichi, Japan
| | - KEIJI SATO
- Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan
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