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BackgroundMindfulness-based interventions (MBIs) are supported by clinical practice guidelines as effective non-pharmacologic interventions for common symptoms experienced by cancer patients, including anxiety, depression, and fatigue. However, the evidence predominately derives from White breast cancer survivors. Racial and ethnic minority patients have less access to integrative oncology care and worse cancer outcomes. To address these gaps, we designed and piloted a series of mindfulness-based group medical visits (MB-GMVs), embedded into comprehensive cancer care, for racially and ethnically diverse patients in cancer treatment.MethodsAs a quality improvement project, we launched a telehealth MB-GMV series for patients undergoing cancer treatment, delivered as four weekly 2-hour visits billable to insurance. Content was concordant with evidence-based guidelines and established MBIs and adapted to improve cultural relevance and fit (eg, access-centered, trauma-informed, with inclusive communication practices). Program structure was adapted to address barriers to participation, with ≥50% slots per series reserved for racial and ethnic minority patients. Intake surveys incorporated a demographic questionnaire and symptom assessments. Evaluations were sent following the visits.ResultsIn our first ten cohorts (n = 78), 80% of referred patients enrolled. Participants were: 22% Asian, 14% Black, 17% Latino, 45% non-Latino White; 65% female; with a median age of 54 years (range 27-79); and 80% had metastatic cancer. Common baseline symptoms included lack of energy, difficulty sleeping, and worrying. Most patients (90%) attended ≥3 visits. On final evaluations, 87% patients rated the series as "excellent"; 81% "strongly agreed" that they liked the GMV format; and 92% would "definitely" recommend the series to others. Qualitative themes included empowerment and connectedness.ConclusionTelehealth GMVs are a feasible, acceptable, and financially sustainable model for increasing access to MBIs. Diverse patients in active cancer treatment were able to participate and reported high levels of satisfaction with this series that was tailored to center health equity and inclusion.

Parents of children with cancer face bio-psycho-social-spiritual concerns which can significantly reduce quality of life (QoL). We examined the impact of an integrative oncology (IO) intervention on QoL-related concerns among parents of children in a pediatric hematology-oncology department. The study was prospective, controlled, nonrandomized and patient-preferenced. Parents of children recently (≤6 weeks) diagnosed with cancer were assessed using the measure yourself concerns and wellbeing (MYCaW), Edmonton Symptom Assessment Scale (ESAS) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Parents in both groups were reassessed after three weeks. An IO consultation was provided, with training in daily relaxation-breathing and manual treatments, and guidance on herbal medicine. Of 68 parents consenting to participate, 37 (54%) underwent the intervention with 31 serving as controls. Multivariate analysis found the IO intervention group to contain more Hebrew-speakers (OR=5.96, 95% CI=1.3-27.3, P =0.022); females (OR=5.23, 95% CI=1.1-24.8, P =0.038); and report pain (OR=1.2, 95% CI=1.0-1.4, P =0.045) and impaired appetite on ESAS (OR=1.23, 95% CI=1.01-1.48, P =0.034) when compared to controls. Only the intervention group showed improved baseline-to-3-week scores for physical functioning (P <0.001), cognitive functioning (0=0.018) and fatigue on EORTC (P <0.001); and for ESAS appetite (P <0.001) and anxiety (P =0.02). ESAS sleep increased only in controls (P =0.029). IO interventions in pediatric hematology-oncology addressing QoL-related concerns among parents are feasible, potentially increasing predominantly physical symptoms and functioning. Further research is needed to confirm these "real-world" clinical outcomes, and the role of IO in "Caring for the Caregiver". [ABSTRACT FROM AUTHOR]

Study Objective: The study examined a training program for integrative medicine (IM) providers, teaching clinical skills for treating acute stress disorder (ASD). Methods: A 10‐h online training program, designed by IM and mental health professionals, was attended by a group of 32 IM providers working in supportive and palliative oncology care. Pre‐ and post‐course questionnaires assessed self‐perceived levels of IM and mental health ASD‐related skills (from 1, very low; to 7, very high). Results: Most participants (25; 78%) completed pre‐ and post‐study questionnaires, which showed an increase in post‐course scores for the expectation that IM could reduce ASD‐related pain (p = 0.004). Scores for self‐assessed skill levels increased for treating gastro‐intestinal symptoms and appetite (p = 0.039) and for dyspnea (p = 0.048). A borderline increase for arousal was observed (p = 0.063), with no increase with other arousal symptom cluster symptoms. Conclusions: The ASD‐focused training program for IM practitioners was associated with an increase in self‐perceived levels for related clinical skills quality of life‐related concerns, primarily pain, appetite and dyspnea. Further research is needed to better understand the implications of the findings, and to explore the implementation of the learned skills in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Intravenous vitamin C (IVC, ascorbate [Asc]) and alpha-lipoic acid (ALA) are frequently coadministered in integrative oncology clinics, with limited understanding of combination effects or drug-drug interactions. As high-dose IVC has anticancer activity through peroxide (H2O2), it is hypothesized that IV ALA, a thiol antioxidant, might have untoward effects when combined with IVC. Methods: In vitro combination index (CI) was investigated in 6 types of human cancer cells, using clinically relevant concentrations of Asc (0.625-20 mM) and ALA (0.25, 0.5, and 1 mM) evaluated by nonconstant ratio metrics. Cellular H2O2 was measured using HeLa cells expressing a fluorescent probe HyPer. Mouse xenografts of the metastatic breast cancer MDA-MB-231 were treated with intraperitoneal injections of ALA (10, 20, and 50 mg/kg) and Asc (0.2, 0.5, and 4 g/kg) at various dose levels. Results: Cancer cell lines were sensitive to Asc treatment but not to ALA. There is no evidence ALA becomes a prooxidant at higher doses. The CIs showed a mixture of synergistic and antagonistic effects with different ALA and Asc combination ratios, with a "U" shape response to Asc concentrations. The ALA concentrations did not influence the CIs or cellular H2O2 formation. Adding ALA to Asc dampened the increase of H2O2. Toxicity was observed in mice receiving prolonged treatment of ALA at all doses. The Asc at all doses was nontoxic. The combination of ALA and Asc increased toxicity. The ALA at all doses did not inhibit tumor growth. The Asc at 4 g/kg inhibited tumor growth. Adding ALA 50 mg/kg to Asc 4 g/kg did not enhance the effect, but lower doses of ALA (10 or 20 mg/kg) dampened the inhibitory effect of Asc. Conclusions: These data do not support the concurrent or relative concurrent use of high-dose intravenous ALA with prooxidative high-dose IVC in clinical oncology care with potentially increased toxicity. [ABSTRACT FROM AUTHOR]

Medical guidelines recommend actively addressing patients' information needs regarding complementary and integrative healthcare (CIH). Within the CCC-Integrativ study, an interprofessional counseling program on CIH was developed and implemented at four comprehensive cancer centers (CCCs) in Germany. As part of the process evaluation, this study examines cancer patients' experiences with interprofessional CIH counseling sessions conducted by a physician and a nurse. Forty problem-centered interviews were conducted using a semi-structured interview guide. All interviews were audio-recorded, transcribed verbatim, and analyzed using deductive–inductive content analysis based on Kuckartz and Rädiker's approach. Findings revealed that most participants had prior experience with CIH approaches and were burdened by physiological and psychological symptoms. Counseling sessions focused on cancer- and treatment-related symptoms and appropriate CIH recommendations (e.g., herbal poultice against anxieties and acupressure against nausea). Participants appreciated the mutual exchange and integration of perspectives from different healthcare professions within the interprofessional approach. They noted that the counseling team comprehensively addressed their healthcare and CIH information needs. Suggestions for improvement included the specificity of the CIH recommendations. As the participants only received counseling and no CIH treatments, information about reputable CIH providers was particularly important to many seeking advice. Patients with cancer receiving tailored CIH counseling from two healthcare professionals experienced benefits in CIH counseling for symptom management. The interprofessional teams offered a comprehensive perspective on patients' needs, proposing personalized recommendations for symptom control. These insights may foster collaboration between healthcare professionals interested in CIH counseling, enabling them to expand and consolidate their counseling services. [ABSTRACT FROM AUTHOR]

