Complementary And Integrative Medicine Use Research Articles

Exploring Integrative Approaches: Insights Into Complementary Medicine Practices Among Breast Cancer Survivors in Saudi Arabia.

Complementary and integrative medicine (CAM) is a prevalent approach often used with conventional medical practices The study aims to understand the factors influencing breast cancer (BC) survivors' decisions regarding CAM therapy and the drivers behind their use. This research was conducted at an academic hospital in Saudi Arabia. The study used cross-sectional research with a questionnaire. Participants were enrolled in the study through BC survivors' groups on WhatsApp. Individuals who were actively following up at the clinic were also interviewed. Informed consent was obtained. The study surveyed 211 BC survivors, aged 34-49 (50.2%), who had undergone surgery (93.4%), hormonal therapy (66.4%), and chemotherapy (87.7%). Less than half (44.5%) had chronic conditions such as diabetes and hypertension. CAM users were 43.6%. The most used CAM modalities were Zamzam water, honey, and water read-upon Quran. A significant motivator for CAM use was to boost the immune system. More than half of patients used less than 100 SAR per month on CAM modalities. Exactly 80.4% of CAM users perceived benefits from CAM use. Predictors of CAM use included higher family monthly income, radiation therapy, and being diagnosed from 1 to 5 years. BC survivors without medical conditions after diagnosis were less likely to use CAM. The study highlights the prevalence, predictive factors, motivations, and perceived benefits of CAM use among BC survivors in Saudi Arabia, emphasizing the need for understanding and integration into cancer care plans and the need for further research on CAM safety and efficacy.

Temporal Trends in Use of Complementary Therapies Among Patients With Cardiovascular Disorders

This study aimed to evaluate the use and frequency of complementary and integrative medicine (CIM) therapies in an outpatient cohort with cardiovascular disease (CVD) and compare trends over time. This cross-sectional point-of-care prospective study assessed patients attending a cardiology outpatient clinic. As in our 2009 cohort, data were collected with a 17-question survey on demographic characteristics, CVD history, current use and future interest in CIM. In total, 964 patients completed the survey. CIM use continues to be high (2009 vs 2018, 83.4% vs 81.8%) (p=0.34), with dietary supplements the most common therapy (75% in both studies). We observed increased use of mind-body therapies (28.5% vs 23.9%, p=0.02), especially meditation, yoga, and tai chi. Of the patients receiving CIM therapies, 41.9% reported using CIM for heart-related symptoms. Relaxation, stress management, and meditation were the top three mind-body therapies for CVD-related symptoms in both cohorts. Reporting of CIM use to clinicians is low (15%) and interest on future use is high (47%). In conclusion, CIM is highly used in cardiology patients-4 of 10 patients use CIM for CVD-related symptoms. Most take dietary supplements, with an increased use of mind-body therapies. Our data highlight the importance of documenting CIM use in practice and the need for research to document efficacy.

Complementary and Integrative Medicines Used by Cancer Patients to Cope With Chemotherapy-Related Taste Alterations

Introduction: Cancer is a global health problem. Taste change is one of the most common symptoms in cancer patients undergoing chemotherapy. Cancer patients often use Complementary and Integrative Medicine (CIM) to manage chemotherapy complications. Objective: This study aimed to evaluate CIM used by cancer patients to cope with chemotherapy-related taste alterations. Materials and Methods: This cross-sectional study was carried out on 318 cancer patients receiving chemotherapy in an oncology hospital in Malatya City, Turkey. The samples were recruited by convenience sampling method. The study data were collected with a data form developed by the research team. Written permissions were obtained from all participants and the Ethics Committee. Frequencies, mean scores, and standard deviation were used to present descriptive findings. The independent t-test, Chi-square test, and multivariate logistic regression analysis were used to analyze the obtained data. Results: The Mean±SD age of the patients was 65.18±8.36 years, and the mean duration of their diseases was 35.34±16.27 months. About 54.1% of the patients were female, and 42.8% had some information about CIM. Their primary source of information was other patients (49.6%), and 34.9% used CIM to cope with chemotherapy-related taste alterations. The most common method used was phytotherapy (50.5%), and the most commonly used herb was miracle fruit (21.4%). It was also determined that the frequency of CIM use was affected by age, illness duration, gender, living in a city, family history of cancer, having breast cancer, having information on CIM, having metastasis, and lacking complications (R2= 0.426, P=0.025). Conclusion: Cancer patients frequently use CIM to cope with chemotherapy-related taste alterations, and phytotherapy was the most commonly-used CIM.

