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Integrative oncology for palliative care nurses: pre-post training evaluation. BMJ Support Palliat Care 2024; 14:178-182. [PMID: 36690415 DOI: 10.1136/spcare-2022-004117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/09/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Integrative oncology (IO) is increasingly being incorporated in supportive and palliative cancer care. This study examined an IO-palliative care training programme for nurses from community and hospital settings. METHODS A 120-hour course, attended by 24 palliative care nurses without IO training, included precourse/postcourse questionnaires examining knowledge, attitudes and level of IO-palliative care skills. Qualitative analysis examined precourse and postcourse narratives. RESULTS Most (18; 75%) completed study questionnaires, with knowledge and attitudes towards IO changing only modestly and IO-related skills significantly for guidance on herbal medicine and lifestyle changes, manual-movement and mind-body modalities. Greater consultation skills were reported for fatigue, stomatitis, nausea, appetite, constipation/diarrhoea, insomnia, peripheral neuropathy and hot flashes. Trainees reported improved skills for pain (p=0.003), emotional (p<0.001) and informal caregiver-related concerns (p<0.001), with no change in palliative care-related skills. Qualitative analysis found both personal and professional attitude changes, with enhanced mindfulness and an expressed intent to implement the learnt skills in daily practice. CONCLUSIONS The IO-palliative care nurse training programme increased IO-related and palliative care-related consultation skills for a wide range of quality of life-related concerns. Further research is needed to explore both short-term and long-term effects and the implementation of the learnt skills in clinical practice. TRIAL REGISTRATION NUMBER NCT03676153.
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Fine-tuning the needle: analysis of acupuncturist response to alarming events during gynecological oncology surgery. Support Care Cancer 2024; 32:343. [PMID: 38739310 DOI: 10.1007/s00520-024-08552-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/07/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE Examining an intra-operative acupuncture/acupressure setting, with real-time "fine-tuning" in response to alarming events (AEvs) during gynecological oncology surgery. METHODS Narratives of acupuncturists providing intraoperative acupuncture during gynecological oncology surgery were qualitatively analyzed. These described real time "fine-tuning" in response to AEvs during surgery, identified through hemodynamic changes (e.g., systolic/diastolic arterial pressure); bispectral index (BIS) elevation; and feedback from surgeons and anesthesiologists. Documentation of acupuncturist responses to AEvs was addressed as well. RESULTS Of the 48 patients in the cohort, 33 had at least one intraoperative AEv (69%), of which 30 were undergoing laparoscopic surgery and 18 laparotomies. A total of 77 AEvs were documented throughout surgery (range 1-7; mean: 2.3 events per patient), identified through increased (63 events) or decreased (8) mean arterial pressure (MAP); increased BIS levels (2), or other hemodynamic parameters (4). Integrative oncology interventions implemented in response to AEs included acupressure alone (59); combining acupressure with acupuncture (10); or acupuncture alone (4). In 54 (70%) events, documentation was provided from beginning to conclusion of the AEv, with a mean duration of 9.7 min, with 32 events including a documented anesthesiologist intervention. CONCLUSION The present study demonstrated the feasibility of intraoperative acupuncture with acupressure, with ongoing "fine-tuning" to AEvs identified through objective pain-related parameters (MAP, heart rate and BIS) and real-time input from surgeons and anesthesiologists. Documentation of the intraoperative IO practitioner's response to these AEvs is important, and should be addressed in future research of the innovative integrative model of care. TRIAL REGISTRATION NUMBER CMC-18-0037 (Carmel Medical Center, June 11, 2018).
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Integrative Medicine Across the Pediatric Cancer Care Trajectory: A Narrative Review. Curr Oncol Rep 2024:10.1007/s11912-024-01538-1. [PMID: 38733465 DOI: 10.1007/s11912-024-01538-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE OF THE REVIEW Children and adolescents with cancer, along with their parents and other informal caregivers, often report using complementary and alternative medicine (CAM) during active oncology and hemato-oncology treatment. Some adopt an "alternative" approach to conventional medical care, which often entails the use of these practices without the knowledge of the treating pediatrician. In contrast, many others search for consultation provided by a pediatric integrative oncology (IO) practitioner working with the conventional medical team. IO seeks to provide evidence-based complementary medicine therapies, many of which have been shown to augment conventional supportive and palliative care, while ensuring the patient's safety. The present narrative review examines the current state of and future direction for the IO setting of care. RECENT FINDINGS A large body of published clinical research supports the effectiveness of leading Pediatric IO modalities, while addressing potential safety-related concerns. Despite the growing amount of clinical research supporting the beneficial effects and implementation of Pediatric IO models of care, there is still a need for further studies in order to establish clinical guidelines in the treatment of children and adolescents with cancer. Such IO-directed guidelines will need to address both the effectiveness and the safety of the CAM modalities being used in pediatric oncology and hemato-oncology settings, promoting a better understanding among pediatric healthcare professionals and helping them understand the indications for referral to the IO treatment service.
