Elad Schiff

Bnai Zion Medical Center, Haifa, H̱efa, Haifa, Israel

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Publications (75)172.51 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Patients undergoing chemotherapy frequently suffer from gastrointestinal (GI) symptoms and functional difficulties in preparing and eating meals. We conducted a qualitative assessment of an integrative cuisine workshop program designed for patients receiving chemotherapy, examining the effects of the program on patient-reported GI symptoms and nutritional challenges. Patients and methods: Patients were referred to a complementary/integrative medicine (CIM)-trained physician for consultation, followed by a patient-tailored treatment program. Patients with GI-related symptoms and nutritional concerns were offered a two-session integrative cuisine workshop program. The effects of the workshops were examined using inductive and deductive qualitative research methodologies. Patient narratives, as recorded in the Measure Yourself Concerns and Wellbeing (MYCAW) study tool, and electronic medical files were analyzed. Results: Of 125 patients referred to the integrative cuisine program, 86 participated in at least one workshop. Participants and non-participants had similar demographic and disease-related characteristics, as well as quality-of-life (QOL)-related concerns. Inductive analysis suggested that participation in the workshops was helpful in developing social relationships, providing emotional support, and enhancing spirituality and nutritional awareness. Implementing the recommended changes at home led to improved QOL-related outcomes. The predominant themes derived from deductive analysis were the implementation of dietary changes and improved gastrointestinal and emotional issues. Conclusions: Chemotherapy-treated patients participating in an integrative cuisine workshop program showed improved QOL outcomes, specifically GI and emotional-related symptoms, and a reduction in nutritional and functional concerns. Increased knowledge and awareness of nutrition and supplement use ultimately resulted in implementation of the CIM recommendations by patients at home.
    Supportive Care in Cancer 09/2015; DOI:10.1007/s00520-015-2934-z · 2.36 Impact Factor
  • European Journal of Integrative Medicine 09/2015; 7:29. DOI:10.1016/j.eujim.2015.09.073 · 0.78 Impact Factor
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    ABSTRACT: Complementary medicine (CM) is extensively used by patients with cancer across the Middle East. We aimed to compare the perspectives of two Arab populations residing in diverse socioeconomic-cultural settings in Palestine and Israel regarding CM's role in supportive cancer care. A 27-item questionnaire was constructed and administered to a convenience sample of Arab patients receiving cancer care in four oncology centers in northern Israel and Palestine. Each of the two groups had 324 respondents and were equally distributed by age and marital status. Compared with the Israeli-Arab group, Palestinian participants reported significantly higher CM use for cancer-related outcomes (63.5% vs. 39.6%, P<0.001) which included more herbal use (97.6% vs. 87.9%, P=0.001), and significantly lower use of dietary supplements, acupuncture, mind-body and manual therapies, and homeopathy. The majority of respondents in both groups stated that they would consult CM providers if CM were integrated in oncology departments. Related to this theoretical integrative scenario, Palestinian respondents expressed fewer expectations from their oncologists to actively participate in building their CM treatment plan. Whereas treatment expectations in both groups focused on improving quality of life, Palestinian respondents had fewer expectations for CM to improve fatigue, emotional concerns, sleep, and daily functioning. Arab patients with cancer from Palestine and Israel highly support CM integration within their oncology institutions aiming to improve quality of life. Nevertheless, respondents differed in their perceived model of CM integration, its treatment objectives and their oncologists' role in CM integration. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
    Journal of Pain and Symptom Management 05/2015; Volume 49(5):878–884. DOI:10.1016/j.jpainsymman.2014.10.006 · 2.80 Impact Factor
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    ABSTRACT: In the last decade, a number of integrative oncology programs have been established within leading oncology departments in Israel aiming to provide consultations that address patients' concerns and improve their quality of life (QOL). To identify Arab cancer patients' attitudes, needs and expectations concerning integration of complementary and traditional medicine (CTM) in their supportive oncology care. This article presents studies based on both qualitative (including interviews with patients, oncologists and CTM practitioners) and quantitative studies which were designed to evaluate patients' attitudes, needs and expectations regarding CTM integration in supportive oncology care. Of the 313 Arab respondents, 109 reported on the use of herbal medicine for cancer-associated outcomes. Over 78% of respondents considered QOL improvement as their main expectation of integrated CM consultation. Similar expectations were expressed in studies exploring 155 cancer care practitioners in Israel and Arab countries, 27 CTM-trained Arab practitioners, and a sample of 15 Arab patients referred to integrative medicine consultation. Arab cancer patients support QOL-oriented integrated medicine programs provided in oncology settings. Integrative medicine consultation should provide patients with an evidence-based recommendation on efficacy and safety of herbs commonly used concomitant with chemotherapy. We recommend designing integrative oncology training courses for physicians who will provide evidence-based consultation attuned with Arab patients' needs, concerns and cultural-sensitive orientation.
