Evidence supports the value of co-designing health policy through meaningful engagement with communities, ensuring their priorities are central to the process. However, there has been limited guidance for ‘how to’ authentically engage community members to create ideas for health policy guided by equity. This paper outlines a clear, actionable process for co-designing health policy that ‘accords’ with lay priorities - the Accordion Process. Using an emancipatory methodology based on human-centred, experience-based design thinking, our dialogic process involves researchers acting as conduits between community members and stakeholder groups, making sure both are engaged with, and recursively attending to community members’ voices to ensure policy options reflect lay priorities. The Accordion Process facilitated the identification of policy options using lay priorities (women across different social classes) and enabled stakeholders in media, service delivery and advocacy to develop recommendations that can be feasibly implemented in the context of real-world policy ecosystems for alcohol-related breast cancer prevention. The process moved beyond refutation of existing policies targeting individual-level behaviour change to identify entirely new options that venerated women’s ‘asks’ for changes at the ‘systems’ level to mediate social, political and commercial determinants of health. Our dialogic process bridges the gap between theorising the importance of co-design and developing recommendations for real-world policy. This paper offers a unique, instructive guide for co-designing inclusive health policy with the goal of increasing acceptability and effectiveness.

First Nations Australians consistently exhibit lower bowel screening participation rates than non-First Nations Australians. However, limited studies have been conducted to understand the factors associated with bowel cancer screening participation among First Nations Australians. This study aims to identify factors associated with bowel cancer screening participation among older First Nations Peoples receiving home health care services in New South Wales (NSW), Australia. A cross-sectional study among older First Nations customers receiving Australian Unity Aboriginal home health care services in NSW was conducted from June to September 2023. Data were collected through face-to-face interviews administered by trained First Nations staff, using a structured, culturally appropriate online survey. Multivariable logistic regression was performed, and adjusted odds ratios (aOR) with 95

Employment for cancer survivors impacts psychological, physical, and financial wellbeing. Existing systematic reviews of factors associated with employment outcomes are limited to specific cancer types, determinants, outcomes, and/or settings. This scoping review spanning one decade of international research aimed to provide a comprehensive overview of factors associated with employment outcomes in cancer survivors. Systematic scoping review methodology was used to identify primary studies conducting multivariate analysis of factors associated with any employment outcome (negative: reduced or less timely, productive, sustained, or satisfying employment or positive: maintained/return or more timely, productive, sustained, or satisfying employment) in adult cancer survivors (January 2014 to March 2024). Data were extracted on population, setting, outcomes, and associated factors. Across 185 included studies, factors frequently associated with negative employment outcomes included older age, female sex, advanced cancer stage, some cancer types, and receipt of chemotherapy. Factors frequently associated with positive employment outcomes included higher education, more advantaged insurance status, some cancer types, and higher physical function. Research gaps were identified in specific populations/settings at risk of poorer outcomes. Modifiable and nonmodifiable factors associated with employment outcomes require screening and targeted interventions in clinical settings as well as the development of healthcare delivery, workplace, and national policies and resources. Future research should address gaps in people with advanced cancer, vulnerable groups, and lower resource settings. Survivors at risk for negative outcomes should be identified and offered relevant, tailored information and resources regarding the impact of cancer and treatment on employment outcomes.

Cancer significantly impacts First Nations Australians, with higher incidence and lower survival rates. However, understanding of end-of-life (EOL) service use and costs in this population is limited. We aimed to assess EOL healthcare utilisation and costs for First Nations cancer patients in Queensland, Australia. Retrospective data from CancerCostMod, a linked administrative dataset of all cancer diagnoses in Queensland, were used. This dataset includes records from the Queensland Cancer Registry (QCR) from July 1, 2011, to June 30, 2015, linked to Queensland Health Admitted Patient Data Collection (QHAPDC), Emergency Department (ED) Information Systems, Medicare Benefits Schedule (MBS), and Pharmaceutical Benefits Scheme (PBS) data from July 2011 to June 30, 2018. All diagnosed cancer patients who had died during the study period (N = 467) were included. Health service usage and costs during the last 6 months of life were described and compared across care type, comorbidity status, age group, and residential remoteness using Mann–Whitney and Kruskal–Wallis tests. Individuals had at least one hospital episode (100

