Current Oncology

42 KiB

Open AccessAbstract

Integrative Practices of Canadian Oncology Health Professionals

by A. S. A. Brazier, L. G. Balneaves, D. Seely, J. E. Stephen, N. Suryaprakash and J. W. Taylor-Brown

Curr. Oncol. 2008, 15(s2), 110; https://doi.org/10.3747/co.v15i0.283 - 1 Aug 2008

Cited by 6 | Viewed by 63

Abstract

Objective: Cancer patients are increasingly known to use complementary medicine (cam) during conventional treatment, but data are limited on how Canadian oncology health professionals attempt to assist patients with their use of cam in the context of conventional cancer care. As part of [...] Read more.

Objective: Cancer patients are increasingly known to use complementary medicine (cam) during conventional treatment, but data are limited on how Canadian oncology health professionals attempt to assist patients with their use of cam in the context of conventional cancer care. As part of a larger qualitative study assessing the perceptions of Canadian oncology health professionals regarding integrated breast cancer care, we undertook an exploration of current integrative practices of oncology health professionals. Design: Using an interpretive description research design and a purposive sampling, we conducted a series of in-depth qualitative interviews with various oncology health professionals recruited from provincial cancer agencies, hospitals, integrative clinics, and private practice settings in four Canadian cities: Vancouver, Winnipeg, Montreal, and Halifax. A total of 16 oncology health professionals participated, including medical and radiation oncologists, nurses, and pharmacists. Results: Findings highlighted two main strategies used by oncology health professionals to create a more integrative approach for cancer patients: acting as an integrative care guide, and collaborating with other health professionals. Conclusions: Although few clear standards of practice or guidance material were in place within their organizational settings, health professionals discussed some integrative roles that they had adopted, depending on interest, knowledge, and skills, in supporting patients with cam decisions. Given that cancer patients report that they want to be able to confer with their conventional health professionals, particularly their oncologists, about their cam use, health professionals who elect to adopt integrative practices are likely offering patients much-welcomed support. Full article

4 pages, 42 KiB

Open AccessArticle

Impact and Outcomes of an Iyengar Yoga Program in a Cancer Centre

by M. D. Duncan, A. Leis and J. W. Taylor–Brown

Curr. Oncol. 2008, 15(s2), 109; https://doi.org/10.3747/co.v15i0.284 - 1 Aug 2008

Cited by 20 | Viewed by 1771

Abstract

Background: Individuals have increasingly sought complementary therapies to enhance health and well-being during cancer, although little evidence of their effect is available. Objectives: We investigated (1) how an Iyengar yoga program affects the self-identified worst symptom in a group of participants. (2) whether [...] Read more.

Background: Individuals have increasingly sought complementary therapies to enhance health and well-being during cancer, although little evidence of their effect is available. Objectives: We investigated (1) how an Iyengar yoga program affects the self-identified worst symptom in a group of participants. (2) whether quality of life, spiritual well-being, and mood disturbance change over the Iyengar yoga program and at 6 weeks after the program. (3) how, from a participant’s perspective, the Iyengar yoga program complements conventional cancer treatment. Patients and Methods: This pre–post instrumental collective case study used a mixed methods design and was conducted at a private Iyengar yoga studio. The sample consisted of 24 volunteers (23 women, 1 man; 88% Caucasian; mean age: 49 years) who were currently on treatment or who had been treated for cancer within the previous 6 months, and who participated in ten 90-minute weekly Iyengar yoga classes. The main outcome measures were most-bothersome symptom (Measure Your Medical Outcome Profile 2 instrument), quality of life and spiritual well-being (Functional Assessment of Chronic Illness Therapy–General subscale and Spiritual subscale), and mood disturbance (Profile of Mood States–Short Form). Participant perspectives were obtained in qualitative interviews. Results: Statistically significant improvements were reported in most-bothersome symptom (t₍₂₃₎ = 5.242; p < 0.001), quality of life (F_(2,46) = 14.5; p < 0.001), spiritual well-being (F_(2,46) = 14.4; p < 0.001), and mood disturbance (F_(2,46) = 10.8; p < 0.001) during the program. At follow-up, quality of life (t₍₂₁₎ = −3.7; p = 0.001) and mood disturbance (t₍₂₁₎ = 2.4; p = 0.025) significantly improved over time. Categorical aggregation of the interview data showed that participants felt the program provided them with various benefits not included on the outcomes questionnaires. Conclusions: Over the course of the Iyengar Yoga for Cancer program, participants reported an improvement in overall well-being. The program was also found to present participants with a holistic approach to care and to provide tools to effectively manage the demands of living with cancer and its treatment. Full article

