Complementary And Alternative Medicine Treatments Research Articles

A perspective on complementary/alternative medicine use among survivors of hematopoietic stem cell transplant: Benefits and uncertainties.

The widespread use of complementary and alternative medicine (CAM) in cancer survivors is well known despite a paucity of scientific evidence to support its use. The number of survivors of hematopoietic stem cell transplant (HCT) is growing rapidly and HCT clinicians are aware that many of their patients use CAM therapies consistently. However, due to a paucity of data regarding the benefits and harms of CAM therapies in these survivors, clinicians are reluctant to provide specific recommendations for or against particular CAM therapies. A systematic literature review was conducted with a search using PubMed, the Cochrane Database of Systematic Reviews, and Ovid online for each CAM therapy as defined by the National Center of Complementary and Alternative Medicine. The search generated 462 references, of which 26 articles were deemed to be relevant for the review. Due to extensive heterogeneity in data and limited randomized trials, a meta-analysis could not be performed but a comprehensive systematic review was conducted with specified outcomes for each CAM therapy. In randomized controlled trials, certain mind and body interventions such as relaxation were observed to be effective in alleviating psychological symptoms in patients undergoing HCT, whereas the majority of the other CAM treatments were found to have mixed results. CAM use is an understudied area in HCT survivorship and clinicians should convey the benefits and uncertainties concerning the role of CAM therapies to their patients.

Use of Complementary and Alternative Medicine in Women With Heart Disease, Hypertension and Diabetes (from the Australian Longitudinal Study on Women's Health)

The uptake of complementary and alternative medicine (CAM) is common, especially among patients with chronic illness. However, the use of CAM by women with cardiovascular disease and how this influences the interface with conventional medicine is poorly understood. To examine the relation between heart disease, hypertension, and diabetes and the use of CAM and conventional medicine in a cohort of women, data were taken from the 2010 survey (n=9,748) of the 1946 to 1951 cohort of the Australian Longitudinal Study on Women's Health (ALSWH). Analyses focused on women who had been diagnosed or treated for heart disease, diabetes, and/or hypertension. The outcome measures were the use of conventional or CAM treatments in the previous year. Most women had hypertension only (n= 2,335), and few (n= 78) reported having heart disease, hypertension, and diabetes. Women with hypertension were less likely (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.74 to 0.91) to consult with a CAM practitioner and less likely (OR 0.86, 95% CI 0.77 to 0.97) to use self-prescribed CAM, while women with diabetes were also less likely (OR 0.66, 95% CI 0.54 to 0.81) to consult with a CAM practitioner and less likely (OR 0.68, 95% CI 0.55 to 0.83) to use self-prescribed CAM. In conclusion, compared with studies conducted on CAM use and other chronic illness groups, the use of CAM by women with heart disease, hypertension, and/or diabetes in this study was lower, and future research is needed to explore patients' perceptions of cardiovascular risk and the role of CAM in their self-management in the community, among other issues.

Differences in referral and use of complementary and alternative medicine between pediatric providers and patients

The goal of this study was to compare pediatric complementary and alternative medicine (CAM) use and pediatric health care provider CAM referral as well as identify predictors of use and referral. Surveys were administered to 283 parents/caregivers of pediatric patients and 200 pediatric health care providers (HCP). This study took place at the Children's Hospital of Orange County (CHOC Children's) in Orange, CA. Caregivers and HCP were provided a list of 32 CAM interventions and asked to indicate which treatments their child had ever used or which they would consider using for their child and which treatments they had ever referred or which they would consider referring, respectively. The main outcome variables were the number and type of CAM therapies endorsed by participants. Providers referred the majority of CAM therapies significantly more often than patients used each therapy and more often than caregivers would consider each therapy for their child. In addition, children from families with higher incomes, whose parents were older and had more education, who were White, and whose primary language spoken at home was English were more likely to use CAM therapies, all p's<0.05. HCP CAM referral was not significantly predicted by number of years a health care provider practiced or health care profession, all p's<0.05. HCP referred CAM therapies more often than parents reported use for their children. Findings may imply that parents/caregivers are underutilizing CAM therapies for their children. Potential barriers to CAM use in pediatric patients needs to be explored.

Complementary and alternative medicine in US medical schools.

