Alternative Medicine Modalities Research Articles

Successful Treatment of Sperm DNA Fragmentation Through Ayurveda Rasayana Therapy: A Case Study

Background: Sperm DNA fragmentation (SDF) can affect fertilization rate and embryo development, making it a useful measure for assessing male fertility. Available evidence supports the association between high sperm DNA fragmentation and poor outcomes, with regard to natural conception. Several treatment options are being adopted with varying degrees of success. Some of the commonly used treatment options are the intake of oral antioxidants, varicocele repair, and techniques like micro-manipulation-based sperm selection and use of testicular sperm for intracytoplasmic sperm injection.
 Case Presentation: Studies have shown that around 29% of couples depend on complementary and alternative medicine (CAM) modality for the treatment of infertility. However, there is a lack of substantial evidence regarding its efficacy in treating various aspects of infertility in couples. The current case report is about a 44 year-old male patient with infertility, who has a known diagnosis of sex chromosome abnormalities. Meanwhile, the SDF study reports indicated the presence of chromosomal abnormalities. This patient was treated exclusively with Ayurveda therapy aimed towards qualitative improvement in reproductive tissues (Shukra Dhatu as per Ayurveda). Patient was assessed periodically for changes in chromosomal abnormality. After four months of treatment, the evaluations demonstrated the presence of completely normal chromosomes.
 Conclusion: This case study indicates the potential of Ayurveda therapy in treating cases of male infertility caused by DNA fragmentation. Furthermore, observations and systematically designed clinical trials are warranted to establish a stronger level of evidence before making further clinical recommendations.

Unexplained Phenomena in Auricular Medicine

Auricular medicine, an integral component of traditional medicine, has grown famous as a complementary and alternative Medicine (CAM) modality. Despite its widespread acceptance and anecdotal support, the scientific community grapples with multifaceted challenges that impede the establishment of a comprehensive empirical foundation for auricular medicine. This editorial critically assesses the current scientific landscape, delineating unresolved issues and scientific lacunae that demand rigorous investigation.

A Systematic Review of Quantitative and Qualitative Results of Randomized Controlled Trials Assessing the Effect of Yoga in Adult Women With Post-traumatic Stress Disorder: What Is Known So Far.

Yoga has been increasingly practiced in recent years, with many of its practitioners being female. Adults may seeka complementary and alternative medicine (CAM) modality, such as yoga, to attempt to alleviate symptoms related to mental health conditions such as post-traumatic stress disorder (PTSD). Our goal for this systematic review was to collect and analyze all available data from quantitative and qualitative reports of randomized controlled trials (RCTs) conducted over the past 10 years on the impact of yoga on women diagnosed with PTSD. We included RCTs with the adult female population in which yoga was practiced for more than one week. We searched the databases PubMed, PubMed Central (PMC), and MEDLINE on June 11, 2022, Embase on June 12, 2022, and Science Direct on June 13, 2022, to find relevant articles. With the Cochrane RoB2 tool and Critical Appraisal Skills Programme (CASP) criteria, we checked for their quality, after which we selected 13 high-quality reports comprising seven original study designs and a total of 496 women. Of the 13 reports, nine evaluated effectiveness, four assessed feasibility, three explored acceptability, and four identified qualitative themes. We compared the results based on the assessed themes. Our results found yoga effective, feasible, acceptable, and a viable interoceptive pathway for emotional and personal growth. Limitations in our study include insufficient papers with large sample sizes and not including papers other than RCTs. With our research, we hope to present healthcare providers with research-based data on the effects of yoga so that they may better navigate its role in therapy as the trend of seeing more patients taking an interest in such alternative approaches rises.

Molecular Evidence of Breast Cancer Cell Proliferation Inhibition by a Combination of Selected Qatari Medicinal Plants Crude Extracts.

