- Email: [email protected]
A systematic review of epidemiological studies on the prevalence of complementary and alternative medicine (CAM) use by paediatric cancer patients
ARTICLE IN PRESS European Journal of Integrative Medicine (2008) 1S, S43–S66
Poster presentations CANCER Primary and secondary prevention of prostate cancer J.E. Altwein Chirurgische Klinik, Urologische Abteilung, Munich-Bogenhausen, Germany
Background: Due to the very high prevalence of prostate cancer (420% among men aged 50–60), prevention is essential. In contrast to chemoprevention (e.g. with finasteride), which is not common practice, there is broad acceptance of dietary interventions. Methods: Analysis of epidemiological studies located via MEDLINE, EMBASE, and the World Cancer Research Fund (2007). Results: Consuming milk products, calcium-rich foods, saturated fats, red meat, and multivitamin products (47 /week) increases the risk of developing clinically manifest prostate cancer. This risk is reduced by consuming soy products (tofu), Brassica vegetables (e.g. broccoli), lycopene-rich foods (tomato products), selenium, tocopherol, linseed (lignans), red wine (resveratrol), and especially pomegranate products (e.g. ellagitannins). In secondary prevention, which is a key component in the current concept of active surveillance in prostate cancer, pomegranate products play the most important role. It is currently a matter of controversy whether lycopene is protective [Giovannuci, Exp Biol Med (Maywood) 2002;227(10): 852–9.] or not [Kirsh et al., Cancer Epidemiol Biomakers Prev 2006;15(1):92–8.] Consistent prevention of prostate cancer has the added benefit of helping protect against other conditions, including cardiovascular disease and metabolic syndrome, and can thus be described as integrated prevention. Conclusion: Dietary prevention of prostate cancer requires a special nutritional regimen combined with nutritional supplements (e.g. neutraceuticals, functional food, and selenium). 10.1016/j.eujim.2008.08.081
1876-3820/$ - see front matter & 2008 Published by Elsevier GmbH. doi:10.1016/S1876-3820(08)00081-4
A systematic review of epidemiological studies on the prevalence of complementary and alternative medicine (CAM) use by paediatric cancer patients F. Bishopa, Y.K. Chana, G. Lewitha, P. Prescottb a
Complementary Medicine Research Unit, University of Southampton, Southampton, UK b School of Mathematics, University of Southampton, Southampton, UK
Background: Paediatric cancer patients are likely to use complementary and alternative medicines (CAMs) alongside more conventional interventions. A number of individual studies have been carried out to examine prevalence rates of CAM use amongst paediatric cancer patients. These studies have varied findings and are of mixed quality. This meta-analytic review therefore aimed to assess the quality of this literature and to determine what is known about the prevalence of the CAM use in paediatric cancer. Secondary research questions focused on the types of CAM used, trends in CAM use over time, reasons for CAM use, and demographic characteristics associated with CAM use. Method: Electronic and manual searches for relevant studies identified 26 English language journal articles of primary research studies investigating the prevalence of CAM usage among paediatric cancer patients in peerreviewed journals. A quality assessment checklist was rigorously developed based on the strengthening the reporting of observational studies in epidemiology (STROBE) statement in collaboration with Dr. Erik von Elm (lead author of the STROBE statement). Data were extracted and validated by more than one author and analysed using meta-analytic techniques. Results: The prevalence of CAM use by paediatric cancer patients ranged from 40% to 53%. The quality of the studies was mixed and did not correlate with the estimated prevalence of CAM use. ‘Herbals’ was the most popular CAM modality. Paediatric cancer patients use CAM for
ARTICLE IN PRESS S44
Poster presentations
various reasons. Higher level of education and income were associated with CAM use in North America; the opposite was true for CAM use in Mexico and Turkey. Conclusion: A substantial proportion of paediatric cancer patients use CAM. There is a need to use standardised definitions of the CAM in future studies to generate comparable data. The quality assessment checklist has potential to be a useful quality assessment instrument for other reviews of similar epidemiological studies. 10.1016/j.eujim.2008.08.082