Objective:To investigate patterns and factors associated with podiatry service use following chemotherapy for colorectal cancer (CRC) in South Australia (SA), with a focus on addressing needs related to Chemotherapy Induced Peripheral Neuropathy (CIPN), a common and detrimental complication of neurotoxic chemotherapy. Methods:This retrospective cohort study included adult CRC cases in SA (2011 to 2013). Patient characteristics, chemotherapy and podiatry service use were determined using linked health and administrative datasets. Crude and adjusted Poisson regression analyses compared annual rates of podiatry service use between chemotherapy recipients and non-recipients, and whether chemotherapy was neurotoxic from four years before to five years after diagnosis. Multivariable Poisson regression identified factors associated with podiatry service use post-diagnosis. Results:This is the first population-level study to examine the use of Medicare funded podiatry services by people with CRC within South Australia. Of 3,292 patients, 1,535 (47%) received chemotherapy. Despite a high prevalence of CIPN reported in the literature (up to 24% at 3 years post-chemotherapy), the crude rate of podiatry service use among chemotherapy recipients in this study did not exceed 20% across the five years post-diagnosis. Adjusted analyses showed similar podiatry service use among chemotherapy recipients and non-recipients, except for higher rates during the second-year post-diagnosis in chemotherapy recipients (Incidence Rate Ratios (IRR) 1.22, 95% CI: 1.01-1.48). No differences were observed at any timepoint between neurotoxic or non-neurotoxic chemotherapy recipients. Podiatry service use post-diagnosis was positively associated with prior podiatry service use (IRR 4.08, 95% CI: 3.48-4.79), having diabetes (IRR 1.26, 95% CI: 1.01-1.57), receiving chemotherapy (IRR 1.18, 95% CI: 1.01-1.37) and older age (IRR 1.28, 95% CI: 1.07-1.53, 80+ vs <80years). Conclusion:Despite a known higher prevalence of CIPN of up to 24% at 3 years post-chemotherapy, the podiatry service use by chemotherapy recipients in this study appears low, and independent of neurotoxic risk. This may indicate suboptimal follow up care for CIPN in CRC patients receiving chemotherapy who are at an inferred higher risk of CIPN. Given the known risks of CIPN to lower limb health (eg, proprioception loss, falls, ulcers), improved integration of podiatry services into cancer survivorship care is critical to address unmet needs in CIPN management.

AIM:PREDICT-5FU aimed to document 5-fluorouracil (5FU) exposure in a cancer population and to evaluate the feasibility of 5FU and capecitabine therapeutic drug monitoring (TDM) in patients receiving standard doses and schedules. METHODS:Multicentre, prospective, observational single-arm study. Eligible adult patients received 5FU (infusional ≥24 h) or capecitabine. Patients were treated for gastrointestinal, breast and head-and-neck cancers at four Australian hospitals. TDM was performed in consecutive cycles until target area under the curve (AUC) was reached. Pharmacogenetic testing was performed for all patients. RESULTS:Fifty patients (24 males, 26 females) were recruited. Median age was 63 years; common diagnoses were lower gastrointestinal cancers 40% (20/50) and metastatic disease 80% (40/50). The majority received 5FU (38/50, 76%) over 46 h. Only 36% of 5FU patients achieved target AUC when dosed based on body surface area; 61% were below and 3% above target range. Post TDM-adjusted dosing, target AUC was achieved in 58% of patients (22% absolute increase vs. BSA dosing, p = 0.03), within median three cycles (range 1-5). DPYD variant allele carriers (3/4) had upfront reduced dosing due to heterozygosity; all were below the target AUC and one experienced Grade 3 toxicity. There was no correlation between dihydrouracil: uracil ratio [UH2/U] or uracilemia [U] and DPYD genotype. TDM results were reported with an average of 4 days from sampling. CONCLUSION:TDM dosing is feasible and increases the proportion of patients reaching target AUC. Findings are relevant across all cancers treated with 5FU, and particularly for DPYD variant allele carriers receiving upfront dose reductions.