Breast cancer (BC) is the most common malignancy, and conventional medicine has failed to establish efficient treatment modalities. Conventional medicine failed due to lack of knowledge of the mechanisms that underpin the onset and metastasis of tumors, as well as resistance to treatment regimen. However, Complementary and Alternative medicine (CAM) modalities are currently drawing the attention of both the public and health professionals. Our study examined the effect of a super-combination (SC) of crude extracts, which were isolated from three selected Qatari medicinal plants, on the proliferation, motility and death of BC cells. Our results revealed that SC attenuated cell growth and caused the cell death of MDA-MB-231 cancer cells when compared to human normal neonatal fibroblast cells. On the other hand, functional assays showed that SC reduced BC cell migration and invasion, respectively. SC-inhibited cell cycle and SC-regulated apoptosis was most likely mediated by p53/p21 pathway and p53-regulated Bax/BCL-2/Caspace-3 pathway. Our ongoing experiments aim to validate these in vitro findings in vivo using a BC-Xenograft mouse model. These findings support our hypothesis that SC inhibited BC cell proliferation and induced apoptosis. These findings lay the foundation for further experiments, aiming to validate SC as an effective chemoprevention and/or chemotherapeutic strategy that can ultimately pave the way towards translational research/clinical trials for the eradication of BC.

Attitudes and understanding of complementary and alternative medicine in cancer care: An exploratory study of patients' perspectives in Karachi, Pakistan

Objective: To evaluate the prevalence and types of complementary and alternative medicine (CAM) modalities among patients with cancer in Karachi, Pakistan. Methods: This descriptive cross-sectional study was conducted from March 2021 to December 2021. Five hundred patients with cancer were invited to participate in the study. Electronic databases, namely, Google scholar, Publons, EMBASE, PubMed, Chinese National Knowledge Infrastructure Database, and ResearchGate was used for questionnaire designed. The self-administered survey included questions on demographic characteristics, education level, socio-economic conditions and information about CAM therapies, prevalence, effectiveness, and common CAM modalities. Statistical analysis was conducted using SPSS software version 22. Results: Out of the 500 invited patients, 433 (86.6%) successfully completed and returned the questionnaires. In contrast to patients who were with younger, highly educated, professionally active, higher income, and had advanced cancer, time since diagnosis, type of treatment, cancer types and family history are significantly associated with CAM use. The results showed that 59.8% of the participants were acquainted with complementary and/or alternative medicine and considered safe owing to its natural ingredients. The prevalence of CAM usage among cancer patients was 40.9% and the most widely used CAM modality was herbal medicine (27.7%) and dietary supplements (28.8%). Patients used CAM as a complementary therapy to improve the morphological parameter (28.2%), strengthen the immune system (6.8%), and to decrease the side effects of conventional treatment (18.1%). Most of the respondents get the information regarding CAM therapy from the electronic media (43.2%) and the family members (48%) rather than healthcare personnel. Conclusions: Participants used CAM modalities along with the conventional health care practices. Further multicentre studies should be conducted to provide information regarding the usage of CAM therapies and their eventual benefits in patients with cancer.

<i>AYUSH</i> in Oral Health and Diseases: An Overview

"AYUSH” is an abbreviated form for Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy. These are the indigenous complementary and alternative medical practices used in India. Oral diseases are significant global health ailments and greatly influence the general life quality. Compromised oral health is connected with numerous systemic chronic diseases. Oral healthcare professionals face many challenges in the management of dental conditions. It is essential for oral healthcare professionals to be abreast of Complementary and Alternative Medicine modalities, as there is a growing need for the amalgamation of these traditional systems with conventional, science-based Dentistry for the holistic management of oral diseases. The present paper highlights the AYUSH medicine systems that can be comprehensively integrated into modern oral healthcare.

The effectiveness of teaching complementary and alternative medicine based on the components of theory of planned behavior on nutrition students: multicenter research study

ObjectiveSafe and beneficial use of complementary and alternative medicine (CAM) modalities results from integrating CAM education into curricula and increasing CAM knowledge. We sought how much teaching CAM procedures in a virtual environment can influence the components of the theory of planned behavior (TPB), including knowledge, attitude, behavioral intention, and behavior of nutrition students.MethodsThis cross-sectional descriptive-analytic study was conducted on 162 undergraduate nutrition students were selected through convenience sampling based on inclusion criteria in 2021–2022. Data were collected through a validated researcher-made CAM questionnaire that was designed based on TPB questionnaire that consisted of four constructs (knowledge, attitude, behavioral intention, and behavior). The content validity index and content validity ratio of the questionnaire were evaluated.ResultsOur results revealed that students who significantly scored the highest scores in attitude, behavioral intention, and behavior constructs were the students who claimed that “teaching two credits of CAM for nutrition students is not enough” (p. value = < 0.001, < 0.001, and 0.005, respectively). In addition, these students used treatment methods of CAM for themselves, suggested treatment methods of CAM to others, and followed the recommendations of the CAM specialists (for three pairwise comparisons: p. value = < 0.001, < 0.001, and < 0.001, respectively). The attitude could predict 70% of behavioral intention. However, attitude and behavioral intention could predict 90% of behavior.ConclusionAttitude was the most critical determinant influencing behavioral intention and behavior. CAM teaching using evidence-based CAM-ITM principles with a succinct, concerted, and collaborative curriculum, integration of CAM into continuing education, and integration of educational CAM programs continuously for several years into the academic curriculum in the actual setting influence the success of the educational CAM program.

