Integrative Medicine Consultation Research Articles

Factors influencing caregiver decisions to use complementary and integrative therapies in pediatric oncology settings: Findings from a qualitative analysis

PurposeComplementary and integrative medicine (CIM) therapies (i.e., non-conventional Western medicine interventions) may reduce side-effects associated with pediatric oncology treatment. CIM therapies may also improve caregiver psychological and physical health that is exacerbated during pediatric cancer treatment. Despite known benefits, these therapies are not widely used within pediatric oncology populations in the United States. To guide and promote CIM use among this population, the aim of this project was to qualitatively explore factors that contribute to caregivers' decision to include CIM use in their own and child's care. MethodsTwenty caregivers of children (ages 0.5–14 years) being treated for cancer participated in this study. Each completed a demographic form and the CIM use questionnaire. Qualitative interviews followed by a card sort task were used to assess barriers and facilitators of uptake for caregivers and their child with cancer. ResultsA number of predisposing (e.g., child age, beliefs) and needs factors (e.g., potential to treatment-related side-effects) provide insight into caregivers’ decisions to use CIM for their child. Analyses also revealed the importance of enabling factors (e.g., resources) for caregiver use. Caregivers also reported benefiting from additional information about risk/benefit analysis of these therapies, and current research for CIM use in caregivers and children being treated for cancer. ConclusionChildren may benefit from individually tailored complementary and integrative medicine consultations that explore patient history and specific needs factors to improve preference concordant care and uptake. Caregivers may benefit from support that improves enabling factors associated with care (e.g., improved accessibility).

Immediate Effects of Integrative Health and Medicine Modalities Among Outpatients With Moderate-To-Severe Symptoms.

Patients seeking integrative health and medicine (IHM) modalities often present with multiple physical and psychological concerns. Research supports IHM's effectiveness for addressing symptoms over longer time periods. However, few studies have evaluated immediate outpatient effects. This study describes pre-encounter patient-reported outcome (PRO) clusters and examines the immediate clinical effectiveness of IHM modalities on pain, stress, and anxiety among outpatients with moderate-to-severe symptoms. A retrospective review was conducted of encounters among adults presenting to outpatient acupuncture, chiropractic, massage, integrative medicine consultation, or osteopathic manipulation treatment between January 2019 and July 2020. Encounters were included if patients reported pre-encounter pain, stress, or anxiety ≥4 on a numeric rating scale (NRS). Outcome analyses included random effects for patient and provider using a mixed model. Across 7335 clinical encounters among 2530 unique patients (mean age: 49.14 years; 81.0% female; 75.9% White; 15.8% Black/African American), the most common pre-encounter PRO clusters were pain, stress, and anxiety ≥4 (32.4%); pain ≥4 only (31.3%); and stress and anxiety ≥4 (15.6%). Clinically meaningful single-encounter mean [95% CI] changes were observed across all modalities in pain (-2.50 [-2.83, -2.17]), stress (-3.22 [-3.62, -2.82]), and anxiety (-3.05 [-3.37, -2.73]). Patients presenting to outpatient IHM with moderate-to-severe symptoms most often presented with pain, stress, and anxiety ≥4 on the NRS. Multiple IHM modalities yielded clinically meaningful (≥2 unit) immediate reductions in these symptoms. Future research measuring immediate and longitudinal effectiveness is needed to optimize the triage and coordination of IHM modalities to meet patients' needs.

Effect of Inpatient Integrative Medicine Consultation on 30-Day Readmission Rates: A Retrospective Observational Study at a Major U.S. Academic Hospital.