Use of Complementary and Integrative Medicine Among Patients With Glioblastoma Multiforme Seen at a Tertiary Care Center.

BackgroundGlioblastoma multiforme (GBM) is among the most aggressive and lethal tumors, with a median survival of 12–15 months. Many patients use complementary and integrative medicine (CIM) therapies to supplement their cancer treatment.ObjectiveTo determine the prevalence of CIM use and identify the most frequently used types of CIM in a cohort of patients with GBM seen at a tertiary care medical center in the United States.MethodsAn anonymous survey was mailed through the US Postal Service from August 1, 2019, through February 21, 2020, to patients with GBM.ResultsA total of 346 surveys were mailed, and 146 responses (42%) were received. The median age of respondents was 61 years (range, 52–68 years), and 85 (58%) were male. Most patients had undergone surgery (90%), chemotherapy (96%), and radiotherapy (95%). The median time from diagnosis of GBM to survey participation was 18 months (range, 12–31 months). Most respondents (81%) used some form of CIM, most frequently meditation (22%), relaxation and other stress management techniques (19%), chiropractic therapy (16%), and acupuncture (12%). Compared with men, women more commonly meditated (32% vs 16%; P = .046) and practiced yoga (20% vs 6%; P = .04). We observed age-based differences, with younger patients more commonly meditating, practicing relaxation and stress management techniques, and receiving chiropractic therapy (P < .05 for all).ConclusionsProviders should encourage patients with GBM to discuss their interest in CIM therapies and guide them to evidence-based treatments that may help improve their quality of life.

Do Palliative Care Providers Use Complementary and Integrative Medicine? A Nationwide Survey

ContextGiven the high prevalence of burdensome symptoms in palliative care (PC) and increasing use of complementary and integrative medicine (CIM) therapies, research is needed to determine how often and what types of CIM therapies providers recommend to manage symptoms in PC. ObjectivesTo document recommendation rates of CIM for target symptoms and assess if, CIM use varies by provider characteristics. MethodsNationwide survey's of physicians (MD and DO), physician assistants, and nurse practitioners in PC. ResultsParticipants (N = 404) were mostly female (71.3%), physicians (74.9%), and cared for adults (90.4%). Providers recommended CIM an average of 6.82 times per-month (95% CI: 6.04–7.60) and used an average of 5.13 (95% CI: 4.90–5.36) out of 10 CIM modalities. Respondents recommended mind-body medicines (e.g., meditation, biofeedback) most, followed by massage, and acupuncture and/or acupressure. The most targeted symptoms included pain; followed by anxiety, mood disturbance, and distress. Recommendation frequencies for specific modality-for-symptom combinations ranged from little use (e.g., aromatherapy for constipation) to occasional use (e.g., mind-body interventions for psychiatric symptoms). Finally, recommendation rates increased as a function of pediatric practice, noninpatient practice setting, provider age, and proportion of effort spent delivering palliative care. ConclusionTo the best of our knowledge, this is the first national survey to characterize PC providers’ CIM recommendation behaviors and assess specific therapies and common target symptoms. Providers recommended a broad range of CIM but do so less frequently than patients report using CIM. These findings should be of interest to any provider caring for patients with serious illness.

Characteristics of Provider-Focused Research on Complementary and Integrative Medicine in Palliative Care: A Scoping Review.

