Mangosteen is an evergreen tree native to Southeast Asian countries, including India, Myanmar, Malaysia, Philippines, Sri Lanka, and Thailand. Its reddish to dark purple fruit, with white juicy edible pulp, is considered one of the best tasting tropical fruits. Mangosteen has a long history of medicinal use to treat skin infections, wounds, and dysentery; in ayurveda, it is used for inflammation, diarrhea, and cholera.
OBJECTIVE:To examine the impact of random assignment to music versus usual care on anxiety, perceived pain level and patient satisfaction in patients undergoing bone marrow biopsies.METHOD:Patients were randomized to music or usual care after completing a baseline questionnaire. All patients completed a post-procedure questionnaire.RESULTS:Study participants (N=59) had a mean age of 50.9 years (SD = 13.9; range 22-78). Post-procedure state anxiety (STAI) and pain rating (VAS) were not significantly different between groups (STAI p=0.766; VAS p=0.771). However, patient satisfaction with music was high; 66% of these patients said they very much preferred to listen to music at a future biopsy.CONCLUSIONS:While there were no significant group differences for the music intervention compared to standard of care for anxiety or perceived pain, additional feedback indicated that patients found the music intervention beneficial and requested use of music during future procedures.
The purpose of this article is to share the lessons learned in forming an interdisciplinary team that implements a team science approach to integrative medicine (IM) research. The disciplines of nursing, statistics, and engineering, along with consultants and a reflexology practitioner, formed this university-based team to conceptualize and develop a prototype robotic device for reflexology for breast cancer patients. The nurse investigator contributed the intervention background and access to the population; the statistician guided the team thinking on factors that needed to be controlled for; the engineers provided the expertise in device design and development; consultants facilitated the team's thinking in new directions; and the reflexology practitioner prescribed the protocol. We discuss the contributions and achievements of each discipline, as well as the challenges, and share the team experiences with the intent to help guide the formation of new IM teams that promote a conducive atmosphere for carrying out cutting-edge IM research and advancing the science.
The purpose of this survey was to examine patient-doctor communication about the use of complementary and alternative medicine (CAM) by adult patients with cancer and compare patients' satisfaction with the consultation between patients who had and those who had not discussed the use of CAM with their doctors. Oncologists from three hospitals screened patients for eligibility. Eligible patients were mailed a letter of invitation with a questionnaire (N = 1,323). Three hundred eighty-one questionnaires were returned. Sixty-five percent of cancer patients used at least one form of CAM. Use of CAM was not discussed with the oncologist by 55% of respondents using biologically based CAM and by 80% of those using non-biologically based CAM since the diagnosis of cancer. Patients who discussed the use of biologic CAM with their oncologists were more satisfied with the consultation than those who had not (p = .027), whereas there were no significant differences between patients who discussed or did not discuss use of non-biologically based CAM (p = .102). A substantial proportion of cancer patients do not discuss the use of CAM with their oncologists. It is important to improve patient-doctor communication about the use of CAM to increase patients' satisfaction with the oncology consultation.
There are important safety concerns associated with dietary supplements and foods rich in phytoestrogens, especially for breast cancer patients with hormone-sensitive disease. However, no consensus has been reached concerning specific dietary items that should be avoided, and safe levels of potentially problematic foods have yet to be determined. Excellent qualitative reviews of phytoestrogens and breast cancer have been published. These list agents that contain phytoestrogens and offer general cautions. Quantitative reviews, however, are needed but not yet available. Here we review quantitative data on phytoestrogens, their interaction with estrogen receptors, their bioavailability and pharmacokinetics, and their effects on breast cancer cells and animal models. We also note foods and botanicals with substances that interact with estrogen receptors and discuss the phytoestrogens they contain. Based on current evidence, we propose recommendations for advising breast cancer patients, which may also serve as a basis for the development of clinical practice guidelines.
The purpose of this phase I dose-finding randomized controlled trial was to evaluate the safe and effective dose of isoflavones to be used in future clinical trials for prostate cancer prevention. Forty-five eligible men were supplemented with 40, 60, and 80 mg of purified isoflavones or no supplement from biopsy to prostatectomy. Compliance with the study agent, toxicity, and changes in plasma isoflavones, serum steroid hormones, prostate-specific antigen (PSA), and tissue Ki-67 were analyzed from baseline to completion of the study. Forty-four subjects completed the study with a duration of intervention of 30 (+/- 3) days. We observed significant increases in plasma isoflavones with treatment for all doses compared with controls without producing any toxicity. Significant increases in serum total estradiol were observed in the 40 and 60 mg isoflavone-treated arms. However, a significant increase in serum free testosterone was observed in the 60 mg isoflavone-treated arm. Changes in serum sex hormone-binding globulin, PSA, and percentage of tissue Ki-67 were not statistically significant with treatment for this sample size and duration of intervention. Our results identify a safe dose of purified isoflavones for future clinical trials and establish the need for further definitive, well-powered trials to examine the role of isoflavones in prostate carcinogenesis.