meaning should be interpreted. Finally, the relevance of the mistletoe therapy with respect to the maintenance/ improvement of the quality-of-life was approached. The evaluation of the questionnaires showed a tendency for an improvement of the patients’ quality-of-life, which was revealed by all three types of questionnaires. The interviews’ analysis indicated that the patients adopt the mistletoe therapy with a supportive goal rather then as an anti-tumour therapy. Moreover, psychosocial considerations and ideal reasons do often play an immediate role. 10.1016/j.eujim.2008.08.083
Mistletoe in the supportive care of cancer patients— Improvement of quality-of-life a,b
c
b
M. Brandenberger , P. Simoes-Wu ¨st , R. Saller , G. Salzwedelc, L. Ristc, M. Ramosd a
Sta ¨dtische Gesundheitsdienste, Zu ¨ rich, Switzerland Naturheilkunde, Universita ¨t, Inn. Med., Zu ¨ rich, Switzerland c Spital, Richterswil, Switzerland d Weleda, Arlesheim, Switzerland b
Mistletoe (Viscum album) preparations are often used in the adjuvant setting, together with standard chemo- or radiotherapy. Several clinical studies have shown that treatment with mistletoe preparations—often in combination with standard treatment—can improve the quality-oflife and even prolongs relapse-free intervals in cancer patients. Furthermore, some patients can better stand aggressive chemotherapies if they receive mistletoe preparations at the same time. In the present clinical study, which was authorized by the ethical commission of the canton Zurich, questionnaires were used to characterise the alterations in the quality-oflife experienced by cancer patients during the treatment with mistletoe preparations. Furthermore, the patients were interviewed by the researchers to unveil their goals while accepting this therapy. A small (N ¼ 25) cohort of patients with different types of malignant diseases received subcutaneous applications of mistletoe preparations in the course of their treatment at the Paracelsus Hospital in Richterswil. All patients filled in the following questionnaires on quality-of-life at the beginning of the treatment: EORTC QLQ-C30 Version 3.0, SELT-M and HLQ Version 2.5. Approximately 3 months later, 21 of the 25 patients filled in the questionnaires a second time, to document the variation in the quality-of-life during this time period. The scores of the different questionnaires, as well as the differences between the scores at the two visits, were determined. The statistical analysis (merely descriptive) was performed with SAS 9.1. When the patients agreed, they were interviewed by the researchers. These interviews included questions on why the patients used the mistletoe therapy including objective and subjective reasons. Another goal of the interviews was to characterise the functional meaning of the mistletoe therapy within the context of the whole therapeutic concept and some questions attempted to find out how this
Modulation of chemotherapy-associated immunosuppression by intravenous application of Viscum album L. Extract (Iscador): A randomised phase II study A. Bu ¨ssinga, U. Bu ¨cknerb, U. Enser-Weisb, c M. Schnelle , A. Schumannc, M. Schietzeld, W. Hatzmanne, J. Hackmanne a
Universita ¨t Witten/Herdecke, Lehrstuhl fu ¨r Medizintheorie und Komplementa ¨rmedizin, Herdecke, Germany b Onkologische Praxis, Bochum, Germany c Institute of Clinical Research (IKF), Berlin d Krebsforschung Herdecke, Immunologisches Labor, Bochum, Germany e Chair of Gynaecology and Obstetrics, University Witten/Herdecke, Witten, Germany
Background: In a previous phase II study with breast cancer patients, a single intravenous application of the fermented Viscum album extract (VA-E; Iscador M spezial) prior to surgery prevented the surgery-/anaesthesia-associated inhibition of granulocyte function. We thus intended to investigate whether i.v. applications of fermented VA-E may have positive effects also on chemotherapy-induced immunosuppression. Patients and methods: We randomised 65 breast cancer patients to adjuvant (F)EC chemotherapy+VA-E (32 pats) or (F)EC alone (33 pats), mean age 54.7 years (26–77 years). The primary aim of this RCT was the functional competence of granulocytes (flow cytometric analysis of the oxidative burst of peripheral blood granulocytes stimulated with Escherichia coli or PMA), as measured prior to chemotherapy cycles and at day 8 of each cycle. The area under curve (AUC) of the burst activity (MCh R123) was calculated for each cycle. Results: The AUC of PMA- or E.coli-stimulated burst did not significantly differ between both groups; this was in part due to the surprising fact that—despite randomisation—the PMA-stimulated burst activity in control patients at baseline was already significantly below that in the VA-E group (p ¼ 0.042). Therefore, the observation of a small increase of burst activity in the control group (ITT: p40.14; PP: p40.15) can be interpreted as a regression to the mean effect. The sensitivity analysis of differences to the baseline