The use of complementary and integrative medicine (CIM) continues to grow in palliative care. While research supports the use of many CIM therapies for symptom relief, the scope of provider-focused research on CIM remains poorly characterized. We conducted a scoping review to characterize provider-focused research on CIM in palliative care in order to map existing evidence and identify knowledge gaps. We developed a protocol outlining the study population, concept, and context; then used a validated approach per the JBI manual and searched MEDLINE, EMBASE, CINAHL, and AMED. We identified 34 studies that were conducted primarily in the US (n = 9) and UK (n = 6), focused mostly on nurse (n = 29) and physician (n = 22) providers, and employed questionnaires (n = 16) or qualitative (n = 15) methods. Studies investigated 58 CIM modalities, including massage (n = 13), music therapy (n = 12), and aromatherapy (n = 10), to address common symptoms including pain (n = 17), fatigue (n = 6), and nausea/vomiting (n = 6). Study outcomes included perceived benefits of CIM (n = 17) and types of CIM modalities that providers offer (n = 15). Uncommonly studied phenomena included referral patterns (n = 4), facilitators of provider recommendation of CIM (n = 3), and rates of CIM use (n = 3). Provider-focused research on CIM in palliative care can expand its scope by addressing perspectives of interdisciplinary providers, examining CIM modalities that patients report using, addressing symptoms commonly encountered in palliative care, and researching provider-use-focused outcomes. We identify these possibilities for future studies in addition to opportunities for systematic investigations to enhance the safe and efficacious delivery of CIM in the palliative care setting.

The use of complementary and integrative therapies as adjunct interventions during radiotherapy: a systematic review.

Literature supporting the efficacy of complementary and integrative medicine (CIM) alongside radiotherapy is fragmented with varying outcomes and levels of evidence. This review summarizes the available evidence on CIM used with radiotherapy in order to inform clinicians. A systematic literature review identified studies on the use of CIM during radiotherapy. Inclusion required the following criteria: the study was interventional, CIM therapy was for human patients with cancer, and CIM therapy was administered concurrently with radiotherapy. Data points of interest were collected from included studies. A subset was identified as high-quality using the Jadad scale. Fisher's exact test was used to assess the association between study results, outcome measured, and type of CIM. Overall, 163 articles met inclusion. Of these, 68 (41.7%) were considered high-quality trials. Articles published per year increased over time (p < 0.01). Frequently identified therapies were biologically based therapies (47.9%), mind-body therapies (23.3%), and alternative medical systems (13.5%). Within the subset of high-quality trials, 60.0% of studies reported a favorable change with CIM while 40.0% reported no change. No studies reported an unfavorable change. Commonly assessed outcome types were patient-reported (41.1%) and provider-reported (21.5%). Rate of favorable change did not differ based on type of CIM (p = 0.90) or outcome measured (p = 0.24). Concurrent CIM may reduce radiotherapy-induced toxicities and improve quality of life, suggesting that physicians should discuss CIM with patients receiving radiotherapy. This review provides a broad overview of investigations on CIM use during radiotherapy and can inform how radiation oncologists advise their patients about CIM.

A patient perspective of complementary and integrative medicine (CIM) for migraine treatment: a social media survey