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Identifying Factors Associated With Disparities in Access to Integrative Oncology Program. J Pain Symptom Manage 2024:S0885-3924(24)00673-0. [PMID: 38552747 DOI: 10.1016/j.jpainsymman.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/28/2024] [Accepted: 03/14/2024] [Indexed: 04/09/2024]
Abstract
CONTEXT AND OBJECTIVES Cancer centers are increasingly providing complementary medicine as part of an emerging discipline termed 'integrative oncology' (IO). The present study explored factors associated with disparities in referral and adherence to a freely-provided IO program. METHODS The databases of three oncology centers in northern Israel were searched retrospectively for chemotherapy-treated oncology patients eligible for referral by their oncology healthcare professionals to an integrative physician (IP) consultation. Demographic and cancer-related variables associated with the referral, and attendance by patients at the consultation were identified, as was adherence to the 6-week IO treatment program (high adherence, attending ≥4 IO treatment sessions; low adherence, 0-3 sessions). RESULTS Of 4988 eligible patients, 1694 (34%) were referred to the IP consultation, with 1331 (78.6%) attending the consultation of which 766 (57.6%) were adherent to IO treatments. Multivariate analysis revealed lower referral rates among patients speaking primarily Arabic and Russian vs. Hebrew (OR = 3.0, 95% CI = 2.0-4.6, P < 0.0001); males vs. females (OR = 1.94, CI = 1.3-2.9, P = 0.001); those not reporting emotional distress (OR = 1.5, CI = 1.02-2.16, P = 0.037); and older age (OR = 1.04, CI = 1.03-1.06, P < 0.0001). Arabic and Russian-speaking patients were less likely to adhere to IO treatments (OR = 0.52, 95% CI = 0.32-0.83, P = 0.006). CONCLUSION Patients' ethno-national origin and immigration status (primary language, Arabic and Russian), male gender and older age were associated with lower rates of referral to and attendance of the IP consultation, with reduced adherence to weekly IO treatments. These findings require further study to identify barriers toward diversity, equity and inclusion in IO care, increasing awareness among healthcare professionals regarding the benefits of these services for improving patient wellbeing.
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A randomized-controlled trial assessing the effect of intraoperative acupuncture on anesthesia-related parameters during gynecological oncology surgery. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04758-3. [PMID: 37061627 PMCID: PMC10105534 DOI: 10.1007/s00432-023-04758-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/08/2023] [Indexed: 04/17/2023]
Abstract
CONTEXT AND OBJECTIVES The present study examined the impact of intraoperative acupuncture on anesthesia-related parameters in patients undergoing gynecological oncology surgery. METHODS Participants underwent preoperative integrative oncology (IO) touch/relaxation treatments, followed by intraoperative acupuncture (Group A); preoperative IO treatments without acupuncture (Group B); or standard care only (Group C). Mean arterial pressure (MAP), heart rate (HR), MAP variability (mean of MAP standard deviation), bispectral index (BIS), and calculated blood pressure Average Real Variability (ARV) were measured intraoperatively. RESULTS A total of 91 patients participated: Group A, 41; Group B, 24; Group C, 26. Among patients undergoing open laparotomy, Group A showed lower and more stable MAP and HR compared to Group B, (MAP, p = 0.026; HR, p = 0.029) and Group C (MAP, p = 0.025). Mean BIS, from incision to suture closing, was lower in Group A (vs. controls, p = 0.024). In patients undergoing laparoscopic surgery, MAP was elevated within Group A (p = 0.026) throughout surgery, with MAP variability significantly higher in Group A (P = 0.023) and Group B (P = 0.013) 10 min post-incision (vs. pre-incision). All groups showed similar intraoperative and post-anesthesia use of analgesic medication. CONCLUSION Intraoperative acupuncture was shown to reduce and stabilize MAP and HR, and reduce BIS in gynecology oncology patients undergoing laparotomy, with no impact on perioperative analgesic medication use. In the laparoscopic setting, intraoperative acupuncture was associated with elevated MAP. Further research is needed to explore the hemodynamic and BIS-associated benefits and risks of intraoperative acupuncture, and the impact on the use of analgesic drugs in response to these changes.
