The impact of integrative medicine on quality of life in patients with diabetes mellitus and cancer

Background: Research on quality of life (QoL)-related concerns among patients with both diabetes mellitus (DM) and cancer is limited. This study compared the QoL-related concerns and characteristics among chemotherapy-treated patients with cancer and DM to those without DM. Methods: Chemotherapy-treated patients were evaluated during integrative oncology (IO) consultations, which included evidence-based complementary therapies recommended by their healthcare providers to address quality of life (QoL) concerns. During these consultations, the participants were assessed for comorbidities, including diabetes mellitus (DM). QoL-related concerns were measured using the Edmonton Symptom Assessment Scale (ESAS) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Results: Of the 1171 patients referred for an IO consultation, 272 (23.2%) had an established diagnosis of DM. The DM patients were older, presented with more advanced stages of cancer, and had more chronic comorbidities (p < 0.001). While fatigue was the most frequently reported QoL-related concern in both groups, the patients with DM had more severe pain scores in the ESAS (4.9 vs. 4.4, p = 0.022) and lower ESAS well-being scores (5.9 vs. 5.5, p = 0.021). Conclusions: Chemotherapy-treated patients with cancer and DM are characterized by higher rates of comorbidities and report more severe scores for pain and for poorer general well-being. Oncologists and diabetologists should consider referring patients with both diagnoses for an IO consultation to address their QoL-related concerns. More research is needed to understand the impact of IO consultations and treatments on well-being among patients diagnosed with both DM and cancer.

Objective To investigate the impact of diabetes on quality of life in breast cancer patients. Methods A cross-sectional study was conducted among 3 344 community patients suffering from breast cancer during April to July 2013, in Shanghai. Data were collected using a questionnaire, which included socio-demographic situation, diagnosis, and treatment of cancer, as well as diabetes mellitus. European Organization for Research and Treatment of Cancer QOL Questionnaire-C30(EORTC QLQ-C30)Simplified Chinese Version and Functional Assessment of Cancer Therapy(FACT-G)Simplified Chinese Version were used to investigate the quality of life in the patients. The quality of life scores in breast cancer patients with and without diabetes were compared. Results The prevalence of diabetes was 14.38% in the patients with breast cancer. Breast cancer patients without diabetes reported significantly higher EORTC QLQ-C30 scores in physical functioning, role functioning, cognitive functioning, emotional functioning, social functioning, global health, lower EORTC QLQ-C30 scores in fatigue, pain, dyspnoea, insomnia, appetite loss, constipation, diarrhoea, and higher FACT-G scores in physical well-being, social/family well-being, emotional well-being, functional well-being, compared with the patients with diabetes(P<0.05). Conclusions Diabetes mellitus affects the quality of life in patients with breast cancer. Integrated measures for chronic disease management should be taken to improve the quality of life in patients with breast cancer as well as diabetes mellitus. (Chin J Endocrinol Metab, 2015, 31: 43-46) Key words: Diabetes; Breast cancer; Quality of life

Complementary/integrative medicine (CIM) is increasingly being integrated with standard supportive cancer care. The effects of CIM on quality of life (QOL) during chemotherapy need to be examined in varied socio-cultural settings. We purpose to explore the impact of CIM on QOL-related outcomes among Russian-speaking (RS) patients with cancer. RS patients undergoing chemotherapy receiving standard supportive care were eligible. Patients in the treatment arm were seen by an integrative physician (IP) and treated within a patient-tailored CIM program. Symptoms and QOL were assessed at baseline, at 6, and at 12weeks with the Edmonton Symptom Assessment Scale (ESAS), the Measure Yourself Concerns and Wellbeing (MYCAW) questionnaire, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Of 70 patients referred to the treatment arm, 50 (71.4%) underwent IP assessment and CIM treatments. Of 51 referred to the control arm, 38 (76%) agreed to participate. At 6weeks, CIM-treated patients reported improved ESAS scores for fatigue (P = 0.01), depression (P = 0.048), appetite (P = 0.008), sleep (P < 0.0001), and general wellbeing (P = 0.004). No improvement was observed among controls. Between-group analysis found CIM-treated patients had improved sleep scores on ESAS (P = 0.019) and EORTC (P = 0.007) at 6weeks. Social functioning improved between 6 and 12weeks (EORTC, P = 0.02), and global health status/QOL scale from baseline to 12weeks (EORTC, P = 0.007). A patient-tailored CIM treatment program may improve QOL-related outcomes among RS patients undergoing chemotherapy. Integrating CIM in conventional supportive care needs to address cross-cultural aspects of care. The study protocol was registered at ClinicalTrials.gov ( https://clinicaltrials.gov/ct2/show/NCT01860365 ).

