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PubMed2002

Complementary and alternative therapies in prostate cancer.

Complementary and alternative therapies are used with increasing frequency in men with prostate cancer. However, little is known about the efficacy of such therapies for this cancer. While epidemiological data support the association between intake of certain micronutrients with development of prostate cancer, there exist limited prospective data that support the chemopreventative or therapeutic value of such nutritional agents in prostate cancer. To date, one of the most studied treatments has been PC-SPES, a combination of eight herbal therapies with activity against prostate cancer. Studies in cell lines of human prostate cancer demonstrate significant dose-dependent decreases in cellular viability after exposure to extracts of this agent. Clinical studies suggested that PC-SPES could reduce prostate specific antigen levels in patients with either androgen-dependent or androgen-independent prostate cancer. Toxicity was mild, although there was a low risk of thromboembolic events with such treatment. Manufacture of PC-SPES was recently halted, after revelations that the herbal combination was contaminated with warfarin, which led to a recall by the manufacturer. Subsequent analyses also revealed the presence of diethylstilbestrol (DES) and indomethacin in some lots of PC-SPES. Available data regarding other alternative therapies are reviewed as well.

Acupuncture Therapy↗
PubMed2006

Can complementary and alternative medicine clinical cancer research be successfully accomplished? The Mayo Clinic-North Central Cancer Treatment Group experience.

Some critics question whether research on complementary and alternative modalities for patients with cancer can be done efficiently in traditional clinical settings. This article reviews a program of complementary medicine research that has been done in a traditional clinical setting over the past 30 years. Trials using complementary therapies for both symptom management and cancer treatment done by the Mayo Clinic and the North Central Cancer Treatment Group are reviewed. Twenty-seven studies have been developed using complementary therapies, addressing such issues as mucosal and epidermal toxicity, hot flashes, lymphedema, anorexia and cachexia, insomnia, cognitive dysfunction, fatigue, and cancer treatment. Nineteen of them have been completed and have had results published in peer-reviewed clinical journals, whereas two manuscripts are in press. Two other trials have recently completed accrual, and the data are being analyzed so that manuscripts can be prepared. In addition, four clinical trials are actively accruing patients. The data presented in this article demonstrate that complementary and alternative medicine research can be done in a scientifically sound manner. Well-designed and adequately powered studies can be implemented, and large numbers of patients can be accrued. The resulting research evaluations can be published in peer-reviewed medical journals.

Biomedical Research↗
PubMed2003

Oncology nursing and integrative care: a new way of being.

Oncology nursing is a long-established specialty in the practice of professional nursing. The paradigm shift to a more holistic perspective in health care is affecting not only the delivery of care but also the beliefs and value of nurses who work with people experiencing cancer. This article will examine the role of holistic theory and complementary therapies as innovations in nursing education and nursing practice. Suggestions for assessing and planning for an integrative approach to intervention will be discussed. Outcomes from a senior nursing student survey concerning the integration of holistic nursing and complementary therapies will be described. The future offers many challenges for professional nursing as a major player in today's health care system.

Complementary Therapies↗
PubMed2000

Location bias in controlled clinical trials of complementary/alternative therapies.

UNLABELLED: To systematically investigate location bias of controlled clinical trials in complementary/alternative medicine (CAM). METHODS: Literature searches were performed to identify systematic reviews and meta-analyses, which were used to retrieve controlled clinical trials. Trials were categorised by whether they appeared in CAM-journals or mainstream medical (MM)-journals, and by their direction of outcome, methodological quality, and sample size. RESULTS: 351 trials were analysed. A predominance of positive trials was seen in non-impact factor CAM- and MM-journals, (58) / (78) (74%) and (76) / (102) (75%) respectively, and also in low impact factor CAM- and MM-journals. In high impact factor MM-journals there were equal numbers of positive and negative trials, a distribution significantly (P < 0.05) different from all other journal categories. Quality scores were significantly lower for positive than negative trials in non-impact factor CAM-journals (P < 0.02). A similar trend was seen in low-impact factor CAM journals, but not to a level of significance (P = 0.06). There were no significant differences between quality scores of positive and negative trials published in MM-journals, except for high impact factor journals, in which positive trials had significantly lower scores than negative trials (P = 0.048). There was no difference between positive and negative trials in any category in terms of sample size. CONCLUSION: More positive than negative trials of complementary therapies are published, except in high-impact factor MM-journals. In non-impact factor CAM-journals positive studies were of poorer methodological quality than the corresponding negative studies. This was not the case in MM-journals which published on a wider range of therapies, except in those with high impact factors. Thus location of trials in terms of journal type and impact factor should be taken into account when the literature on complementary therapies is being examined.

Acupuncture Therapy↗
PubMed2006

Gynaecological oncology perspective on management of the menopause.