Prevalence of late and long-term effects of cancer (treatment) and use of complementary and alternative medicine in Norway

BackgroundThe increasing number of patients surviving cancer leads to more people experiencing late and long term-effects from the disease and its treatment. Fatigue, sleep disorders, early menopause, pain, and nerve damage are commonly reported. Methods helping people to recover after cancer treatment are therefore essential. The aims of this study were threefold; (1) to determine the level of cancer patients suffering from late and long-term effects of cancer diagnosis and treatment in Norway, (2) explore complementary and alternative medicine (CAM) modalities used for managing these adversities, and (3) describe self-perceived benefits and harms of the CAM interventions.MethodsThe study was conducted in cooperation with the Norwegian Cancer Society (NCS) and consisted of an online cross-sectional study among members of the NCS user panel with present or previous cancer (n = 706). The study was carried out in September/October 2021 using a modified cancer-specific version of the International Questionnaire to Measure Use of Complementary and Alternative Medicine (I-CAM-Q). A total of 315 women and 153 men agreed to participate, resulting in a response rate of 67%.ResultsMost of the participants (83%) suffered from late and long-term effects of cancer treatment; mostly fatigue (59.2%), sleep disorder (41.5%), hot flashes (39.2%), nerve damage (polyneuropathy, 38.0%), and pain (36.6%) with a mean number of 5.1 different late and long-term effects. Late and long-term effects were positively associated with younger age and college/university education. Nearly half of the participants experiencing late and long-term effects (43%) reported having used CAM to treat these complaints. Most frequently used were self-help practices (26%) such as relaxation therapy (19%), yoga (14%) and meditation (13%), but also visits to CAM providers were reported by 22%. Herbal- and other natural remedies to treat late and long-term effects were used by 13%. A high percentage of CAM users reported self-perceived improvements of their symptoms (86% for self-help practices, 90% for visits to CAM providers). Few experienced adverse effects of the CAM treatment.ConclusionA large proportion of cancer patients suffered from a wide range of late and long-term effects of cancer diagnosis and treatment, and they use CAM to treat these complaints to a rather high degree. Relaxation therapy, yoga, meditation, massage, and acupuncture were the most frequently used therapies regardless of complaint. The therapies used are generally considered to be both safe and beneficial for the respective complaint, indicating that the participants seem to be well informed about the choices they make.

The relationship between individuals' use of complementary and alternative medicine during the pandemic in Turkey and their attitudes towards perceived COVID-19 risk.

IntroductionThe perceived COVID-19 risk may lead to the use of various complementary and alternative medicine (CAM) modalities to reduce the potential risks of this disease. This study was conducted to investigate the relationship between individuals' use of complementary and alternative medicine during the pandemic in Turkey and their attitudes towards perceived COVID-19 risk.MethodsThe study was conducted in Turkey between November 2021 and March 2022 and 1003 individuals voluntarily participated. The Personal Information Form, Attitude Towards Holistic Complementary and Alternative Medicine Scale (HCAMS), and Perceived COVID-19 Risk Scale (PCRS) were used for data collection. To evaluate the data descriptive statistics, Pearson's correlation, and Cronbach's alpha reliability analysis were used.ResultsIn the study, 54.2% of the individuals were found to use CAM during the pandemic, and 56.2% believed that CAM practices were useful in preventing or recovering from COVID-19. It was revealed that 53.8% of the individuals drank herbal tea, 55.2% used religious and spiritual healing to manage, 6.6% used massage, and 10.1% applied aromatherapy. The mean total score of the HCAMS was 28.29 ± 4.99, and the mean total score of the perceived COVID-19 risk scale was 27.78 ± 6.35. A statistically significant positive correlation was identified between the CAM subscale and the emotional risk subscale (p < 0.05).ConclusionIndividuals had a positive attitude towards using CAM during the pandemic period, the risk perception of COVID-19 was high and CAM methods were widely used.The literature should be supported by increasing the current and scientific studies in which CAM methods are questioned and their benefits are investigated during epidemic periods.