    Harefuah 03/2015; 154(154):25-30.
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    ABSTRACT: Systematic integration of complementary medicine in hospital departments for inpatients is rarely discussed in the medical literature. Positive outcomes from trials in this setting should encourage evaluation of complementary medicine services in hospitals. To identify the potential role of complementary medicine in the Cardiology Department, characterize its implementation process, and conduct a feasibility study in this context. A narrative overview of the implementation process of complementary medicine in the Cardiology Department was used alongside a statistical analysis of a feasibility trial This was in order to determine the sample size for a larger pragmatic trial that will assess the effectiveness of complementary medicine, as compared to standard of care, in relieving common symptoms of patients hospitalized in the Cardiology Department. Focus groups consisting of representatives from the Cardiology Department, and the Complementary Medicine Service identified areas for possible integration of complementary medicine in the Cardiology Department. A literature review was conducted in order to assess complementary medicine effectiveness and safety in this setting. Consequently, appropriate treatment protocols were developed. The Complementary Medicine team participated in cardiology patient rounds, and presentations on complementary medicine were provided to the cardiology staff. Treatment indications, and contraindications were mutually developed, and questionnaires to assess treatment effectiveness were developed. A feasibility trial was completed for 237 patients who were treated with complementary medicine. Integration of complementary medicine in an inpatient setting is possible following a carefully structured implementation process that is shared by champions from the medical department and the Complementary Medicine Service. Results from the feasibility trial indicate the potential positive role that complementary medicine treatments have on common symptoms of inpatients at the Cardiology Department. There is a need for high quality trials that will assess the effectiveness of complementary medicine treatments in this setting.
    Harefuah 03/2015; 154(1):35-8, 68, 67.
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    ABSTRACT: The introduction of a quality of life (QOL)-centered complementary medicine (CM) consultation over the past decade has been integrated within various oncology departments in Israel and around the globe. The consultation is provided by an integrative physician (IP) trained in CM who recommends treatment options attuned with patients' expectations, concerns and QOL, while taking safety and efficacy into consideration. To identify, based on the initial IP consultation, factors predicting patients' compliance to a QOL-oriented integrative treatment. Analysis of demographic data was conducted, together with an assessment of patients' concerns and well-being as documented in a registry protocol. Dependent and non-dependent factors were compared in two groups of patients: those with a low and a high degree of adherence to the integrative consultation. Patients in the low- and high-adherence groups (83 and 160, respectively) shared similar demographic, disease- and treatment-related, as well as QOL-dependent data. Adherence to the CM treatments was higher in patients reporting prior CM use, and in patients with less severe gastro-intestinal complaints. IP assessment regarding patients' difficulties in undergoing the CM treatment process predicted low patient adherence. We recommend including an initial IP assessment of patients undergoing chemotherapy, using a structured assessment in order to identify the following factors predicting low adherence to a CM treatment program: absence of prior CM use, severe gastro-intestinal symptoms, and IP assessment of expected difficulties in implementing the treatment plan.
    Harefuah 03/2015; 154(1):21-5, 69.
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    ABSTRACT: Consumption of dietary supplements (DS) by patients in the community is rising. DS affect human health, and safety issues regarding concomitant DS-medication use are underemphasized. Consequently, the Ministry of Health issued a directive regarding the need for assessing DS use in every patient and documenting such use in the medical record. To evaluate the rate of DS consumption in hospitalized patients, and to assess documentation of such consumption. This was a prospective cross-sectional study. Patients hospitalized in the medical wards of a public-academic hospital in Israel, between the years 2009-2010, were interviewed regarding their use of DS. The medical records were searched for documentation of DS use. A total of 895 hospitalized patients were interviewed; 691 agreed to answer the questionnaire (compliance rate 77%). The analysis referred to 648 fully-completed questionnaires. Of the participants, 359 (55.4%) were DS consumers. On multivariable analysis, DS consumption was associated with older age, female gender, higher education status, and the presence of psychiatric disease. Only 11.4% of DS users had documentation of such use in their medical record. DS consumption is common amongst hospitalized patients, and is overlooked by the medical team. Patients and doctors should be more aware of the possible adverse effects of DS use and their potential herb-drug interactions. Education regarding appropriate communication on DS use should be established.