39 KiB

Open AccessAbstract

Interactions of Natural Health Products with Biomedical Cancer Treatments

by D. Seely and D. Oneschuk

Curr. Oncol. 2008, 15(s2), 109-110; https://doi.org/10.3747/co.v15i0.282 - 1 Aug 2008

Cited by 38 | Viewed by 56

Abstract

The use of complementary and alternative medicine (cam), including the ingestion of natural health products (nhps), is common among cancer patients. Of concern to clinicians and patients alike is the possibility that cam, used concurrently with biomedical therapy, may interact poorly with that [...] Read more.

The use of complementary and alternative medicine (cam), including the ingestion of natural health products (nhps), is common among cancer patients. Of concern to clinicians and patients alike is the possibility that cam, used concurrently with biomedical therapy, may interact poorly with that therapy, especially chemotherapy and radiotherapy. Proponents of nhps argue that taking such products can help to reduce the side effects of conventional therapy and can provide an additional anticancer effect. However, opponents insist that the potential for harm is too great to warrant the risk of concurrent administration. There are promising examples of specific nhps that may provide patient benefit even when given in close proximity both to chemotherapy and to radiotherapy, but unfortunately, in part because of a rather limited evidence base, caution is warranted when considering the issue of therapeutic interactions. Strategic application of nhps before or after conventional therapy may be considered; however, concurrent application should be avoided as a general principle until further evidence is available regarding specific interactions. Full article

4 pages, 42 KiB

Open AccessArticle

How to Put Wellness on the Prescription Pad: Recommendations

by P. R. Fortin

Curr. Oncol. 2008, 15(s2), 109; https://doi.org/10.3747/co.v15i0.277 - 1 Aug 2008

Cited by 1 | Viewed by 803

Abstract

The Integrating Wellness into Cancer Care conference was held at the University of Toronto, October 4–5, 2007, and was dedicated to the memory of the late Dr. Véronique Benk. This article summarizes the workshops at that conference. The notion of wellness and an [...] Read more.

The Integrating Wellness into Cancer Care conference was held at the University of Toronto, October 4–5, 2007, and was dedicated to the memory of the late Dr. Véronique Benk. This article summarizes the workshops at that conference. The notion of wellness and an integrated approach should be introduced from the outset as part of the cancer patient’s management. Having wellness as part of the treatment sets a standard for taking care of the patient’s emotional, spiritual, physical, and nutritional needs, and for providing information on complementary therapies. A focus on holistic supportive care during treatment and survivorship is important. The whole medical team should support an integrative program. Referral to an education program and one-to-one assessments by a point person such as an advanced nurse practitioner, a social worker, or a psychological counsellor with appropriate special training should be mandatory. The concept of a pathfinder or cancer guide was discussed. Full article

4 pages, 42 KiB

Open AccessArticle

An Integrated Support and Information Centre in a Large U.K. Cancer Centre Established in 1993 and Replicated in More Than 60 Units Across the United Kingdom and Australia

by E.J. Maher

Curr. Oncol. 2008, 15(s2), 108; https://doi.org/10.3747/co.v15i0.276 - 1 Aug 2008

Cited by 9 | Viewed by 806

Abstract

Established in 1993 after a 2-year consultation between professionals and cancer patients, the Lynda Jackson Macmillan Centre (ljmc) has been a catalyst for change in the United Kingdom. The Centre began with a small core staff in a purpose-built building next to a [...] Read more.