Many oncology centers provide integrative oncology (IO) care, many within palliative care settings. The primary study objective was to examine the impact of IO-palliative patient-tailored program on quality of life (QoL) among patients with advanced cancer. In this pragmatic prospective controlled study, patients with advanced cancer undergoing chemotherapy/palliative care were referred by their oncology healthcare providers to an integrative physician (IP) consultation and weekly IO treatments. Patients with high adherence to integrative care (AIC; ≥ 4 IO sessions/6weeks) were compared with moderate (2-3 sessions) or low AIC patients (regarded as control group). Outcomes were assessed at 6- and 12-week follow-up with Edmonton Symptom Assessment Scale (ESAS) and EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) tools. Change in QoL scores (ESAS fatigue in particular) was considered a primary study outcome. Of 225 eligible patients, 153 underwent baseline and 6-week optimal assessment (high AIC, 100; moderate AIC, 22; low AIC, 31). High AIC patients reported greater improvement on ESAS scores for fatigue (vs. low-moderate AIC, P < 0.001), depression (vs. moderate AIC, P = 0.01) at 6 weeks, and sleep (P = 0.007) at 12weeks. High AIC patients had significantly improved EORTC global health status/QoL at 6weeks (vs. moderate-low AIC, P = 0.01), cognitive functioning (vs. moderate AIC, P = 0.043), and social functioning (vs. moderate AIC, P = 0.032). High AIC patients had lower rates of hospitalizations at 12weeks (19% vs. 35% in low AIC, P = 0.02; 44% in moderate AIC, P = 0.003), hospitalization days (vs. low AIC, P = 0.003), and opioid use (vs. low AIC, P < 0.001). High adherence to integrative care was associated with a significant effect on fatigue, depression, global QoL at 6weeks, and need for hospitalizations at 12weeks.

Gastrointestinal (GI) cancers are a growing global health issue, causing various symptoms. Based on Orem's self-care deficit theory, planned nursing care alleviates symptoms and supports self-care, while mobile applications assist in symptom monitoring. This study aimed to examine the effect of an Orem-based nursing intervention, supported by a mobile application, on symptoms, quality of life, and self-care in patients with GI cancer undergoing chemotherapy. This quasi-experimental study was conducted between May 2021 and May 2023 at the chemotherapy unit of Atatürk University Research Hospital in Türkiye, and included 56 chemotherapy patients who were assigned to an intervention group (n = 27), or to a control group (n = 29). Over 6 weeks, the intervention group received nursing care based on Orem's self-care deficit theory, facilitated through a mobile application, while the control group received standard care. Data were collected using the Edmonton symptom assessment scale (ESAS), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), and the self-care ability scale (SCAS). After the intervention, significant differences were observed between groups in ESAS, EORTC QLQ-C30 Symptom subscale, and SCAS scores (P < 0.01). The intervention group showed decreased scores on the EORTC QLQ-C30 Functional subscale, while the control group's scores increased, a statistically significant difference (P < 0.01). Additionally, general well-being scores increased in the intervention group and decreased in the control group, with significance (P < 0.01). This study highlights the potential of theory-based, application-supported nursing interventions in cancer care. The synergy between theoretical nursing frameworks and innovative tools offers a promising application approach to optimize symptom management, quality of life, and self-care.