An analysis of complementary and alternative medicine (CAM) in US medical school curriculum was undertaken. Websites for 130 US medical schools were systematically analyzed for course listings and content. Half of the schools (50.8%) offered at least one CAM course or clerkship. A total of 127 different course listings were identified, embracing a range of topics and methods of instruction. The most frequently listed topics were traditional medicine, acupuncture, spirituality, and herbs, along with the general topic of CAM. Nearly 25.0% of the courses referenced personal growth or self-care through CAM practices, while only 11.0% referenced inter-professional education activities involving interaction with CAM providers. The most frequently reported instructional methods were lectures, readings, and observation of, or receiving a CAM treatment. The findings of this analysis indicated fewer medical schools offered instruction in CAM than previously reported and a wide range of approaches to the topic across the schools where CAM is taught.

Severe cyanide poisoning from an alternative medicine treatment with amygdalin and apricot kernels in a 4-year-old child

The use of complementary and alternative medicine (CAM) is widespread in children with cancer and is poorly regulated. Case report. We describe a case of severe cyanide poisoning arising from CAM use. A severely agitated, encephalopathic, unresponsive 4-year-old boy (initial Glasgow Coma Scale of 3) with a history of metastatic ependymoma was brought to our emergency department by ambulance services. Initial blood gas analysis demonstrated severe metabolic/lactic acidosis. On detailed questioning of the parents, the use of CAM including intravenous and oral "vitamin B 17" (amygdalin) and oral apricot kernel was reported. After administering sodium thiosulfate, rapid improvement in his medical condition with complete recovery without need for further intensive care treatment was seen. Serum cyanide level was markedly elevated. Cyanide poisoning can be the cause of severe encephalopathy in children receiving CAM treatment with substances containing cyanogenic glycosides.

Towards improving the reporting quality of clinical case reports in complementary medicine: Assessing and illustrating the need for guideline development

Case reports have had a varying level of recognition as a source of evidence throughout the history of medicine. In recent years, there has been a revival of interest in clinical case reports in both conventional and complementary medicine. There is a need to further improve the reporting quality of clinical case reports of different Complementary and Alternative Medicine (CAM) therapies. To provide an overview of the different objectives for clinical case reports, identify those that are most relevant for CAM, and to develop a conceptual framework for purpose orientated clinical case reporting guidelines for CAM therapies. To practically illustrate the chosen approach by developing a clinical case reporting guideline for homeopathic cases. The various objectives of clinical case reports were described by Prof. Milos Jenicek, and the potential relevance of these objectives for CAM were discussed and graded by a mixed panel of experts. A conceptual framework for developing clinical case reporting guidelines for CAM treatments with specific objectives is proposed. The aim is to integrate both 'generic' and 'CAM therapy specific' quality items. This framework has been practically applied to the development of a reporting guideline for clinical case reports in homoeopathy which will be reported in a second article. An overview is given of the clinical case reporting literature. The conceptual framework for the development of purpose orientated CAM clinical case reporting guidelines is presented. This framework is based on alignment with the recently published 'generic' CARE guideline for reporting of clinical case reports, whilst addressing the CAM specific elements at the same time. The scope and importance of clinical case reporting guideline development in CAM is illustrated. A conceptual framework for developing CAM specific clinical case reporting guidelines was established. It has been implemented using homoeopathy as an illustration, and this will be reported in a separate article. Further improvements in clinical case reporting in CAM will greatly contribute to CAM research and education, as well as to improved patient care.

Trends in publications on complementary and alternative medicine in the medical literature.

Public interest in and demand for complementary and alternative medicine (CAM) services have increased in recent years throughout the Western world. The aim of the study was to assess trends in publications on CAM in the medical literature between 1963 and 2012 and to compare them with overall trends in publications on medical issues. A search of the literature was conducted on CAM and integrative medicine using the PubMed and Google Scholar search engines with key search terms. Articles on CAM began to appear in the medical literature 50 years ago. Over the years there has been an increase in the number of publications. On PubMed the increase was from 15,764 to 144,288 articles from 1963 to 2012. In the decade between 1963 and 1972 publications on CAM comprised 0.81% of all the articles appearing in PubMed. Over the course of the 50 years, the percentage increased more than twofold to 1.92% from 2003 to 2012. On Google Scholar there were 27,170 citations related to CAM between 1963 and 1972. This increased to 2,521,430 between 2003 and 2012. Over the last 50 years there has been an increase in scientific publications on CAM in general, and on specific CAM treatments in particular.