AIM:Oncology care provision by multidisciplinary teams (MDTs) is widely acknowledged as best practice. Formal team meetings, led by chairpersons, coordinate decisions on diagnosis, staging, treatment planning, and review. This study addresses a gap in meeting Chairs' perspectives on factors affecting functionality across the meeting cycle, from pre-meeting patient list triage to post-meeting dissemination of recommendations. METHODS:Semi-structured interviews were conducted in person with Chairs within two urban geographical regions in New South Wales, Australia as part of a larger project. Though the population of oncology MDT Chairs in Australia is small, the richness and depth of data from nine Chairs were considered to be valuable knowledge in support of extant literature on meeting functionality. An integrated deductive-inductive approach was applied to data analysis. RESULTS:Perceived facilitators, barriers, and ideals relating to pre-meeting, in-meeting, and post-meeting functionality were identified across five pre-determined analytic categories: the team; meeting infrastructure; meeting organization and logistics; patient-centered clinical decision-making, and; team governance. Key barriers included inadequate information technology, limited support staff, and lack of dedicated time for Chair duties. Corresponding facilitators included robust Information Technology infrastructure and support, provision of clinically knowledgeable MDT meeting coordinators, and formal employment recognition of Chairs' responsibilities and skill sets. CONCLUSION:Chairs across various tumor streams develop workarounds to overcome barriers and ensure quality meeting outcomes. With more robust support they could enhance value by sharing evidence, conducting audits, and engaging in research. The findings highlight the need for healthcare systems to support tumor stream clinical networks by allocating greater resources to prioritize multidisciplinary meetings and cancer care decision-making.

OBJECTIVE:Zero-alcohol beverages containing 0.0-0.5% alcohol by volume may offer public health benefits if individuals use them to substitute for alcohol-containing products, thereby reducing alcohol use. There are, however, concerns that zero-alcohol beverages may encourage adolescents' earlier interest in alcohol and increase exposure to alcohol company branding. As this poses a challenge for parents, we studied parents' views on zero-alcohol beverages and their provision to adolescents. METHODS:We interviewed n=38 parents of 12-17-year-olds and used reflexive thematic analysis to interpret interview data. RESULTS:Parents considered zero-alcohol beverages to be 'adult beverages' that potentially supported reduced adult drinking but were unnecessary for adolescents. Parents were concerned that adolescent zero-alcohol beverage use could normalise alcohol consumption and be a precursor to alcohol initiation. There was a potential conflict between moderate provision in 'appropriate' contexts, and potential benefits, which were each supported by some parents. Uncertainty on health qualities was also reported. CONCLUSIONS:Parents reported conflicting and cautious views on zero-alcohol beverage provision to adolescents. IMPLICATIONS FOR PUBLIC HEALTH:As evidence on the impacts of zero-alcohol beverage availability develops, parent-targeted messages highlighting the potential risk of normalisation of alcohol use for young people could be developed, in conjunction with broader policy responses.

Increasing numbers of patients with cancer are considering or undergoing immunotherapy, however, little is known about patients' perspectives on this treatment. We undertook a systematic review for use by clinicians and researchers, consolidating published qualitative research studies on patient experience of checkpoint inhibitor therapy. A search of Medline, Embase, and PsycINFO was carried out for publications in English to 30 June 2022. Publications were selected if they reported a qualitative study of patient experience with checkpoint inhibitor therapy for cancer, either by patients or their families or carers. Quality was appraised using the Johanna Briggs Institute quality assessment tool for qualitative studies. A thematic synthesis was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standard was followed. We identified 17 eligible studies published between 2017 and 2022, 9 using mixed methods, and 8 solely using qualitative methods. Most studies reported on the experiences of patients with advanced stage melanoma and were using the earliest approved checkpoint inhibitors for cancer therapy. Studies met most formal quality criteria but varied in the extent of their qualitative explorations of data; some mixed methods studies had limited reporting of qualitative results. Through thematic synthesis, we categorized study findings into four domains: (1) treatment decision-making; (2) success with immunotherapy; (3) treatment-related adverse events (AEs); and (4) quality of life on immunotherapy. Our review identified several areas with potential for improving the care system. These include, for example: routinely linking patients to peers who have experienced this therapy; improving the capacity of patients and carers to identify and report AEs faster; and supporting patients and carers to live with changed circumstances after successful treatment. Most studies focused on patients who had successful treatment, effectively excluding those who do not respond or who discontinue due to serious side effects; future research targets are suggested.

