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Integrative oncology for breast cancer-patients: Introduction of an expert-based model
164
Invited Lectures / European Journal of Integrative Medicine 2 (2010) 159–164
plementary medicine in patients undergoing treatment for cancer.
Integrative oncology for breast cancer-patients: Introduction of an expert-based model
doi:10.1016/j.eujim.2010.09.210
G. Dobos a,∗ , P. Voiss a , I. Schwidde b , A. Paul a , F.J. Saha a , F. Musial a , S. Kuemmel b
Out-patient care—The physicians’ perspective
a
S. Joos Ruprecht Karl University Heidelberg, Medical clinic, Heidelberg, Germany More than two thirds of patients in Germany use Complementary and Alternative Medicine (CAM). A substantial part of CAM diagnostic and therapy takes place in out-patient care and is initiated by general practitioners (GPs). At the end of 2009 nearly 64,000 CAM qualifications (including naturopathy, chiropractic, homeopathy, balneology & medical climatology and acupuncture) were registered at the federal medical associations, thereof 43,000 belonged to physicians working in out-patient care. In addition, many physicians are providing CAM in their daily practice without having any certified CAM qualification. In a recently published nationwide survey 60% of GPs in Germany had indicated to use CAM in every-day practice, especially neural therapy, phytotherapy and acupuncture. In the same survey, 49% of GPs had indicated to have a positive attitude, whereas 12% to have a rather negative attitude towards CAM. In addition to physicians, there are also non-medical practitioners (‘Heilpraktiker’) providing CAM care in Germany. Specific CAM methods are recommended in the guidelines of the German College of General Practitioners and Family Physicians (DEGAM) (e.g. acupuncture and manual medicine in the neck pain guideline and several herbal drugs in the cough and rhinosinusitis guideline resp.). Some CAM interventions are covered by the statutory health insurance (e.g. manual medicine and acupuncture in patients with knee pain and lumbar pain). However, most CAM therapies have to be paid out-of-pocket by patients. In summary, CAM is already making a substantial contribution to outpatient care in Germany. Nevertheless, there are still physicians having rather ideological reservations against CAM. The philosophy of care of GPs providing CAM care might be different from that of GPs providing ‘pure’ primary care. Knowing that the philosophy of care is an important physician-factor determining diagnosis, treatment and prevention strategies in patient care this will be an important issue for further research. Furthermore, the research agenda for the next years should include not only efficacy research but also health-care delivery, regulatory issues regarding professions, organizational aspects and knowledge transfer to improve quality and to prevent patients from medical and financial harm arising from the use of CAM in outpatient care. doi:10.1016/j.eujim.2010.09.211
University of Duisburg-Essen, Chair for Complementary and Integrative Medicine, Kliniken Essen-Mitte, Essen, Germany b University of Duisburg-Essen, Kliniken Essen-Mitte, Department of Senology, Essen, Germany Breast cancer is currently one of the most frequent forms of cancer occurring in the Western world. Even though conventional therapies have been standardized by guidelines, in up to 40% of the cases the decision for chemotherapy has to be questioned. Also, in spite of promising evidence, treatment methods of Complementary and Alternative Medicine (CAM) are mostly ignored by oncologists but used by patients. In a co-operation the Departments for Senology and for Complementary and Integrative Medicine at Kliniken EssenMitte are establishing a concept for Integrative Oncology on the basis of an evidence-based evaluation process (SenoExpert), permanently updating the current scientific literature for mainstream medicine as well as CAM-therapies in order to obtain state-of-the-art knowledge for the treatment decisions for breast cancer patients. Just an additional consultation-hour for CAM in a breast unit is not enough. In this model breast surgeons, scientifically trained physicians specialized in CAM-therapies and mind-body instructors closely work together and treat their breast patients from the initial diagnosis on together. In the talk the CAM-part of the SenoExpert-Program will be introduced. The focus for CAM-therapies is mostly on strengthening the self-healing capacity of the body as well as the treatment of side-effects of chemotherapy such as: xerostomia, bone marrow depression, polyneuropathy, gastrointestinal disorders, pain of muscle and joints, depression and fatigue. The main topics of treatments are nutrition, exercise, training in mindfulness and relaxation (relaxation response), phytotherapy, as well as acupuncture, Chinese herbal treatment, qigong, massage therapy, substitution of vitamin D and social support. Supportive CAM-treatments of patients are useful before, during and after chemotherapy. Based on current evidence recommendations for the integrative treatment are being developed. The concept of Integrative Oncology for breast cancer patients will be discussed. doi:10.1016/j.eujim.2010.09.212
Invited Lectures / European Journal of Integrative Medicine 2 (2010) 159–164
plementary medicine in patients undergoing treatment for cancer.