Acupressure as a Model for Complementary and Alternative Medicine (CAM) Treatment Following Acquired Brain Injury: Translating Lessons from the Laboratory

Background: Acquired brain injury (e.g., stroke and traumatic brain injury or TBI) and associated sequelae are highly prevalent in the United States (U.S.), impacting both civilians and military populations. Because conventional treatments can be limited and functional recovery incomplete, complementary and alternative medicine (CAM) is often sought out. The popularity of CAM exists despite inconclusive research findings for CAM treatments for injuryassociated sequelae. Apparent methodological limitations in CAM studies include issues related to experimental design, control groups, sample size, blinding and disparities in outcome measures. Overcoming these limitations poses challenges, but not insurmountable ones. Objective: Delineate and describe the necessary evidence-based infrastructure so that efficacious CAM treatments can be identified and this information disseminated to individuals seeking CAM therapies. With the full information of both risks and benefits, there is a increased likelihood of resources being invested in treatments that will achieve outcomes of interest. Design: The present review of a published body of work will describe, step-by-step, the fundamental framework within which researching the CAM intervention acupressure for two types of acquired brain injury (traumatic brain injury/TBI and stroke), can be accomplished using the highest methodological rigor. Results: Included is a review and description of the points encountered in the decade-plus of published research from the CAIRR (Clinical Assessment of Injury, Recovery and Resilience) Neuroscience Laboratory, the methodological framework underlying these choice points, and how decisions at each choice point were made to optimize rigor. Conclusions: Cogent scientific research is essential for identifying effective treatments for acquired brain injury, regardless of whether the treatments are conventional or CAM-based. In terms of CAM, such work will provide the opportunity to characterize both efficacy and limitations of CAM treatments, so that CAM may be fully understood and accessed appropriately by both treatment teams and those engaged in rehabilitation.

Resistance to Antibiotics and Antifungal Medicinal Products: Can Complementary and Alternative Medicine Help Solve the Problem in Common Infection Diseases? The Introduction of a Dutch Research Consortium

The increase of antibiotic resistance worldwide, rising numbers of deaths and costs associated with this, and the fact that hardly any new antimicrobial drugs have been developed during the last decade have increased the interest in Complementary and Alternative Medicine (CAM) therapeutic interventions, if proven safe and effective. Observational studies on clinical CAM practices demonstrate positive effects of treatment of infections with CAM therapies (clinical effects, patient satisfaction) in combination with small percentages of antibiotics prescription. However, Cochrane reviews and other studies demonstrate that in most instances the quality of clinical trials on CAM treatment of infections is currently too low to provide sufficient evidence. Therefore a Dutch consortium on (in vitro and clinical) scientific research on CAM and antibiotic resistance has been formed. The aim and objective of the consortium is to establish an enduring partnership and to develop expertise to further develop and investigate safe and effective CAM treatments for infectious diseases of humans (and animals). A first ongoing project on the development of safe and effective biobased CAM antimycotics in women with (recurrent) vaginal candidiasis infection is introduced.

Complementary and alternative medicine in cancer prevention and therapy.