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Purpose of Review: This article aims to offer a comprehensive review of optimal integrative medicine practices for geriatric oncology patients. Given the aging population and the global rise in cancer incidence, it is crucial to identify evidence-based modalities and employ an integrated approach to enhance cancer outcomes and quality of life in older adults. Recent Findings: It has been predicted that 20.5% (6.9 million) of new cancer cases in 2050 will occur in adults over 80 years old.1 The increasing focus on lifestyle factors in healthy aging has shed light on various overlooked areas of significance. Notably, anti-inflammatory diets and the promotion of a healthy gut microbiome have demonstrated significant impacts on overall health outcomes, bolstering the body's innate capacity to combat disease. This review delves into further evidence and extrapolation concerning integrative approaches and their influence on cancer outcomes and older adults quality of life. Summary: The complexity and unique nature of cancer in older adults requires a wide range of support from medical providers. Incorporating various integrative techniques as part of cancer treatment and side effect support can improve health outcomes and patient's quality of life. Familiarity with the lifestyle interventions and other topics explored in this review equips healthcare providers to offer tailored and holistic care to geriatric patients navigating cancer. [ABSTRACT FROM AUTHOR]

Purpose of Review: Myeloproliferative neoplasm (MPN) burdens the lives of those affected. MPN patients endure significant impacts on their physical, psychological, and social well-being. While pharmacological interventions offer some disease and symptom control, they often have unfavorable side effects. This review explores the potential of Integrative Oncology (IO) therapies in managing MPNs and their associated symptoms. Recent Findings: IO is dedicated to augmenting conventional treatments through integrating interventions targeting the mind, body, nutrition, supplements, and other supportive care therapies. Several small studies suggest the benefit of an IO approach in MPN patients. These benefits are postulated to be modulated through enhanced physical capacity, reduced disease-related inflammation, subconscious mind training, and gut microbiome modulation. Summary: By combining IO with evidence-based pharmacological treatments, the potential exists to enhance the quality of life and clinical outcomes for individuals with MPNs. Future research should prioritize well-powered studies, including diverse demographics and symptom profiles, with appropriate study duration, to draw definite conclusions regarding the observed effects. [ABSTRACT FROM AUTHOR]

Simple Summary: The demand for traditional and complementary medicine (T&CM), perceived as natural and safe, among cancer patients has been steadily increasing. However, this trend raises concerns about the potential risks of using these therapies concurrently with conventional treatments and whether patients are fully adhering to their prescribed treatments. In Asia, T&CM is particularly common due to cultural and historical influences. This systematic review and meta-analysis is the first study to investigate the prevalence of T&CM use among cancer patients in Asia, how often they disclose this use to their physicians, and the factors influencing their choices. Understanding these aspects may enhance communication between patients and physicians, ultimately leading to safer and more effective cancer care. Globally, cancer patients frequently use T&CM during their treatment for various reasons. The primary concerns regarding the use of T&CM among cancer patients are the potential risks associated with interactions between pharmaceuticals and T&CM, as well as the risk of noncompliance with conventional cancer treatments. Despite the higher prevalence of T&CM use in Asia, driven by cultural, historical, and resource-related factors, no prior review has tried to estimate the prevalence and influencing factors of T&CM use and disclosure among cancer patients in this region. This study aims to examine the prevalence and disclosure rates of T&CM use among cancer patients in Asia to assess various factors influencing its use across different cancer treatment settings in Asia. Systematic research on T&CM use was conducted using four databases (PubMed, EMBASE, Web of Science, and CINAHAL) from inception to January 2023. Quality was assessed using the Appraisal Tool for Cross-Sectional Studies (AXIS). A random effects model was used to estimate the pooled prevalence of T&CM use, and data analysis was performed using Stata Version 16.0. Among the 4849 records retrieved, 41 eligible studies conducted in 14 Asian countries were included, involving a total of 14,976 participants. The pooled prevalence of T&CM use was 49.3%, ranging from 24.0% to 94.8%, and the disclosure rate of T&CM use was 38.2% (11.9% to 82.5%). The most commonly used T&CM modalities were herbal medicines and traditional medicine. Females were 22.0% more likely to use T&CM than males. A subgroup analysis revealed the highest prevalence of T&CM use was found in studies conducted in East Asia (62.4%) and those covered by both national and private insurance (55.8%). The disclosure rate of T&CM use to physicians remains low. Moreover, the factors influencing this disclosure are still insufficiently explored. Since the disclosure of T&CM use is a crucial indicator of patient safety and the quality of cancer treatment prognosis, future research should focus on identifying the determinants of non-disclosure. [ABSTRACT FROM AUTHOR]

Introduction: Integrative oncology combines evidence-based methods of oncological therapy, supportive medicine, nutrition and physical activity as well as complementary medicine and can significantly improve the effectiveness of therapy and the quality of life for cancer patients. However, scientifically based continuing education in this area has so far rarely been available. Project outline: The part-time continuing education program in "Integrative Onkologie" at the University of Jena is the first in Germany to offer scientifically based training for various healthcare professions. The focus lies on evidence-based content regarding the diagnosis, therapy, prevention and survivorship of cancer from the fields of complementary medicine, sport and nutrition. The course comprises 3 semesters of distance learning with one attendance weekend in Jena and concludes with a Master's thesis (M.Sc.). All healthcare professionals with a first university degree in medicine or health sciences and at least one year of professional experience are eligible for admission. The development of the study program was supported by surveys and statements from students and experts. Results: A demand survey of students (N=128) and statements (N=15) from healthcare professionals show that the course closes a gap in education and training. The course was seen as an attractive and suitable alternative to subject-specific consecutive Master's courses. Its interdisciplinary focus and its high relevance with regard to improvements in healthcare were rated particularly positive. From the students' point of view, the topics of nutrition and physical activity were seen as particularly interesting, while the expert's statements emphasized the need for evidence-based discussion, especially in the field of complementary medicine. Discussion: The course fills an important gap and provides evidence-based further training in integrative oncology. The presented conditions are rated as appropriate and the extended professional options and improvement of care in everyday practice are emphasized. The course was approved in April 2023 and has already started with the first cohort in the winter semester 2023 (October). Conclusion: The postgraduate course in integrative oncology at the University of Jena offers thorough training for healthcare professionals and fulfills the requirements for continuing education programs. It can therefore make a significant contribution to medical consultation needs and improving care in oncology and enable a faster path to specialized continuing education for many specialties. [ABSTRACT FROM AUTHOR]