UNLABELLED: Treatment for gynaecological cancer may ablate ovarian function through surgery (oophorectomy), radiotherapy or chemotherapy. Bilateral oophorectomy or surgical menopause results in an immediate menopause which may be intensely symptomatic in young women. Also oestrogen deficiency before the age of 40 increases the risk of osteoporosis and cardiovascular disease. This article will describe the use of oestrogen and non-oestrogen-based treatments as well as alternative and complementary therapies in gynaecological cancer survivors. AIMS: To review the use of oestrogen and non-oestrogen-based treatments as well as alternative and complementary therapies in gynaecological cancer survivors in whom ovarian function has been ablated through surgery (oophorectomy), radiotherapy or chemotherapy. METHODS: Literature search using PubMed for indexed articles. RESULTS: Ovarian, cervical, vaginal and vulval cancers are not oestrogen dependent conditions and oestrogen replacement is not contraindicated. However, there is some doubt with regard to endometrioid ovarian cancer and endometrial carcinoma is often listed in data sheets as an absolute contra-indication to hormone replacement therapy. Progestogens may be effective in treating vasomotor symptoms. A variety of agents are available for the prevention and treatment of osteoporosis and all except parathyroid hormone and strontium ranelate act mainly by inhibiting bone resorption. There is little scientific evidence that complementary and alternative therapies can help menopausal symptoms or conserve bone mass and there are no safety data in women with gynaecological cancer. CONCLUSIONS: Oestrogen-based therapies are the treatments of choice in young women with a premature menopause since oestrogen deficiency before the age of 40 increases the risk of osteoporosis and cardiovascular disease.

Female↗
PubMed1998

Complementary medicine use by patients with inflammatory bowel disease.

OBJECTIVE: The purpose of this study was to establish the degree and determinants of the use of complementary therapies by patients with inflammatory bowel disease (IBD) and their reasons for seeking them. METHODS: The first phase was a cross-sectional survey of 134 patients with IBD (98 with Crohn's disease, 34 with ulcerative colitis, and two indeterminate) using a mailed, structured questionnaire (response rate 70%). Determinants of complementary medicine use were examined using logistic regression. The second phase was an in-depth exploration using personal interviews of the beliefs and perceptions of 14 complementary medicine users about the management of their disease. Analysis was performed using standard qualitative techniques and the identification of important, patient-identified themes about the management of IBD. RESULTS: Complementary therapies had been used by 51% of patients in the previous 2 yr. Current use was reported by 33%, of whom one-half were using it for their IBD. Vitamins and herbal products were the most commonly reported therapies. In multivariate analysis, duration of disease > 10 yr and a history of hospitalization were independent predictors of complementary medicine use. The side effects and lack of effectiveness of standard therapies were the most commonly cited reasons for seeking complementary medicine. Sixty-two percent had told their doctor about their use of complementary medicine. CONCLUSION: Complementary medicine use is common in patients with IBD, especially among those with a longer duration of disease or a history of hospitalization.

Adolescent↗
PubMed1997

A rat model of focal embolic cerebral ischemia.

We developed a new model of embolic cerebral ischemia in the rat which provides a reproducible and predictable infarct volume within the territory supplied by the middle cerebral artery (MCA). The MCA was occluded by an embolus in Wistar rats (n = 71). An additional three non-embolized rats were used as a control. Cerebral blood flow (CBF) was measured by means of laser Doppler flowmetry (LDF) and perfusion weighted imaging (PWI) before and after embolization. The evolution of the lesion was monitored by diffusion weighted imaging (DWI). Cerebral vascular perfusion patterns were examined using laser scanning confocal microscopy. Infarct volumes were measured on hematoxylin and eosin (H&E) stained coronal sections. The lodgment of the clot at the origin of the MCA and the ischemic cell damage were examined using light microscopy. Regional CBF in the ipsilateral parietal cortex decreased to 43 +/- 4.1% (P < 0.05) of preischemic levels (n = 10). Confocal microscopic examination revealed a reduction of cerebral plasma perfusion in the ipsilateral MCA territory (n = 6). MRI measurements showed a reduction in CBF and a hyperintensity DWI encompassing the territory supplied by the MCA (n = 4). An embolus was found in all rats at 24 h after embolization. The infarct volume as a percentage of the contralateral hemisphere was 32.5 +/- 3.31% at 24 h (n = 20), 33.0 +/- 3.6% at 48 h (n = 13), and 34.5 +/- 4.74% at 168 h (n = 12) after embolization. This model of embolic focal cerebral ischemia results in ischemic cell damage and provides a reproducible and predictable infarct volume. This model is relevant to thromboembolic stroke in humans and may be useful in documenting the safety and efficacy of fibrinolytic intervention and in investigating therapies complementary to antithrombotic therapy.

Animals↗
PubMedDate not supplied

[Therapy of cancers from the viewpoint of the Austrian population].