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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] [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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Acupuncture during gynecological oncology surgery: A randomized controlled trial assessing the impact of integrative therapies on perioperative pain and anxiety. Cancer 2023; 129:908-919. [PMID: 36647622 DOI: 10.1002/cncr.34542] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/28/2022] [Accepted: 05/12/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND In this study, the impact of a multimodal integrative oncology pre- and intraoperative intervention on pain and anxiety among patients undergoing gynecological oncology surgery was explored. METHODS Study participants were randomized to three groups: Group A received preoperative touch/relaxation techniques, followed by intraoperative acupuncture; Group B received preoperative touch/relaxation only; and a control group (Group C) received standard care. Pain and anxiety were scored before and after surgery using the Measure Yourself Concerns and Wellbeing (MYCAW) and Quality of Recovery (QOR-15) questionnaires, using Part B of the QOR to assess pain, anxiety, and other quality-of-life parameters. RESULTS A total of 99 patients participated in the study: 45 in Group A, 25 in Group B, and 29 in Group C. The three groups had similar baseline demographic and surgery-related characteristics. Postoperative QOR-Part B scores were significantly higher in the treatment groups (A and B) when compared with controls (p = .005), including for severe pain (p = .011) and anxiety (p = .007). Between-group improvement for severe pain was observed in Group A compared with controls (p = .011). Within-group improvement for QOR depression subscales was observed in only the intervention groups (p <0.0001). Compared with Group B, Group A had better improvement of MYCAW-reported concerns (p = .025). CONCLUSIONS A preoperative touch/relaxation intervention may significantly reduce postoperative anxiety, possibly depression, in patients undergoing gynecological oncology surgery. The addition of intraoperative acupuncture significantly reduced severe pain when compared with controls. Further research is needed to confirm these findings and better understand the impact of intraoperative acupuncture on postoperative pain. PLAIN LANGUAGE SUMMARY Integrative oncology programs are increasingly becoming part of supportive/palliative care, with many working within the Society for Integrative Oncology. This study examined the impact of a multimodal integrative oncology program on pain and anxiety among 99 patients undergoing gynecological oncology surgery. Participants were randomized to three groups: preoperative touch/relaxation treatments, followed by intraoperative acupuncture; preoperative touch/relaxation without acupuncture; and a control group receiving standard care only. The preoperative touch/relaxation intervention significantly reduced perioperative anxiety, with the addition of intraoperative acupuncture significantly reducing severe pain as well, when compared with controls. Further research is needed to confirm these findings.
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Exploring a multi-disciplinary model of supportive cancer care for monoclonal antibody treatment-related dermatological symptoms. Support Care Cancer 2023; 31:185. [PMID: 36821054 PMCID: PMC9947431 DOI: 10.1007/s00520-023-07642-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
CONTEXT AND OBJECTIVES The present study examined the perspectives of healthcare providers (HCPs) in designing a multi-disciplinary model of supportive cancer care for the relief of dermatology-related symptoms caused by monoclonal antibody therapies. METHODS The study employed a mixed research methodology, with qualitative research embedded within a pragmatic prospective study of a registry protocol study. Patients undergoing oncology therapy with MoAB, anti-HER2, and anti-PD-L1 monoclonal antibodies were identified among a cohort of patients referred to an integrative oncology (IO) consultation for symptom relief and improved quality of life (QoL). Case studies with significant dermatology-related concerns were selected and presented to a panel of 6 HCPs trained in medical oncology, oncology nursing, family medicine, supportive cancer care, and IO. HCP narratives were qualitatively analyzed and assessed using ATLAS.Ti software for systematic coding. RESULTS Of the 924 patients referred to the IO consultation, 208 were treated with monoclonal antibodies, from which 50 were selected for further evaluation. Of these, 7 cases were presented to the HCP team who were asked to identify treatment gaps requiring a multi-disciplinary approach. Qualitative analysis identified 3 major themes: a biophysical perspective; a psycho-social-spiritual perspective; and the implementation of integrated care. DISCUSSION There is a need for a multi-disciplinary approach when treating patients suffering from monoclonal antibody treatment-related skin toxicities. HCP-reported themes highlight the need to identify patients for whom such an approach is warranted; conditions in which a psycho-social-spiritual perspective should be considered, in addition to a bio-physical approach; and considerations of who should be designated as the patient's primary case manager.