Purpose of Review: Communicating effectively with patients having a traditional, alternative or complementary medicine-related health-belief model is challenging in today's cross-cultural society. This narrative review explores the integrative medicine setting of care, focusing on insights from the integrative oncology daily practice, while addressing the relevance to the mental health setting. The way in which healthcare providers can enhance cultural-sensitive communication with patients and informal caregivers; recognize and respect health-beliefs to bridge cultural gaps; and generate an open, non-judgmental and mindful dialogue are discussed. Recent Findings: Identifying cross-cultural barriers to healthcare provider-patient communication is important in order to address the potential for conflict between conventional and "alternative" health beliefs; difficulties in creating a shared-decision making process; disagreement on therapeutic goals and treatment plan; and finally, the potential for non-compliance or non-adherence to the conventional oncology treatment. Summary: Acquiring intercultural competencies is needed at all stages of medical education, and should be implemented in medical and nursing curricula, as well as during specialization and sub-specialization. As with patient-centered paradigms of care, integrative medicine entails a dual patient-centered and sensitive-cultural approach, based on a comprehensive bio-psycho-social-spiritual model of care. [ABSTRACT FROM AUTHOR]

Purpose: Many cancer patients wish for complementary and integrative medicine (CIM) consultations led by their oncology physician. Within the KOKON‐KTO study, oncology physicians in the intervention group were trained in a blended learning to provide CIM consultations to their cancer patients in addition to distributing a leaflet about CIM websites. Control oncology physicians only distributed the leaflet. The training showed positive effects on the patient‐level. As of now, no consistent evidence exists on the long‐term effects of such one‐time‐only CIM consultation during cancer treatment. Methods: In the KOKON‐KTO follow‐up study, cancer patients previously participating in the KOKON‐KTO study (intervention group:IG and control group: CG) received, at least 24 months later, a follow‐up questionnaire by post, evaluating long‐term effects of the KOKON‐KTO consultation using the measures provided in the original study (patient‐physician communication (EORTC‐QLQ‐COMU2), satisfaction with cancer treatment (PS‐CaTE), CIM disclosure with healthcare provider (HCP), and need for CIM consultation during cancer therapy). Results: In total, 102 cancer patients participated in the follow‐up study (IG n = 62; CG n = 40). The overall reponse rate was around 36% (IG: 48.4%; CG: 23.7%). In the follow‐up study, differences between groups had increased and were still shown (EORTC‐QLQ‐COMU26, 0–100 point scale, ≥10‐point‐group difference) in some subscales: patient's active behavior (in means; IG:73.6 (95% CI, 63.8–83.5); CG:61.1 (95% CI, 52.4–69.8)); clinician‐patient relationship (IG:80.9 (95% CI, 71.8–90.0); CG:68.7 (95% CI, 59.3–78.0)). For some outcomes, differences decreased over time (e.g., EORTC‐QLQ‐COMU26 subscales "takes into account patient's preference" and "corrects misunderstandings"). More patients in the CG used CIM without oncology physicians' knowledge (IG: 13.7%, CG: 24.0%). Conclusion: This study presents first findings that one‐time‐only CIM consultations may enhance patient‐physican relationship and CIM disclosure long‐term. To further support cancer patients' in their wish for CIM consultations, training programs should provide oncology physicians with CIM competencies for different cancer stages including cancer survivors. [ABSTRACT FROM AUTHOR]

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. 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). 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). 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. [ABSTRACT FROM AUTHOR]

BackgroundIntegrative Oncology (IO) – the use of lifestyle modifications, mind-body practices and natural products in oncology – is increasingly asked for by patients. The evidence base of IO is growing and IO measures are included in national guidelines. Still, many questions about IO remain unanswered or still show a poor evidence base.MethodData about demography, socioeconomic status, cancer disease and therapy, integrative oncology measures and patient reported outcomes will be collected in regular visits in oncological patients at the University Cancer Center Ulm, Germany. An expansion to further study centers is planned. After one year and at regular intervals, the registry will be evaluated and adapted accordingly.DiscussionThe PRIO registry builds a solid data base to evaluate the use of integrative oncology measures in cancer patients. It includes patient reported outcome measures to investigate quality of life and satisfaction with health services in this population. The registry aims to enhance transparency in IO use and wants to inform future research in IO. The trial has been registered in the German Clinical Trials Register (DRKS) under the ID DRKS00033250 and in the studyBox of the German Cancer Association under the ID ST-U173 on 18th December 2023. The trial was approved by the ethics committee of the University Medical Center Ulm under the number 375/23 on 7th December 2023.

During the oncological care path, breast cancer patients treated with chemotherapy suffer from a number of psycho-physical changes, and appearance-related side effects are among the primary determinants of psychosocial impairment. Appropriate interventions are needed due to the fact that treatment-induced transformations have been associated with a decline in overall quality of life, interpersonal and sexual difficulties, and adverse effects on therapeutic adherence. In the framework of integrative oncology, beauty therapy is an affordable and straightforward intervention that could be used in the clinical management of breast cancer side effects. This study aims to comprehend the emotional and lived experiences of women undergoing chemotherapy after a brief beauty therapy intervention with licensed beauticians. The Interpretative Phenomenological Analysis was used as a methodological guideline. Sixteen women were purposefully recruited in a day hospital of a cancer unit, where the beauty therapy was implemented. At the end of the intervention, data were gathered using a semi-structured interview with open-ended questions. A thematic analysis was performed on verbatim transcriptions. Findings support the proposal of beauty therapy for patients undergoing chemotherapy. Assuming a relational viewpoint, beauty therapy could improve patients’ feelings about themselves and the way they feel about others, even if they do not declare a specific interest in their outward appearance.

BackgroundNeuropsychiatric symptoms, comprising cognitive impairment, fatigue, insomnia, depression, and anxiety, are prevalent and may co-occur during and after chemotherapy treatment for cancer. Electroacupuncture (EA), which involves mild electrical stimulation with acupuncture, holds great potential in addressing the management of individual symptoms. However, there is a lack of studies evaluating if EA can manage concurrent neuropsychiatric symptoms in cancer (i.e., symptom cluster). Hence, we designed a trial to evaluate the efficacy, safety, and feasibility of administering EA as an intervention to mitigate neuropsychiatric symptom clusters amongst cancer patients and survivors.MethodsThe EAST study is a randomized, sham-controlled, patient- and assessor-blinded clinical trial. Sixty-four cancer patients and survivors with complaints of one or more neuropsychiatric symptom(s) in the seven days prior to enrollment are recruited from the University of California Irvine (UCI) and Children's Hospital of Orange County (CHOC). Individuals with needle phobia, metastases, bleeding disorders, electronic implants, epilepsy, exposure to acupuncture in the three months prior to enrollment, and who are breastfeeding, pregnant, or planning to get pregnant during the duration of the study will be excluded. Screening for metal fragments and claustrophobia are performed prior to the optional neuroimaging procedures. Recruited patients will be randomized (1:1) in random blocks of four or six to receive either ten weekly verum EA (treatment arm, vEA) or weekly sham EA (control arm, sEA) treatment visits with a follow-up appointment four to twelve weeks after their last treatment visit. The treatment arm will receive EA at 13 acupuncture points (acupoints) chosen for their therapeutic effects, while the control arm receives minimal EA at 7 non-disease-related acupoints. Questionnaires and cognitive assessments are administered, and blood drawn to assess changes in symptom clusters and biomarkers, respectively.ConclusionThe EAST study can provide insight into the efficacy of EA, an integrative medicine modality, in the management of cancer symptom clusters in routine clinical practice.Trial registrationThis trial is registered with clinicaltrials.gov NCT05283577.