Objectives: The prevalence of inpatient integrative medicine (IM) consult services is increasing among academic health care institutions. The diversity of services between institutions, as well as the novel nature of such interventions, makes it challenging for health care administrators to determine the cost/benefit of adding such a program to their institution. The main purpose of this study was to examine the performance of the new University of California, Los Angeles (UCLA) East-West (EW) consult service as measured by 30-day readmission rates and lengths of stay. Design: This is a retrospective observational case-control study with participants matched to themselves. Setting: UCLA Santa Monica Hospital, a 281-bed academic tertiary care hospital near Los Angeles, California. Subjects: Patients who had received an EW consultation during the inaugural 20 months of the program (2018-2020), and who had been hospitalized in the prior 2 years from the date of their first EW consult. Intervention: Inpatient East-West consultation, which may include counseling, acupuncture and/or trigger point injections depending on medical necessity. Outcome Measures: Thirty-day readmission rates and lengths of hospital admission were compared between the hospitalization that included an EW consult (which included the use of acupuncture and/or trigger point injections when appropriate) and any prior admissions during the 2 years before that EW consult. Secondary outcomes included quantitative analysis of average number of treatments and qualitative assessment of integrative treatment(s) received, conditions treated, and reasons that EW treatment may have been deferred during a consult. Results: One hundred sixty-five unique patients met the study criteria. The EW consultation was associated with clinically relevant, statistically significant decreased 30-day readmission rates (33.0% vs. 4.6%, p < 0.001, odds ratio [OR] 0.10, 95% confidence interval [CI] 0.06-0.17). This effect was similar when limiting the analysis to pain-related admissions (32.3% vs. 3.4%, p < 0.001, OR = 0.07, 95% CI 0.03-0.16). Hospital admissions with EW consults were found to have a statistically significant increased length of stay (7.03 days vs. 5.40 days, p < 0.001). Conclusion: The EW medicine, an example of IM, correlates with a reduced risk of 30-day readmission and with modestly increased lengths of stay.

From the "what" to the "how": Teaching integrative medicine-related skills to medical students during COVID-19

ObjectiveTo examine the impact of an integrative medicine (IM) course on self-perceived IM-related communication and research skills. MethodsA 3-day mandatory "hybrid" (online and in-person) IM course was held within COVID-19 restrictions for 161 pre-clerkship medical students, with workshops facilitated by mentor healthcare professionals (IM and non-IM) and student-directed tasks. Self-perceived levels of 6 IM-related skills were scored (from 1 to 5) for history-taking; communicating with patients with "alternative" health-beliefs; referral to IM consultations; assessing risks/benefits; and working with non-medical IM practitioners. Results137 students (85.1%) completed pre-/post-course questionnaires, with overall scores improving from pre-course (1.98 ± 0.92) to post-course (3.31 ± 0.63; p < 0.0001), for the entire group and student subgroups (with vs. without prior IM experience). Multivariate analysis found no association between age, gender, primary language or prior experience with IM and improvement in skill scores. ConclusionsThe IM course increased self-perceived skill levels, reflecting the course curriculum and workshops. Further research needs to explore the application of these skills during clinical training. Practice implicationsTeaching medical students about IM in a course comprising communication and research skills was shown to be feasible and effective. The application of IM-related skills needs to be evaluated during the clinical clerkship.

Integrative Medicine Clinical Centers Keys to Success: Innovative Programming, Education, and Collaboration

Integrative Medicine Clinical Centers Keys to Success: Innovative Programming, Education, and Collaboration

Integrative therapies for symptom management in cancer survivors: Assessment of an on-site integrative medicine (IM) program.

142 Background: Up to 89% of oncology patients utilize integrative therapies with reported improvements in quality of life. However, less than half of patients report IM use to providers, potentially impeding optimal care. In September 2016, MedStar Montgomery Medical Center (MMMC), part of the MedStar Georgetown Cancer Network, opened the Center for Integrative Medicine (CIM) with support from MedStar’s Institute for Innovation (MI2). This clinical program offers IM consultation, acupuncture, mindfulness, psychology services, nutrition, and reiki. The purpose of this analysis is to examine oncology patient utilization of the CIM. Methods: Medical records of 174 patients seen September 2016 - October 2017 were reviewed, and 39 patients with a cancer diagnosis identified. Data regarding chief complaints, treatments, number of visits, and outcomes were analyzed. Results: 39 (22%) of 174 patients had a cancer diagnosis. After initial consultation, 29 of these patients received IM treatment; 14 returned for ≥5 treatments. Most common chief complaints were pain, stress/anxiety, fatigue, insomnia, and arthralgias (Table 1). The majority of CIM’s oncology patients was female and referred from in-network clinicians. The CIM referred 7 patients to other medical providers for unexpected medical issues and 2 required same-day appointments arranged by the CIM. Conclusions: These data illustrate oncology patients’ utilization and benefit of IM services within a hospital network. Communication between IM and referring providers may address unexpected clinical situations, potentially avoiding care delays and facilitating transparency with the use of IM services. Unpleasant symptom treatment may improve therapy adherence and quality of life. This review illustrates feasibility for an on-site CIM and the benefit to cancer survivors when IM services are offered collaboratively.[Table: see text]