Mindfulness as a Symptom Management Strategy for Fibromyalgia: An Integrative Review.

Introduction: Mindfulness Meditation is a complementary and alternative medicine (CAM) modality growing in popularity. Currently, mindfulness is under-studied regarding efficacy; however, it offers a potentially accessible way to contribute to symptom management in chronic pain conditions. The purpose of this integrative review was to examine the literature for the use of mindfulness as symptom management strategy for persons diagnosed with the chronic pain condition, fibromyalgia. Methods: Six scientific databases were searched, using various keywords. Inclusion criteria were: (a) fibromyalgia, (b) English language, (c) experimental research designs; (d) adults age ≥ 18 years, and (e) mindfulness. Results: Seven studies were reviewed. Most interventions were completed over several months in the form of multiple group sessions lasting several hours each. Evaluations of effectiveness varied by study, but variables most commonly demonstrating improvement from mindfulness were anxiety, depression, sleep-related symptoms, coping and perceived stress. Mechanisms by which these outcomes may have been mediated included increases in self-compassion and psychological flexibility. Discussion: There is insufficient evidence to recommend mindfulness as an effective way to manage all fibromyalgia symptoms; however, promise lies in its usefulness addressing mood- and sleep-related symptoms. We suggest that further, more rigorous, research is warranted.

Use of Complementary and Alternative Medicine in the context of cancer; prevalence, reasons for use, disclosure, information received, risks and benefits reported by people with cancer in Norway

BackgroundResearch exploring the use of specific Complementary and Alternative Medicine (CAM) modalities by Norwegian cancer patients is sparse. The aims of this study were therefor to map the different CAM modalities cancer patients use and further investigate their rationale for use, communication about use, self-reported benefits and harms, and their sources of information about the different modalities.MethodsIn cooperation with the Norwegian Cancer Society (NCS), we conducted an online cross-sectional study among members of their user panel with present or previously cancer (n = 706). The study was carried out in September/October 2021 using a modified cancer-specific version of the International Questionnaire to Measure Use of Complementary and Alternative Medicine (I-CAM-Q). In total, 468 members, 315 women and 153 men, agreed to participate resulting in a response rate of 67.2%. The study was reported in accordance with the National Research Center in Complementary and Alternative Medicine’s (NAFKAM) model of reporting CAM use.ResultsA large proportion of the participants (79%, n = 346) had used some form of CAM with a mean of 3.8 modalities each (range 1-17); 33% (n = 143) had seen a CAM provider, 52% (n = 230) had used natural remedies, while 58% (n = 253) had used self-help practices. Most of the participants used CAM to increase their quality of life, cope with the cancer disease or for relaxation/well-being (64%-94%), mostly with high satisfaction and low rates of adverse effects. Few used CAM to treat cancer or prevent it from spreading (16%, n = 55). The main information sources were health care providers (47%), the internet (47%), and family and friends (39%). More than half (59%) of the cancer patients discussed their use of at least one CAM modality with a physician.ConclusionsThe results of this survey will provide health professionals with more in-depth insight into the patterns of CAM use by cancer patients and facilitate better-informed discussions with their patients. Considering the high use of CAM, reliable information provision supporting cancer care providers’ knowledge and health literacy among patients as well as good communication are crucial. The cooperation between the NCS and NAFKAM provides an example of how to address these issues.

Thymoquinone's Antiviral Effects: It is Time to be Proven in the Covid-19 Pandemic Era and its Omicron Variant Surge.

The COVID-19 pandemic has impacted every country in the world. With more than 400 million cases and more than 5.5 million deaths. The FDA either approved or authorized the emergency use for three vaccines against COVID-19. The treatment options of COVID-19 are very limited. Multiple complementary and alternative medicine modalities were suggested to be efficacious in the treatment of COVID-19 such as Thymoquinone. The effects of Thymoquinone have been examined and multiple studies indicate a promising beneficial effect. However, the current body of research is limited in terms of its scope, quality, and quantity. While higher-quality studies are required, physicians do not routinely recommend the use of marketed supplements of natural products, including Thymoquinone for COVID-19. Given the numerous suggested positive effects of Thymoquinone, including anti-inflammatory and antimicrobial properties, additional research is required to confirm or refute these promising benefits. Complementary and alternative medicine is an area that requires additional evidence-based practice and research to confirm effects observed in clinical practice.

