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Background Although physical activity (PA) is associated with improved survival and quality of life of cancer patients, few are actively engaged. We intended to analyze the perceived and expected effects of physical activity (PEEPA) and the ascribed significance of PA aims (SPAA). To operationalize these complex dimensions, we developed a research tool that should be validated in female cancer survivors. Methods Enrolling 395 women with cancer, we performed reliability and factor analysis of the German language PEEPA and SPAA questionnaires. Results Reliabilities of the 22-item PEEPA and the 10-item SPAA were both very good (Cronbach's α =0.940 and 0.916, respectively). Exploratory factor analysis of the PEEPA differentiated intended “Well-being/Strengthening” and “Psycho-emotional Stabilization”, and perceived “Health Stabilization” and “Resilience/Balance in daily life”. Seven items, which conceptually refer to the “Experience of deficiency/Hindrance” to be physically active, made up an independent factor ( α =0.817). Factor analysis for the SPAA differentiated “Coping: Change/Support” and “Improvement of abilities”. We found complex correlations with SF-12's health-related quality of life, depression (HADS), and engagement in leisure-time PA. Conclusions Both instruments and the preliminary results provide useful information on the underlying attitudes and intentions of cancer survivors towards PA.

Purpose There are several studies that indicate that spirituality/religiosity (SpR) may be associated with lower incidence of depression and anxiety. Most of these studies were from the US, and one may doubt that these results can easily be transferred to more secular countries. We thus indented to investigate whether patients with depressive disorders and/or addiction utilize intrinsic religiosity as a resource to cope. Methods The sample of this cross-sectional survey contained 96 patients recruited consecutively in 3 psychotherapeutic German clinics, i.e. Oberberg Clinics Schwarzwald, Weserbergland and Berlin/Brandenburg. Their mean age was 47.2±10.5 years; 50% women; 67% had a Christian denomination; 32% none; 67% had depressive disorders and 33% addictions (mostly alcohol). To measure non-organized intrinsic religiosity in the context of disease coping, we used the 5-item scale Trust in God's Help (TGH, Cronbach's alpha=0.914), which is derived from the AKU questionnaire. Depressive states were measured with Beck's Depression Inventory (BDI), and the scale which Escape from Illness . Life Satisfaction was measured with the Brief Multidimensional Life Satisfaction Scale (BMLSS). Results TGH was moderately expressed in the patients (47.1±35.2), indicating that this coping strategy was of minor significance; the strong variations can be explained in part by the lack of a religious denomination in about 1/3 of the patients. Patients with depressive states had significantly lower TGH than patients with addictions (40.9±31.9 versus 61.4±37.2; F =7.7, p F =2.6; p =0.08) and higher life satisfaction ( F =2.4, p =0.10) than patients without or indifferent TGH, while Escape scores were significantly lower ( F =3.6, p =0.03) in patients with high TGH. In contrast, patients within a depressive state had significantly lower life satisfaction ( F =29.6, p F =5.5, p=0.02). Correlation analyses confirmed that TGH correlated weakly (negative) with depression ( r =−0.24, p =0.03) and Escape ( r =−0.25, p =0.01), and positively with life satisfaction ( r =0.24). Conclusions The results indicate that it is not intrinsic religiosity that accounts for the significant effects on depression, but instead it is the depressive state, which is associated with lower Trust in God's Help as an attitude which includes an engagement in private religiosity.