Rationale for routine collection of patient reported outcomes during integrative medicine consultation visits

ObjectivesIntegrative medicine (IM) is whole-person care utilizing complementary health approaches to address numerous physical or emotional influences that can impact an individual’s health. Patient-reported outcomes (PRO) are subjective measures that quantify patients’ perception of their quality of life. While PRO measures have been routinely assessed in specific oncology clinics, our objective was to assess the ability and utility of routine collection of PRO measures in an IM clinic. Design/setting/main outcomePatients receiving a clinical consultation in an ambulatory IM clinic completed the PROMIS Global Health Form in the clinic waiting room. ResultsFrom November 2013 through October 2016, the PROMIS Global Health Form (PROMIS-10) was administered during 59% of IM provider consultation visits (7172/12,207), representing 3473 unique patients. Most patients were female (81%), White (93%), middle-aged (49.2; SD 15.4) and had commercial health insurance (66%). Baseline Mental (44.9; SD 9.1) and Physical Health (44.2; SD 8.6) scores were roughly 0.5 standard deviation below the national mean values (50; SD 10). Factors such as age, race and non-commercial insurance were associated with lower PROMIS-10 scores. Patients completing at least two PROMIS-10 questionnaires (n = 1541) exhibited increases of 2.3% and 2.8% from first to last PROMIS-10 assessment in Mental and Physical Heath scores respectively. ConclusionsIt is possible to routinely collect PRO measures in large IM clinic and longitudinal improvements in Mental and Physical Health scores were observed. Future research should focus on understanding how providers can utilize PRO results in real-time to improve patients’ clinical outcomes and potentially decrease healthcare utilization.

Inclusion of spiritual pain in patient reported outcome assessments as part of an integrative medicine physician consultation.

190 Background: Complementary and integrative health services are increasingly available to patients at cancer centers to help address physical and psychological needs. We review inclusion of spiritual pain (SP) as part of patient reported outcome (PRO) assessments in patients presenting for an outpatient integrative medicine consultation at a comprehensive cancer center. Methods: PRO data were collected as part of outpatient physician consultations at an integrative medicine clinic; we reviewed data between January 2013 and April 2017. Patients completed the Edmonton Symptom Assessment Scale (ESAS-FS, 12 symptoms, scale 0-10, 10 worst possible) immediately prior to the clinical encounter. ESAS distress subscales analyzed included psychological, physical, and global. Statistical analyses included summary statistics, two sample t-tests, correlations, and logistic regression. Results: We analyzed data from 4348 unique participants. Demographics included 65% women, average age 55.5, 78% Caucasian, 72% married or with significant other, majority Christian non-Catholic (49%) followed by non-specified (23%), and Catholic (20%). Overall, 41% of patients reported SP at baseline. Patients reporting a SP score of ≥ 1 (n = 1549) reported significantly higher levels of global, physical, and psychological distress than patients with SP scores of 0 (n = 2275) (all p’s &lt; 0.001). Older patients and men were less likely to report SP. SP clustered with psychological symptoms of depression and anxiety (reliability coefficient 0.76). Conclusions: A significant number of cancer patients presenting for integrative medicine consultations reported having SP, with SP clustering with psychological versus physical symptoms. More research is needed to better understand how routine screening for SP contributes to assessments of overall psychological health.