Established in 1993 after a 2-year consultation between professionals and cancer patients, the Lynda Jackson Macmillan Centre (ljmc) has been a catalyst for change in the United Kingdom. The Centre began with a small core staff in a purpose-built building next to a cancer centre, networking with outreach workers in 12 surrounding hospitals, with a mission to improve information, communication, and support for cancer patients. Since 1996, the ljmc model has been adopted and developed by the charity Macmillan Cancer Support and has been spread to more than 60 units across the United Kingdom and Australia. Full article

4 pages, 42 KiB

Open AccessArticle

Integrative Cancer Care in a US Academic Cancer Centre: The Memorial Sloan–Kettering Experience

by G. Deng

Curr. Oncol. 2008, 15(s2), 108; https://doi.org/10.3747/co.v15i4.267 - 1 Aug 2008

Cited by 6 | Viewed by 985

Abstract

Various surveys show that interest in complementary and alternative medicine (<italic>cam</italic>) is high among cancer patients. Patients want to explore all options that may help their treatment. Many cam modalities offer patients an active role in their self-care, and the resulting sense [...] Read more.

Various surveys show that interest in complementary and alternative medicine (<italic>cam</italic>) is high among cancer patients. Patients want to explore all options that may help their treatment. Many cam modalities offer patients an active role in their self-care, and the resulting sense of empowerment is very appealing. On the other hand, many unscrupulous marketeers promote alternative cancer “cures,” targeting cancer patients who are particularly vulnerable. Some alternative therapies can hurt patients by delaying effective treatment or by causing adverse effects or detrimental interactions with other medications. It is not in the best interest of cancer patients if they cannot get appropriate guidance on the use of cam from the health care professionals who are part of their cancer care team. The Integrative Medicine Service at Memorial Sloan–Kettering Cancer Center in New York was established in 1999 to address patient interest in cam, to incorporate helpful complementary therapies into each patient’s overall treatment management, to guide patients in avoiding harmful alternative therapies, and to develop prospective research to evaluate the efficacy of cam modalities. Full article

4 pages, 42 KiB

Open AccessArticle

Research and Regulatory Issues for Integrative Oncology

by S. M. Sagar and R. K. W. Wong

Curr. Oncol. 2008, 15(s2), 107-108; https://doi.org/10.3747/co.v15i0.273 - 1 Aug 2008

Viewed by 672

Abstract

Many oncology patients are empowering themselves to self-treat with herbs, nutritional supplements, and mind–body techniques. Other practitioners, such as acupuncturists, are becoming involved in the supportive care of cancer patients. Government research agencies are supporting studies that evaluate complementary therapies. This educational article [...] Read more.

Many oncology patients are empowering themselves to self-treat with herbs, nutritional supplements, and mind–body techniques. Other practitioners, such as acupuncturists, are becoming involved in the supportive care of cancer patients. Government research agencies are supporting studies that evaluate complementary therapies. This educational article provides an overview of the challenges in designing appropriate studies of complementary and alternative therapies, evaluating the results, and regulating implementation of useful therapies. Full article

4 pages, 42 KiB

Open AccessArticle

The Soul’s Wisdom: Stories of Living and Dying

by M. L. S. Vachon

Curr. Oncol. 2008, 15(s2), 107; https://doi.org/10.3747/co.v15i0.272 - 1 Aug 2008

Cited by 1 | Viewed by 724

Abstract

Cancer can lead to spiritual transformation, which can be seen as a form of alchemy. During this process, patients, family members, and even professional caregivers can find themselves having spiritual experiences that go beyond any they had previously encountered. This paper provides qualitative [...] Read more.

Cancer can lead to spiritual transformation, which can be seen as a form of alchemy. During this process, patients, family members, and even professional caregivers can find themselves having spiritual experiences that go beyond any they had previously encountered. This paper provides qualitative descriptions of the “Field” or “Soul Wisdom” experienced by patients and caregivers. Full article

4 pages, 42 KiB

Open AccessArticle

Supporting Cancer Patients through the Continuum of Care: A View from the Age of Social Networks and Computer-Mediated Communication

by J. L. Bender, L. O’Grady and A. R. Jadad

Curr. Oncol. 2008, 15(s2), 107; https://doi.org/10.3747/co.v15i0.270 - 1 Aug 2008

Cited by 9 | Viewed by 1043

Abstract

Almost since its inception, the Internet has been used by ordinary people to connect with peers and to exchange health-related information and support. With the rapid development of software applications deliberately designed to facilitate social interaction, a new era is dawning in which [...] Read more.