To survey persons with migraine who use social media about Complementary and Integrative Medicine (CIM) for the treatment of migraine.BackgroundCIM encompasses medical treatments that are not part of but are used in concert with mainstream medicine. Between 28 and 82% of people with migraine use non-drug approaches, and approximately 50% of people with migraine do not discuss non-drug treatments with their healthcare providers (HCPs). It is important for providers to be conversant with CIM treatments and the available evidence-based data. To further this effort, people with migraine were surveyed directly through social media to identify CIM practices in which they engage.MethodsIn collaboration with the American Migraine foundation (AMF) and Yakkety Yak, a digital marketing agency, we conducted a cross-sectional survey study. Participants were recruited from the Move Against Migraine (MAM) Facebook group which has 20,000+ members. The goals of the survey were to assess the attitudes toward CIM among this group, to identify which CIM modalities are being used and to determine what patients considered to be the most effective CIM modalities. While Yakkety Yak posted the survey link on the group page, the survey itself was hosted on Qualtrics, a confidential survey service.Results372 MAM members (approximately 2%) responded to the questionnaire, of which 335 reported using CIM; between 114 and 139 (34–42%) found CIM modalities to be at least mildly effective. Of note, 164 (49%) reported using cannabis derivatives or cannabinoids, specifically with, 64/164 (39%) reporting that cannabis was not effective for them.ConclusionsThis study provides an initial investigation into the demographic and practice patterns of migraine patients who use CIM. While this sampling may not reflect CIM use across all individuals with migraine, it does strongly suggest the need for better education on the role of, and evidence for, CIM among headache care providers, and the need to ask patients specifically about their use of and interest in CIM.

Clinician perspectives of complementary and integrative medicine (CIM) at an academic cancer center.

e24047 Background: Surveys suggest up to 87% of patients with cancer use complementary and integrative (CIM) therapies such as herbal medicine, acupuncture, massage and mind-body practices. These therapies may assist with symptoms of pain, nausea and anxiety. However, several studies have demonstrated that many clinicians do not inquire about CIM use, which may be due to lack of education and/or limited evidence-based data. We sought to explore the perspectives of clinicians at an academic comprehensive cancer center on the use of CIM therapies. Methods: Physicians and advanced practice providers (APPs) who practice medical oncology, hematology, radiation oncology, surgical oncology and neuro-oncology in a Midwest tertiary comprehensive cancer center were asked to participate in a 9-question online survey which inquired about their personal knowledge and recommendation for 21 different CIM therapies (not all are offered at the cancer center). Responses were summarized using descriptive statistics. Results: The response rate for this survey was 24.5% (n = 49). Responders were from the following specialties: hematology (n = 17; 35%); solid tumor (n = 18; 37%); both hematology and solid tumor (n = 8; 16%), surgical oncology (n = 3; 6%); gynecologic oncology (n = 2; 4%) and radiation oncology (n = 1; 2%). Sixty-seven percent were attending physicians and hematology/oncology fellows (n = 33), and 33% were APPs (n = 16). Median age range was 30-39 years (range 20-59). The most recommended CIM therapy for cancer treatment-related effects was massage (80%), followed by deep breathing (55%). The least recommended CIM therapies were traditional Chinese medicine (TCM) and Ayurvedic medicine (2%), followed by vitamins/minerals and homeopathy (both 6%). Participants requested more education on CBD/CBD oil (59%) and herbs/botanicals (49%). Up to 14% of respondents already had education on five integrative therapies. Conclusions: Hematology/oncology clinicians do not routinely recommend most CIM therapies, except for massage therapy. Efforts should be made to educate clinicians regarding CIM therapies used by patients with cancer as well resources that appraise the efficacy, safety, and potential drug interactions of these therapies. Education could encourage informed decision-making and improved patient-clinician communication and satisfaction.

Training oncology physicians to advise their patients on complementary and integrative medicine: An implementation study for a manual-guided consultation.

The unmonitored use of complementary medicine in patients with cancer can be associated with an increased risk of safety-related issues, such as lower adherence to conventional cancer therapies. Training oncology physicians to advise their patients about the effectiveness and safety of these therapies could improve this situation. The objective of this study was to develop and pretest a consultation framework that has high potential to be widely implemented. The framework comprises: 1) a systematically developed and tested, manualized, guided consultation; and 2) blended learning training (e-learning and communication skills training workshop) to upskill oncology physicians in advising their patients on complementary and integrative medicine (CIM). For this implementation study, mixed methods were used to develop the manual (literature review, consensus procedure, pilot testing) and the training (questionnaires and interviews with oncology physicians and patients with cancer and an examination of the skills in a setting with standardized patients). The training was tested with 47 oncology physicians from across Germany. The manual-guided consultation (context: general information on the setting and communication techniques; inform: consultation duration and content; capture: previous CIM use; prioritize: focus on consultation; advise: evidence-based CIM recommendations; discuss, advise, accept, or advise against other CIM; concretize advice: summary and implementation; and monitor: documentation) was considered suitable. The structure and time frame (maximum, 20minutes) of the consultation as well as the training were feasible and well accepted. The current study demonstrates that the KOKON-KTO framework (a German acronym for Competence Network for Complementary Medicine - ConsultationTraining for Oncology Physicians) is suitable for training oncology physicians. Its implementation can lead to better physician-patient communication about CIM in cancer.