    Harefuah 03/2015; 154(1):39-42, 67.
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    ABSTRACT: Integrative oncology incorporates complementary medicine (CM) therapies in patients with cancer. We explored the impact of an integrative oncology therapeutic regimen on quality-of-life (QOL) outcomes in women with gynecological cancer undergoing chemotherapy. A prospective preference study examined patients referred by oncology health care practitioners (HCPs) to an integrative physician (IP) consultation and CM treatments. QOL and chemotherapy-related toxicities were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and Measure Yourself Concerns and Wellbeing (MYCAW) questionnaire, at baseline and at a 6-12-week follow-up assessment. Adherence to the integrative care (AIC) program was defined as ≥4 CM treatments, with ≤30 days between each session. Of 128 patients referred by their HCP, 102 underwent IP consultation and subsequent CM treatments. The main concerns expressed by patients were fatigue (79.8 %), gastrointestinal symptoms (64.6 %), pain and neuropathy (54.5 %), and emotional distress (45.5 %). Patients in both AIC (n = 68) and non-AIC (n = 28) groups shared similar demographic, treatment, and cancer-related characteristics. ESAS fatigue scores improved by a mean of 1.97 points in the AIC group on a scale of 0-10 and worsened by a mean of 0.27 points in the non-AIC group (p = 0.033). In the AIC group, MYCAW scores improved significantly (p < 0.0001) for each of the leading concerns as well as for well-being, a finding which was not apparent in the non-AIC group. An IP-guided CM treatment regimen provided to patients with gynecological cancer during chemotherapy may reduce cancer-related fatigue and improve other QOL outcomes.
    Supportive Care Cancer 03/2015; DOI:10.1007/s00520-015-2690-0 · 2.36 Impact Factor
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    ABSTRACT: In this multinational Middle-Eastern study, we assessed health-care providers' (HCPs) perspectives on their patients' use of complementary and traditional medicine (CTM) and identified the leading barriers to CTM integration in supportive cancer care. A 17-item questionnaire was developed and administered to HCPs attending palliative medicine workshops conducted across the Middle East by the Middle East Cancer Consortium. 339 HCPs from 16 countries across the Middle East completed the questionnaire (80.3 % response rate). Respondents perceived their patients' reasons for CTM use primarily in the context of cancer cure (63 %) and quality of life (QOL) improvement (57 %). Expectation regarding CTM's role in cancer cure/survival was more pronounced in Turkey, Jordan, the Palestinian Authority, and the Persian Gulf area. In contrast, the expectation that CTM would improve QOL was more emphasized in Israel. A mid-position between the cure/survival and QOL poles was observed in Cyprus, Lebanon, and the North African countries. Leading barriers to CTM integration in supportive cancer care included oncologists' skepticism and a gap between patients' expectations and HCP's objectives. Respondents' leading recommendation to HCPs was to communicate integrative care emphasizing well-being and improved functioning in accordance with their patients' health beliefs. CTM integration in supportive cancer care can be facilitated by implementing a platform for Middle Eastern clinical collaborations. HCPs' expectations and experiences with CTM have been positive in the oncology setting. These data need to be corroborated with information of patients' expectations on the provision of CTM over all phases of the oncology treatment.