Almost since its inception, the Internet has been used by ordinary people to connect with peers and to exchange health-related information and support. With the rapid development of software applications deliberately designed to facilitate social interaction, a new era is dawning in which patients and their loved ones can collaboratively build knowledge related to coping with illness, while meeting their mutual supportive care needs in a timely way, regardless of location. In this article, we provide background information on the use of “one-to-one” (for example, e-mail), “one-to-many” (for example, e-mail lists), and “many-to-many” (for example, message boards and chat rooms, and more recently, applications associated with Web 2.0) computer-mediated communication to nurture health-related social networks and online supportive care. We also discuss research that has investigated the use of social networks by patients, highlight opportunities for health professionals in this area, and describe new advances that are fuelling this new era of collaboration in the management of cancer. Full article

4 pages, 42 KiB

Open AccessArticle

The HealingJourney: Incorporating Psychological and Spiritual Dimensions into the Care of Cancer Patients

by A. J. Cunningham

Curr. Oncol. 2008, 15(s2), 107; https://doi.org/10.3747/co.v15i0.269 - 1 Aug 2008

Cited by 1 | Viewed by 882

Abstract

Research on the factors that promote healing of the body through mind and spirit is at a very early stage. Reliance on experimental designs seems premature; we need much more exploratory research to identify relevant variables and useful therapeutic approaches before applying to [...] Read more.

Research on the factors that promote healing of the body through mind and spirit is at a very early stage. Reliance on experimental designs seems premature; we need much more exploratory research to identify relevant variables and useful therapeutic approaches before applying to them the same methods used to evaluate drugs. The Healing Journey is a program that has been in operation since 1982 at the Princess Margaret Hospital, Toronto, Ontario. Observational data collection, followed by qualitative analysis has demonstrated benefits for many cancer patients. Full article

85 KiB

Open AccessPerspective

Declining Conventional Cancer Treatment and Using Complementary and Alternative Medicine: A Problem or a Challenge?

by M. J. Verhoef, M. S. Rose, M. White and L. G. Balneaves

Curr. Oncol. 2008, 15(s2), 101-106; https://doi.org/10.3747/co.v15i0.281 - 1 Aug 2008

Cited by 25 | Viewed by 79

Abstract

Background: Several studies have shown that a small but significant percentage of cancer patients decline one or more conventional cancer treatments and use complementary and alternative medicine (cam) instead. Objectives: Here, drawing on the literature and on our own ongoing research, we describe [...] Read more.

Background: Several studies have shown that a small but significant percentage of cancer patients decline one or more conventional cancer treatments and use complementary and alternative medicine (cam) instead. Objectives: Here, drawing on the literature and on our own ongoing research, we describe why cancer patients decide to decline conventional cancer treatments, who those patients are, and the response by physicians to patients who make such decisions. Results: Poor doctor–patient communication, the emotional impact of the cancer diagnosis, perceived severity of conventional treatment side effects, a high need for decision-making control, and strong beliefs in holistic healing appear to affect the decision by patients to decline some or all conventional cancer treatments. Many patients indicate that they value ongoing follow-up care from their oncologists provided that the oncologists respect their beliefs. Patients declining conventional treatments have a strong sense of internal control and prefer to make the final treatment decisions after considering the opinions of their doctors. Few studies have looked at the response by physicians to patients making such a decision. Where research has been done, it found that a tendency by doctors to dichotomize patient decisions as rational or irrational may interfere with the ability of the doctors to respond with sensitivity and understanding. Conclusions: Declining conventional treatment is not necessarily an indicator of distrust of the medical system, but rather a reflection of many personal factors. Accepting and respecting such decisions may be instrumental in “keeping the door open.” Full article