Although there have been great achievements in the battle against cancer over the past decades, cancer is still the leading cause of death in developing countries like China. Complementary and alternative medicine (CAM), especially traditional Chinese medicine (TCM), usually having good clinical tolerability, is applied as an adjuvant therapy to treat cancer in China based on TCM or modern pharmacological theories. In the west, CAM has increasingly become popular in cancer patients. It is estimated that the United States National Cancer Institute (NCI) spends around $120 million each year on complementary and alternative medicine related research projects. However, a fact is that although a lot of CAMs are widely used clinically, most evidence supporting their use came from poorly reported published clinical studies or studies with questionable methodology. Call for high quality evidence is a mission of this special issue. This issue on CAM for treatment or prevention of cancer compiles 13 exciting manuscripts, most of which reporting the efficacy and possible mechanisms of action of CAM or active constituents on cancer prevention and/or therapy in clinical and experimental levels. S. S. M. Fong et al. contributed high quality evidence about Tai Chi Qigong Training for balance performance in irradiated survivors of nasopharyngeal cancer by a well-designed, well-conducted, and well-reported randomized controlled trial. Totally 120 senior adults participated in the study voluntarily. In this cross-sectional exploratory study, they have done very well on the ethics issues including protocol approval by ethical committee, properly informed consent, and high quality methodological issues, including the randomization method and allocation procedure, the recruitment of patients, the data management, the analysis method of results. All of the procedures were conducted according to the Declaration of Helsinki. This transparency makes readers confident to trust the result of the study. This is the first study to show that participating survivors of NPC had inferior OLS balance performances in all of the visual and supporting surface conditions compared with age-matched healthy counterparts. TC Qigong might be a potential rehabilitation exercise to improve the somatosensory function and single-leg standing balance performance of survivors of NPC. The shortcoming of this study is that it uses a convenience sample which may have introduced a self-selection bias that may threaten the internal validity of the study. In addition, homogenous subject group, small sample size, and OLS clinical test for balance performance assessment may limit the generalizability of results. However, we still believe that this study and its report could be a good evidence for efficacy of CAMs. This edition also includes a review that discusses the possibility of TCM as maintenance therapy for advanced nonsmall cell lung cancer. The review concludes that TCM as maintenance therapy can improve the QOL and prolong the PFS of advanced NSCLC patients. Besides, TCM can be applied for NSCLC patients not limited in population selection. However, there are only small sample clinical trials about TCM as maintenance therapy for advanced NSCLC. More large-scale trials of TCM as maintenance therapy for advanced NSCLC are expected. For experimental study, A. Movahedi et al. investigated the capability of the decoction of Teucrium polium L. from Lamiaceae family to protect liver cells against hepatocellular carcinoma in carcinogenesis-induced animal model. After 28 weeks of treatment, they found that serum biochemical markers (ALT, AST, AFP, GGT, ALP, HCY, TNF-α, α2MG, and CBG), total antioxidant status, liver lesion, and glucocorticoid activity were all regulated auspiciously by Teucrium polium L. Y. Lin et al. studied that elemene, a compound found in an herb used in traditional Chinese medicine, has the effect of protecting cancer cells from death either in apatinib induced nutrient deficient environment or in serum-free induced starvation. Further data on the mechanism study revealed that elemene induced protective autophagy and prevented human hematoma cancer cells from undergoing apoptosis. In addition to the mentioned papers above, other studies included in this issue provide sufficient scientific evidence from CAM research to clarify their mechanism of action and demonstrate their efficacy and safety. Through the rigorous researches, the benefits of CAM therapies will be highlighted, and this will support the clinical use of CAMs and help integrating CAM into the mainstream medicine. We hope that this special issue informs us about the rationale use of CAM in cancer prevention and therapy. We also hope that the papers included in this issue play a role in reflecting the recent advancement in the field of CAM. Peng Cao Senthamil R. Selvan Esra Kupeli Akkol Ning Wang Hongjun Yang Xiaolan Cheng

A Good Policy for Guaranteed Safe Practice of Complementary and Alternative Medicine, Usage of Disposable Cupping Cups.

This is a comment on “Addendum: Safety Standards for Gua Sha (Press-Stroking) and Ba Guan (Cupping)” [1]. Interventions of complementary and alternative medicine (CAM) are facing huge challenges whether their effectiveness and safety can be supported by concrete evidence. Although CAM is widely used and takes considerable charge of public health worldwide, benefits and harms related to each CAM intervention are frequently disputable, which urges relevant researchers and academic societies to conduct rigorous clinical trials and to support information for medical decision with evidence-based knowledge through reputable clinical guidelines. One of the major factors that may be inhibiting referrals of CAM treatments by biomedical doctors is the absence of appropriate information related to CAM interventions [1]. In this sense, this current safety guideline on the Gua sha (press-stroking) and Ba guan (cupping) by Nielsen et al. deserves a passionate welcome, even though it seems to have room for improvement, especially in the field of cupping [2]. Compromising with reality inevitably, recently published addendum of this guideline added a process for disinfection or sterilization of cupping devices, which might retract clinical importance of this guideline [3]. Although recommended sterilization process might be effective in preventing most unnecessary adverse events related to wet-cupping, it seems quite clear that all the blood-borne viral infection cannot be blocked perfectly with it. Single use of cupping device is the best way we need to pursue, and it is not an impossible measure practically. In this letter, we want to show a good example of dissemination of single-use, disposable cupping cup through the government policy in Korea. Korean National Health Insurance Service has reimbursed the material costs of single-use, disposable cupping cups for wet-cupping treated by doctors of Korean Medicine (KM) abiding by the decision of National Health Insurance Policy Deliberative Committee, Ministry of Health & Welfare Since 2012. Presently, there are seven companies producing disposable cups after obtaining approval from the ministry (Table 1). Any licensed doctors of KM who use these products for wet-cupping can get reimbursement from the service after easy registration in the website of Korean Health Insurance Review & Assessment Service (http://www.hira.or.kr/). From our experience of clinical practice and trials, these single-use cups can be utilized very safely and any specific adverse events hardly occur [4]. Table 1 The list of authorized companies producing disposable cupping cups which can be reimbursed by National Health Insurance Service in Korea. Because there is not yet any survey result on the current state of utilization of disposable cupping in Korea, future related study will be necessary on the real usage of disposable cupping cups in KM clinics. But it seems to be that more and more doctors of KM move to using disposable cupping cups because they are safer than reused ones, and doctors do not need to pay for them. Patients who are prejudiced against the wet-cupping therapy for its unsanitary nature will participate in cupping treatment willingly in this situation. As several times used, sterilized blunt needles were thrown out by single-use, disposable needles for acupuncture treatment currently, single-use, disposable cupping cups will be a market leader in future. Government policy can also promote this process as it is working in Korea.