Integrative oncology for breast cancer-patients: Introduction of an expert-based model
doi:10.1016/j.eujim.2010.09.210
G. Dobos a,∗ , P. Voiss a , I. Schwidde b , A. Paul a , F.J. Saha a , F. Musial a , S. Kuemmel b
Out-patient care—The physicians’ perspective
a
S. Joos Ruprecht Karl University Heidelberg, Medical clinic, Heidelberg, Germany More than two thirds of patients in Germany use Complementary and Alternative Medicine (CAM). A substantial part of CAM diagnostic and therapy takes place in out-patient care and is initiated by general practitioners (GPs). At the end of 2009 nearly 64,000 CAM qualifications (including naturopathy, chiropractic, homeopathy, balneology & medical climatology and acupuncture) were registered at the federal medical associations, thereof 43,000 belonged to physicians working in out-patient care. In addition, many physicians are providing CAM in their daily practice without having any certified CAM qualification. In a recently published nationwide survey 60% of GPs in Germany had indicated to use CAM in every-day practice, especially neural therapy, phytotherapy and acupuncture. In the same survey, 49% of GPs had indicated to have a positive attitude, whereas 12% to have a rather negative attitude towards CAM. In addition to physicians, there are also non-medical practitioners (‘Heilpraktiker’) providing CAM care in Germany. Specific CAM methods are recommended in the guidelines of the German College of General Practitioners and Family Physicians (DEGAM) (e.g. acupuncture and manual medicine in the neck pain guideline and several herbal drugs in the cough and rhinosinusitis guideline resp.). Some CAM interventions are covered by the statutory health insurance (e.g. manual medicine and acupuncture in patients with knee pain and lumbar pain). However, most CAM therapies have to be paid out-of-pocket by patients. In summary, CAM is already making a substantial contribution to outpatient care in Germany. Nevertheless, there are still physicians having rather ideological reservations against CAM. The philosophy of care of GPs providing CAM care might be different from that of GPs providing ‘pure’ primary care. Knowing that the philosophy of care is an important physician-factor determining diagnosis, treatment and prevention strategies in patient care this will be an important issue for further research. Furthermore, the research agenda for the next years should include not only efficacy research but also health-care delivery, regulatory issues regarding professions, organizational aspects and knowledge transfer to improve quality and to prevent patients from medical and financial harm arising from the use of CAM in outpatient care. doi:10.1016/j.eujim.2010.09.211
University of Duisburg-Essen, Chair for Complementary and Integrative Medicine, Kliniken Essen-Mitte, Essen, Germany b University of Duisburg-Essen, Kliniken Essen-Mitte, Department of Senology, Essen, Germany Breast cancer is currently one of the most frequent forms of cancer occurring in the Western world. Even though conventional therapies have been standardized by guidelines, in up to 40% of the cases the decision for chemotherapy has to be questioned. Also, in spite of promising evidence, treatment methods of Complementary and Alternative Medicine (CAM) are mostly ignored by oncologists but used by patients. In a co-operation the Departments for Senology and for Complementary and Integrative Medicine at Kliniken EssenMitte are establishing a concept for Integrative Oncology on the basis of an evidence-based evaluation process (SenoExpert), permanently updating the current scientific literature for mainstream medicine as well as CAM-therapies in order to obtain state-of-the-art knowledge for the treatment decisions for breast cancer patients. Just an additional consultation-hour for CAM in a breast unit is not enough. In this model breast surgeons, scientifically trained physicians specialized in CAM-therapies and mind-body instructors closely work together and treat their breast patients from the initial diagnosis on together. In the talk the CAM-part of the SenoExpert-Program will be introduced. The focus for CAM-therapies is mostly on strengthening the self-healing capacity of the body as well as the treatment of side-effects of chemotherapy such as: xerostomia, bone marrow depression, polyneuropathy, gastrointestinal disorders, pain of muscle and joints, depression and fatigue. The main topics of treatments are nutrition, exercise, training in mindfulness and relaxation (relaxation response), phytotherapy, as well as acupuncture, Chinese herbal treatment, qigong, massage therapy, substitution of vitamin D and social support. Supportive CAM-treatments of patients are useful before, during and after chemotherapy. Based on current evidence recommendations for the integrative treatment are being developed. The concept of Integrative Oncology for breast cancer patients will be discussed. doi:10.1016/j.eujim.2010.09.212