7 pages, 120 KiB

Open AccessArticle

Patient Decision-Making about Complementary and Alternative Medicine in Cancer Management: Context and Process

by L. G. Balneaves, L. Weeks and D. Seely

Curr. Oncol. 2008, 15(s2), 94-100; https://doi.org/10.3747/co.v15i0.280 - 1 Aug 2008

Cited by 38 | Viewed by 1367

Abstract

Objective: In this paper, we set out to describe the personal and social contexts of treatment decisions made by cancer patients concerning complementary and alternative medicine (cam) and also the process through which cancer patients reach cam decisions throughout the cancer trajectory. Methods: [...] Read more.

Objective: In this paper, we set out to describe the personal and social contexts of treatment decisions made by cancer patients concerning complementary and alternative medicine (cam) and also the process through which cancer patients reach cam decisions throughout the cancer trajectory. Methods: We selected and reviewed a variety of cam decision-making models published in the past 10 years within the Canadian health literature. Results: The cam decision-making process is influenced by a variety of sociodemographic, disease-related, psychological, and social factors. We reviewed four main phases of the cam decision-making process:(1) Taking stock of treatment options; (2) Gathering and evaluating cam information; (3) Making cam decisions; (4) Revisiting the cam decision. Immediately following diagnosis, cancer patients become interested in taking stock of the full spectrum of conventional and cam treatment options that may enhance the effectiveness of their treatment and mediate potential side effects. Information about cam is then gathered from numerous information sources that vary in terms of credibility and scientific legitimacy, and is evaluated. When making a decision regarding cam options, patients attempt to make sense of the diverse information obtained, while acknowledging their beliefs and values. The cam decision is often revisited at key milestones, such as the end of conventional treatment and when additional information about disease, prognosis, and treatment is obtained. Conclusions: The cam decision-making process is a dynamic and iterative process that is influenced by a complex array of personal and social factors. Oncology health professionals need to be prepared to offer decision support related to cam throughout the cancer trajectory. Full article

6 pages, 86 KiB

Open AccessPerspective

Talking to Cancer Patients about Complementary Therapies: Is It the Physician’s Responsibility?

by M. J. Verhoef, H. S. Boon and S. A. Page

Curr. Oncol. 2008, 15(s2), 88-93; https://doi.org/10.3747/co.v15i0.279 - 1 Aug 2008

Cited by 38 | Viewed by 804

Abstract

Background: To ensure the safety and effectiveness of cancer management, it is important for physicians treating cancer patients to know whether their patients are using complementary and alternative medicine (cam) and if so, why. Objective: Here, we discuss the ethical and legal obligations [...] Read more.

Background: To ensure the safety and effectiveness of cancer management, it is important for physicians treating cancer patients to know whether their patients are using complementary and alternative medicine (cam) and if so, why. Objective: Here, we discuss the ethical and legal obligations of physicians to discuss cam use in an oncology setting, and we provide practical advice on how patient–provider communication about cam can be improved. Results: Physicians have both ethical and legal obligations to their patients, including the obligation to respect patient autonomy. This latter obligation extends to use of cam by patients and needs to be addressed beginning early in the patient–provider relationship. Because lack of education in this field and lack of time during patient consultations are barriers to talking with patients about cam, we provide resources to facilitate such discussions. These resources include suggestions on how to discuss the topic of cam and a wide range of information sources. Conclusions: Discussing cam with patients is the physician’s responsibility, and such discussion will facilitate evidence-based, patient-centred cancer care. Full article

5 pages, 82 KiB

Open AccessArticle

Principles to Guide Integrative Oncology and the Development of an Evidence Base

by A. M. Leis, L. C. Weeks and M. J. Verhoef

Curr. Oncol. 2008, 15(s2), 83-87; https://doi.org/10.3747/co.v15i0.278 - 1 Aug 2008

Cited by 15 | Viewed by 1000

Abstract

Background: Integrative oncology uses both conventional and complementary medicine to meet the needs of individual patients and to focus on the whole person. The core principles of integrative oncology include individualization, holism, dynamism, synergism, and collaboration, but the nature of the evidence to [...] Read more.