Complementary and alternative medicine modalities used to treat adverse effects of anti-cancer treatment among children and young adults: a systematic review and meta-analysis of randomized controlled trials

BackgroundDealing with the symptom burden of cancer diagnosis and treatment has led parents to seek different self-management strategies including Alternative and Complementary Medicine (CAM). The aim of this study was to perform a systematic review and meta-analysis about the use and effect of CAM modalities to treat adverse effects of conventional cancer treatment among children and young adults.MethodsSix scientific research databases were used to identify randomized controlled trials (RCTs) from 1990 to September 2020. Included studies investigated the use of CAM to treat cancer treatment related adverse effects in children and young adults compared to controls.ResultsTwenty RCTs comprising 1,069 participants were included in this review. The included studies investigated acupuncture, mind–body therapies, supplements, and vitamins for chemotherapy-induced nausea and vomiting (CINV), oral mucositis, and anxiety among children and young adults who underwent conventional cancer treatment. Seven studies (315 participants) were included in the meta-analysis. The overall effect of CAM (including acupuncture and hypnosis only) on chemotherapy-induced nausea and/or vomiting and controls was statistically significant with a standard mean difference of -0.54, 95% CI [-0.77, -0.31] I2 = 0% (p < 0.00001). There was a significant difference between acupuncture and controls (n = 5) for intensity and/or episodes of CINV with an SMD -0.59, 95% CI [-0.85, -0.33] (p < 0.00001). No significant difference was found between hypnosis and controls (n = 2) for severity or episodes of CINV with an SMD -0.41, 95% CI [-1.09, 0.27] I2 = 41% (p = 0.19).ConclusionCurrent evidence from this meta-analysis of randomized controlled trials shows that CAM, including acupuncture and hypnosis only, is effective in reducing chemotherapy-induced nausea and vomiting in children and young adults. More rigorous trials and long-term effects should be investigated if acupuncture and hypnosis are to be recommended for clinical use.

Liver Diseases and Adverse Reactions Induced by Medicinal Herbs and Herb-Drug Interactions

Integrative medicine encompasses several modalities of complementary and alternative medicine, of which the most relevant is the herbal medicine. Herbal formulations contain multiple pharmacologically active phytochemicals with isolated active compounds usually can achieve better therapeutic performance. In general, herbal medicines are believed to be more effective and safer than prescription drugs. Prescription drugs are approved and licensed only after well regulated clinical trials have been carried out, but a majority of marketed herbal products remain non-regulated without evidence of efficacy and safety. In this article, we review the potential risk of liver diseases or other organ toxicity related to herbs or the combined use of herb and drug. This article also discusses certain medicinal herbs as well as hepatotoxicy and adverse reactions induced by herb-drug interactions in liver disease patients.

Parental Attitude and Awareness of the Use of Complementary and Alternative Medicine for the Management of Respiratory Tract Infections in Children: A Cross-Sectional Study from Aseer Region, Saudi Arabia

Respiratory tract infections are considered the major cause of pediatric hospitalization requiring direct supervision by a clinician. The use of antibiotics that are commonly used for treatment is sometimes associated with the development of antibiotic resistance and less than desirable treatment outcome. Despite limited clinical evidence, complementary and alternative medicine is widely used as an alternative to antibiotics worldwide for treatment of respiratory tract infections in children. Therefore, we decided to explore the parental attitude and awareness regarding the use of the complementary and alternative medicine for the management or prevention of respiratory tract infections in children in Aseer region, Saudi Arabia. Over a 4-month period during influenza season, 1,192 parents were administered two sets of seven questionnaires dealing with attitude and awareness about the complementary and alternative medicine use. The results show that parents who felt that respiratory tract infections in children do need antibiotics supported the use of the complementary and alternative medicine modalities. More than half of the participants agreed that the complementary and alternative medicine would produce fewer side effects on their children's immunity than antibiotics and produce less bacterial resistance. In conclusion, the complementary and alternative medicine use for the treatment of respiratory tract infections in children should be based only on reliable and evidence-based advice.

Perspectives of patients on medical acupuncture in a primary care setting in Lebanon: a cross-sectional study.