A Systematic Overview of Reviews for Complementary and Alternative Therapies in the Treatment of the Fibromyalgia Syndrome.

Objectives. This systematic overview of reviews aimed to summarize evidence and methodological quality from systematic reviews of complementary and alternative medicine (CAM) for the fibromyalgia syndrome (FMS). Methods. The PubMed/MEDLINE, Cochrane Library, and Scopus databases were screened from their inception to Sept 2013 to identify systematic reviews and meta-analyses of CAM interventions for FMS. Methodological quality of reviews was rated using the AMSTAR instrument. Results. Altogether 25 systematic reviews were found; they investigated the evidence of CAM in general, exercised-based CAM therapies, manipulative therapies, Mind/Body therapies, acupuncture, hydrotherapy, phytotherapy, and homeopathy. Methodological quality of reviews ranged from lowest to highest possible quality. Consistently positive results were found for tai chi, yoga, meditation and mindfulness-based interventions, hypnosis or guided imagery, electromyogram (EMG) biofeedback, and balneotherapy/hydrotherapy. Inconsistent results concerned qigong, acupuncture, chiropractic interventions, electroencephalogram (EEG) biofeedback, and nutritional supplements. Inconclusive results were found for homeopathy and phytotherapy. Major methodological flaws included missing details on data extraction process, included or excluded studies, study details, and adaption of conclusions based on quality assessment. Conclusions. Despite a growing body of scientific evidence of CAM therapies for the management of FMS systematic reviews still show methodological flaws limiting definite conclusions about their efficacy and safety.

Prevalence of musculoskeletal disorder and alternative medicine therapies among dentists of North India: A descriptive study.

Aim:Health professionals especially the dental professional are the frequent targets of musculoskeletal disorders (MSD). Complementary and alternative medicine (CAM) can be of some help in managing these MSD especially in. The purpose of this study was to determine the prevalence of CAM therapies as a treatment modality for MSD management among dental professionals of north India.Materials and Methods:Registered dentist of North Indian origin, India (n = 3598) were included in the study. The questionnaire was sent to all the dentists which consisted of the demographic profile, MSD in the past year, CAM therapies utilization and opinion about CAM therapies. Data analysis was done using SPSS version 21 and data were presented in tabular and graphic form. Test of significance was done using chi-square statistics with P < 0.05 considered as significant.Results:A response rate of 80% (n = 2879) was obtained, and all complained of MDS in some or the other part of their life. The use of CAM was reported among 70% (n = 2015) of the dentist who suffered from MSD. Other dentists either used conventional treatment or did not use anything.Conclusion:As the name implies, alternative medical systems is a category that extends beyond a single modality and refers to an entire system of theory and practice that developed separately from conventional medicine. CAM should be subject to rigorous scientific inquiry so that interventions that work are systematically distinguished from those that do not. In addition, the use of CAM treatments should be based on evidence of effectiveness and safety as demonstrated in randomized clinical trials.