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) [ABSTRACT FROM AUTHOR]

Purpose: Breast cancer survivors following disease-modifying treatment frequently experience multiple-concurrent symptoms (Jansana et al. in Int J Cancer 149(10):1755 1767, 2021), negatively impacting their quality of life and increasing the risk of polypharmacy (Alwhaibi et al. in J Oncol Pharm Pract 26(5):1052 1059, 2020). This study evaluates the feasibility and acceptability of acupuncture for the management of the pain-fatigue-sleep disturbance-numbness/tingling symptom cluster in breast cancer survivors, and investigates relationships between the symptom cluster and Traditional Chinese Medicine (TCM) syndrome diagnosis. Methods: This was a single-arm, pre-test/post-test feasibility trial conducted at Chris O'Brien Lifehouse Hospital, Australia. Breast cancer survivors who completed treatment and experienced clinically significant levels of two or more symptoms (pain, fatigue, sleep disturbance, numbness/tingling) were eligible to participate in the individualized, pragmatic 6-week acupuncture intervention. The primary outcome was feasibility and acceptability. Effectiveness was explored using a symptom cluster mean score. Results: Twenty women enrolled in the study over an 11-week period and 90% completed the study. Most women agreed or completely agreed that acupuncture was feasible (85%), acceptable (90%), and appropriate (90%). Both mean and composite symptom cluster scores were significantly reduced (p < 0.001), as were individual symptom scores in fatigue (p < 0.001), sleep disturbance (p = 0.04), and numbness/tingling (p = 0.01). TCM syndromes most closely associated with this symptom cluster were Spleen qi deficiency and Heart fire. No adverse events were reported. Conclusion: This study demonstrated that acupuncture was safe and feasible, justifying a powered randomized control trial. Preliminary findings suggest beneficial effects of acupuncture for the management of the pain-fatigue-sleep disturbance-numbness/tingling symptom cluster for women with breast cancer. TCM syndromes identified in this trial may be used to guide acupuncture treatment protocols. Clinical trial registration: This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000590763) on 21 April 2022. [ABSTRACT FROM AUTHOR]

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. Summary: 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. [ABSTRACT FROM AUTHOR]

Background: Advanced cancer patients benefit less from aggressive therapies and more from goal-directed palliative management. Early and clearly documented goals-of-care discussions, including end-of-life decision making, are essential in this patient population. Integrated healthcare systems are comprehensive care models associated with improved quality of care and lower mortality compared to other healthcare models. The role of advance care planning within our system is understudied. Methods: Patients 18 years and older with a diagnosis of advanced-stage cancer were identified over a 6-month period. Expert panel review was performed to evaluate medical appropriateness of the selected diagnostic workup and management. The role and extent of care planning was reviewed in association with the clinical context. Results: In a cohort of 82 patients, evidence-based and individualized appropriateness of medical management was found to be consistent for all patients. Eighty-two percent of patients elected for oncologic-based treatment, 5% pursued active surveillance, and 11% did not receive treatment. Seventy-three percent of patients were referred to palliative care. Fifty-six percent of patients had a full goals-of-care conversation documented; yet only 9% of goals-of-care conversations were documented by an oncologist. Prognosis was documented fully for only 22% of patients. At the end of the study period, 43 patients were deceased (52%), further indicating the critical importance of documentation. Conclusions: Within our integrated health system, we found consistent guideline- and patient-directed diagnosis and management, along with frequent integration of palliative care services. Goals-of-care conversation and prognosis documentation, especially by the oncologist, remains an area of needed improvement. [ABSTRACT FROM AUTHOR]

Background: Pediatric cancer patients' oncology teams regularly take on a primary care role, but due to the urgent nature of cancer treatment, developmental screenings may be deprioritized. This leaves patients at risk of developmental diagnoses and referrals being delayed. Aims: Clarify the current developmental surveillance and screening practices of one pediatric oncology team. Materials and methods: Researchers reviewed charts for patients (n = 66) seen at a pediatric oncology clinic in a suburban academic medical center to determine engagement in developmental screening (including functioning around related areas such as speech, neurocognition, etc.) and referrals for care in these areas. Results: Developmental histories were collected from all patients through admission history and physical examination (H&P), but there was no routinized follow‐up. Physicians did not conduct regular developmental screening per American Academy of Pediatrics guidelines for any patients but identified n = 3 patients with needs while the psychology team routinely surveilled all patients seen during this time (n = 41) and identified n = 18 patients as having delays. Discussion: Physicians did not routinely screen for development needs beyond H&P and were inconsistent in developmental follow‐up/referrals. Integrated psychologists were key in generating referrals for developmental‐based care. However, many oncology patients were not seen by psychologists quickly or at all, creating a significant gap in care during a crucial developmental period. Conclusion: The case is made for further routinization of ongoing developmental screening in pediatric oncology care. Key points: For pediatric oncology patients, oncology providers may take on a primary care role to surveil, screen, and refer for developmental concerns per guidelines issued by the American Academy of Pediatrics.This quality improvement study sought to explore the developmental monitoring practices of one pediatric oncology clinic.Only a portion of pediatric oncology patients diagnosed with cancer between 6 months and 5 years 11 months received developmental surveillance, screenings, and/or referrals from the oncology team beyond patients' initial history and physical.Patients who were seen by the integrated psycho‐oncology team were the most likely to have received developmental surveillance, screening, and referrals. Integrated psycho‐oncology providers may serve to address gaps in developmental monitoring practices in pediatric oncology clinics. [ABSTRACT FROM AUTHOR]

During the oncological care path, breast cancer patients treated with chemotherapy suffer from a number of psycho-physical changes, and appearance-related side effects are among the primary determinants of psychosocial impairment. Appropriate interventions are needed due to the fact that treatment-induced transformations have been associated with a decline in overall quality of life, interpersonal and sexual difficulties, and adverse effects on therapeutic adherence. In the framework of integrative oncology, beauty therapy is an affordable and straightforward intervention that could be used in the clinical management of breast cancer side effects. This study aims to comprehend the emotional and lived experiences of women undergoing chemotherapy after a brief beauty therapy intervention with licensed beauticians. The Interpretative Phenomenological Analysis was used as a methodological guideline. Sixteen women were purposefully recruited in a day hospital of a cancer unit, where the beauty therapy was implemented. At the end of the intervention, data were gathered using a semi-structured interview with open-ended questions. A thematic analysis was performed on verbatim transcriptions. Findings support the proposal of beauty therapy for patients undergoing chemotherapy. Assuming a relational viewpoint, beauty therapy could improve patients' feelings about themselves and the way they feel about others, even if they do not declare a specific interest in their outward appearance. [ABSTRACT FROM AUTHOR]

Integrative oncology comprises a range of therapies that can complement standard cancer treatments, such as chemotherapy, surgery, and radiotherapy. One commonly used approach to complementary medicine involves using naturally occurring antioxidants, such as Ayurvedic herbal extracts, to assist in reducing the adverse effects of cancer treatment on healthy cells. Swastharakshak Plus® (SR plus®) is a polyherbal formulation consisting of Tinospora cordifolia, Curcuma longa, and Camellia sinensis, known for their phytochemical content. This research paper hypothesized that SR plus® has anti-oxidant properties and a cytotoxic effect on HeLa cancer cells. The study found significantly lower IC50 values for SR plus® ethanol extract after both 24 hours (22 µg/ml) and 48 hours (8.65 µg/ml) of exposure, compared to methanol and water extracts of SR plus®. Also, fluorescence staining using Hoechst dye, DAPI, and dual staining (acridine orange and propidium Iodide) revealed the occurrence of apoptosis in HeLa cells treated with the IC50 concentration of SR plus® ethanol extract for 48 hr. HeLa cells showed 43% cell death SR plus® ethanol extract. In conclusion, the SR plus® formulation exhibited cytotoxicity activity against the HeLa cell line, possibly due to apoptosis. By investigating complementary therapies like SR plus®, we may find valuable additions to existing cancer treatments that can enhance their efficacy and reduce side effects. [ABSTRACT FROM AUTHOR]