There is paucity of data on the knowledge of acupuncture and its use among patients in Lebanon and the Arab countries. The primary objectives of this study were to determine the knowledge and attitude of patients in a primary care setting in Lebanon toward Western medical acupuncture and to determine factors that may affect their attitudes toward acupuncture use. The secondary objective was to compare the attitudes and knowledge of patients who had tried acupuncture with those who had not. This was a cross-sectional descriptive study about the perspectives of patients in a primary care setting in Lebanon on medical acupuncture. A total of 212 surveys were completed (78.5% response rate). 24% of participants had not tried and were unwilling to try acupuncture (group 1), 63.5% of participants had not tried but indicated they would be willing to try acupuncture (group 2), and 12.5% of participants had previously tried acupuncture (group 3). Most participants in group 1 (55.6%) stated they would be unwilling to try acupuncture even if referred for it by a physician. Participants who had tried acupuncture (12.5%) had done so for pain conditions. Group 3 scored higher on knowledge questions and had a more positive attitude toward the acupuncture procedure. Most patients who had tried it had done so to treat pain complaints. Patients in groups 2 and 3 were more knowledgeable about acupuncture, had tried more complementary and alternative medicine (CAM) modalities, and were more likely to try acupuncture as an add-on or last resort treatment, compared to group 1.

Use and perception of complementary and alternative medicine among Iranian psychologists.

The seeking and use of Complementary and Alternative Medicine (CAM) modalities by people to treat mental disorders has increased and it is necessary for psychologists to have the necessary information in this field. This study aims to evaluate the use and perception of CAM by Iranian psychologists. This cross-sectional study was conducted on 100 psychologists selected by the census in 2019. Data collection tools consisted of four sections of the demographic section, the CAM questionnaire for psychologists, awareness of CAM, and use of CAM. The validity and reliability of this questionnaire were confirmed. The mean (standard deviation) scores of attitude and educational needs were 40.45 (11.36) and 33.93 (5.96), respectively. Only 19.25% of psychologists had sufficient knowledge of CAM, and most of them (56.34%) reported that there is an educational need for CAM. In this study, 64% of psychologists used CAM for themselves. There was a significant relationship between the attitude toward CAM modalities and the suggestion of CAM to the clients (p=0.025). There was also a significant relationship between the use of CAM by psychologists and the suggestion of these modalities to their clients (p<0.001). Psychologists had not sufficient awareness about CAM and had a moderate attitude. Most of the psychologists reported that there is educational need for CAM. Therefore, it is necessary to design and implement appropriate training courses for psychologists toward CAM modalities.

Prevalence of Complementary and Alternative Medicine Use in Professional Voice Users

Objectives To determine the prevalence and specific modalities of complementary and alternative medicine (CAM) by professional voice users (PVUs) for vocal ailments and to examine the PVU's health care utilization. Methods A Canadian national cross-sectional survey was conducted. Surveys were distributed electronically to members of the Alliance of Canadian Cinema, Television, and Radio Artists; the National Association of Teachers of Singing; the Canadian Actors Equity Association; and the Department of Vocal Performance at Western University. Participants were asked about the products/therapies they use to improve vocal health. Frequency of use, health care utilization, and general influencers in treatment choice were also collected. Results Two hundred eighty-eight participants completed the survey. 86% of participants claimed to have taken at least one form of CAM when experiencing voice loss or a negative voice change. Of the respondents, 18% claimed to use products/therapies for vocal health routinely in the absence of vocal ailments. The most common CAMs used were hot drinks with honey and/or lemon, lozenges, and inhaling steam. When vocally ill, PVUs were significantly more likely to use CAMs than any other treatment method. Voice teachers and medical doctors most commonly influenced the choice of the treatment. Conclusion This study illustrated the substantial prevalence of CAMs in the PVU community. Understanding the utilization of CAMs can help clinicians navigate treatment strategies for this patient population.

Supportive care for cancer patients: a survey of available settings and current practices in Belgium.