Longitudinal survey on integrative medicine education at an underserved health centre

Complementary and alternative medicine (CAM) is widely used by adults in the USA. However, most physicians do not inquire about CAM use leading to missed opportunities to dialogue about wellness and detect harmful practices. In 2012, an integrative medicine (IM) consultation clinic alongside an optional IM Residency Track for family medicine residents was established at the University of California, Irvine Family Health Center in Santa Ana, CA. This study evaluated the impact of these programmes on physicians’ CAM/IM knowledge and receptiveness. Online surveys assessing self-reported attitudes, knowledge and practices were distributed in 2012 (baseline) and 2014 (follow-up) to family physicians with response rates of 83% (35/42) and 62% (23/37), respectively. At baseline, 91.5% of physicians believed that patient satisfaction would moderately/strongly increase if offered CAM/IM consultations and therapies. At follow- up, physician understanding of clinical applications of massage, acupuncture, meditation/relaxation, yoga and Tai Chi increased. Percentage of physician referrals to a CAM/IM consultation clinic increased (5.7– 69.6%; p < 0.01) as well as physician-initiated CAM/IM discussion (20.0–60.9%; p < 0.01). This study demonstrates the immediate effect of IM education in a primary care training site and the receptiveness of its community-based physicians towards these changes.

Development and Validation of a Standardized Questionnaire and Standardized Diary for Use in Integrative Medicine Consultations in Gynecologic Oncology.

Introduction: Use of complementary and alternative medicine (CAM) in diagnoses is not standardized and is very heterogeneous. There are few published standards on integrative medicine consultations or CAM-specific validated follow-up questionnaires. The aim of this study was to develop a standard for integrative medicine consultations, a patient questionnaire which could be used as a basis for medical decisions, and a diary to evaluate the course of the integrative therapy. Patients and Methods: Between June 2013 and September 2014 a standardized integrative medicine consultation in gynecologic oncology was developed and implemented at the Department of Gynecology and Obstetrics of Erlangen University Hospital. A standard operating procedure for consultations was developed; the necessary instruments were developed and validated. Results: Overall patient assessment of the integrative medicine questionnaire and the integrative medicine diary with regard to the time required for completion, comprehensibility, complexity and functionality was positive. Patients evaluated the standardized overall concept of the integrative medicine consultation and its instruments as suitable. Conclusion: Our team is one of the first study groups to develop, validate and publish a standard procedure for integrative medicine consultations. In future, the standard operating procedure for integrative medicine procedures of the Department of Gynecology and Obstetrics of Erlangen University Hospital could be introduced in other hospitals and certified breast cancer centers and gynecologic cancer centers. This would offer patients maximum security and a standardized quality of care in integrative medicine.

Expectations from an integrative medicine consultation in breast cancer care: a registry protocol-based study.

The purpose of this study is to compare the rationale given by oncology health care practitioners (HCPs) for referral of their patients with breast cancer to a complementary medicine (CM) consultation with patient expectations from the CM treatment process. We conducted a prospective, registry protocol-based, open-label study. We compared the indications given by oncology HCPs for their referral of patients to the CM consultation with patient expectations from the CM therapeutic process. Patients were asked regarding prior CM use for cancer- and non-cancer-related indications. A total of 127 patients referred to the CM consultation were studied, with half reporting prior CM use. The most popular treatment for non-cancer-related indications was acupuncture (46.9 %), with only 20.3 % reporting herbal medicine use (P ≤ 0.04). For cancer-related indications, herbal medicine was the most popular modality (42.4 %), with 11.6 % reporting acupuncture use. The most frequently cited indications for referral were general symptom reduction (19.7 %), emotional/spiritual relief (18.1 %), alleviation of weakness and fatigue (17.3 %), and reduction of gastrointestinal symptoms (10.2 %). For patients, the most important outcome was alleviation of weakness and fatigue (70.4 %), followed by emotional/spiritual relief (50 %), and the reduction of gastrointestinal symptoms (33.3 %). The correlation between HCP indications for referral and patient expectations was poor (Cohen's kappa of 0.19, 0.328, and 0.20, respectively). The findings suggest that expectations from a CM treatment process differ greatly between oncology HCPs and patients with breast cancer. The use of a structured clinical referral process and a better understanding of patient concerns are factors which play a central role in the CM referral process.