Poster presentations CANCER Primary and secondary prevention of prostate cancer J.E. Altwein Chirurgische Klinik, Urologische Abteilung, Munich-Bogenhausen, Germany
Background: Due to the very high prevalence of prostate cancer (420% among men aged 50–60), prevention is essential. In contrast to chemoprevention (e.g. with finasteride), which is not common practice, there is broad acceptance of dietary interventions. Methods: Analysis of epidemiological studies located via MEDLINE, EMBASE, and the World Cancer Research Fund (2007). Results: Consuming milk products, calcium-rich foods, saturated fats, red meat, and multivitamin products (47 /week) increases the risk of developing clinically manifest prostate cancer. This risk is reduced by consuming soy products (tofu), Brassica vegetables (e.g. broccoli), lycopene-rich foods (tomato products), selenium, tocopherol, linseed (lignans), red wine (resveratrol), and especially pomegranate products (e.g. ellagitannins). In secondary prevention, which is a key component in the current concept of active surveillance in prostate cancer, pomegranate products play the most important role. It is currently a matter of controversy whether lycopene is protective [Giovannuci, Exp Biol Med (Maywood) 2002;227(10): 852–9.] or not [Kirsh et al., Cancer Epidemiol Biomakers Prev 2006;15(1):92–8.] Consistent prevention of prostate cancer has the added benefit of helping protect against other conditions, including cardiovascular disease and metabolic syndrome, and can thus be described as integrated prevention. Conclusion: Dietary prevention of prostate cancer requires a special nutritional regimen combined with nutritional supplements (e.g. neutraceuticals, functional food, and selenium). 10.1016/j.eujim.2008.08.081
1876-3820/$ - see front matter & 2008 Published by Elsevier GmbH. doi:10.1016/S1876-3820(08)00081-4
A systematic review of epidemiological studies on the prevalence of complementary and alternative medicine (CAM) use by paediatric cancer patients F. Bishopa, Y.K. Chana, G. Lewitha, P. Prescottb a
Complementary Medicine Research Unit, University of Southampton, Southampton, UK b School of Mathematics, University of Southampton, Southampton, UK
Background: Paediatric cancer patients are likely to use complementary and alternative medicines (CAMs) alongside more conventional interventions. A number of individual studies have been carried out to examine prevalence rates of CAM use amongst paediatric cancer patients. These studies have varied findings and are of mixed quality. This meta-analytic review therefore aimed to assess the quality of this literature and to determine what is known about the prevalence of the CAM use in paediatric cancer. Secondary research questions focused on the types of CAM used, trends in CAM use over time, reasons for CAM use, and demographic characteristics associated with CAM use. Method: Electronic and manual searches for relevant studies identified 26 English language journal articles of primary research studies investigating the prevalence of CAM usage among paediatric cancer patients in peerreviewed journals. A quality assessment checklist was rigorously developed based on the strengthening the reporting of observational studies in epidemiology (STROBE) statement in collaboration with Dr. Erik von Elm (lead author of the STROBE statement). Data were extracted and validated by more than one author and analysed using meta-analytic techniques. Results: The prevalence of CAM use by paediatric cancer patients ranged from 40% to 53%. The quality of the studies was mixed and did not correlate with the estimated prevalence of CAM use. ‘Herbals’ was the most popular CAM modality. Paediatric cancer patients use CAM for
ARTICLE IN PRESS S44
Poster presentations
various reasons. Higher level of education and income were associated with CAM use in North America; the opposite was true for CAM use in Mexico and Turkey. Conclusion: A substantial proportion of paediatric cancer patients use CAM. There is a need to use standardised definitions of the CAM in future studies to generate comparable data. The quality assessment checklist has potential to be a useful quality assessment instrument for other reviews of similar epidemiological studies. 10.1016/j.eujim.2008.08.082
meaning should be interpreted. Finally, the relevance of the mistletoe therapy with respect to the maintenance/ improvement of the quality-of-life was approached. The evaluation of the questionnaires showed a tendency for an improvement of the patients’ quality-of-life, which was revealed by all three types of questionnaires. The interviews’ analysis indicated that the patients adopt the mistletoe therapy with a supportive goal rather then as an anti-tumour therapy. Moreover, psychosocial considerations and ideal reasons do often play an immediate role. 10.1016/j.eujim.2008.08.083