The aim of this study was to survey the level of knowledge of the Austrian population about cancer treatment and to explore the ratings of the respondents concerning the importance of different modalities of treatment. A representative sample of Austrians > or = 15 years of age (n = 2073) was interviewed. Out of the respondents 94% claim that they have heard or read about chemotherapy. With regard to surgery and radiotherapy, this is stated by 83% and 73%, respectively. Hormonal therapy, immunotherapy and complementary therapy are known by a much smaller percentage (34% and less), whereas 52% claim that they have heard about homeopathy as a form of cancer treatment. The self-assessment of knowledge shows that 64% of all respondents state to have some knowledge about chemotherapy (surgery: 45%, radiotherapy: 26%). Persons with limited formal education report to have a lower level of knowledge. Surgery is rated to be the most important regimen, followed by chemotherapy and radiotherapy. Respondents with some knowledge about a certain treatment give higher ratings concerning the importance of this modality. The survey shows that a high percentage of the Austrian population has heard or read about chemotherapy and claims to have some knowledge about it. Especially the latter is not found for other treatments. Surgery, chemotherapy and radiotherapy are seen as the most important modalities of treatment. Individuals with a low level of education constitute an especially important target group for information about cancer treatment.

Adolescent↗
PubMed1997

A new rat model of thrombotic focal cerebral ischemia.

We developed a fibrin-rich thrombotic focal cerebral ischemic model with reproducible and predictable infarct volume in rats. In male Wistar rats (n = 77), a thrombus was induced at the origin of the middle cerebral artery (MCA) by injection of thrombin via an intraluminal catheter placed in the intracranial segment of the internal carotid artery (ICA). Thrombus induction and consequent ischemic cell damage were examined by histopathological analysis and neurological deficit scoring, and by measuring changes in cerebral blood flow (CBF) using laser-Doppler flowmetery (LDF), perfusion-weighted imaging (PWI), and by diffusion weighted imaging (DWI). Histopathology revealed that a fibrin-rich thrombus localized to the origin of the right MCA. Regional cerebral blood flow (rCBF) in the right parietal cortex was reduced by 34-58% of preinjection levels after injection of thrombin in rats administered 30 U of thrombin (n = 10). Magnetic resonance imaging (MRI) showed a reduction in CBF and a hyperintensity DWI encompassing the territory supplied by the right MCA. The infarct volume in rats administered 80 U of thrombin was 31.29 +/- 12.9% of the contralateral hemisphere at 24 h (n = 13), and 34.7 +/- 16.4% of the contralateral hemisphere at 168 h (n = 6). Rats administered 30 U of thrombin exhibited a hemispheric infarct volume of 34.0 +/- 14.5% (n = 9) at 24 h and 29.7 +/- 13.9% (n = 8) at 168 h. In addition, thrombotic rats (n = 3) treated with recombinant tissue plasminogen activator (rt-PA) (10 mg/kg) 2 h after thrombosis showed that CBF rapidly returned towards preischemic values as measured by PWI. This model of thrombotic ischemia is relevant to thromboembolic stroke in humans and may be useful in documenting the safety and efficacy of thrombolytic intervention as well as for investigating therapies complementary to antithrombotic therapy.

Animals↗
PubMed2003

Alternative approaches to immunotherapy of allergy.

Alternative therapies for allergic diseases may be prescribed by physicians or provided by other practitioners or selected by patients without resorting to consultation with a health advisor. The most popular alternative therapies include dietary manipulation and exaggerated avoidance of allergens. Established medical therapies include herbs (Western and Asian), homeopathy and acupuncture; many publications suggest they are of value in allergic disease management. However, most studies lack sufficient power, do not have adequate controls, fail to duplicate standard clinical practices, or utilize a heterogeneous group of subjects. Careful analysis suggest that popular alternative therapies might offer a minimal benefit over placebos, but further studies are required for more rigorous evaluation of outcomes. Numerous esoteric or non-specific methods of treating allergic diseases are also available which may be promoted by enthusiastic practitioners or supported by satisfied patients. The majority of such therapies will never be scientifically evaluated, and the results of such modalities will be difficult to separate out from those of true placebo treatments. It is evident that while the "prose" of scientifically established therapies is appealing to a declining number of patients, the "poetry" of complementary therapies resonates with an increasing majority of the public who believe in the magic of alternative medicine.

Acupuncture Therapy↗
PubMed2005

Do GPs practice what they preach? A questionnaire study of GPs' treatments for themselves and their patients.

Anecdotal evidence indicates a difference between doctors' health seeking behaviours for their patients and for themselves. This difference remains untested. This study aimed to assess any differences between the first-line treatment options GPs would accept for themselves and those they would advise their patients. A postal questionnaire was completed by 286 GPs based in two west London Health Authorities (response rate 51.4%) asking them to score the treatment options of 6 common symptoms for both themselves and their patients in terms of over the counter (OTC) remedies, prescriptions, referrals and complementary therapies. The results showed that GPs differentiated between themselves and their patients in terms of OTC remedies for indigestion and depression, prescriptions for indigestion, hypertension, depression and 'tired all the time' (TATT); referrals for indigestion, hypertension, low back pain and TATT; and complementary therapy for depression. GPs may be prepared to cross the boundary be treated the same as their patients if the symptoms are relatively uncontroversial. Stigmatised problems and those with clinical guidelines, however, seem to result in a 'do as I say not as I do' approach to health care.

Attitude of Health Personnel↗