Background: Chronic cancer-related pain (CRP) can have a significant negative impact on quality of life. Mindfulness is hypothesized to mitigate chronic CRP by regulating both physical and emotional resistance to pain. In recent years, there has been interest in the use of virtual reality (VR) to deliver mindfulness meditation. VR provides an immersive and engaging environment, which may enhance one's focused attention to present-moment experiences, potentially making mindfulness less effortful and more efficacious for individuals with chronic pain. There has been little research in this area for people with a history of cancer. Objective: The aim of this mixed methods study is to evaluate the feasibility of a VR-guided mindfulness (VRGM) intervention offered to adult cancer survivors with chronic CRP. Methods: This mixed methods feasibility study will employ a single-arm, pretestposttest design with semistructured interviews. In total, 15 cancer survivors will be enrolled in a 6-week home-based intervention that consists of 10-15 min of daily VRGM practice. The primary outcome is feasibility as assessed by accrual rates, retention in the study, intervention adherence, questionnaire completion, and side effect rates. Participants will be assessed on psychosocial outcome measures (i.e., pain, sleep, depressive and anxiety symptoms, fatigue, quality of life, and mindfulness) before and after the intervention, and 6 weeks post intervention (follow-up). Changes in pain will be described in relation to levels of immersion and presence in the virtual environment, trait mindfulness, and amount of VRGM practice. Qualitative information will provide subjective detail on participants' experience with VRGM to complement quantitative data. This study has been approved by the Health Research Ethics Board of Alberta Cancer Committee (HREBA.CC-20-0411). Conclusions: This novel intervention provides a potential alternative treatment to pharmacological pain management. Results from this study may inform future larger VGRM trials for chronic CRP to help reduce suffering in people with cancer. Study findings will be disseminated through open access publications, traditional conference presentations, professional cancer organizations, and social media platforms. [ABSTRACT FROM AUTHOR]

Background: Up-to-date recommendations for the safe practice of acupuncture in integrative oncology are overdue with new cancer treatments and an increase in survivors with late effects of disease; 17 years have elapsed since Filshie and Hester’s 2006 guidelines. During 2022/2023 an expert panel assembled to produce updated recommendations aiming to facilitate safe and appropriate care by acupuncturists working with people with cancer. Methods: A core development team comprising three integrative oncology professionals comprehensively updated pre-existing unpublished recommendations. Twelve invited international experts (senior acupuncturists with and without experience of working in oncology settings, oncologists, physicians and nurses trained in integrative oncology, researchers, academics, and professional body representatives) reviewed the recommendations. In multiple iterations, the core team harmonised comments for final ratification. To aid dissemination and uptake the panel represents national and international integrative oncology associations and major cancer treatment centres in Europe, USA, Australia, and the Middle East. Results: These recommendations facilitate safe care by articulating contra-indications, cautions, and risks for patients both on and off treatment (surgery, SACT, radiotherapy). Situations where acupuncture may be contra-indicated or practices need adapting are identified. “Red and Amber Flags” highlight where urgent referral is essential. Conclusion: These are the first international, multidisciplinary peer-reviewed recommendations for safe acupuncture practice in integrative oncology. Concerns about safety remain a significant barrier to appropriate referral from oncology teams, to use by acupuncturists and to uptake by patients. Disseminating trustworthy, widely accessible guidance should facilitate informed, confident practice of acupuncture in and outside of oncology healthcare settings. [ABSTRACT FROM AUTHOR]

Background: Breast cancer (BC) treatment has recently been revolutionized by the introduction of newer targeted agents, that helped tailoring therapies around the single patient. Along with increased survival rates, a careful evaluation of diet, lifestyle habits, physical activity, emotional and psychological experiences linked to the treatment journey, is now mandatory. However, a true proposal for an omnicomprehensive and "integrative" approach is still lacking in literature. Methods: A scientific board of internationally recognized specialists throughout different disciplines designed a shared proposal of holistic approach for BC patients. Results: A narrative review, containing information on BC treatment, endocrinological and diet aspects, physical activity, rehabilitation, integrative medicine, and digital narrative medicine, was developed. Conclusions: In the context of a patient-centered care, BC treatment cannot be separated from a patient's long-term follow-up and care, and an organized interdisciplinary collaboration is the future in this disease's cure, to make sure that our patients will live longer and better. Trial Registration: NCT05893368: New Model for Integrating Person-based Care (PbC) in the Treatment of Advanced HER2-negative Breast Cancer (PERGIQUAL). Registration date: 29th May 2023. [ABSTRACT FROM AUTHOR]

Abstract Purpose Many cancer patients wish for complementary and integrative medicine (CIM) consultations led by their oncology physician. Within the KOKON‐KTO study, oncology physicians in the intervention group were trained in a blended learning to provide CIM consultations to their cancer patients in addition to distributing a leaflet about CIM websites. Control oncology physicians only distributed the leaflet. The training showed positive effects on the patient‐level. As of now, no consistent evidence exists on the long‐term effects of such one‐time‐only CIM consultation during cancer treatment. Methods In the KOKON‐KTO follow‐up study, cancer patients previously participating in the KOKON‐KTO study (intervention group:IG and control group: CG) received, at least 24 months later, a follow‐up questionnaire by post, evaluating long‐term effects of the KOKON‐KTO consultation using the measures provided in the original study (patient‐physician communication (EORTC‐QLQ‐COMU2), satisfaction with cancer treatment (PS‐CaTE), CIM disclosure with healthcare provider (HCP), and need for CIM consultation during cancer therapy). Results In total, 102 cancer patients participated in the follow‐up study (IG n = 62; CG n = 40). The overall reponse rate was around 36% (IG: 48.4%; CG: 23.7%). In the follow‐up study, differences between groups had increased and were still shown (EORTC‐QLQ‐COMU26, 0–100 point scale, ≥10‐point‐group difference) in some subscales: patient's active behavior (in means; IG:73.6 (95% CI, 63.8–83.5); CG:61.1 (95% CI, 52.4–69.8)); clinician‐patient relationship (IG:80.9 (95% CI, 71.8–90.0); CG:68.7 (95% CI, 59.3–78.0)). For some outcomes, differences decreased over time (e.g., EORTC‐QLQ‐COMU26 subscales “takes into account patient's preference” and “corrects misunderstandings”). More patients in the CG used CIM without oncology physicians' knowledge (IG: 13.7%, CG: 24.0%). Conclusion This study presents first findings that one‐time‐only CIM consultations may enhance patient‐physican relationship and CIM disclosure long‐term. To further support cancer patients' in their wish for CIM consultations, training programs should provide oncology physicians with CIM competencies for different cancer stages including cancer survivors.