    Supportive Care Cancer 01/2015; 23(9). DOI:10.1007/s00520-015-2619-7 · 2.36 Impact Factor
  • Supportive Care in Cancer 01/2015; · 2.36 Impact Factor
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    ABSTRACT: Chemotherapy-induced gastrointestinal (GI) toxicities often impair quality-of-life (QOL) and require reduction of the chemotherapy dose intensity. We explored the effects of a complementary integrative medicine (CIM) therapeutic process, administered in conjunction with conventional supportive care, on GI-related symptoms and concerns in patients undergoing chemotherapy. We conducted a prospective, pragmatic study among patients undergoing chemotherapy referred by their healthcare providers to a CIM-trained integrative physician (IP) for consultation, followed by CIM treatments. Symptom severity and patient concerns were assessed at baseline and at an IP follow-up visit at 6-12 weeks, using the Edmonton Symptom Assessment Scale (ESAS) and the Measure Yourself Concerns and Wellbeing (MYCAW) questionnaires. Adherence to the integrative care (AIC) program was defined as attendance of ≥4 CIM treatments, with ≤30 days between sessions. Of the 308 patients referred to the IP consultation, 275 (89.3%) expressed GI symptoms and concerns, 189 of whom attended the follow-up IP assessment. Of these, 144 (46%) were found to be adherent to the treatment plan (AIC group). Repeated measure analysis indicated a statistical interaction between baseline and follow-up scores, for ESAS (appetite, p = 0.005; drowsiness, p = 0.027; shortness of breath, p = 0.027; and sleep, p = 0.034) and for MYCAW outcomes. This when comparing the AIC to the non-AIC group responses. Reduction of GI concerns (p = 0.024) was greater among patients in the AIC group (MYCAW questionnaire), with significantly less chemotherapy-related hospitalizations found in this group (p = 0.008). The participation of a registered dietitian during CIM treatments led to greater reduction in nausea (from 4.24 to 1.85 vs. 2.73 to 1.36, respectively; p = 0.017). Integration of CIM with standard supportive care, especially in patients adhering to the CIM treatment regimen, may help reduce chemotherapy-induced GI symptoms and concerns, as well as QOL-related non-GI symptoms. Further research is needed in order to explore the effects of specific CIM modalities on GI symptoms and concerns during chemotherapy. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
    Clinical nutrition (Edinburgh, Scotland) 12/2014; DOI:10.1016/j.clnu.2014.12.011 · 4.48 Impact Factor
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    ABSTRACT: there is a dearth of studies on how cultural background influences patients' attitudes and choices regarding complementary and traditional medicine (CTM) integration.Objectives To explore Arab and Jewish patients' perspectives regarding CTM use, and its possible integration within conventional cancer care.Methods This was a cross-cultural study. We developed a 27-item questionnaire that evaluates patients’ perceptions regarding CTM integration in supportive cancer care. The questionnaire was administered to a convenience sample of patients receiving cancer care in community and hospital oncology centers.ResultsOf the 770 respondents (88% response rate), 324 defined their religion as Muslim, Christian, or Druze (henceforth regarded as Arabs) and 446 were Jews. Respondents in the two groups differed significantly in terms of age, gender, marital status, number of children, education, religiosity, and prevalence of cancer types (excluding breast cancer). Although Arab respondents reported less use of CTM for cancer-related outcomes (39.6% vs. 52.1%, P=0.001), they expressed greater support than Jewish respondents for optional CTM consultation if provided within conventional oncology care (P<0.0001). Respondents in both groups stated that their primary expectation from the oncologist concerning CTM was to participate in formulating a CTM treatment plan to be provided within the oncology department. Compared with Arab respondents, Jews expected CTM consultations to focus on improving daily functioning and coping, reducing chemotherapy side effects, and providing spiritual support.Conclusion Although quality of life-related expectations are more pronounced among Jewish respondents, both groups share the expectation from their health care providers to be actively involved in construction of a tailored integrative CTM treatment plan.
    Journal of Pain and Symptom Management 11/2014; 49(5). DOI:10.1016/j.jpainsymman.2014.09.014 · 2.80 Impact Factor
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    ABSTRACT: The purpose of this case study is to provide a unique perspective on the integration of Traditional Chinese Medicine (TCM) in an acute care hospital setting. This case report tells the story of a patient who was hospitalized in the cardiac intensive care unit and received both western and TCM treatments. The patient's medical narrative is illustrated using pictures of her tongue that were taken along the course of her hospitalization. Analysis of the medical file, and each picture provide in-depth understanding of her medical condition from both western and TCM perspectives respectively.