The increasing number of cancer diagnoses and deaths underlines the importance of supportive and palliative care. It is defined as "all the care and the support necessary for patients throughout their illness." To evaluate the current status of the supportive and palliative care organization in Belgium. The Belgian Society of Medical Oncology (BSMO) supportive care task force conducted an observational study by sending a 31-point questionnaire to medical doctors responsible for the supportive care units of university, public, or private hospitals in Belgium. Thirty centers completed the questionnaire, of which 12 were university hospitals. Inpatient supportive care units are available in more than 50% of the centers, whereas outpatient supportive care is less available in Brussels than in Flanders and Wallonia. Multidisciplinary teams or specific units dedicated exclusively to supportive care are represented less frequently in all 3 areas of Belgium. Intensive care units for cancer patients are even scarcer. In terms of research and teaching, active research is present in 10 (33%) centers. Of complementary and alternative medicine modalities available to cancer patients, mindfulness and massage are offered most frequently. Reference guidelines for various symptoms are widely used in Flanders and Brussels but less so in Wallonia. This is the first in-depth survey in Belgium that shows the limited availability of dedicated supportive care services throughout the country. This represents an unmet need for Belgian cancer patients. Within the BSMO supportive care task force, there is a great opportunity to expand services and develop active research in the area of supportive and palliative care.

A DEEP-TISSUE MASSAGE WITH UNINTENDED CONSEQUENCES

SESSION TITLE: Fellows Critical Care Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Rhabdomyolysis is a common clinical syndrome that can result from a variety of insults that are generally evident, and well-described. We report a patient with rhabdomyolysis associated with an unusual inciting event. CASE PRESENTATION: A 44-year-old gentleman presented to the hospital with upper extremity myalgias. About 48 hours prior to presentation, he received an upper body massage at a commercial spa over a 30-60 minute duration. Hours after, he sustained a fall from standing via a relatively low mechanism of injury. After waking from sleep the following day his symptoms worsened and he developed dark-brown urine discoloration, prompting his presentation to the hospital. He denied any new medications, excessive physical exertion, or prior similar episodes in himself or relatives. His medication list included gabapentin, oxycodone, and doxepin, without concurrent anabolic steroid use, or illicit drug use. On examination, he was mildly tachycardic but otherwise hemodynamically normal. He had a general muscular build, and bilateral deltoid, upper arm, and forearm edema and tenderness. There was no evidence of neurovascular compromise. Workup showed an elevated creatine phosphokinase (CPK) (66,100 U/L), myoglobinuria (3+ blood, 0-5 RBCs), with unremarkable potassium, phosphate, urine drug screen, and plain films of the affected extremities. The patient was admitted to the medical ICU for hydration and neurovascular monitoring. His serial CPK levels gradually improved over days (1,483 U/L) and he was discharged home. DISCUSSION: Rhabdomyolysis occurs when injured myocytes release their intracellular contents into the extracellular space, which results in subsequent myoglobinuria. Supporting diagnostic features include elevated serum muscle enzymes (CPK =500-1000 U/L), myoglobinuria, proteinuria, hyperkalemia, hyperphosphatemia, and acute kidney injury. Insults include physical, ischemic, chemical and biologic causes. Physical insults such as prolonged exertion and immobilization are established causes for rhabdomyolysis. However, only one previously published report has implicated massage therapy, in which an elderly man developed rhabdomyolysis after a 120-minute massage by two therapists. While massage remains a common Complementary and Alternative Medicine modality, serious adverse events rarely may occur. CONCLUSIONS: Our patient's course highlights a rare encounter which associates deep-tissue massage and rhabdomyolysis by close temporal association, anatomic distribution, and lack of other significant contributing causes. Reference #1: Zimmerman JL, Shen MC. Rhabdomyolysis. Chest. 2013 Sep;144(3):1058-1065. doi: 10.1378/chest.12-2016. Review. PubMed PMID: 24008958. Reference #2: Lai MY, Yang SP, Chao Y, Lee PC, Lee SD. Fever with acute renal failure due to body massage-induced rhabdomyolysis. Nephrol Dial Transplant. 2006 Jan;21(1):233-4. Epub 2005 Oct 4. PubMed PMID: 16204282. Reference #3: Yin P, Gao N, Wu J, Litscher G, Xu S. Adverse events of massage therapy in pain-related conditions: a systematic review. Evid Based Complement Alternat Med. 2014;2014:480956. doi: 10.1155/2014/480956. Epub 2014 Aug 12. Review. PubMed PMID: 25197310; PubMed Central PMCID: PMC4145795. DISCLOSURES: No relevant relationships by Jason Stankiewicz, source=Web Response No relevant relationships by Nevins Todd, source=Web Response