Introduction: Palliative care (PC) improves the quality of life of patients and their families. The use of antimicrobials is controversial in PC patients, especially in those admitted to the intensive care unit (ICU). Objective: To evaluate the use of antimicrobials in PC patients admitted to the ICU. Methods: This is a retrospective study, performed from August 2019 to September 2020. Data on demographic profile, hospitalization, PC, and use of antimicrobials were collected from the Erasto Gaertner Hospital database, in Curitiba, Brazil. Results: 182 patients were studied, median age of 65 years and 52% men. The median length of stay in the ICU was 3 days; the median total length of stay in the hospital was 6 days and 89.5% of the patients died. The time in ICU of patients treated with antibiotics (14.8%) was significantly longer (p=0.033) than for patients who were not (85.2%). Using or not using antibiotics did not change the outcome. Among those who took antibiotics, death occurred in 81.5% of cases and among those who did not use, 74.8% died (p=0.627). Between the cases that used broad-spectrum antibiotics 17/19 (89.5%) died and the mean hospital stay was 16.2 days. Among cases that used narrow-spectrum 5/9 (62.5%) died and the mean hospital stay was 6.4 days (p=0.033). Conclusion: The administration and/or the spectrum of antibiotics in PC patients admitted to the ICU did not change the mortality rate. The administration of antibiotics increased the length of stay in the ICU.

Background Survival rates for breast cancer are increasing, but many clinical needs in a larger and larger population of survivors are not properly met. During and beyond cancer treatments, patients tend to reduce their physical activity levels, gain weight and may complain about chronic pain, lymphedema, fatigue, cognitive problems, depression and anxiety, reduced social contacts and difficulties in resuming daily activities. In addition, younger women must also face fertility issues and early menopause, higher levels of distress regarding body image, sexual health, childcare and career management. Beside this, all the survivors may feel a fear for disease recurrence and many of them are not educated to identify and express their needs. Materials and Methods Tailored supportive strategies, including physical and psychological interventions, should be offered since the time of diagnosis and along the entire cancer journey and the follow up period. They should be aimed not only to the prevention and control of psychological and physical impairments (such as anxiety, stress, depression, lymphedema, genitourinary symptoms and sexual dysfunctions), but also to encourage remodulation of personal lifestyles for tertiary prevention and nurture patient’s resources that can promote a personal growth after the traumatic experience of cancer. Conclusions Toward this goal, many cancer centres worldwide including ours offer dedicated programs of psycho-oncological support, nutritional and physical activity counselling and evidence based complementary treatments (such as acupuncture, mindfulness, meditation, reflexology, herbal medicine, music therapy and more).

Purpose of Review: Over the last 2 decades, integrative oncology (IO) has seen exponential growth within cancer care. It aims to combine evidence-based complementary therapies with conventional treatments to improve the well-being and quality of life for individuals dealing with cancer. The proliferation of integrative medicine programs in major cancer centers globally reflects varying approaches shaped by cultural, demographic, and resource-based factors. Recent Findings: Drawing upon the expertise of leaders in IO from the Society for Integrative Oncology (SIO) Clinical Practice Committee, this manuscript serves as a practical guide for establishing an IO practice. Collating insights from diverse professionals, including oncologists, integrative oncologists, supportive care physicians, researchers, and clinicians, the paper aims to provide a comprehensive roadmap for initiating and advancing IO services. The primary objective is to bridge the gap between conventional cancer care and complementary therapies, fostering a patient-centric approach to address the multifaceted challenges encountered by individuals with cancer. Summary: This paper delineates several key sections elucidating different aspects of IO practice. It delves into the core components necessary for an IO service's foundation, outlines the initial medical consultation process, and presents crucial tools essential for successful consultations. By consolidating insights and expertise, this manuscript seeks to facilitate the integration of IO into mainstream cancer care, ultimately enhancing patient outcomes and experiences. [ABSTRACT FROM AUTHOR]

This short report evaluated the accuracy and quality of information provided by ChatGPT regarding the use of complementary and integrative medicine for cancer. Using the QUality Evaluation Scoring Tool, a panel of 12 reviewers assessed ChatGPT's responses to 8 questions. The study found that ChatGPT provided moderate-quality responses that were relatively unbiased and not misleading. However, the chatbot's inability to reference specific scientific studies was a significant limitation. Patients with cancer should not rely on ChatGPT for clinical advice until further systematic validation. Future studies should examine how patients perceive ChatGPT's information and its impact on communication with health care professionals. [ABSTRACT FROM AUTHOR]

Purpose of Review: The goal of this review was to examine the role and practical applications of integrative oncology strategies in supporting immune checkpoint inhibitor (ICI) treatment of adult solid tumours. Recent Findings: Beyond tumour-intrinsic factors, several patient-associated factors affect ICI response, including germline genetics, systemic inflammation, the gut microbiota, and diet. Current promising supportive interventions include a Mediterranean-style diet with over 20 g of fibre, regular exercise, use of live biotherapeutics, minimisation of PPI and antibiotic use, and ensuring vitamin D repletion, with many other integrative oncology approaches under study. Caution around medical cannabis use in patients on ICIs is advised due to previously documented adverse impact on overall survival, while VAE (Viscum album extract) therapy studies have not highlighted any safety concerns so far. Summary: With expanding ICI use, it is important to investigate and apply low-cost integrative oncology strategies to support better treatment outcomes and minimise adverse events. Further research may lead to pre-treatment assessment of both tumour and patient-associated biomarkers and personalised multimodal prehabilitation care plans, as well as on-treatment support with targeted nutrition, physical activity, and supplementation regimes, including both systemic inflammation and gut microbiome modulating strategies. Given the emerging understanding of chronic stress impact on ICI treatment outcomes, mind-body approaches require further investigation. [ABSTRACT FROM AUTHOR]

Purpose of Review: After a cancer diagnosis, patients ask what they can do in addition to the recommended treatments to increase their survival. Many turn to integrative medicine modalities and lifestyle changes to improve their chances of survival. Numerous studies have demonstrated that lifestyle changes can significantly improve survival rates for cancer patients. Less support exists for the use of natural products or supplements to improve cancer survival. In this manuscript, we review key findings and evidence in the areas of healthy eating habits, physical activity, stress management and social support, and sleep quality, as well as natural products and supplements as they relate to the cancer recurrence and survival. Recent Findings: While more research is needed to fully understand the mechanisms underlying the associations between lifestyle changes and cancer survival, findings suggest that lifestyle modifications in the areas of diet, physical activity, stress management and social support, and sleep quality improve clinical cancer outcomes. This is especially true for programs that modify more than one lifestyle habit. To date, outside of supplementing with vitamin D to maintain adequate levels, conflicting conclusion within the research remain regarding the efficacy of using natural products or supplement to improve cancer recurrence of disease or cancer survival. A call for further research is warranted. Summary: Lifestyle screening and counseling should be incorporated into cancer treatment plans to help improve patient outcomes. While the scientific community strives for the pursuit of high-quality research on natural products to enhance cancer survival, transparency, dialogue, and psychological safety between patients and clinicians must continue to be emphasized. Proactive inquiry by clinicians regarding patients' supplement use will allow for an informed discussion of the benefits and risks of natural products and supplements, as well as a re-emphasis of the evidence supporting diet and other lifestyle habits to increase survival. [ABSTRACT FROM AUTHOR]

To explore the feasibility of implementing the joint guideline on integrative medicine for pain management in oncology, published by the Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO), for integrative oncology (IO) services in supportive and palliative care. A qualitative research methodology was co-designed by the SIO-ASCO guideline committee, with the Society for Complementary Medicine, Israel Medical Association (IMA). A questionnaire with five open-ended questions exploring barriers and enablers to implementing the guideline was distributed to chairs and board members of nine IMA-affiliated medical societies; four deans of Israeli medical schools; and nurses from the Israeli Society for Oncology Nursing. Respondent narratives were qualitatively analyzed using ATLAS.Ti software for systematic coding. Questionnaires were completed by 52 physicians and nurses from medical oncology, hematology, gynecological oncology, pediatric oncology, palliative medicine, pain, family medicine, internal medicine, and integrative medicine. The SIO-ASCO guidelines were endorsed by nine IMA-affiliated societies. The domains identified included the importance of guideline implementation in clinical practice; barriers and facilitators to implementation; practical aspects required for this implementation (e.g., IO training); clinical indications for referral; budget-related issues; and clinical and administrative models enabling practical implementation of the guideline. We found across-the-board consensus among the nine IMA-affiliated societies supporting the current guideline. This, while identifying potential facilitators and barriers in order to address the implementation of the SIO-ASCO guideline recommendations. [ABSTRACT FROM AUTHOR]