An Integrative Pediatric Oncology Program Addressing Parents’ Quality of Life-Related Concerns

This study was conducted to assess the impact of a patient-tailored complementary/integrative medicine (CIM) program on gastro-intestinal (GI) symptoms and other concerns in female patients with breast/gynecological cancer undergoing chemotherapy. Patients with breast/gynecological cancer reporting GI-related concerns were referred to an integrative physician (IP) consultation. The treatment group included patients agreeing to attend the consultation; controls those who did not. The Edmonton Symptom Assessment Scale (ESAS) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were administered at baseline and at 6 weeks. Adherence to integrative care (AIC) was defined as attending ≥4 CIM treatments, with ≤30 days between each session. Of 496 patients approached, 289 reported GI-related concerns. Optimal assessment at baseline and 6 weeks was achieved in 117 patients in the treatment arm, with 86 adhering to the CIM program (AIC subgroup); and in 89 of controls. EORTC scores improved more significantly in the treatment arm for appetite (P = 0.018), fatigue (P = 0.026), cognitive functioning (P < 0.001) and emotional functioning (P = 0.002); and ESAS scores for pain (P = 0.038), anxiety (P = 0.016), and sleep (P = 0.001). EORTC scores improved more significantly in the AIC group for global health status/QOL (P = 0.041), physical functioning (P = 0.004), role functioning (P = 0.011), appetite (P = 0.019), and fatigue (P = 0.001); and ESAS scores for pain (P = 0.048), fatigue (P = 0.011), drowsiness (P = 0.035), and appetite (P = 0.002). The integration of CIM may improve chemotherapy-related GI and other QOL-related concerns in patients with breast and gynecological cancer, with greater benefit observed in adherent patients.

Fatigue and Quality of Life Among Patients with Diabetes and Non-diabetes Receiving Primary Percutaneous Coronary Interventions

Patients with pancreatic cancer exhibit various symptoms and numerous physiological and psychological complications. Therefore, designing intervention measures to alleviate symptoms is crucial. This study explored the effectiveness of a 4-week auricular acupressure intervention for reducing fatigue and improving quality of life, sleep quality, and physical activity in patients receiving chemotherapy for pancreatic cancer. This randomized controlled trial was conducted at a medical center in northern Taiwan. The study participants comprised 80 patients undergoing chemotherapy for pancreatic cancer. The experimental group received auricular acupressure therapy for 4 weeks, which targeted the shenmen (TF4), sympathetic (AH6), liver (CO12), spleen (CO13), and subcortex (AT4) acupoints, and the control group received routine care. The European Organization for Research and Treatment of Cancer Quality of Life Group Core Questionnaire-C30, European Organization for Research and Treatment of Cancer Quality of Life Group Core Questionnaire-PAN26, Brief Fatigue Inventory-Taiwanese version, Pittsburgh Sleep Quality Index, and 3-day Physical Activity Record were used for assessment. After auricular acupressure therapy for 4 weeks, the experimental group exhibited significant improvements in insomnia symptoms during weeks 1 to 4, as measured using the European Organization for Research and Treatment of Cancer Quality of Life Group Core Questionnaire-C30 (all P < .01), and improvements in sleep quality by week 4, as measured using the Pittsburgh Sleep Quality Index ( P < .036). After auricular acupressure therapy for 4 weeks, significant improvements were observed in patients' sleep quality and quality of life in terms of insomnia. Auricular acupressure can improve sleep quality and other aspects of quality of life among patients undergoing chemotherapy for pancreatic cancer. The study findings indicate the potential of auricular acupressure as an adjunctive cancer care treatment.