Purpose Mind–Body therapies are considered as adjunctive treatments to help ameliorate or at least cope with chronic pain conditions. Despite a lack of scientific acceptance, these approaches are of interest to patients which widely use relaxation techniques, biofeedback, imagery, hypnosis, etc. We intended to analyze the scientific literature with respect to the impact of yoga on chronic pain conditions. Methods In January 2009 we searched the databases Medline, Pubmed and CAMbase. The search terms were >yoga pain Results We found 15 studies which addressed the impact of yoga on chronic pain conditions. The studies enrolled patients with chronic low back pain ( n =6), headache/migraine ( n =2), various other chronic pain conditions ( n =6), and one experimental study with healthy individuals. Fourteen studies addressed pain perception or disability, 6 mood states (anxiety/depression) and distress, and one study health-related quality of life. Nine studies were randomized, 2 controlled, and 3 had a single arm design; one study was an experimental study with yoga trained and non-trained individuals. The number of patients in the randomized or controlled studies ranged from 15 to 101. The randomized and controlled studies described positive effects in terms of decreased pain frequency and intensity, decreased anxiety/depression, and improvement of fatigue- and health-related quality of life. Conclusions There is reasonable evidence that yoga practices may have positive effects on pain perception and mood states. The overall positive findings in the identified studies indicate that yoga may enhance patients’ self-efficacy, inner balance, adjustment and coping abilities. Nevertheless, there are several research questions, which have to be addressed in future studies, i.e., adequate control interventions; patients’ positive expectations; patients’ ability and will to change behavior, etc. Several of the unspecific effects of distinct mind–body therapies are nevertheless critical aspects (i.e., expectancy, sense of control, mindfulness, etc.) which cannot be ignored as they contribute to the intended treatment effect. Mind–body interventions such as yoga may become important adjunctive interventions in the multi-modal treatment of patients with chronic pain conditions as they foster self-control and self-management.

Background Although there is mounting research showing a connection between spirituality/religiosity (SpR) and health, understanding their relationship is only preliminary. Future studies depend on having reliable measures of these constructs which address SpR in the context coping, and can be easily incorporated into the study designs. The SpREUK questionnaire [Ostermann et al., Forsch Komplement Klass Naturheil 2004;11:346–53; Bussing et al., Health Qual life outcomes 2005;3:1–10; Int J Psychiatr Med 2007;37:39–57; Zeitschr Gesundheits 2008;31:35–7] appears to be a good choice for assessing a patient's interest in spiritual concerns which is not biased for or against a particular religious commitment. Methods The SpREUK comprises a 16-item main manual (Cronbach's alpha=0.92), a 6-item BENEFIT manual (alpha=0.93), and a 25-item PRACTICES manual (alpha=0.92). The main manual differentiates Search for Meaningful Support because of illness (spiritual quest orientation); Trust in Higher Guidance (intrinsic religiosity); and Positive Interpretation of Disease (hint to change life because of illness; healing is regarded as a process of ‘becoming’ in terms of reflection of life). The BENEFIT scale assesses beneficial aspects of intrinsic SpR. To avoid intermixes of attitudes, convictions, and forms of SpR practices, PRACTICES manual can be used as a separate tool and differentiates Conventional Religious Practice; Existentialistic Practice; Spiritual Body–Mind Practices; and Humanistic Practice. Results On the basis of data from 821 patients with various chronic diseases (mean age 54±14 years), we can confirm the underlying concept of the SpREUK. Particularly Positive Interpretation of Disease had an obvious spiritual connotation and correlated with Search ( r =0.56), Trust ( r =0.45), Spiritual Body–Mind Practices ( r =0.45), and Existentialistic Practices ( r =0.47). Patients with higher age and cancer had significantly higher interest in SpR issues than patients with chronic pain diseases or patients with multiple scleroses. With respect to Life Satisfaction (modified BMSLS), in patients with chronic pain disease, just the BENEFIT scale correlated with life satisfaction aspects Future Perspectives ( r =0.29), Myself ( r =0.28), and Overall Life ( r =0.22). Physical Health (SF-12) did correlate with SpR issues, while Mental Health (SF-12) correlated negatively with the spiritual quest dimension ( r =−0.34). Conclusion The SpREUK questionnaire reveals to be a valid and reliable instrument tested in patients with chronic diseases and a Christian, Muslim, or agnostic/atheistic background, which heeds the spiritual quest orientation, intrinsic religiosity, and uniquely integrates the topic of ‘meaning of disease’ (reappraisal, i.e. hint to change life and). Although the relationship between SpR and various dimensions of health and quality of life has been extensively examined during the past decade, SpR has to be regarded as a distinctive concept which nevertheless may be related to quality of life aspects.