Yoga is highly sought after by people seeking oncology care, endorsed by clinical practice guidelines, and supported by leading cancer organizations, yet barriers related to access, time, cost, and availability of quality providers remain. Shared medical appointments (SMA), a group healthcare model where patients with similar medical conditions participate in a collective appointment with healthcare providers, are associated with increased access to quality care, patient satisfaction, and clinician satisfaction. We piloted a unique insurance-covered virtual yoga SMA series to assess feasibility and acceptability in a mixed-diagnosis population. In this prospective cohort pilot, a trauma-informed Hanna Somatic Yoga instructor and an integrative medicine physician co-led yoga SMAs via live web-based conferencing. SMA content included conscious self-regulation through mind-body practices including breathing, movement, visualization, meditation, chanting, and guided relaxation. Qualitative and quantitative data were gathered to assess satisfaction with the 88 sessions offered over 33 months. Sixty-nine participants with diverse demographics attended a total of 500 visits. Class attendance ranged from 2–11 participants (mean 6 participants). Participants attended a mean of 7 sessions (range 1–63 sessions), with 63% attending > 1 session. Participants' diagnoses/symptoms included cancer (77%), anxiety/depression (38%), and pain (38%). Preseries, participants reported pain, weakness, neuropathy, lymphedema, insomnia, and fatigue. Postseries survey results suggested improvements in anxiety/fear, pain, fatigue, poor sleep, neuropathy, brain fog, isolation, weakness, inflexibility, and poor balance. Postseries, participants also reported incorporating mindfulness, breathing techniques, somatic skills, weight training, and yoga into their daily routines, with 91% reporting that their goals had been met. Participants appreciated remote delivery, learning new skills, community, and the instructors. This virtual yoga SMA series in a diverse population with mixed diagnoses was feasible, acceptable to participants, and showed promising positive impact. A larger randomized controlled trial with longer follow-up is recommended. [ABSTRACT FROM AUTHOR]

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BackgroundChronic cancer-related pain (CRP) can have a significant negative impact on quality of life. Mindfulness is hypothesized to mitigate chronic CRP by regulating both physical and emotional resistance to pain. In recent years, there has been interest in the use of virtual reality (VR) to deliver mindfulness meditation. VR provides an immersive and engaging environment, which may enhance one's focused attention to present-moment experiences, potentially making mindfulness less effortful and more efficacious for individuals with chronic pain. There has been little research in this area for people with a history of cancer.ObjectiveThe aim of this mixed methods study is to evaluate the feasibility of a VR-guided mindfulness (VRGM) intervention offered to adult cancer survivors with chronic CRP.MethodsThis mixed methods feasibility study will employ a single-arm, pretest-posttest design with semistructured interviews. In total, 15 cancer survivors will be enrolled in a 6-week home-based intervention that consists of 10–15 min of daily VRGM practice. The primary outcome is feasibility as assessed by accrual rates, retention in the study, intervention adherence, questionnaire completion, and side effect rates. Participants will be assessed on psychosocial outcome measures (i.e., pain, sleep, depressive and anxiety symptoms, fatigue, quality of life, and mindfulness) before and after the intervention, and 6 weeks post intervention (follow-up). Changes in pain will be described in relation to levels of immersion and presence in the virtual environment, trait mindfulness, and amount of VRGM practice. Qualitative information will provide subjective detail on participants’ experience with VRGM to complement quantitative data. This study has been approved by the Health Research Ethics Board of Alberta Cancer Committee (HREBA.CC-20-0411).ConclusionsThis novel intervention provides a potential alternative treatment to pharmacological pain management. Results from this study may inform future larger VGRM trials for chronic CRP to help reduce suffering in people with cancer. Study findings will be disseminated through open access publications, traditional conference presentations, professional cancer organizations, and social media platforms.

Abstract Motivation Cancer patients often use complementary and/or alternative medicine, such as mistletoe therapy, alongside conventional cancer therapies. In Switzerland, so far not much is known about treatment patterns of breast cancer patients using integrative oncology. Solid knowledge on complementary care utilization may help to enhance integrative oncology care in Switzerland. Methods In this exploratory, descriptive database study, we investigated the treatment pathways of a cohort of breast cancer patients who received mistletoe therapy and were documented in the cancer registry of an anthroposophic Swiss hospital offering integrative oncology treatments. Results Patients treated with mistletoe in this cohort are in median 10 years younger than Swiss breast cancer patients as a whole. Only 5.8% of these patients were treated with mistletoe alone, while 60.5% of them supplemented chemotherapy and/or hormone therapy and/or surgery and/or radiation with mistletoe therapy. Nearly 80% of patients started conventional therapy followed by additional mistletoe therapy or started mono mistletoe therapy after completion of conventional therapies. The median time from initial diagnosis to hospital admission (inpatient and/or outpatient) was less than one year. Almost ¾ of the patients were treated in an outpatient setting only. Conclusion From our data, it appears that younger breast cancer patients are more likely to use mistletoe therapy simultaneously with or following their conventional medical therapies. The extent to which these patients discuss their mistletoe therapy and eventually other complementary and/or alternative therapies with their primary oncologists is not clear from the data. We therefore recommend that (Swiss) oncologists should openly discuss the desire for integrative oncology therapies, especially with their younger breast cancer patients, in order to find the best holistic care pattern for these patients.

Background: We aim to evaluate the safety and efficacy of mistletoe extract (ME) use during the oncological perioperative period. Methods: Details registered a priori on PROSPERO (CRD42018086168). Results: Seven RCTs (comprising 663 participants in nine reports) and three nonrandomized studies were included. In five RCTs, ME was evaluated as adjunctive care and the control group had no additional intervention, whereas in two RCTs, ME was compared head-to-head against common cancer treatments (i.e., etoposide or bacillus Calmette-Guérin) with the intervention groups not receiving standard care. Meta-analyses found no evidence for a difference between ME and no added therapy for mortality and recurrence (RR, 95% CI: 1.00, 0.79–1.27; and 1.03, 0.79–1.33, respectively). Two RCTs reported beneficial effects of ME on immune cells, specifically natural killer cells, in colorectal cancer, and one RCT reported quality of life improvement. Two RCTs reported ME discontinuations due to adverse events and grade 3/4 toxicities. Nevertheless, no safety signals were detected from these 10 studies. Quality appraisal revealed a substantial risk of bias. Conclusions: Preliminary data are encouraging for mistletoe extracts, particularly in the context of colorectal cancer. However, the evidence is limited by the number of studies, an evaluation of different outcomes, and methodological limitations. Further high-quality research is warranted.