A retrospective analysis of integrative medicine consultations at a major cancer center: Reasons for consultation, symptom burden, quality of life, and satisfaction.

e17630 Background: Many cancer patients use complementary and alternative medicine, but limited data exists regarding the reasons for an integrative medicine consultation and the patient’s symptom ...

Bridging cross-cultural gaps: monitoring herbal use during chemotherapy in patients referred to integrative medicine consultation in Israel.

The high prevalence of the use of traditional herbs among patients with cancer is a cause for concern with regard to potentially adverse interactions with conventional oncology treatments. In this study, we explore herbal use among patients with cancer in northern Israel who are referred by their health care providers to complementary and traditional medicine (CTM) consultations provided to them within the conventional oncology department. The study's objectives were to identify which herbs patients use and to examine the scope of current research on the efficacy and safety regarding the identified herbs. Herbal use by patients receiving oncology care was assessed prospectively from July 2009 to July 2012 by integrative physicians (IPs) trained in herbal medicine. Historical, ethnobotanical, basic research, and clinical data regarding the identified herbs were explored by using a keyword search in PubMed and Middle Eastern ethnohistorical literature. Disclosure of herbal use was reported by 154 of the 305 patients (50.5 %) interviewed by IPs. The use of 85 single herbs and 30 different herbal formulas was documented during the initial or follow-up IP assessments. Patients reported 14 quality of life-associated indications for herbal use. The ten most prevalent herbs displaying in vitro/in vivo anticancer activity and nine other herbs were preliminarily assessed concerning potential risks, safety, and interaction with chemotherapy. Herbal use by patients with cancer in northern Israel is widespread and calls for further study in order to address issues of safety and effectiveness. We recommend constructing a multinational and multidisciplinary team of researchers with ethnopharmacological and clinical expertise that will explore the use of herbs among patients with cancer in a cross-cultural perspective attuned with patients' affinity to traditional herbal medicine.

A Retrospective Analysis of Integrative Medicine Consultations at MD Anderson Cancer Center: Reasons for Consultation, Symptom Burden, Quality of Life, and Satisfaction

The Journal of Alternative and Complementary MedicineVol. 20, No. 5 Health Services ResearchA Retrospective Analysis of Integrative Medicine Consultations at MD Anderson Cancer Center: Reasons for Consultation, Symptom Burden, Quality of Life, and SatisfactionRichard Lee, Gabriel Lopez, Jane Williams, Jill Flury, Amica Onyemeh-Sea, Amy Spelman, Bryan Fellman, Kay Garcia, Alejandro Chaoul, Kathrin Milbury, Yisheng Li, and Lorenzo CohenRichard LeeSearch for more papers by this author, Gabriel LopezSearch for more papers by this author, Jane WilliamsSearch for more papers by this author, Jill FlurySearch for more papers by this author, Amica Onyemeh-SeaSearch for more papers by this author, Amy SpelmanSearch for more papers by this author, Bryan FellmanSearch for more papers by this author, Kay GarciaSearch for more papers by this author, Alejandro ChaoulSearch for more papers by this author, Kathrin MilburySearch for more papers by this author, Yisheng LiSearch for more papers by this author, and Lorenzo CohenSearch for more papers by this authorPublished Online:7 May 2014https://doi.org/10.1089/acm.2014.5324.abstractAboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"A Retrospective Analysis of Integrative Medicine Consultations at MD Anderson Cancer Center: Reasons for Consultation, Symptom Burden, Quality of Life, and Satisfaction." The Journal of Alternative and Complementary Medicine, 20(5), p. A122FiguresReferencesRelatedDetails Volume 20Issue 5May 2014 InformationCopyright 2014, Mary Ann Liebert, Inc.To cite this article:Richard Lee, Gabriel Lopez, Jane Williams, Jill Flury, Amica Onyemeh-Sea, Amy Spelman, Bryan Fellman, Kay Garcia, Alejandro Chaoul, Kathrin Milbury, Yisheng Li, and Lorenzo Cohen.A Retrospective Analysis of Integrative Medicine Consultations at MD Anderson Cancer Center: Reasons for Consultation, Symptom Burden, Quality of Life, and Satisfaction.The Journal of Alternative and Complementary Medicine.May 2014.A122-A122.http://doi.org/10.1089/acm.2014.5324.abstractPublished in Volume: 20 Issue 5: May 7, 2014PDF download