How and why patients use acupuncture: an interpretive phenomenological study

The usual drivers of health care provision, namely efficacy and cost, might be expected to drive down the use of Complementary and Alternative Medicines (CAMs), given the relative paucity of evidence of efficacy for many CAMs. Usage of CAMs remains extensive and little attention has been given to explaining this paradox. This paper explores how patients integrate acupuncture, as a CAMs exemplar, within their personal schemes of health care. An interpretive phenomenological approach underpinned the inquiry, which gathered data from in-depth interviews with 12 participants who had recently consulted acupuncturists. Thematic analysis was conducted using a constant comparison methodology. Participants mostly accessed acupuncture for musculoskeletal and pain-related conditions. Usage was often initially motivated by dissatisfaction with conventional health care, perceptions that the source of the problem had not been addressed, and sometimes was due to negative experiences with medical professionals. Previous positive outcomes with acupuncture motivated more extensive use, as did personal health ideologies. Acupuncture was viewed to be appropriate for treating chronic and quality of life health issues, while treatment-associated cost was identified as a barrier to access. CAMs usage has been explained variously by 'push' and 'pull' factors; however, this study has shown that reasons for patient use of acupuncture may be complex and change over time. This qualitative study suggests that acupuncture fulfils specific health needs unmet in conventional health care, but also that patients view CAMs treatment as part of a broader and more pluralistic scheme of health care.

The Role of CAM in Public Health, Disease Prevention, and Health Promotion.

As the worldwide burden of chronic disease continues to rise, disease prevention and health promotion become increasingly important components of public health. Although many complementary and alternative medicine (CAM) practices have emphasized health promotion and the area of CAM health care holds much opportunity and challenge for issues of public health, CAM research to date has been dominated by more clinically restrictive issues [1, 2]. However, CAM practitioners can constitute a public health resource to increase the population's access to certain clinical preventive services if integrated into mainstream public health practice. As part of this integration of CAM practices, it is important to investigate methods of effective interprofessional collaboration involving both CAM and mainstream professions. It is also essential to identify issues that might be challenging to integration from the perspective of both mainstream and CAM providers such as professional biases on both sides, differences in perception of health and disease, common language, and adherence to evidence-based principles. This special issue includes original research papers and systematic reviews investigating the issues related to CAM practices in the public health arena as well as outcomes of CAM treatment for chronic disease prevention and/or management (tertiary prevention). There are 14 articles in this issue, from six countries and on a wide variety of topics. The topics addressed are almost equally divided between treatment of specific conditions of public health importance and disease prevention through risk factor reduction. A smaller number of articles address issues related to traditional medicine use among the general public. Articles on treatment of conditions include a large clinical study by J.-F. Tang et al. on safety and evaluation of Danhong injection; a basic science study on Brucea javanica oil by Y. Liu et al.; a systematic review and meta-analysis of the efficacy of compound kushen on cancer pain by X. Ma et al.; an analysis of Qigong's effect on chronic fatigue syndrome by L. P. Yuen et al.; a systematic review of acupuncture for allergic rhinitis and asthma by L. Zhou et al.; and an analysis of the effects of guided imagery on patients on mechanical ventilation by B. Brakovich et al. Articles on prevention and risk factor reduction were a randomized controlled trial of Tai Chi on weight loss, metabolic syndrome, and bone mineral density by T. C.-Y. Kwok et al.; an analysis of body constitution through Traditional Chinese Medicine by C.-H. Lee et al.; a survey of apitherapy use for disease prevention by S. Trumbeckaite et al.; an exploration of the possible effect of CAM on antibiotic resistance by W. B. V. Leeuwen et al.; and a survey of the effect of Traditional Chinese Medicine on decreasing stroke risk among users of corticosteroids for dermatitis by J.-L. Shen et al. Finally, F. Xu et al. described the validation of a questionnaire based on Traditional Chinese Medicine to assess health status; S. H. Ng et al. described use of the Theory of Planned Behaviour related to Traditional Chinese Medicine use; and G. D. Hughes et al. characterized the use of herbal medicines for noncommunicable disease. These articles tended to focus more on single herbal or other traditional preparations or procedures for both treatment and prevention, with very little emphasis on health behaviour, which is typically a cornerstone of public health programs. Behaviours related to diet, physical activity, and stress reduction are known to be increasingly important factors in determining the health of the public and are also areas of importance and emphasis for many CAM practitioners. It is necessary for CAM professions to become visible in this arena and for CAM research to extend into this direction rather than focusing narrowly on specific therapies if these efforts are to be recognized and utilized for the benefit of populations. Cheryl Hawk Jon Adams Jan Hartvigsen