BACKGROUND:Primary hypogonadism is a recognised complication in survivors of testicular cancer. However, secondary hypogonadism can result from other causes that suppress the hypothalamic-pituitary axis, including obesity, high dose glucocorticoids, chronic end organ failure, and diabetes. The aim of this study was to explore low total serum testosterone in Australian survivors of testicular cancer and examine associations with body mass index, age, and prior chemotherapy use. METHODS:Clinical data including height, weight, diagnosis, treatment, and hormonal evaluations during follow-up were extracted from the Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group Chemocog study (2007-2012), accompanied by data from two Australian, high-volume testicular cancer centres included in the iTestis testicular cancer registry (2012-2019). Low testosterone was defined by a serum concentration of testosterone (T) < 10 nmol/L, and was classified as primary by a serum concentration of luteinising hormone (LH) > 8 IU/L, otherwise as secondary. RESULTS:Two hundred eighty-five individuals with either stage 1 or advanced testicular cancer were included. Of these, 105 (37%) were treated with orchidectomy and chemotherapy. Forty-nine (17%) met criteria for low testosterone during follow-up: 21 (43%) had primary and 27 (55%) had secondary low testosterone. Survivors of testicular cancer with higher body mass index were more likely to display low testosterone, both primary (p = 0.032) and secondary (p = 0.028). Our data did not show evidence of an association between older age or chemotherapy use and low testosterone in our cohort. CONCLUSIONS:Low total serum testosterone was common in survivors of testicular cancer, and associated with a higher body mass index prior to orchidectomy, suggesting that elevated body mass index may contribute to low testosterone in this population, and that body weight, diet, and exercise should be addressed in testicular cancer follow-up.

Medical Journal of AustraliaEarly View Perspective Ethics of artificial intelligence in supportive care in cancer Ian N Olver, Corresponding Author Ian N Olver [email protected] orcid.org/0000-0001-5478-1576 University of Adelaide, Adelaide, SASearch for more papers by this author Ian N Olver, Corresponding Author Ian N Olver [email protected] orcid.org/0000-0001-5478-1576 University of Adelaide, Adelaide, SASearch for more papers by this author First published: 07 May 2024 https://doi.org/10.5694/mja2.52297Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1Olver I, Keefe D, Herrstedt J, et al. Supportive care in cancer — a MASCC perspective. Support Care Cancer 2020; 28: 3467-3475. 10.1007/s00520-020-05447-4 PubMedWeb of Science®Google Scholar 2 Business Wire. Halo Intelligence, by VieCure, is the first whole knowledge system in oncology that brings together everything clinicians need to find the right treatment path for every patient, every time. BusinessWire (Denver, CO) 2022; 6 June. https://www.businesswire.com/news/home/20220606005818/en/Halo-Intelligence-by-VieCure-Is-the-First-Whole-Knowledge-System-in-Oncology-That-Brings-Together-Everything-Clinicians-Need-to-Find-the-Right-Treatment-Path-for-Every-Patient-Every-Time (viewed Dec 2023). Google Scholar 3Patel JN, Olver IN, Ashbury F. Pharmacogenomics in cancer supportive car: key issues and future directions. 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Objective The introduction and implementation of voluntary assisted dying (VAD) legislation represents a major shift in Australian health policy. Given potential repercussions for health professionals, understanding how they are being affected by this legislation is important to guide future policy and legislative changes. This study aims to explore the perspectives and experiences of Australian health professionals on VAD and compare impacts on those working under different state legislation in Victoria and WA.Methods Data were collected using a cross-sectional survey design, targeting health professionals nationally, primarily doctors and nurses. The survey had closed and open-ended response options, was informed by previous publications and was piloted prior to further roll-out. Recruitment was via professional networks and social media. Quantitative data were descriptively analysed and qualitative data were coded using NVivo and thematically analysed.Results There was a final sample size of 223. Impacts on clinicians identified include inadequate remuneration, a need for ongoing support and the recognition of barriers to mandatory training.Conclusions Impacts on health practitioners, if not addressed, have future implications for workforce sustainability. Increasing numbers of trained VAD practitioners may enable distribution of clinical load and prevent burnout. VAD practitioners are not being appropriately remunerated, which could be addressed by introducing dedicated Medicare Benefits Schedule items for VAD. Attention should also be given to incentivising training, including continuing professional development accreditation and appropriate funding. Strategies to support staff could include debriefing, mentoring, peer support and psychological consultations.