In response to rising interests from patients, many comprehensive cancer centers now offer an integrative model of care which includes the provision of complementary medicine. Yoga is one such intervention that has been used in children. We performed an Institutional Review Board (IRB) approved chart review of pediatric hematology-oncology patients who received yoga. Patients with sickle cell vaso-occlusive pain crises or cancer were offered bedside yoga by a certifi ed yoga instructor. Pain before and after yoga was reported using the 10-point Wong-Baker FACES pain scale. Anxiety before and after yoga was assessed with the State-Trait Anxiety Inventory. Qualitative patient quotes were extracted from the yoga therapist’s notes. Twenty patient’s charts were reviewed, 50% were male. The mean age was 18 years, (range 11–26 years.) Most common diagnoses were sickle cell vaso-occlusive pain crises (45%), and sarcoma (40%.) The mean reduction in pain score was 0.94 (SD ± 1.68), p = .005, and the mean reduction in anxiety T-score was 9.62 (SD ± 6.74), p = .0001. Patient quotes suggest that yoga was benefi cial, especially for relaxation. Literature review offers preliminary support for the use of yoga for anxiety in children. Our data suggest that further research on yoga as an effective intervention for pediatric hematology-oncology patients for pain and anxiety is needed.
This study examined the effects of yoga on quality of life (QOL) and psychosocial outcomes in women with breast cancer undergoing radiotherapy. Sixty-one women were randomly assigned to either a yoga or a wait-list group. Yoga classes were taught biweekly during the 6 weeks of radiotherapy. Participants completed measures of QOL, fatigue, benefit finding (finding meaning in the cancer experience), intrusive thoughts, sleep disturbances, depressive symptoms, and anxiety before radiotherapy and then again 1 week, 1 month, and 3 months after the end of radiotherapy. General linear model analyses revealed that compared to the control group, the yoga group reported significantly better general health perception (p = .005) and physical functioning scores (p = .04) 1 week postradiotherapy; higher levels of intrusive thoughts 1 month postradiotherapy (p = .01); and greater benefit finding 3 months postradiotherapy (p = .01). There were no other group differences in other QOL subscales for fatigue, depression, or sleep scores. Exploratory analyses indicated that intrusive thoughts 1 month after radiotherapy were significantly positively correlated with benefit finding 3 months after radiotherapy (r = .36, p = .011). Our results indicated that the yoga program was associated with statistically and clinically significant improvements in aspects of QOL.
Over one-third of Americans use complementary and alternative medicine (CAM). The prevalence among cancer patients may even be higher. Complementary therapies may reduce possible symptom burdens caused by conventional cancer treatments. Integrating CAM therapies has become more common and more accepted in clinical oncology. However, little research is available on beneficial CAM therapies for radiation therapy patients. This article reviews potential CAM therapies that have been shown to be effective in decreasing the symptom burden related to radiation therapy treatments and includes clinical observations from CAM practitioners in a comprehensive cancer center.
Current evidence indicates that acupuncture-like transcutaneous electrical nerve stimulation (ALTENS) can provide sustained benefit for established radiation-induced xerostomia (RIX) symptoms. This is further being evaluated by comparing it with standard treatment (pilocarpine) in a randomized controlled trial. This report studies the potential effectiveness of xerostomia prevention using ALTENS delivered concomitantly with radiotherapy administered to head and neck cancer patients. Sixty patients were randomized to either the treatment group (n = 30) that received ALTENS daily with radiotherapy or the control group (n = 26) that had standard mouth care only. Stimulated and basal unstimulated whole saliva production (WSP) plus RIX symptoms visual analogue score (RIXVAS) were assessed at specific time points. Generalized linear models and generalized estimating equations were used for analysis. RIXVAS at 3 months follow-up after therapy completion was used as the primary study endpoint. The mean RIXVAS for the ALTENS intervention at 3 months was 39.8, which was not significantly different from the control arm value of 40.5. There were no statistically significant differences between the two groups for their mean RIXVAS and WSP at all assessment time points. In conclusion, there was no significant difference in mean WSP and RIXVAS between the two groups, so ALTENS is not recommended as a prophylactic intervention.
Healing Touch (HT) is a biofield therapy used to enhance well-being. We conducted a pilot study to assess its effects in pediatric oncology patients. We enrolled patients in the continuation or consolidation phase of therapy. Patients or their parent completed simple visual analogue scales (VASs; 0-10) for relaxation, vitality, overall well-being, stress, anxiety, and depression before and after a 20-minute period of rest and a standardized HT treatment. Patients' heart rates were monitored and later analyzed for heart rate variability (HRV) characteristics. Of the nine patients, all completed VASs and six had usable HRV data. The average age was 9 years. VAS scores for stress decreased significantly more for HT treatment than for rest (HT: 4.4-1.7; rest: 2.3-2.3; p = .03). The HRV characteristic of total power was significantly lower during HT than for rest (HT 599 +/- 221; rest: 857 +/- 155; p = .048), and sympathetic activity was somewhat but not significantly lower (HT: 312 +/- 158; rest: 555 +/- 193; p = .06). HT is associated with lowered stress and changes in HRV. Further studies are needed to understand the mechanisms of these effects in larger samples and to explore the impact on additional clinically relevant measures.
