[Show abstract][Hide abstract] 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 · 2.50 Impact Factor
[Show abstract][Hide abstract] 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 · 2.50 Impact Factor
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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 · 2.74 Impact Factor
[Show abstract][Hide abstract] 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 · 2.22 Impact Factor
[Show abstract][Hide abstract] 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 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.
[Show abstract][Hide abstract] 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.
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.
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.
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 · 0.94 Impact Factor
[Show abstract][Hide abstract] 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.
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.
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).
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 · 2.50 Impact Factor
[Show abstract][Hide abstract] 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 · 2.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective. The purpose of this study was to examine the effect of acupuncture on postlaparoscopic shoulder pain (PLSP) which is a common side effect in patients undergoing abdominal laparoscopic surgery. Methods. Patients with moderate to severe PLSP in spite of analgesic treatment, which were referred by the medical staff to the Complementary-Integrative Surgery Service (CISS) at our institution, were provided with acupuncture treatment. The severity of PLSP and of general pain was assessed using a Visual Analogue Scale (VAS) from 0 to 10. Pain assessment was conducted prior to and two hours following acupuncture treatment. Acupuncture treatment was individualized based on traditional Chinese medicine diagnosis. Results. A total of 25 patients were evaluated during a 14-month period, from March 2011 to May 2012. A significant reduction in PLSP (mean reduction of 6.4 ± 2.3 P < 0.0001) and general pain (mean reduction 6.4 ± 2.1 P < 0.0001) were observed, and no significant side effects were reported. Conclusion. Individualized acupuncture treatments according to traditional Chinese medicine principles may improve postlaparoscopic shoulder pain and general pain when used in conjunction with conventional therapy. The primary findings of this study warrant verification in controlled studies.
Evidence-based Complementary and Alternative Medicine 04/2014; 2014:120486. DOI:10.1155/2014/120486 · 1.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The use of complementary traditional medicine (CTM) is prevalent among patients with cancer. An understanding of cultural and religious values is needed to design an effective patient-centered supportive treatment program. To examine gender-related demographic and professional characteristics; treatment goals and approaches; and attitudes toward integration among Arab practitioners of CTM. Male and female Arab CTM practitioners treating patients with cancer were located by snowballing through practitioner and clientele networks. Participants underwent semi-structured, in-depth interviews which were analyzed thematically, with a focus on gender-related issues. A total of 27 Arab CTM practitioners participated in the study (17 males, 10 females). Female practitioners were found to be treating women exclusively, with male practitioners treating both genders. Female practitioners tend to be younger, unmarried, urban-based and non-Muslim. Male practitioners set out to "cure" the cancer, while female practitioners focus on symptoms and quality of life. Male practitioners employ a more schematic and structured therapeutic approach; female practitioners a more eclectic and practical one. Male practitioners employ a collectivist approach, involving family members, while female practitioners interact exclusively with the patient. Finally, male CTM practitioners see integration as a means for recognition, increasing their power base. In contrast, female practitioners perceive integration as a foothold in fields from which they have previously been shut out. A number of gender-related issues can have a significant impact on CTM therapy among Arab patients. Further research is needed in order to understand the implications of these differences.
Journal of Immigrant and Minority Health 04/2014; 17(3). DOI:10.1007/s10903-014-0019-6 · 1.16 Impact Factor