Background: Quality of life in patients with breast cancer is an important outcome. This paper presents an overview and outcome after surgery in breast cancer patients on the topic ranging from descriptive findings to clinical trials.&#x0D; Methods: This is a bibliographic review of the literature covering publications that appeared in English language in biomedical journals between 1992 and 2013. The search strategy included a combination of key words 'quality of life' and 'breast cancer', 'breast carcinoma' or post mastectomy in Titles. Of these, research articles like randomized controlled trials, reviews, abstracts, editorials, brief commentaries, letters were included. The major findings are summarized and presented under several headings: instruments used, validation studies, measurement issues, surgical treatment, quality of life as predictor of survival, psychological distress, supportive care, symptoms and sexual functioning.&#x0D; Results: Instruments-Several valid instruments were used to measure quality of life in breast cancer patients. The European Organization for Research and Treatment of Cancer Core Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its breast cancer specific complementary measure (EORTC QLQ-BR23) were listed in this study, as it is a common, highly standard and well developed instruments to measure quality of life in breast cancer patients. Different surgical procedures led to relatively similar results in terms of quality of life assessments, although mastectomy patients compared to conserving surgery patients usually reported a lower body image and sexual functioning. Systemic therapies-almost all studies indicated that breast cancer patients receiving chemotherapy might experience several side-effects and symptoms that negatively affect their quality of life. Adjuvant hormonal therapies also were found to have similar negative impact on quality of life, although in general they were associated with improved survival. Quality of life as predictor of survival-similar to known medical factors, quality of life data in metastatic breast cancer patients were found to be prognostic and predictive of survival time. Psychological distress-anxiety and depression were found to be common among breast cancer patients even years after the disease diagnosis and treatment. Psychological factors also were found to predict subsequent quality of life or even overall survival in breast cancer patients. As recommended, recognition and management of these symptoms is an important issue since such symptoms impair health-related quality of life. Sexual functioning-breast cancer patients especially younger patients suffer from poor sexual functioning that negatively affect quality of life.&#x0D; Conclusion: There was quite an extensive body of the literature on quality of life in breast cancer patients. These papers have made a considerable contribution to improving breast cancer care, although their exact benefit was hard to define. However, quality of life data provided scientific evidence for clinical decision-making and conveyed helpful information concerning breast cancer patients' experiences during the course of the disease diagnosis, treatment, disease-free survival time, and recurrences.&#x0D; Journal of Surgical Sciences (2013) Vol. 17 (1) : 35-44

Introduction: Diabetes mellitus (DM) has been generally considered one of the risk factors of breast cancer (BC) development. Glucagon-like-peptide-1 (GLP-1) has been reported to be associated with increased risks of cancer development in some human malignancies. Koehler et.al.,reported that GLP-1 analogues could be associated with intestinal tumor growth through increased Fibroblast Growth Factor 7 (FGF7). However, the involvement of GLP-1 has not been studied in BC. Therefore, in this study, we explored the possible association of GLP-1 with BC risk in DM patients, by comparing GLP-1 receptor (GLP-1R), FGF7 and Fibroblast Growth Factor Receptor2 (FGFR2) status of BC between DM and non-DM BC patients. Method: We immunolocalized GLP-1R, FGFR2 and FGF7, the ligand of FGFR2 in 125 BC cases with DM and 57 without DM (NDM), operated from 2005 to 2013 and 2017 at Nahanishi Clinic and Tohoku University Hospital, Japan, excluding those who received neoadjuvant chemotherapy. Result: The status of GLP-1R was significantly more frequent in BC tissue (Ca) than in normal mammary gland tissue (NCa) regardless of DM (DM Ca 67.2% vs NCa 19.5% P&amp;lt;0.001, NDM Ca 51.7% vs NCa 16.4% P&amp;lt;0.001). That of GLP-1R in Ca of the DM group was significantly more frequent than in the NDM group (DM 67.2% vs NDM 51.7% P=0.044). That of FGFR2 was significantly more frequent in Ca than NCa of DM group (Ca 92% vs NCa 59.3% P&amp;lt;0.01), although no significant difference detected in NDM group (Ca 82.8% vs NCa 74.5% P=0.29). There were no significant differences of FGFR2 status in BC between the DM and NDM groups (DM 92% vs NDM 82.8% P=0.062). H score of FGF7 tended to be higher in Ca than NCa in the DM group (Ca 176.5 vs NCa 158.5 P=0.058) but this was not detected in the NDM group (Ca 166.3 vs NCa 161.1 P=0.7). The status of FGF7 in Ca was not different between the DM and NDM groups (DM 176.5 vs NDM 166.3 P=0.37). That of FGF7 in Ca harboring GLP-1R was significantly higher than Ca without GLP-1R regardless of DM (DM GLP-1R+ 189.4 vs GLP-1R- 150 P&amp;lt;0.01, NDM GLP-1R+ 185.5 vs GLP-1R- 146.4 P&amp;lt;0.01) with the same findings obtained in NCa tissue (DM GLP-1R+ 237.8 vs GLP-1R- 137.8 P&amp;lt;0.001, NDM GLP-1R+ 228.8 vs GLP-1R- 149.3 P=0.032). Conclusion: Results of our present study did demonstrate that GLP-1R was more frequently detected in BC tissue than in normal mammary gland tissue with more pronounced in DM patients. These results also indicated an association between GLP1 and FGF7 in the development of BC in DM patients. Citation Format: Naoko Takigami, Shimpei Kuniyoshi, Yasuhiko Miki, Kentaro Tamaki, Yoshihiko Kamada, Kano Uehara, Seiko Tsuchiya, Shigeharu Terukina, Takanori Ishida, Minoru Miyashita, Ayako Kanai, Keely May McNamara, Nobumitsu Tamaki, Hironobu Sasano. The possible association among breast cancer, diabetes mellitus and GLP-1 receptor [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-02-10.