    Complementary Therapies in Medicine 10/2014; 22(6). DOI:10.1016/j.ctim.2014.10.003 · 1.55 Impact Factor
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    ABSTRACT: Background: Mental training (MT) is used extensively by musicians and athletes to improve their performance. Recently, it has been suggested as a training method for surgical trainees. We assessed the influence of MT, induced by hypnosis, on the performance of simulated tasks on a laparoscopic simulator, as compared to a non-specific relaxing intervention. Methods: 11 surgeons completed a proficiency-based training program on the Fundamentals of Laparoscopic Surgery (FLS) simulator, until they reached performance plateau of the peg transfer task. Thereafter, they received a single music session, as a relaxing intervention, followed by repeating of the peg transfer task. Then they went through a hypnosis session guided by an experienced psychologist, with suggestions of smooth flow of pegs from one position on the board to another, and re-performed the task. Results: Plateau performance was 51.1 ± 6.9 s. After the music session performance improved by 6.3% to 47.9 ± 5.4 s (p = 0.86). After the MT session performance further improved by 15.3% to 40.1 ± 5.8 s (p = 0.009), which was a 21.6% improvement from baseline (p < 0.001). Subject's satisfaction from their performance, without knowledge of the task scores, was 6.0 ± 2.9 on 0-10 VAS after the music and reached as high as 8.5 ± 1.7 after the hypnotic session (p = 0.01). Conclusions: Hypnosis-induced MT significantly improves performance on the FLS simulator, which cannot be attributed to its relaxing qualities alone. This study contributes evidence to the effectiveness of MT in surgical skills acquisition and suggests that hypnotic techniques should be used in mental preparation processes. There is a need to further study these effects on operating room performance.
    Surgical Endoscopy 10/2014; 29(5). DOI:10.1007/s00464-014-3786-1 · 3.26 Impact Factor
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    ABSTRACT: Background The integration of complementary medicine is gradually becoming an accepted part of standard care for patients with cancer. In our integrative oncology program we have encountered difficulties in recruiting Arab patients. In order to understand the special needs of this population, we conducted interviews among Arab practitioners of complementary and traditional medicine (CTM). The characteristics of practitioners and their views regarding the therapeutic process were examined. Methods Semi-structured qualitative interviews were administered to 27 Arab practitioners of CTM whose clientele was comprised primarily of Arab cancer patients. Conventional content analysis of the transcribed interviews and field notes were performed in order to identify key themes. Result Three groups of CTM practice were identified: Folk-herbal medicine (n=9); complementary medicine (CM; n=14); and religious healing (n=4). Seven factors were identified in the practitioner accounts: the duration and scheduling of treatment sessions; the language of communication; the presence of family members; the appearance of the practitioner; the definition of treatment goals; the discussion of behavioral and lifestyle changes; and finally, the use of tangible elements in treatment. Conclusions The study of Arab CTM practitioner recommendations may help facilitate a culture-sensitive encounter with Arab patients with cancer. This approach may also have implications for other ethno-culturally unique populations. [207 words]
    EXPLORE The Journal of Science and Healing 08/2014; 10(6). DOI:10.1016/j.explore.2014.08.004 · 1.00 Impact Factor
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    ABSTRACT: Purpose: The purpose of this study is to compare the rationale given by oncology health care practitioners (HCPs) for referral of their patients with breast cancer to a complementary medicine (CM) consultation with patient expectations from the CM treatment process. Methods: We conducted a prospective, registry protocol-based, open-label study. We compared the indications given by oncology HCPs for their referral of patients to the CM consultation with patient expectations from the CM therapeutic process. Patients were asked regarding prior CM use for cancer- and non-cancer-related indications. Results: A total of 127 patients referred to the CM consultation were studied, with half reporting prior CM use. The most popular treatment for non-cancer-related indications was acupuncture (46.9 %), with only 20.3 % reporting herbal medicine use (P ≤ 0.04). For cancer-related indications, herbal medicine was the most popular modality (42.4 %), with 11.6 % reporting acupuncture use. The most frequently cited indications for referral were general symptom reduction (19.7 %), emotional/spiritual relief (18.1 %), alleviation of weakness and fatigue (17.3 %), and reduction of gastrointestinal symptoms (10.2 %). For patients, the most important outcome was alleviation of weakness and fatigue (70.4 %), followed by emotional/spiritual relief (50 %), and the reduction of gastrointestinal symptoms (33.3 %). The correlation between HCP indications for referral and patient expectations was poor (Cohen's kappa of 0.19, 0.328, and 0.20, respectively). Conclusions: The findings suggest that expectations from a CM treatment process differ greatly between oncology HCPs and patients with breast cancer. The use of a structured clinical referral process and a better understanding of patient concerns are factors which play a central role in the CM referral process.