Use of Complementary and Integrative Therapies by Fibromyalgia Patients: A 14-Year Follow-up Study.

ObjectiveTo reevaluate the frequency and pattern of complementary and integrative medicine (CIM) use in patients with fibromyalgia (FM).Patients and MethodsConsecutive patients with FM who were referred to the Mayo Clinic fibromyalgia treatment program from January 5 through July 27, 2017, were invited to complete a survey about their use of CIM therapies in the preceding 6 months. The survey asked about 3 primary CIM domains: treatments and techniques, vitamins and minerals, and herbs and other dietary supplements. For direct comparative purposes, we reused the survey instrument from our prior analogous study of CIM use, performed in 2003.ResultsOf the 310 patients who completed the survey, 304 (98.1%) reported using some form of CIM, similar to the percentage reported in our 2003 study (98%). The most frequently used CIM therapies in the current cohort were spiritual healing (54.0% [163 of 302]), massage therapy (50.0% [152 of 304]), chiropractic treatments (39.3% [118 of 300]), aromatherapy (39.0% [117 of 300]), exercise for a specific medical problem (38.6% [117 of 303]), melatonin (37.9% [77 of 203]), magnesium (36.3% [107 of 295]), green tea (36.1% [73 of 202]), and fish oil (34.5% [68 of 197]). We noted numerous substantial differences from the 2003 data in terms of the pattern of CIM use.ConclusionThe use of CIM therapies among patients with FM continues to be extremely common for adult patients of all ages. Given the continued high prevalence of CIM use, health care professionals must have awareness and knowledge of these various modalities and their potential incorporation into a multifaceted FM treatment regimen.

Assessment of the complementary and integrative medicine utilization among patients with multiple sclerosis using a translated and adapted version of the international questionnaire (I-CAM-QP): A cross-sectional study in Southern Iran

AimsTo assess the prevalence of and factors related to complementary and integrative medicine (CIM) use among multiple sclerosis (MS) patients, using a translated and adapted version of a standard international questionnaire. MethodsInternational complementary and alternative medicine questionnaire (I-CAM-Q) was used. A cross-sectional study was done to assess the prevalence of and factors associated with CIM use among MS patients in Southern Iran. Patients who were randomly selected from MS registry center, were interviewed via phone calls. ResultsThree hundred patients were enrolled in the study; 69% of them were female. Their mean age was 36.6±8.53 years and the mean duration of the disease was 5.6 ± 4.22 years. In all, 99.3% (95% CI) of the patients had used at least one type of CIM. Herbal medicines and dietary supplements were the most commonly used CIM type (97.3%; 95% CI). Praying was the most common modality among all CIM subgroups (81.3%; 95% CI). Long term illness (MS) was selected as the main reason for the last use of all CIM types. Having non-tertiary education and having sequel due to MS were related to visiting a CIM provider (adjusted odds ratio (AOR) = 2.32, 95% confidence interval (CI) = 1.22–4.43), (AOR = 2.67, 95% CI = 1.47–4.83) respectively. Being female was related to the use of self-help practices (AOR = 3.41, 95% CI = 1.5–7.72). ConclusionThere is a high prevalence of CIM use among MS patients. Therefore, patient- physician communication about CIM use should be emphasized.

Complementary and Integrative Medicine Use in Individuals Seeking Conventional Medical Oncology Care in Chile: Prevalence and Patient Characteristics.