Background In a previous phase II study with breast cancer patients, a single intravenous application of the fermented Viscum album extract (VA-E; Iscador M spezial) prior to surgery prevented the surgery-/anaesthesia-associated inhibition of granulocyte function. We thus intended to investigate whether i.v. applications of fermented VA-E may have positive effects also on chemotherapy-induced immunosuppression. Patients and methods We randomised 65 breast cancer patients to adjuvant (F)EC chemotherapy+VA-E (32 pats) or (F)EC alone (33 pats), mean age 54.7 years (26–77 years). The primary aim of this RCT was the functional competence of granulocytes (flow cytometric analysis of the oxidative burst of peripheral blood granulocytes stimulated with Escherichia coli or PMA), as measured prior to chemotherapy cycles and at day 8 of each cycle. The area under curve (AUC) of the burst activity (MCh R123) was calculated for each cycle. Results The AUC of PMA- or E.coli-stimulated burst did not significantly differ between both groups; this was in part due to the surprising fact that—despite randomisation—the PMA-stimulated burst activity in control patients at baseline was already significantly below that in the VA-E group (p=0.042). Therefore, the observation of a small increase of burst activity in the control group (ITT: p>0.14; PP: p>0.15) can be interpreted as a regression to the mean effect. The sensitivity analysis of differences to the baseline level (instead of AUC values) also did not give hints to positive effects of VA-E application compared to control (p>0.27). However, in several cases we observed violations of the study protocol by the investigators, i.e., patients of both groups received granulocyte-colony-stimulating factor. The effects on the granulocyte function are thus difficult to interpret. With respect to the secondary aims, chemotherapy-related side effects (WHO-grading) were significantly lower in the VA-E group (Odds Ratio 6.0 nausea; OR 4.6 constipation; OR 2.7 pain; OR 5.7 stomatitis, OR 8.2 appetite), which was in part supported by patients marking significantly less nausea on the visual analogue scale (local p=0.04). However, neither lymphocyte subsets, quality of life (EORTC C30+BR 23), nor emesis and retching (Rhodes index) did significantly differ between both groups. Conclusion Intravenous application of VA-E during chemotherapy had no significant effect on granulocyte function. Nevertheless, there were significant beneficial effects with respect to chemotherapy-related side effects, which should be approved in further RCTs. The i.v. application of Iscador M spezial at concentrations between 1 and 5 mg was safe and tolerable.

Purpose Most clinical studies on the clinical effects of extracts from Viscum album, the European white-berry mistletoe, focus on the survival of cancer patients, while the effects on the patients’ quality of life (QoL) received less consideration. Thus, we intended to determine the effectiveness of the most commonly used mistletoe extracts which is covered by a large spectrum of published studies, the fermented plant extract Iscador, in the treatment of patients with cancer with respect to QoL-related dimensions. Methods We searched several databases such as PubMed/Medline, Excerpta Medica Database (EMBASE), CAMbase and other. Inclusion criteria were controlled clinical studies on parameters associated with QoL in cancer patients treated with Iscador. Separate search terms were “Iscador” and “study”, “mistletoe” and “study”, and “Viscum” and “study”. Studies were analyzed with respect for trials where patients of the control group received only standard care but no extra treatment. QoL-associated outcome data (mean values and standard deviations, mean/median differences, effect estimates and confidence intervals, odds ratios, etc.) were extracted as they were given in the publication, and converted into standardized mean differences (SMD) and their standard errors using standard formulas. Results We found 13 prospective and controlled studies (9 of them were randomized) that met the inclusion/exclusion criteria and the intended focus on mistletoe extract versus no extra treatment; two additional randomized studies controlled Iscador against placebo/alternative treatment, and thus were not enrolled in the evaluation. The number of patients enrolled varied considerably from 32 to 396. The addressed studies reported positive effects with respect to QoL and related dimension in favor of the Iscador application. A random effect meta-analysis estimated the overall treatment effect at SMD=0.56 (CI: 0.41–0.71, p Conclusion The analyzed studies give some evidence that Iscador treatment might have beneficial short-time effects on QoL-associated dimensions and psychosomatic self-regulation. However, most studies used instruments not appropriate to measure QoL. Thus, well-designed randomized controlled trials with appropriate test instruments are encouraged.