Abstract Background The use of complementary and alternative medicines (CAM) among cancer patients varies greatly. The available data suggest an increasing use of CAM over time and a higher prevalence in low- and middle-income countries. However, no reliable data are available from Latin America. Accordingly, we examined the prevalence of CAM use among cancer patients from six Colombian regions. Methods We conducted a survey on cancer patients attending comprehensive cancer centres in six capital cities from different regions. The survey was designed based on a literature review and information gathered through focus groups on CAM terminology in Colombia. Independent random samples of patients from two comprehensive cancer centres in every city were obtained. Patients 18 years and older with a histopathological diagnosis of cancer undergoing active treatment were eligible. The prevalence of CAM use is reported as a percentage with the corresponding confidence interval. CAM types are reported by region. The sociodemographic and clinical characteristics of CAM users and non-users were compared using Chi square and t tests. Results In total, 3117 patients were recruited. The average age 59.6 years old, and 62.8% were female. The prevalence of CAM use was 51.7%, and compared to non-users, CAM users were younger, more frequently women, affiliated with the health insurance plan for low-income populations and non-Catholic. We found no differences regarding the clinical stage or treatment modality, but CAM users reported more treatment-related side effects. The most frequent types of CAM were herbal products, specific foods and vitamins, and individually, soursop was the most frequently used product. Relevant variability between regions was observed regarding the prevalence and type of CAM used (range: 36.6% to 66.7%). The most frequent reason for using CAM was symptom management (30.5%), followed by curative purposes (19.5%). Conclusions The prevalence of CAM use among cancer patients in Colombia is high in general, and variations between regions might be related to differences in cultural backgrounds and access to comprehensive cancer care. The most frequently used CAM products and practices have little scientific support, suggesting the need to enhance integrative oncology research in the country.

Abstract Background Many oncology physicians are confronted with the topic of complementary and integrative medicine (CIM) by cancer patients. This study examined whether a blended learning (e-learning and a workshop) to train oncology physicians in providing advice on CIM therapies to their cancer patients, in addition to distributing an information leaflet about reputable CIM websites, had different effects on physician-reported outcomes in regard to consultations compared with only distributing the leaflet. Methods In a multicenter, cluster-randomized trial, 48 oncology physicians were randomly allocated to an intervention group (CIM consultation and an information leaflet) or a control group (information leaflet only). After the training, the oncology physicians conducted 297 consultations with their cancer patients. Measurements were assessed at oncology physician, physician–patient-interaction (measured by external reviewers), and patient levels. This analysis focused on the physician outcomes of stress reaction and perceived consultation skill competency. In addition, qualitative interviews were conducted with a subsample of oncology physicians who experienced both, the intervention and control condition. Results The oncology physicians in the intervention group showed a lower stress reaction in all measured dimensions after CIM consultations than those in the control group. There was no significant difference between oncology physicians in the intervention and control groups regarding the perceived consultation skill competency (overburden: intervention 1.4 [95% CI: 0.7;2.1]; control 2.1 [95% CI: 1.4;2.7], tension: 1.3 [95% CI: 0.7;2.0] vs. 1.9 [95% CI: 1.3;2.5], and discomfort with consultation situations: 1.0 [95% CI: 0.4;1.7]; vs. 1.7 [95% CI: 1.2;2.3]). The qualitative data showed that only providing the leaflet seemed impersonal to oncology physicians, while the training made them feel well prepared to conduct a full conversation about CIM and provide the information leaflet. Conclusions In our exploratory study providing structured CIM consultations showed positive effects on the perceived stress of oncology physicians, and the training was subjectively experienced as an approach that improved physician preparation for advising cancer patients about CIM, however no effects regarding perceived consultation skill competency were found. Trial registration The trial registration number of the KOKON-KTO study is DRKS00012704 in the German Clinical Trials Register (Date of registration: 28.08.2017).

Introduction: Insomnia is common among cancer patients, affecting about 50% undergoing cancer treatment. Insomnia can be due to various reasons, such as physical-pain, psychological-distress and medication side-effects. Insomnia has significant impact on quality of life of cancer patients. Even-though managed with hypnotics and antipsychotic drugs, they cause dependency with various short-term and long-term complications. Presenting a case throwing light on Ayurveda topical intervention as add-on to standard-of-care in insomnia during cancer chemotherapy. Method: A 51-year-old female patient with breast-cancer with extensive necrosis extending to subcutaneous areas was due for second cycle chemotherapy and was diagnosed with moderate-insomnia with a score of 21 as per Insomnia Severity Index in the Out-Patient-Department. Quality of sleep was assessed using Pittsburgh-Sleep-Quality-Index. Treated for 14 days during the break between cycle two and cycle three with Shirothalam (applied on the vertex) using Kachuradi Churnam with Kshirabala 101 and Padabhyangam (foot massage) using Kshirabala thailam as add-on to Tab Zolpidem5mg. Assessment was conducted on baseline and after 14 days of intervention. Results: Assessment for insomnia before and after intervention was conducted with Insomnia-Severity-Index. The score improved from 21 to 2. Quality of sleep before and after intervention was assessed using global PSQI. It improved from 20 to 8. Discussion: In Ayurveda, Nidranasam (loss of sleep) results from aggravation of Vata-Pitta (body humors responsible for movement and cognition and digestion, metabolism and heat of body), depletion of Kapha (body humor responsible for structural cohesion of body), derangement of Manasika-Dosa (mental constituents) and other diseases. All these etiological factors are attributed by Tikshna(sharp)- Uṣhna(hot potency) and Ruksha(dry) chemotherapy regimens. Vata-Pitta-hara (normalising Vata and Pitta) and Indriyaprasadaka (clearing senses) action of medicines used could induce sleep and effectively improve quality of sleep. Conclusion: Integrative-intervention was found to be beneficial in improving insomnia and quality of sleep without any reported complications or dependency in this case. After 14 days of ayurvedic intervention, the patient could get sleep even without taking zolpidem 5mg and external therapies. Same protocol could be considered for generalization so that it could modify or reduce usage of hypnotics and antipsychotic-drugs.

Background: Natural health products (NHPs), including vitamins, minerals, and herbal supplements, are the most common complementary and alternative medicine (CAM) among cancer patients. Our survey determined the attitudes and behaviors of cancer patients toward natural complementary therapies that should be considered to implement an integrative approach in the future. Methods: Our survey was conducted in four hospitals in Belgium. Questionnaires were posted online from October 2020 to October 2021 for cancer patients. Descriptive statistics were used to analyze the data. A χ 2 test was applied to study the type of NHP consumed according to diagnosis time. Fischer's exact test compared patients who had changed their consumption since diagnosis and those who had not. Results: Out of 349 questionnaires collected, only 59 met all inclusion criteria. 83.1 % of the patients agreed that conventional medicine (CM) could benefit from complementary therapies, but they did not estimate (72.3 % of the patients) that those latter are more effective than conventional medicine. More than half of the patients used five or more NHPs. The most frequent NHPs consumed daily were vitamins (64.4 %), followed by other products (i.e., probiotics, gemmotherapy, birch sap and omega 3/6) (42.4 %) and herbs (40.7 %). Almost all patients started taking NHPs before their cancer diagnosis, but 72.7 % have changed their consumption significantly (p = 0.009) since their diagnosis. Boosting the immune system (79.7 %) and limiting conventional treatment side effects (76.9 %) were the most common reasons for NHPs' use. 74.4 % of the patients did not take complementary therapies to delay or avoid conventional treatment. Conclusions: The combination and high diversity of NHPs consumption highlight the importance of educating patients and healthcare providers (HCPs) about the risk of drug interactions associated with these natural products. Most cancer patients are more interested in using this non-mainstream medicine to complement their conventional treatment than as an alternative. Knowing the patients' reasons and understanding patients' attitudes toward NHPs will be essential for HCPs to address NHPs' use. [ABSTRACT FROM AUTHOR]