PURPOSEComplementary and integrative medicine (CIM) use during cancer care has increased in Western medical settings. Little is known about interest in and use of CIM approaches by oncology patients in Chile and South America.PATIENTS AND METHODSPatients presenting for conventional outpatient or inpatient medical oncology care at the Clinica Alemana in Santiago, Chile, from March to June 2017 were asked to complete a survey about their interest in and use of CIM approaches. Goals included determining the prevalence of CIM use and exploring associations between CIM use and patient characteristics. Statistical analyses included a two-tailed t test for continuous variables, Fischer’s exact test for categorical variables, and logistic regression for association between CIM use and other variables.RESULTSOf 432 patients surveyed, 66.9% were diagnosed with breast cancer, 84.8% were women, the majority of patients (58.1%) were between age 40 and 60 years, and 51.5% (n = 221) reported CIM use. No association was found between CIM use and the sociodemographic variables of sex, age, education, or income. In all, 44.6% of patients with breast cancer reported CIM use compared with 64.8% of patients with other cancer types (P > .001). Most commonly reported types of CIM used included herbals (49.1%), vitamins and minerals (40.8%), and prayer or meditation (40.4%). Most frequent reasons for CIM use were to “do everything possible” (72%) and to “improve my immune function” (67.8%). Most patients (43.4%) reported starting CIM use at the time of cancer diagnosis, with only 55.4% sharing information regarding CIM use with their medical team.CONCLUSIONThe majority of patients surveyed reported engaging in CIM use, with just over half the users communicating with their oncology team about their CIM use. Increased awareness of regional differences in CIM use may help increase communication regarding this subject and contribute to improved outcomes.

Employing Evidence in Evaluating Complementary Therapies: Findings from an Ethnography of Integrative Pain Management at a Large Urban Pediatric Hospital.

Complementary and Integrative Medicine (CIM) shows positive clinical benefit with minimal side effects, yet, challenges to effective integration of CIM providers in biomedical health care settings remain. This study aimed to better understand the role evidence played in the process of integration of complementary therapies into a large urban pediatric hospital from the perspective of patients, caregivers, providers, and administrators through applied medical ethnography. An ethnography was conducted over the course of 6 months in a large urban pediatric hospital in the Southern United States. At the time, the hospital was piloting an integrative medicine (IM) pain consult service. Purposive sampling was used to select providers, patients, administrators, and caregivers to follow as they engaged with both the preexisting pain service and pilot IM pain services. Field observation and interviews were conducted with 34 participants. Thematic content analysis was used to analyze field notes, interview transcripts, and documents collected. Analysis of the data revealed five themes regarding the role of evidence in the process of integration: Anecdotal Evidence and Personal Experience Effecting CIM Use, Open to Trying Whatever Works, Resistance to the Unfamiliar, Patients and Parents Trusting Doctors as Experts, and Importance of Scientific Evidence to Biomedicine. All themes address the role of evidence in relationship to acceptance of complementary therapies and correspond with three thought processes: critical thinking, relying on others for evidence, and reactionary thinking. Both scientific and anecdotal evidence informed CIM use in this context. Biomedical environments seeking to integrate CIM into pain treatment regimens will need to engage all relevant stakeholders in building education, clinical training, and research programs that are critically informed about the context and evidence for CIM.

Abstract P4-12-04: Use of complementary and integrative medicine therapies in Chilean patients with breast cancer. Experience of a private center: prevalence and characteristics of patients