Topical Yunnan Baiyao administration as an adjunctive therapy for bleeding complications in adolescents with advanced cancer

Yunnan Baiyao (White Medicine from Yunnan, YNB) is a Chinese herbal medicinal powder used to stop bleeding and improve circulation in traumatic injuries. We describe the use of YNB in adolescents with cancer as an adjunct to uncontrolled bleeding in the palliative care setting. Through a retrospective chart review of all patients receiving integrative medicine consultations at the Integrative Therapies Program at Columbia University from January 1, 2007 to January 31, 2012, we describe the outcome of patients treated with YNB for management of uncontrolled bleeding. Four patients were identified who received topical YNB for uncontrolled bleeding; patients included two males and two females with diagnoses of solid tumors (n = 3) and Burkitt's lymphoma (n = 1). Mean age was 15.5 years (range 15-17). Fifty percent had life-threatening bleeding from the tumor site and 50 % experienced uncontrollable epistaxis. All patients received preceding therapy with packed red blood cells and platelet transfusions, topical thrombin, and oral aminocaproic acid. Two patients used YNB in the inpatient setting, and all four patients used YNB as outpatients. In all patients, bleeding control improved with the addition of YNB to conventional hemostatic interventions. Two patients using YNB in their home reported control of bleeding episodes. There were no adverse events reported. YNB may be an efficacious agent for uncontrolled bleeding in conjunction with conventional hemostatic agents in adolescents with advanced cancer. It is well accepted by patients. YNB may be especially valuable in the outpatient setting to prevent the recurrence of hemorrhage.

Integrative Medicine Consultation Service in a Comprehensive Cancer Center: Findings and Outcomes

This study portrays the characteristics of patients who attended an integrative oncology clinic at a large comprehensive cancer center and evaluated whether this service addressed patients' concerns about complementary and integrative medicine (CIM). Patient information was collected prior to an integrative consultation, including demographics, previous use of CIM, and primary reason for requesting the consultation. Concerns and outcomes were measured using the Measure Yourself Concerns and Well-being (MYCaW) Scale at the consultation and then again at follow-up (6-12 weeks later). Patients met with a physician for an integrative consultation that included a discussion of nutrition, supplements, physical activity, useful complementary therapies, and the mind-body-spirit connection. A total of 238 patients were referred for consultation regarding the integration of CIM into their care. The majority of participants were female (60%, n = 143), and the mean age was 56 years (range, 21-90 years), with all major cancer types represented. Patients' leading concerns were related to "What else can I do?" and "How can I better cope?" Although distressed over these concerns at the initial consultation, intense distress (5-6 out of 6 on the MYCaW scale) was reduced to less than half (31%) by the follow-up visit. Additional qualitative data revealed that patients value the process of obtaining reliable information that empowers them to be more involved in managing their care. Integrative medicine consultations at a large comprehensive cancer center appear to provide some benefit in addressing patients' concerns about CIM use.

Integrative Tumor Board: A Case Report and Discussion From Dana-Farber Cancer Institute

A 34-year-old woman carrying a BRCA1 gene and a significant family history was diagnosed with T1c, N1 breast cancer. The tumor was estrogen receptor, progesterone receptor, and HER-2/Neu negative. The patient received dose-dense chemotherapy with Adriamycin and Cytoxan followed by Taxol, and left breast irradiation. Later, a bilateral S-GAP flap reconstruction with right prophylactic mastectomy and left mastectomy were performed. During her treatment, the patient had an integrative medicine consultation and was seen by a team of health care providers specializing in integrative therapies, including integrative nutrition, therapeutic massage, acupuncture, and yoga. Each modality contributed unique benefit in her care that led to a satisfactory outcome for the patient. A detailed discussion regarding her care from each modality is presented. The case elucidates the need for integrative approaches for cancer patients in a conventional medical setting.