While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.
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The primary purpose of this survey was to assess the interest and concerns of a group of cancer complementary and alternative medicine (CAM) practitioners regarding CAM research issues. These issues include the CAM modalities used most often by CAM practitioners in the treatment of cancer patients, cancer CAM practitioners' perceptions of the most promising areas of cancer CAM research, the perceived obstacles to carrying out research objectives in the emerging field of cancer CAM research, the extent of awareness of the National Cancer Institute (NCI) Best Case Series Program, and CAM practitioners' level of interest in research collaboration with CAM researchers. A cross-sectional survey of a convenience sample of cancer CAM practitioners was conducted. One hundred thirty-four respondents completed the survey. About 72% of the respondents were involved in the care of cancer patients, and these were considered the informative respondents. All results were from the informative respondent group. Respondent practitioners provided care using interventions from all seven of the predefined CAM categories. This care was provided to improve both quality of life and survival. Over two-thirds of the respondents rated research in pharmacologic and biologic treatments, alternative medical systems and nutritional therapeutics for cancer treatment, and symptom/side-effect management as high-priority areas. Although no single obstacle to research predominated as the most significant, the most frequently encountered obstacle was lack of awareness of appropriate funding sources (75.4%). More than 83% of respondents expressed some interest in or willingness to establish research collaboration with a cancer researcher. The results from this survey indicate that many cancer CAM practitioners have shared interests, perceived obstacles, and desired research opportunities. Despite a small sample size and lack of a feasible process for random sampling, this survey highlights avenues to promote and support collaborative research. The NCI/Office of Cancer Complementary and Alternative Medicine will continue to respond to the concerns elucidated by the survey by developing strategies for future program opportunities within the NCI.
Cancer-induced cachexia (CIC) is a paraneoplastic syndrome that may account for up to 20% of deaths in cancer patients. Cachexia includes distinct metabolic changes that are the result of an acute-phase response (APR) mounted by the host as a reaction to tumor cells. These changes include increased muscle proteolysis, increased fat lipolysis, and increased hepatic production of acute-phase proteins such as C-reactive protein and fibrinogen. This APR pathogenesis is an important consideration in trying to treat cachectic patients as most therapies do not target the APR and its subsequent metabolic effects. Although there is currently no cure for CIC, the oncologist frequently encounters cachectic patients in practice, and evidence-based management is needed. We review the current data for assessment of starvation and cachexia, providing guidelines for management that include serum markers and functional assessment. In addition, a review of current therapies is provided, including hypercaloric feeding and nutritional intervention to address starvation, as well as data on appetite stimulants such as corticosteroids and megestrol acetate. Experimental therapies are also discussed, including nonsteroidal antiinflammatory drugs, tumor necrosis factor alpha antagonists, tetrahydrocannabinol, growth hormone, ghrelin, oxandrolone, and omega-3 fatty acids.
We describe an online narrative and life review education program for cancer patients and the results of a small implementation test to inform future directions for further program development and full-scale evaluation research. The intervention combined three types of psycho-oncology narrative interventions that have been shown to help patients address emotional and existential issues: (1) a physician-led dignity-enhancing telephone interview to elicit the life narrative, (2) delivery of an edited life manuscript, and (3) self-directed life review education delivered via a Web site with instructional materials and expert consultation to help people revise and share their story. Eleven cancer patients tested the intervention and provided feedback in an in-depth exit interview. Although everyone said telling and receiving the edited story manuscript was helpful and meaningful, only people with high death salience and previous computer experience used the Web tools to enhance and share their story. Computer users prodded us to provide more sophisticated tools, and older (> 70 years) users needed more staff and family support. We conclude that combining a telephone expert-led interview with online life review education can extend access to integrative oncology services, is most feasible for computer-savvy patients with advanced cancer, and must use platforms that allow patients to upload files and invite their social network.
The purpose of a phase II trial is to determine whether an anticancer agent is sufficiently promising to take forward to a definitive, randomized, phase III study. Traditional phase II trials use tumor response as an end point, defined as a 50% or greater decrease in tumor size. Anticancer botanicals and supplements are unlikely to bring about rapid tumor regression, even if they do extend survival. Accordingly, response needs to be defined in terms of survival, such as being progression-free at 6 months. Such an approach requires historical data on the expected survival rate in the absence of the botanical or supplement. We present a simple phase II design for botanicals and supplements that is based on appropriate use of historical data, incorporating adjustment for both sampling variation and case mix. The basic principle is to use a historical cohort to generate a statistical prediction model, use this to predict results of patients in the phase II study, and then compare the predictions to the observed results. Such a design asks whether patients treated by the new agent are doing better than expected; if so, this suggests that the agent should be tested further in phase III trials.