    Supportive Care Cancer 07/2014; 23(2). DOI:10.1007/s00520-014-2361-6 · 2.36 Impact Factor
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    ABSTRACT: Objective The aim of this study was to assess patient perspectives regarding non-specific effects of a complementary medicine (CM) consultation and intervention within an integrative oncology setting.Methods Patients undergoing chemotherapy in a community-based oncology service were referred by oncology healthcare providers to an integrative oncology physician trained in CM-oriented supportive care. Assessment of concerns and well-being was made using the Measure Yourself Concerns and Wellbeing questionnaire, at baseline and after 3 months of CM treatments, which were designed to improve quality of life (QoL) outcomes. Patients were asked to describe the most important aspects of the integrative treatment process. Free-text narratives were examined using content analysis with ATLAS.Ti software for systematic coding.ResultsOf 152 patients' narratives analyzed, 44% reported an experience of patient-centered care, including CM practitioners' approach of togetherness, uniqueness, and the invoking of an internal process. CM practitioner approach was experienced within a context of an enhanced sense of confidence; gaining a different perspective; and acquiring emotional resilience and empowerment.Conclusions Short patient narratives should be considered for patient-reported outcomes, expressing perspectives of both effects and experience of care. CM may promote patient QoL-related outcomes through non-specific effects, enhancing patient-centered care. The benefits of CM dependent on general therapeutic incidental aspects (i.e., common factors) warrant attention regarding non-specific components of treatment. Copyright © 2014 John Wiley & Sons, Ltd.
    Psycho-Oncology 07/2014; 24(2). DOI:10.1002/pon.3621 · 2.44 Impact Factor
  • Limor Almog · Efraim Lev · Elad Schiff · Shai Linn · Eran Ben-Arye
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    ABSTRACT: The high prevalence of the use of traditional herbs among patients with cancer is a cause for concern with regard to potentially adverse interactions with conventional oncology treatments. In this study, we explore herbal use among patients with cancer in northern Israel who are referred by their health care providers to complementary and traditional medicine (CTM) consultations provided to them within the conventional oncology department. The study's objectives were to identify which herbs patients use and to examine the scope of current research on the efficacy and safety regarding the identified herbs. Herbal use by patients receiving oncology care was assessed prospectively from July 2009 to July 2012 by integrative physicians (IPs) trained in herbal medicine. Historical, ethnobotanical, basic research, and clinical data regarding the identified herbs were explored by using a keyword search in PubMed and Middle Eastern ethnohistorical literature. Disclosure of herbal use was reported by 154 of the 305 patients (50.5 %) interviewed by IPs. The use of 85 single herbs and 30 different herbal formulas was documented during the initial or follow-up IP assessments. Patients reported 14 quality of life-associated indications for herbal use. The ten most prevalent herbs displaying in vitro/in vivo anticancer activity and nine other herbs were preliminarily assessed concerning potential risks, safety, and interaction with chemotherapy. Herbal use by patients with cancer in northern Israel is widespread and calls for further study in order to address issues of safety and effectiveness. We recommend constructing a multinational and multidisciplinary team of researchers with ethnopharmacological and clinical expertise that will explore the use of herbs among patients with cancer in a cross-cultural perspective attuned with patients' affinity to traditional herbal medicine.
    Supportive Care in Cancer 05/2014; 22(10). DOI:10.1007/s00520-014-2261-9 · 2.36 Impact Factor
  • Journal of alternative and complementary medicine (New York, N.Y.) 05/2014; 20(5):A11. DOI:10.1089/acm.2014.5026.abstract · 1.59 Impact Factor
  • Journal of alternative and complementary medicine (New York, N.Y.) 05/2014; 20(5):A137. DOI:10.1089/acm.2014.5367.abstract · 1.59 Impact Factor

Publication Stats

298 Citations
172.51 Total Impact Points


  • 2007–2015
    • Bnai Zion Medical Center, Haifa
      H̱efa, Haifa, Israel
  • 2009–2014
    • University of Haifa
      • School of Public Health
      H̱efa, Haifa District, Israel
  • 2003
    • The University of Arizona
      Tucson, Arizona, United States