Patterns of complementary and alternative medicine (CAM) use among dental patients

Complementary and alternative medicine (CAM) is a diverse collection of approaches used to prevent or treat diseases. The goal of this study was to examine relationships between dental patient characteristics and current usage of CAM therapies. The CAM definition encompassed 24 therapies excluding prayer. Associations and trends in usage were assessed for gender, income, education, and age. Multivariable logistic and negative binomial models were used to identify factors impacting the use and number of CAM therapies used. In dental patients (n = 402), nearly 67 percent of subjects reported at least one CAM treatment. Gender was significantly associated with recent utilization of CAM, biological, manipulative (all P < 0.01), and mind-body (P = 0.04) therapies, as well as the number (P < 0.01) of therapies used. Higher education levels were significant in usage of any CAM, biological, and mind-body therapies (P < 0.01). A large proportion of dental patients reported use of CAM therapies. While CAM therapies and those who use them are diverse, given their widespread use, they clearly have potential impacts on the oral health of the public. Knowledge of the characteristics of dental patients who use CAM therapies is a first step in developing a broader understanding how CAM therapies and associated beliefs may affect oral health and public health programs.

Fighting for wellness: strategies of mid-to-older women living with cancer.

A significant portion of older adult cancer patients are using complementary and alternative medicine (CAM ) during and after treatment. I used four case studies to examine the strategies of older adult CAM-using cancer patients to maintain a sense of well-being as they transitioned to a post-treatment phase of life. Data were collected via qualitative interviews. Findings included strategies for financing CAM treatments, dealing with life disruption, and managing the complete nutritional overhaul recommended by their program. Participants worked to achieve new lifestyles and senses of wellness, finding ways to pay for expensive, out-of-pocket care while still meeting family obligations. These findings shed light on assumptions about older adult health-seeking behaviors, culturally embedded life course expectations, and raised questions about how the pursuit of health activities involving boundary crossings are received.

National Cancer Institute's support of research to further integrative oncology practice.

In the United States, the term “integrative oncology” may be variably defined, but most definitions would include the idea and prac tice of adding complementary and alternative medicine (CAM) approaches to the range of therapeutic options provided to cancer patients in previously strictly conventional medical environments. This shift in practice has been paralleled and aided by a gradually evolving evidence-base established from the results of welldesigned and conducted research, often funded by the National Institutes of Health. Both the absolute and proportional sizes of the National Cancer Institute’s (NCI’s) CAM research portfolio grew substantially in the early 2000s reaching a peak in FY2004 ($128.7 million; 2.7% of NCI’s appropriations). Over the intervening decade, NCI has annually supported over 300 intramural and extramural projects with some component of CAM research, with research costs totaling 80–120 million dollars annually (1). The great majority of these projects explore aspects of basic science or clinical cancer research; however, NCI also supports research to improve communication about CAM issues (2). The NCI’s Physician’s Data Query program also provides summaries of the literature about several CAM interventions with separate formats developed for healthcare practitioners and for patients (3). NCI’s extramural research portfolio (ie, grants, cooperative agreements, contracts) includes projects addressing all phases of the cancer continuum and is distributed throughout several scientific programs within NCI. The field of cancer survivor ship touches on nearly all the aspects of cancer management and some of prevention as well, thus the great majority of NCI’s CAM research portfolio is relevant to it. This diverse portfolio includes both preclinical and clinical research exploring aspects of traditional medical systems (eg, traditional Chinese medicine [TCM]), exercise, mind-body interventions, manual therapies, various botanicals, and diet (from individual components to whole diet interventions). One major component of NCI’s clinical research activi

Survivorship care planning: unique opportunity to champion integrative oncology?