Abstract Background: During the last decade several studies have been reported that the use of complementary and integrative medicine (CIM), defined as health care methods generated outside of standard Western, or conventional clinical practices has been increasing among breast cancer patients in developed countries. However, there is little information about the use of CIM in developing countries. Chile currently has no published statistics on the use of CIM in breast cancer. Methods: We conducted a cross-sectional survey between March and June 2017 in breast cancer patients treated in Clinica Alemana de Santiago to determine the prevalence of CIM use and the types of preferred CIM. We also analyzed associations between CIM and several variables including sociodemographic variables, the reasons that motivated the use of CIM and the subjective benefits that patients attributed to CIM. Statistical analysis included two tailed t–test for continuous variables, Fischer's exact test for categorical variables and logistic regression for association between CIM use and other variables. Results: 288 patients answered the survey. Among them, 98.9% were women, mostly between 41 and 50 years (40.4%). 44.9% (n = 129) reported using CIM. No association was found between the use of CIM and sociodemographic variables (sex, age, education, income). Most used CIM types were: vitamins / minerals (50.4%), herbs (48.8%), special diets (42.6%), meditation/prayers (37.2%). The reasons for CIM use were "to do everything possible" (72%), "improve immunity" (67.8%), "reduce side effects of treatment" (32.7%), recommendation by family member or friend (32.7%). Regarding CIM habits, 50.8% of patients reported having started CIM use at the time of diagnosis and only 51.6% reported about CIM use to their attending physician. Most patients reported benefits associated to CAM use (61%) but no differences were found in reported quality of life. Conclusions: Great amount of the patients reported using CIM and half of them mentioned that they shared this information with their attending physician. It is necessary incorporate to medical routines questions regarding CIM use and to educate the patients regarding the safe use of CIM and the possible interactions of these approaches with conventional clinical practices. Citation Format: Salas C, Lopez G, Cadiz F, Barriga C, Gonzalez P, Acevedo S, Raimilla P, Pincheira P, Naing A, Quiroga M. Use of complementary and integrative medicine therapies in Chilean patients with breast cancer. Experience of a private center: prevalence and characteristics of patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-12-04.

Complementary and integrative medicine in kidney transplantation.

Complementary and integrative medicine (CIM) use is widely prevalent in kidney transplant recipients but studies of efficacy or potential harm are sparse. This review examines prevalence of use of CIM and discusses potential beneficial and harmful aspects of CIM in renal transplant recipients. The prevalence of CIM use in kidney transplant patients varies from 12 to 45%. There is a knowledge gap regarding CIM modalities among healthcare professionals that may contribute to reluctance to discuss CIM use with patients. Patients often do not spontaneously disclose its use, and those that use it may be more likely to be nonadherent to allopathic therapies. Herbal supplements may be nephrotoxic or interact with pharmaceutical agents, including calcineurin inhibitors. More data are needed to assess the potential benefits of other modalities of CIM, including yoga, Tai Chi or meditation, as these modalities have been beneficial for people with diabetes or hypertension, both of which are common in the posttransplant period. Despite a high prevalence of CIM use in kidney transplant recipients, data are limited regarding risks and benefits. Education of healthcare providers who care for kidney transplant recipients should be encouraged. Intervention studies should be designed to investigate the CIM modalities, including yoga, meditation and Tai Chi that have been shown to be beneficial in other chronic diseases.

Complementary and integrative medicine use for individuals seeking conventional medical oncology care in Chile: Prevalence and patient characteristics.

110 Background: Complementary and integrative medicine (CIM) use during cancer care has increased in western medical settings. Little is known about interest in and use of CIM approaches by oncology patients in South America. Methods: Patients presenting for conventional outpatient or inpatient medical oncology care at the Clinica Alemana in Santiago, Chile (March-June, 2017) were asked to complete a survey about their interest in and use of CIM approaches. Goals included determining prevalence of CIM use and exploring associations between CIM use and patient characteristics. Statistical analyses included two-tailed t-test for continuous variables, Fischer’s exact test for categorical variables, and logistic regression for association between CIM use and other variables. Results: Of 432 patients surveyed, 66.7% had a diagnosis of breast cancer, 84.8% were women, the majority between ages 40-60 (32.7%). Of those surveyed, 221 (51.5%) reported CIM use. No association was found between CIM use and sociodemographic variables (sex, age, education, income). Patients with breast cancer (44.6%) reported CIM use, compared to 64.8% of other cancer types (p=0.0001). Most commonly reported CIM types used included herbals (49.1%), vitamins/minerals (40.8%), prayer/meditation (40.4%), and special diets (38.5%). Most frequent reasons for CIM use included “do everything possible” (72%), “improve my immune function” (67.8%), “reduce treatment related side effects” (32.7%), and “recommended by family/friend” (32.7%). Most (43.4%) reported starting CIM use at the time of cancer diagnosis, with only 55.4% sharing information regarding CIM use with their medical team. Majority reported benefits from CIM use (60%). No differences were observed in self-reported quality of life between those using versus not using CIM. Conclusions: The majority of patients receiving conventional oncology care reported engaging in CIM use, with just over half of users communicating with their oncology team about their CIM use. Increased awareness of regional differences in CIM use may help increase communication regarding this topic and contribute to improved outcomes.