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Acupuncture and integrative oncology for taxane-induced peripheral neuropathy: a randomized multicentered study. Int J Gynecol Cancer 2022; 33:792-801. [PMID: 36600535 DOI: 10.1136/ijgc-2022-004004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To compare the effectiveness of acupuncture alone or with additional integrative oncology modalities for taxane-induced peripheral neuropathy-related symptoms in patients with gynecological and breast cancer. METHODS The study was a prospective evaluation of patients undergoing twice-weekly treatments with either acupuncture alone (single-modality, group A) or with additional manual-movement and mind-body therapies (multimodality, group B), for 6 weeks. Symptom severity was assessed at baseline, 6 weeks, and 9 weeks using the Functional Assessment of Cancer Therapy-Taxane (FACT-Tax) tool; and von Frey perception thresholds. Additional symptoms were also assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the Measure Yourself Concerns and Wellbeing (MYCaW) study tool. RESULTS For the 120 participants (60 in each study arm), baseline to 6-week scores were similar in both groups for improved FACT-Tax physical wellbeing and scores for hand numbness/tingling; EORTC physical functioning and global health status; and MYCaW scores. FACT-Tax taxane subscales and scores for foot numbness/tingling improved only in group A (p=0.038), while emotional wellbeing FACT-Tax (p=0.02) and EORTC pain (p=0.005) improved only in group B. Group B showed greater improvement for FACT-Tax neuropathy-related concerns than group A at 24 hours (p=0.043) and 7 days (p=0.009) after the first treatment. CONCLUSION Acupuncture alone or with additional integrative oncology modalities may help reduce neuropathy-related symptoms. The single-modality group demonstrated greater improvement for foot numbness/tingling, and the multimodality group demonstrated improvement for pain and improved emotional wellbeing and neuropathy-related concerns in the first week of treatment. TRIAL REGISTRATION NUMBER NCT03290976.
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Impact of acupuncture and integrative therapies on chemotherapy-induced peripheral neuropathy: A multicentered, randomized controlled trial. Cancer 2022; 128:3641-3652. [PMID: 35960141 DOI: 10.1002/cncr.34422] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND To explore the impact of acupuncture with other complementary and integrative medicine (CIM) modalities on chemotherapy-induced peripheral neuropathy (CIPN) and quality of life (QoL) in oncology patients. METHODS In this prospective, pragmatic, and patient-preference study, patients with CIPN were treated with acupuncture and CIM therapies (intervention group) or standard care alone (controls) for 6 weeks. Patients in the intervention arm were randomized to twice-weekly acupuncture-only (group A) or acupuncture with additional manual-movement or mind-body CIM therapies (group B). Severity of CIPN was assessed at baseline and at 6 weeks using the Functional Assessment of Cancer Therapy-Taxane (FACT-Tax) tool. Other QoL-related outcomes were assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC); and the Measure Yourself Concerns and Well-being questionnaire. Von Frey measurements examined perception thresholds. RESULTS Of 168 participants, 136 underwent the study intervention (group A, 69; group B, 67), with 32 controls. Baseline-to-6-week assessment scores improved significantly in the intervention arm (vs controls) on FACT-Tax (p = .038) and emotional well-being (p = .04) scores; FACT-TAX scores for hand numbness/tingling (p = .007) and discomfort (p < .0001); and EORTC physical functioning (p = .045). Intervention groups A and B showed improved FACT-Tax physical well-being (p < .001), FACT-TAX total score (p < .001), FACT-TAX feet discomfort (p = .003), and EORTC pain (p = .017) scores. CONCLUSIONS Acupuncture, with or without CIM modalities, can relieve CIPN-related symptoms during oncology treatment. This is most pronounced for hand numbness, tingling, pain, discomfort, and for physical functioning.