Background: Integrative oncology uses both conventional and complementary medicine to meet the needs of individual patients and to focus on the whole person. The core principles of integrative oncology include individualization, holism, dynamism, synergism, and collaboration, but the nature of the evidence to guide the development of integrative oncology has been given little attention. Objectives: (1) To discuss the need for evidence to support the integration of complementary therapies for integrative oncology care. (2) To emphasize that the evidence base must be valid and respect the underlying principles of individual complementary therapies and integrative oncology practice. (3) To suggest ways to begin developing the evidence base. Review and Discussion: Although the evidence for safety and efficacy seems paramount for supporting the integration of an individual complementary therapy into mainstream cancer care, the need for evidence to support the overall practice of integrative oncology has to be considered as well. We argue that developing an evidence base for integrative oncology requires a contextual and comprehensive research approach that assesses a range of outcomes over a suitable period of time that the patient and the patient’s family, in addition to the health care providers, deem important. Conclusion: A whole-systems framework to the development of the evidence base for integrative oncology can guide the development of evidence that respects the complex nature of many complementary and integrative practices and their underlying principles of care delivery. Full article

5 pages, 83 KiB

Open AccessArticle

How Do We Evaluate Outcome in an Integrative Oncology Program?

by S. M. Sagar

Curr. Oncol. 2008, 15(s2), 78-82; https://doi.org/10.3747/co.v15i0.271 - 1 Aug 2008

Cited by 8 | Viewed by 803

Abstract

Integrative oncology focuses on the roles of complementary therapies to increase the effectiveness of conventional cancer treatment programs by improving defined outcomes such as symptom control, quality of life, rehabilitation, and prevention of recurrence. Implementation of integrative oncology programs should be based on [...] Read more.

Integrative oncology focuses on the roles of complementary therapies to increase the effectiveness of conventional cancer treatment programs by improving defined outcomes such as symptom control, quality of life, rehabilitation, and prevention of recurrence. Implementation of integrative oncology programs should be based on the best evidence and must continually be evaluated to ensure quality, optimization of techniques, collection of new data, and cost-effectiveness. Useful domains that can be evaluated include symptom control, adherence to treatment protocols, quality of life, individual outcomes, prevention, rehabilitation, potential advantages of a whole-systems health approach, and economics of health services. Full article

4 pages, 106 KiB

Open AccessArticle

Integrating Science and Human Values for Cancer Patient Care

by S. B. Sutcliffe

Curr. Oncol. 2008, 15(s2), 74-77; https://doi.org/10.3747/co.v15i0.268 - 1 Aug 2008

Viewed by 827

Abstract

The burden of cancer continues to increase globally, with substantial personal, societal, and economic consequences. Population growth and aging underlie this increase—a reflection of the effect of population health interventions in the last two centuries. Much of this gain has come through observation, [...] Read more.

The burden of cancer continues to increase globally, with substantial personal, societal, and economic consequences. Population growth and aging underlie this increase—a reflection of the effect of population health interventions in the last two centuries. Much of this gain has come through observation, derivation of evidence, and rigorous application of valid science to the public, both healthy and affected by diseases such as cancer. Increasingly, molecular medicine will affect the knowledge of cause and the personalization of therapy. However, science informs the decision-making process and places evidence within the beliefs of individuals and society as they relate to innovation, judgment, and values—the “logic” underlying alignment of conventional and complementary (holistic) care as a basis for compelling, consistent, and confident decisions. Full article

3 pages, 71 KiB

Open AccessEditorial

Integrative Oncology: A Canadian and International Perspective

by S. M. Sagar and A. M. Leis

Curr. Oncol. 2008, 15(s2), 71-73; https://doi.org/10.3747/co.v15i0.292 - 1 Aug 2008

Cited by 4 | Viewed by 789

Abstract

We are pleased to present this special supplement of Current Oncology, which is generously financed by a grant from the Lotte and John Hecht Memorial Foundation. Integrative oncology is both a science and a [...]
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Curr. Oncol., Volume 15, Issue s2 (August 2008) – 17 articles

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