Mistletoe in the supportive care of cancer patients— Improvement of quality-of-life a,b
c
b
M. Brandenberger , P. Simoes-Wu ¨st , R. Saller , G. Salzwedelc, L. Ristc, M. Ramosd a
Sta ¨dtische Gesundheitsdienste, Zu ¨ rich, Switzerland Naturheilkunde, Universita ¨t, Inn. Med., Zu ¨ rich, Switzerland c Spital, Richterswil, Switzerland d Weleda, Arlesheim, Switzerland b
Mistletoe (Viscum album) preparations are often used in the adjuvant setting, together with standard chemo- or radiotherapy. Several clinical studies have shown that treatment with mistletoe preparations—often in combination with standard treatment—can improve the quality-oflife and even prolongs relapse-free intervals in cancer patients. Furthermore, some patients can better stand aggressive chemotherapies if they receive mistletoe preparations at the same time. In the present clinical study, which was authorized by the ethical commission of the canton Zurich, questionnaires were used to characterise the alterations in the quality-oflife experienced by cancer patients during the treatment with mistletoe preparations. Furthermore, the patients were interviewed by the researchers to unveil their goals while accepting this therapy. A small (N ¼ 25) cohort of patients with different types of malignant diseases received subcutaneous applications of mistletoe preparations in the course of their treatment at the Paracelsus Hospital in Richterswil. All patients filled in the following questionnaires on quality-of-life at the beginning of the treatment: EORTC QLQ-C30 Version 3.0, SELT-M and HLQ Version 2.5. Approximately 3 months later, 21 of the 25 patients filled in the questionnaires a second time, to document the variation in the quality-of-life during this time period. The scores of the different questionnaires, as well as the differences between the scores at the two visits, were determined. The statistical analysis (merely descriptive) was performed with SAS 9.1. When the patients agreed, they were interviewed by the researchers. These interviews included questions on why the patients used the mistletoe therapy including objective and subjective reasons. Another goal of the interviews was to characterise the functional meaning of the mistletoe therapy within the context of the whole therapeutic concept and some questions attempted to find out how this
Modulation of chemotherapy-associated immunosuppression by intravenous application of Viscum album L. Extract (Iscador): A randomised phase II study A. Bu ¨ssinga, U. Bu ¨cknerb, U. Enser-Weisb, c M. Schnelle , A. Schumannc, M. Schietzeld, W. Hatzmanne, J. Hackmanne a
Universita ¨t Witten/Herdecke, Lehrstuhl fu ¨r Medizintheorie und Komplementa ¨rmedizin, Herdecke, Germany b Onkologische Praxis, Bochum, Germany c Institute of Clinical Research (IKF), Berlin d Krebsforschung Herdecke, Immunologisches Labor, Bochum, Germany e Chair of Gynaecology and Obstetrics, University Witten/Herdecke, Witten, Germany
Background: In a previous phase II study with breast cancer patients, a single intravenous application of the fermented Viscum album extract (VA-E; Iscador M spezial) prior to surgery prevented the surgery-/anaesthesia-associated inhibition of granulocyte function. We thus intended to investigate whether i.v. applications of fermented VA-E may have positive effects also on chemotherapy-induced immunosuppression. Patients and methods: We randomised 65 breast cancer patients to adjuvant (F)EC chemotherapy+VA-E (32 pats) or (F)EC alone (33 pats), mean age 54.7 years (26–77 years). The primary aim of this RCT was the functional competence of granulocytes (flow cytometric analysis of the oxidative burst of peripheral blood granulocytes stimulated with Escherichia coli or PMA), as measured prior to chemotherapy cycles and at day 8 of each cycle. The area under curve (AUC) of the burst activity (MCh R123) was calculated for each cycle. Results: The AUC of PMA- or E.coli-stimulated burst did not significantly differ between both groups; this was in part due to the surprising fact that—despite randomisation—the PMA-stimulated burst activity in control patients at baseline was already significantly below that in the VA-E group (p ¼ 0.042). Therefore, the observation of a small increase of burst activity in the control group (ITT: p40.14; PP: p40.15) can be interpreted as a regression to the mean effect. The sensitivity analysis of differences to the baseline