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Complementary and integrative medicine intervention in front-line COVID-19 clinicians. BMJ Support Palliat Care 2022:bmjspcare-2021-003333. [PMID: 35383045 PMCID: PMC9002254 DOI: 10.1136/bmjspcare-2021-003333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/08/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the impact of a multidisciplinary complementary and integrative medicine (CIM) intervention on physical and emotional concerns among front-line COVID-19 healthcare providers (HCPs). METHODS A multimodality CIM treatment intervention was provided by integrative practitioners to HCPs in three isolated COVID-19 departments. HCPs' two main concerns were scored (from 0 to 6) before and following the CIM intervention using the Measure Yourself Concerns and Wellbeing questionnaire. Postintervention narratives identified reflective narratives specifying emotional and/or spiritual keywords. RESULTS Of 181 HCPs undergoing at least one CIM treatment, 119 (65.7%) completed post-treatment questionnaires. While HCPs listing baseline emotional-related concerns benefited from the CIM intervention, those who did not express emotional or spiritual concerns improved even more significantly following the first session, for both leading concerns (p=0.038) and emotional-related concerns (p=0.023). Nevertheless, it was shown that following subsequent treatments HCPs who expressed emotional and spiritual concerns improved more significantly than those who did not for emotional-related concerns (p=0.017). CONCLUSIONS A CIM intervention for front-line HCPs working in isolated COVID-19 departments can significantly impact emotional-related concerns, more so after the first treatment and among HCPs not using emotional-spiritual keywords in post-treatment narratives. Referral of HCPs to CIM programmes for improved well-being should avoid referral bias to those not expressing emotional/spiritual concerns.
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Can integrative oncology increase adherence to chemotherapy in advanced gynecologic cancer? Support Care Cancer 2022; 30:4345-4354. [DOI: 10.1007/s00520-022-06865-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/24/2022] [Indexed: 11/30/2022]
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Sensing the lightness: a narrative analysis of an integrative medicine program for healthcare providers in the COVID-19 department. Support Care Cancer 2021; 30:1419-1426. [PMID: 34528124 PMCID: PMC8442644 DOI: 10.1007/s00520-021-06546-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/03/2021] [Indexed: 02/13/2023]
Abstract
Objectives
The research addressing physical and emotional exhaustion among healthcare providers (HCPs) in COVID-19 departments is limited. We examined the impact of integrative medicine (IM) intervention for HCPs working in isolated COVID-19 in-patient departments, addressing concerns and well-being. Methods HCPs working in 3 isolated COVID-19 in-patient departments underwent 40-min IM treatment sessions (including acupuncture, manual movement, and/or mind–body modalities) provided by integrative oncology practitioners. The MYCAW (Measure Yourself Concerns and Well-being) questionnaire examined HCP concerns and free-text narratives following IM treatments. Data were qualitatively analyzed using ATLAS.Ti software for systematic coding. Results A total of 181 HCPs underwent 305 IM treatments. Narrative themes focused on physical symptoms (primarily pain and fatigue) and emotional concerns, including perceived communication barriers with patients, and reflections on well-being and insights following IM treatments. HCPs reported feeling a sense of “relief” which was likely related to the 3 main effects of the IM intervention: a sense of “being cared for” and treated; experiencing emotional, sometimes spiritual effects of the treatment; and the feeling of relaxation, combined with the relief of pain. Qualitative analysis identified clusters of emotional and spiritual-related keywords such as “calming,” “release,” “relaxation,” and “disengagement” following the first IM session (119 of 181 narratives, 65.7%). Conclusions HCPs working in isolated COVID-19 departments reported improved well-being and the addressing of their concerns following IM treatment sessions provided during their work shift. Further research is needed to explore the impact of IM on HCP burnout and resilience in palliative care settings.