Already numbering 13.7 million and growing rapidly, cancer survivors have taught us two important lessons. First, even when cancer treatment ends, the cancer experience does not. Rather, the transition from active treatment to recovery ushers in a whole new period in the cancer journey, often referred to as survivorship (1). The second lesson learned, a corollary to the first, is that cancer and its treatment have the capacity to affect not simply physical well-being, but also virtually every aspect of an individual’s life, including psychological, social, economic and existential health and function. While some of these effects (eg, alopecia, nausea, and vomiting) dissipate rapidly once treatment ends, others (eg, fatigue, sexual dysfunction, memory problems) can persist over time, in some cases (eg, lymphedema, pain syndromes), becoming chronic. Still another set of effects may appear months or years after treatment ends (cardiac dysfunction, osteoporosis, diabetes), the most worrisome of these being recurrent or second cancers (1). Today, most oncology practitioners recognize the need to consider cancer’s long-term impact on their patients’ overall health and function. However, how best to do this remains a challenge (2). The evolving mandate to develop survivorship care plans, inclusive of plans to address psychosocial needs and provision of counsel about health promotion, presents a unique opportunity for advancing an integrative model of cancer care for those entering this new phase. Cancer survivors are already employing a menu of complementary and alternative medicine (CAM) practices to manage the chronic effects of treatment, reduce the risk of recurrence or second cancers, gain control over their lives, address comorbid conditions exacerbated by illness, and, ultimately, improve their quality of life. Population-based studies report usage rates ranging from 65% (ever used) to 40% (used in the past year) (3); and data suggest rates are not diminishing over time (4). Within the spectrum of treating the lingering and late effects of cancer, some promising interventions are emerging. For example, ginseng and yoga have shown promise in symptom management trials of fatigue and sleep disturbances respectively, both chronic problems reported frequently by cancer survivors (5,6). Given the documented positive association between quality of life and survival, there is arguably an important role for CAM use in recovery and life after cancer. Many of the challenges in conducting CAM research among survivors are not unique to the field. As with any intervention trial, issues of quality control, standardization, as well as understanding how the treatment might interact with adjuvant or maintenance therapies, which for growing numbers of cancer survivors may be ongoing years after curative therapy ends, must all be adequately addressed. Mind-body therapies, such as yoga and tai chi, also face challenges similar to the more conventional cognitive-behavioral therapies, with respect to selecting an appropriate control arm, maintenance of treatment fidelity, and participant adherence. To date, few treatment centers or clinics provide systematic orientation to CAM therapies, and many survivors still do not ask about the utility of these in managing their long-term health and function. In addition, opportunities to implement an integrative model of care must be carefully balanced against what is known to be safe and effective. Unfortunately, data are lacking on what practice to recommend to whom and for what, or the safety, mechanism of effect and efficacy of many CAM interventions to address troublesome posttreatment concerns. Further, there is no evidence to suggest that specific CAM practices may positively or negatively affect recurrence or prevent new cancers. More research, both descriptive and interventional, is needed if we are to remedy this situation and promote a model of posttreatment care that embraces care for the whole patient.

Experiences of complementary and alternative medicine in patients with inflammatory bowel disease - a qualitative study.

BackgroundThe use of Complementary and Alternative Medicine (CAM) in Inflammatory Bowel Disease (IBD) is increasing. Although CAM often improves patients’ well-being, it can also lead to side-effects and interactions with conventional medications. Research on patients with IBD in Sweden who have experiences of CAM is sparse. More studies are needed to enhance awareness of and improve communication about CAM. The aim of this study was to describe experiences of CAM in the healthcare context reported by patients with IBD.MethodsFifteen patients with IBD, eight with Crohn’s disease (CD) and seven with ulcerative colitis (UC), were recruited. Semi-structured qualitative interviews were conducted and qualitative content analysis was performed.ResultsThe analysis revealed the theme Knowledge and communication lead to participation in the area of CAM based on three categories; CAM use, Communication and Self-care. Patients with IBD wanted to be asked about CAM to be able to start a dialogue, as some perceived being treated in a disparaging manner and not taken seriously when raising the subject. Healthcare professionals (HCPs) need to be aware of this in order to meet and understand patient needs. Patients with IBD found it easier to communicate about CAM with the IBD nurses than physicians and dietary changes was one important CAM treatment.ConclusionsThe finding that it was easier to discuss CAM with nurses than physicians emphasizes the important role of the IBD nurse in communication and monitoring patients’ CAM use. Patients wanted to be asked about CAM to be able to start a dialogue, as some perceived not taken seriously when raising the subject. Furthermore, HCPs need to understand that many patients with IBD regard dietary changes as an important part of CAM treatment. Further research in these areas is needed.