Integrative medicine consultation with cancer patients: Does it affect patients concerns and well-being?

e20581 Background: Increased numbers of cancer patients are searching for additional options outside of their conventional medical care to improve their clinical outcome, quality of life, and overall wellbeing. Complementary and integrative medicine (CIM)) is one of the main options that patients are incorporating. The objectives of this study were to assess the outcome and value of an integrative medicine clinical consultation. Methods: Patients attending academic integrative medicine clinic evaluated their concerns and wellbeing using the Measure Yourself Concerns and Wellbeing (MYCaW) scale, a validated tool assessing outcome of complementary consultation for cancer patients. Prior to each visit patients completed the MYCaW and listed their two main concerns, the severity of the concern (0 = does not bother me at all to 6 = bothers me greatly), and their wellbeing (0 = as good as can be to 6 = as bad as can be). All patients met with a physician who provided an integrative consultation that included discussion of nutrition, supplements, exercise, useful complementary therapies, and the mind-body-spirit connection. At the follow up visit (usually 2–3 months later) patients completed the MYCaW to evaluate if the initial concerns were met. Results: Oncologists in the cancer center referred 197 patients for consultation about the integration of complementary medicine to their care. The majority of the participants were female (n=121), mean age was 56, range 21–90. Patients had been using a large range of CIM therapies including nutritional supplements (n=144), dietary changes (n=36), and acupuncture (n=33). The leading diagnosis was breast cancer followed by prostate cancer, but all major cancer diagnoses were represented. The leading concerns were related to “What else can I do?” and “How can I better cope?” From pre to post there was a reduction in severity of the concerns scores in 79% of patients, no change for 8%, and an increase for 13% (mean pre = 4.6; mean post = 2.6). For the question of Well being there was a reduction for 49%, no change for 32%, and an increase for 18% of the patients (mean pre = 2.5; mean post = 1.82). Conclusions: Integrative medicine consultations for cancer patients appear to be a valuable service that addresses patients’ main concerns and improves well being. No significant financial relationships to disclose.

Integrative Medicine Research at an Academic Medical Center: Patient Characteristics and Health-Related Quality-of-Life Outcomes

To characterize patients seeking care at a university-based integrative medicine practice, and to assess short-term changes in health-related quality of life (HRQoL) associated with integrative medical treatment. Prospective, observational study. This study was conducted at a large U.S. academic medical center affiliated with the Consortium of Academic Health Centers for Integrative Medicine. Seven hundred and sixty-three (763) new patients with diverse medical conditions participated in the study. Mean age was 49 years (standard deviation = 16, range = 14-93). Two thirds of patients were women and three quarters were white. The most common International Classification of Diseases 9th Revision medical diagnoses were malaise and fatigue, myalgia and myositis, allergy, anxiety or depression, hypertension, malignant neoplasm of the breast, lumbago, and irritable bowel disease. Over half the sample had two or more comorbid medical conditions. The Medical Outcomes Study 36-item Short-Form (SF-36) health survey was used to measure HRQoL at initial assessment and 3-months following integrative medicine consultation. Baseline SF-36 scores fell below the 25th percentile, indicating substantially compromised HRQoL. Physician-prescribed treatment modalities included anthroposophical medicine, nutritional medicine, Western herbs, homeopathy, nutritional counseling, and acupuncture. Three (3) month follow-up assessment revealed statistically significant improvements on all eight SF-36 subscales among survey respondents. HRQoL effect sizes ranged from 0.17 (Physical Functioning) to 0.41 (Social Functioning), with a mean of 0.30. HRQoL effects were consistent among demographic subgroups. Integrative medical treatment at a university-based center is associated with significant increases in HRQoL for a medically diverse population with substantial comorbidity and functional limitations. Controlled studies that measure HRQoL and additional outcomes related to whole person health--physical, mental, social, and spiritual--are needed to determine the full therapeutic potential of integrative medicine, and to determine efficacy and cost-effectiveness relative to conventional medical care.