Importance The role of olanzapine has not been adequately evaluated in moderately emetogenic chemotherapy (MEC) regimens with or without neurokinin-1 receptor antagonists. Objective To evaluate whether addition of olanzapine to an MEC regimen reduces nausea, vomiting, and use of nausea rescue medications among patients with solid malignant tumors. Design, Setting, and ParticipantsThis multicenter, open-label phase 3 randomized clinical trial included patients aged 18 years or older with solid malignant tumors who were receiving oxaliplatin-, carboplatin-, or irinotecan-based chemotherapy. The trial was conducted at 3 institutes in India from March 26, 2019, to August 26, 2023; the final cutoff date for analysis was September 10, 2023. Exposure Patients were randomized 1:1 to dexamethasone, aprepitant, and palonosetron with olanzapine (experimental group) or without olanzapine (observation group). The experimental group received 10 mg of olanzapine orally once at night on days 1 through 3 of the chemotherapy regimen. Main Outcomes and Measures The primary end point was complete response (CR), defined as the proportion of patients with no vomiting, no significant nausea (scored as <5 on a visual analog scale of 1 to 100), and no use of rescue medications for nausea. Secondary end points included the proportion of patients experiencing nausea and chemotherapy-induced nausea and vomiting (CINV), receiving rescue medications, and experiencing adverse events. Results A total of 560 patients (259 [64%] male; median age, 51 years [range, 19-80 years]) were randomized. The analysis included 544 patients with evaluable data (274 assigned to olanzapine and 270 to observation). Baseline characteristics were evenly matched between the 2 groups. The proportion of patients with CR was significantly greater in the group with (248 [91%]) than without (222 [82%]) olanzapine in the overall 120-hour treatment period (P = .005). Likewise, there were significant differences between the olanzapine and observation groups for nausea control (264 [96%] vs 234 [87%]; P < .001) and CINV (262 [96%] vs 245 [91%]; P = .02) during the overall assessment period, and the proportion of patients receiving rescue medications significantly increased in the observation group (30 [11%]) compared with the olanzapine group (11 [4%]) (P = .001). Grade 1 somnolence was reported by 27 patients (10%) following administration of chemotherapy and olanzapine and by no patients in the observation group. Conclusions and RelevanceIn this randomized clinical trial, the addition of olanzapine significantly improved CR rates as well as nausea and vomiting prevention rates in chemotherapy-naive patients who were receiving MEC regimens containing oxaliplatin, carboplatin, or irinotecan. These findings suggest that use of olanzapine should be considered as one of the standards of care in these chemotherapy regimens. Trial RegistrationClinical Trials Registry-India (CTRI) Identifier: CTRI/2018/12/016643

Purpose Review the literature to update the MASCC guidelines from 2016 for controlling nausea and vomiting with systemic cancer treatment of low and minimal emetic potential. Methods A working group performed a systematic literature review using Medline, Embase, and Scopus databases between June 2015 and January 2023 of the management of antiemetic prophylaxis for anticancer therapy of low or minimal emetic potential. A consensus committee reviewed recommendations and required a consensus of 67% or greater and a change in outcome of at least 10%. Results Of 293 papers identified, 15 had information about managing systemic cancer treatment regimens of low or minimal emetic potential and/or compliance with previous management recommendations. No new evidence was reported that would change the current MASCC recommendations. No antiemetic prophylaxis is recommended for minimal emetic potential therapy, and single agents recommended for low emetic potential chemotherapy for acute emesis, but no prophylaxis is recommended for delayed emesis. Commonly, rescue medication includes antiemetics prescribed for the next higher level of emesis. Conclusion There is insufficient data to change the current guidelines. Future studies should seek to more accurately determine the risk of emesis with LEC beyond the emetogenicity of the chemotherapy to include patient-related risk assessment.