Complementary and Integrative Medicine in Hematologic Malignancies: Questions and Challenges.

Hematologic malignancies represent 9.7% of all cancers, making them the fourth most common type of cancer in the United States. The aggressive and complex treatments administered in hematologic malignancies result in a high burden of psychological needs. Complementary and integrative medicine (CIM) is becoming one of the options that patients use to address their distress during and after cancer treatments. It is not clear whether appropriate CIM can relieve distress in patients affected by these malignancies. This review covers the potential benefits of CIM as relates to nutrition, nutritional supplements, exercise, circadian rhythm, methods for reducing distress during bone marrow aspiration, massage therapy, and acupuncture, in treating patients with hematological malignancies. This review may provide a framework to enhance patient-doctor dialogue regarding CIM use in hematologic malignancies.

An exploratory typology of provider responses that encourage and discourage conversation about complementary and integrative medicine during routine oncology visits

ObjectiveTo characterize how providers respond to patient mentions of complementary and integrative medicine (CIM) during routine oncology visits. MethodsEthnographic methods were used over a two and a half year period with 82 advanced cancer patients and their providers across four oncology clinics. Participant observation fieldnotes were analyzed using Discourse Analysis. ResultsCIM was mentioned in 78/229 (34%) of the total observed visits. Patients initiated talk about CIM (76%) more than providers (24%). Patients mentioning CIM may indicate a preference for or interest in non-pharmacological adjunctive treatment options. Providers’ responses inhibited further talk in 44% of observations and promoted talk in 56% of observations. ConclusionHow providers respond may indicate their willingness to discuss a range of treatment options and to collaboratively engage in treatment decision-making. Provider responses that inhibited CIM conversation passed on the opportunity to discuss patient preferences, and responses that promoted further conversation helped counsel patients about appropriate CIM use. Promoting discussion did not require additional time or extensive knowledge about CIM. Practice implicationsProviders can facilitate high quality communication without endorsing CIM to help patients make treatment decisions and to evaluate CIM appropriateness in response to patient values and preferences.

Effects of complementary and integrative medicine on cancer survivorship.

Cancer survivorship has become a topic of great interest in the past few years. Unfortunately, even with successful treatment as well as good follow-up care, many patients continue to experience unmet physical, emotional, and spiritual needs as well as having an unsettling fear, fear of recurrence, a fear which most survivors share, even many years after their treatment ended. As a result, patients are continually looking for additional ways to address these needs and fears. Among the most popular approach is the use of complementary and integrative medicine (CIM). Most studies on CIM use among cancer patients and survivors concentrate on symptom improvement and improvement of quality of life and do not touch a crucial question if these therapies can affect patients' survival in terms of prolongation of life. Interestingly, in recent years, there are a growing number of studies that suggest that approaches such as mind-body interventions, enhanced general nutrition, nutritional supplements, physical activity, and other CIM approaches may have a positive effect on survival of cancer patients. Although additional studies are needed to confirm these findings, given the low cost of these CIM interventions, their minimal risk, and the potential magnitude of their effects, these approaches might be considered as additional important tools to integrate into cancer survivorship care plans.