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Exploring the effectiveness of a patient-tailored integrative oncology program on emotional distress during chemotherapy for localized cancer. Psychooncology 2021; 31:207-218. [PMID: 34435403 DOI: 10.1002/pon.5794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/25/2021] [Accepted: 08/11/2021] [Indexed: 01/06/2023]
Abstract
STUDY OBJECTIVE There is a need to explore how patient-tailored integrative oncology (IO) programs reduce emotional distress. This study set out to bridge the IO research gap between non-specific, quality of life-related and specific emotional-related concerns in chemotherapy-treated patients. METHODS This pragmatic, prospective and preference-controlled study examined patients attending an integrative-physician consultation and weekly IO treatments during adjuvant/neo-adjuvant chemotherapy for localized cancer. Patients choosing to attend ≥4 IO sessions (highly adherent to integrative care, AIC) were compared to low AIC patients using the ESAS (Edmonton Symptom Assessment Scale) anxiety, depression and sleep; and the EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) emotional functioning scale, at baseline, 6 and 12 weeks. Emotional distress was assessed by ESAS anxiety and depression, considered as the primary study outcomes. RESULTS Of 439 participants, 260 (59%) were high-AIC and 179 low-AIC, both with similar baseline demographic and cancer-related characteristics. At 6 weeks, high-AIC patients reported greater improvement on ESAS sleep (p = 0.044); within-group improvement on ESAS anxiety and; and EORTC emotional functioning. Compared with low-AIC, high-AIC patients showed greater improvement on ESAS depression (p = 0.022) and sleep (p = 0.015) in those with high baseline ESAS anxiety scores (≥7); and ESAS anxiety (p = 0.049) for patients moderately anxious (4-6) at baseline. CONCLUSIONS High-AIC was associated with significantly reduced anxiety, depression and sleep severity at 6 weeks, especially those with high-to-moderate baseline anxiety levels. These findings reduce the research gap, suggesting specific emotional-related effects of IO.
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Impact of a combined integrative oncology and palliative care program on quality of life of patients with advanced cancer. Med Oncol 2021; 38:93. [PMID: 34241706 DOI: 10.1007/s12032-021-01544-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Abstract
Many oncology centers provide integrative oncology (IO) care, many within palliative care settings. The primary study objective was to examine the impact of IO-palliative patient-tailored program on quality of life (QoL) among patients with advanced cancer. In this pragmatic prospective controlled study, patients with advanced cancer undergoing chemotherapy/palliative care were referred by their oncology healthcare providers to an integrative physician (IP) consultation and weekly IO treatments. Patients with high adherence to integrative care (AIC; ≥ 4 IO sessions/6 weeks) were compared with moderate (2-3 sessions) or low AIC patients (regarded as control group). Outcomes were assessed at 6- and 12-week follow-up with Edmonton Symptom Assessment Scale (ESAS) and EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) tools. Change in QoL scores (ESAS fatigue in particular) was considered a primary study outcome. Of 225 eligible patients, 153 underwent baseline and 6-week optimal assessment (high AIC, 100; moderate AIC, 22; low AIC, 31). High AIC patients reported greater improvement on ESAS scores for fatigue (vs. low-moderate AIC, P < 0.001), depression (vs. moderate AIC, P = 0.01) at 6 weeks, and sleep (P = 0.007) at 12 weeks. High AIC patients had significantly improved EORTC global health status/QoL at 6 weeks (vs. moderate-low AIC, P = 0.01), cognitive functioning (vs. moderate AIC, P = 0.043), and social functioning (vs. moderate AIC, P = 0.032). High AIC patients had lower rates of hospitalizations at 12 weeks (19% vs. 35% in low AIC, P = 0.02; 44% in moderate AIC, P = 0.003), hospitalization days (vs. low AIC, P = 0.003), and opioid use (vs. low AIC, P < 0.001). High adherence to integrative care was associated with a significant effect on fatigue, depression, global QoL at 6 weeks, and need for hospitalizations at 12 weeks.
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Being in touch: narrative assessment of patients receiving online integrative oncology treatments during COVID-19. Support Care Cancer 2021; 29:4819-4825. [PMID: 33538895 PMCID: PMC7859467 DOI: 10.1007/s00520-021-06026-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/21/2021] [Indexed: 11/26/2022]
Abstract
Objective We examined the qualitative impact of an online integrative oncology (IO) treatment program, designed in response to the restrictions created by the current COVID-19 pandemic. Methods Patients undergoing chemotherapy were seen by an integrative physician (IP), together co-designing an IO treatment program of ≥ 6 weekly treatments to alleviate symptoms and improve quality of life (QoL). IO practitioners guided patients and their caregivers online in self-treatment with manual/touch, movement, and/or mind-body modalities. Narratives of both patients and IO practitioners were analyzed for systematic coding, identifying barriers and advantages of the online treatment program. Results Narratives obtained from 30 patients and eight IO-trained practitioners were examined. The patients had undergone 169 online IO sessions with a total of 327 IO interventions during the 3-month study period. Patient narratives included reflections on both non-specific effects (e.g., less of a “sense of isolation”) and specific QoL-related outcomes with the online intervention. IO practitioner narratives focused on barriers to providing manual-movement and mind-body modalities, suggesting practical recommendations on how to address specific QoL-related outcomes using the online IO “toolbox.” Conclusions Effective online IO practitioner-guided treatments are feasible and may induce both specific and non-specific QoL-related effects. Future research needs to explore online IO interventions for additional situations in which access to IO care is limited.