Increasing numbers of patients with cancer are considering or undergoing immunotherapy, however, little is known about patients' perspectives on this treatment. We undertook a systematic review for use by clinicians and researchers, consolidating published qualitative research studies on patient experience of checkpoint inhibitor therapy. A search of Medline, Embase, and PsycINFO was carried out for publications in English to 30 June 2022. Publications were selected if they reported a qualitative study of patient experience with checkpoint inhibitor therapy for cancer, either by patients or their families or carers. Quality was appraised using the Johanna Briggs Institute quality assessment tool for qualitative studies. A thematic synthesis was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standard was followed. We identified 17 eligible studies published between 2017 and 2022, 9 using mixed methods, and 8 solely using qualitative methods. Most studies reported on the experiences of patients with advanced stage melanoma and were using the earliest approved checkpoint inhibitors for cancer therapy. Studies met most formal quality criteria but varied in the extent of their qualitative explorations of data; some mixed methods studies had limited reporting of qualitative results. Through thematic synthesis, we categorized study findings into four domains: (1) treatment decision-making; (2) success with immunotherapy; (3) treatment-related adverse events (AEs); and (4) quality of life on immunotherapy. Our review identified several areas with potential for improving the care system. These include, for example: routinely linking patients to peers who have experienced this therapy; improving the capacity of patients and carers to identify and report AEs faster; and supporting patients and carers to live with changed circumstances after successful treatment. Most studies focused on patients who had successful treatment, effectively excluding those who do not respond or who discontinue due to serious side effects; future research targets are suggested.

The proliferation of assisted dying legislative reforms globally is a significant change in the social and medico-legal landscape of end-of-life care. Understanding the impacts of these legislative reforms on family members who care for a dying person is vital, yet under-theorised in research. In this article, drawing on semi-structured interviews with 42 carers for a person who has sought assisted dying in Australia, and extending ideas of ontological choreography we explore the new and complex choreographies enacted by carers in their endeavour to arrange a 'good death' for the dying person. We find that desires to fulfil the dying person's wishes are often accompanied by normative pressures, affective tensions and complexities in bereavement. Enacting assisted dying requires carers to perform a repertoire of highly-staged practices. Yet, institutional obstacles and normative cultural scripts of dying can constrain carer assisted dying practices. Understanding the nuances of carers' experiences and how they navigate this new end-of-life landscape, we argue, provides critical insights about how assisted dying legislation is producing new cultural touchpoints for caring at the end of life. Moreover, we show how emerging cultural scripts of assisted dying are impacting in the lives of these carers.

PURPOSE:Spiritual care is reported as important for cancer patients, but the role of the doctor in its provision is unclear. We undertook to understand the nature of spiritual support for Australian cancer patients and their preferences regarding spiritual care from doctors.METHODS:Using grounded theory, semistructured interviews were conducted with 15 cancer patients with advanced disease in a variety of care settings. Patients were asked about the source of their spiritual support and how they would like their doctors to engage with them on spiritual issues.RESULTS:Three themes were identified as follows: (1) sources of spiritual support which helped patients cope with illness and meet spiritual needs, (2) facilitators of spiritual support, and (3) role of the doctor in spiritual support. Regardless of religious background, the majority of patients wanted their doctor to ask about their source of spiritual support and facilitate access to it. Patients did not want spiritual guidance from their doctors, but wanted to be treated holistically and to have a good relationship, which allowed them to discuss their fears. Doctors' understanding of the spiritual dimension of the patient was part of this.CONCLUSIONS:Spirituality is a universal phenomenon. Patients in a secular society want their doctor to take an interest in their spiritual support and facilitate access to it during illness.

Purpose Review the literature to propose suggestions or recommendations for controlling nausea and vomiting through integrative and non-pharmacological treatments for the MASCC/ESMO 2023 update of its antiemetic guidelines. Methods The authors identified available systematic reviews and/or meta-analyses for 12 integrative therapies, including acupressure, acupuncture, auricular therapy, electrical stimulation of point PC6, ginger use (i.e., Zingiber officinale ), guided imagery, hypnosis, inhalation aromatherapy, music therapy, food-based interventions, progressive muscle relaxation, and reflexology. Reviews were assessed for quality through the AMSTAR2 tool. A consensus committee reviewed recommendations as per MASCC/ESMO established processes. Results Thirty-nine systematic reviews and/or meta-analyses were used. There were major methodological flaws for many of the trials used as the bases for the reviews. No recommendation for ingested ginger could be made because of conflicting evidence. Recommendations were possible for acupuncture/electroacupuncture treatments, food-based interventions, and progressive muscle relaxation training alone or combined with guided imagery. No recommendations could be reached for a number of food-based approaches, inhalation aromatherapy, hypnosis in adults, music therapy, and reflexology. Conclusion While a limited number of suggestions are provided, there is a need for significantly higher quality trials in many of the therapeutic approaches assessed, before stronger recommendations and a wider range of approaches are made.