To evaluate the effects of combined psychological intervention and early enteral nutrition support on postoperative pain management, sleep quality, psychological well-being, and quality of life in colorectal cancer patients. A total of 320 colorectal cancer patients undergoing surgery were randomized into intervention (n = 160) and control (n = 160) groups. The intervention group received standard care plus psychological intervention and early enteral nutrition support, while the control group received standard care only. Outcomes were assessed pre- and post-intervention using the Pittsburgh Sleep Quality Index (PSQI), Visual Analog Scale (VAS) for pain, Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Compared with the control group, the intervention group showed significant improvements in sleep quality, pain intensity, anxiety, and depression scores (all p < 0.05). Quality of life scores measured by EORTC QLQ-C30 were also significantly higher in the intervention group (p < 0.05). Combined psychological intervention and early enteral nutrition significantly enhance postoperative symptom control, including pain relief, improved sleep, and better psychological health, resulting in an overall improvement in quality of life (QOL) for colorectal cancer patients. This integrated approach is a promising strategy for improving postoperative recovery and symptom management.

Is Video-Assisted Thoracic Surgery Lobectomy Better? Quality of Life Considerations

The present study examined the impact of an integrative oncology treatment program in the relief of pain in patients undergoing chemotherapy and/or palliative care. In this pragmatic prospective controlled study, patients undergoing chemotherapy and/or palliative care were referred by their oncology healthcare providers to an integrative physician (IP) consultation, followed by weekly integrative treatments. Patients attending ≥ 4 sessions during the first 6weeks of the study were considered to be highly adherent to integrative care (AIC). Pain was assessed at baseline and at 6 and 12weeks using the ESAS (Edmonton Symptom Assessment Scale) and EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) tools. Of 815 eligible patients, 484 (59.4%) were high-AIC and 331 low-AIC. Mean pain scores decreased significantly from baseline to 6 and 12weeks in both groups. However, ESAS and EORTC pain scores improved significantly more in the high-AIC group at 6weeks (p= 0.008), though not at 12weeks. Between-group analysis of participants undergoing adjuvant/neo-adjuvant chemotherapy showed higher pain reduction in the high-AIC group at 6weeks (ESAS, p = 0.006; EORTC, p = 0.046), as was the case with patients receiving palliative care (ESAS p = 0.04; EORTC p = 0.056). High adherence to integrative care was found to be associated with a greater effect on pain relief at 6weeks but not at 12weeks in patients undergoing chemotherapy and/or palliative care.

Research on the long-term effects of complementary and integrative medicine (CIM) is limited. In this study, we explore the impact of a CIM intervention on gastro-intestinal (GI)-related concerns in patients with breast/gynecological cancer undergoing chemotherapy. Patients reporting chemotherapy-related GI concerns were referred by their cancer care providers to a CIM consultation and treatments and assessed at baseline and at 12weeks. The following tools were used: Edmonton Symptom Assessment Scale (ESAS), Measure Yourself Concerns and Wellbeing (MYCAW) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). The intervention group was subdivided according to adherence to the integrative care program (AIC), defined as attending ≥4 CIM treatments with ≤30days between each session. Controls chose not to undergo the CIM consultation or treatments. Of 289 patients reporting GI-related concerns, 42 were treated with CIM and optimally assessed (intervention arm; AIC=33), as were 32 of controls. ESAS scores for appetite and nausea improved more significantly in the intervention group, more so in the AIC subgroup (appetite, p=0.025; nausea, p=0.033). MYCAW scores for GI-related concerns also improved in the intervention group, again more so in the adherent subgroup. EORTC scores improved more significantly with respect to global health (p=0.021) and cognitive functioning (p=0.031) in the intervention group, when compared to controls. The integration of a 12-week CIM intervention in conventional supportive cancer care may reduce nausea and improve appetite in patients with breast/gynecological cancer undergoing chemotherapy.