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Enhancing Palliative Care With Mindful Touch: Impact of a Manual and Movement Therapy Training Program in an International Multidisciplinary Integrative Oncology Setting. J Pain Symptom Manage 2021; 61:229-236. [PMID: 32795608 DOI: 10.1016/j.jpainsymman.2020.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/01/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
CONTEXT Manual and movement therapies (MMTs) play a central role in the integrative oncology setting, significantly improving patients' quality of life (QOL). Despite research supporting the effectiveness and safety of these modalities, most oncology health care providers (HCPs) lack any MMT training. OBJECTIVES In this study, we examine the impact of an MMT-based integrative oncology training program with the participation of an international and multidisciplinary group of oncology HCPs. The feasibility of implementing these skills in palliative cancer care is examined. METHODS A three-day evidence-based hands-on teaching program was designed to train oncology HCPs working in supportive cancer care MMT modalities from traditional Chinese and anthroposophic medicine. Prequalitative and postqualitative assessments of the trainees' narratives were analyzed using ATLAS.Ti software (Scientific Software Development GmbH, Berlin, Germany) for systematic coding. RESULTS The training program was attended by 30 participants from Israel (15), Germany (7), Italy (6), Turkey (1), and Cyprus (1). The group included 13 nurses, 10 physicians, 6 complementary/integrative HCPs, and 1 psycho-oncologist. The pretraining expectations that were met at post-training included gaining knowledge and practical QOL-oriented skills, which could be implemented in the palliative and supportive care setting. A significant change in the attitude of trainees to touch therapy was also identified, with respondents seeing MMTs promoting patient-centered palliative care, including nonverbal communication. CONCLUSION An MMT training program for oncology HCPs for QOL-related indications is both feasible and likely to be implemented in palliative and supportive cancer care. Nonspecific effects of MMTs were also recognized for their ability to facilitate patient-centered care.
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Feasibility of an Online Integrative Oncology Treatment Program During COVID-19. J Pain Symptom Manage 2021; 61:e1-e3. [PMID: 33189855 PMCID: PMC7659922 DOI: 10.1016/j.jpainsymman.2020.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
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Effects of a patient-tailored integrative oncology intervention in the relief of pain in palliative and supportive cancer care. J Cancer Res Clin Oncol 2021; 147:2361-2372. [PMID: 33433656 DOI: 10.1007/s00432-020-03506-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/14/2020] [Indexed: 12/29/2022]
Abstract
CONTEXT AND OBJECTIVES The present study examined the impact of an integrative oncology treatment program in the relief of pain in patients undergoing chemotherapy and/or palliative care. METHODS In this pragmatic prospective controlled study, patients undergoing chemotherapy and/or palliative care were referred by their oncology healthcare providers to an integrative physician (IP) consultation, followed by weekly integrative treatments. Patients attending ≥ 4 sessions during the first 6 weeks of the study were considered to be highly adherent to integrative care (AIC). Pain was assessed at baseline and at 6 and 12 weeks using the ESAS (Edmonton Symptom Assessment Scale) and EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) tools. RESULTS Of 815 eligible patients, 484 (59.4%) were high-AIC and 331 low-AIC. Mean pain scores decreased significantly from baseline to 6 and 12 weeks in both groups. However, ESAS and EORTC pain scores improved significantly more in the high-AIC group at 6 weeks (p= 0.008), though not at 12 weeks. Between-group analysis of participants undergoing adjuvant/neo-adjuvant chemotherapy showed higher pain reduction in the high-AIC group at 6 weeks (ESAS, p = 0.006; EORTC, p = 0.046), as was the case with patients receiving palliative care (ESAS p = 0.04; EORTC p = 0.056). CONCLUSIONS High adherence to integrative care was found to be associated with a greater effect on pain relief at 6 weeks but not at 12 weeks in patients undergoing chemotherapy and/or palliative care.
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