According to the American Cancer Society, more than 11.4 million Americans are currently living with cancer. While cancer treatments are plentiful, many have negative side effects. Previous studies have indicated that a significant number of patients who receive chemotherapy also experience cognitive declines, including decreases in verbal fluency and memory. Now, one University of Missouri health psychologist has found evidence that indicates Tai Chi, a Chinese martial art, might help overcome some of those problems.
"Scientists have known for years that Tai Chi positively impacts physical and emotional health, but this small study also uncovered evidence that it might help cognitive functioning as well," said Stephanie Reid-Arndt, assistant professor and chair of the Department of Health Psychology in the School of Health Professions. "We know this activity can help people with their quality of life in general, and with this new study, we are encouraged about how Tai Chi could also help those who have received chemotherapy. I also hope this encourages more people to think about Tai Chi positively on a broader scale in their lives."
Tai Chi involves practicing slow motion routines and is based on several principles, including mindfulness, breathing awareness, active relaxation and slow movements. The emphasis on slow movement makes Tai Chi particularly suited to a wide range of fitness levels, which makes it very relevant for those who have had chemotherapy and might be experiencing physical limitations as a result, Reid-Arndt said.
The MU pilot study followed a group of women with a history of chemotherapy. The women participated in a 60-minute Tai Chi class two times a week for 10 weeks. The women were tested on memory, language, attention, stress, mood and fatigue before and after the 10-week sessions. According to Reid-Arndt, the results of the tests indicated that the women had made significant improvements in their psychological health and cognitive abilities.
"Tai Chi really helps individuals focus their attention, and this study also demonstrates how good Tai Chi could be for anyone, whether or not they have undergone treatment for cancer," Reid-Arndt said. "Due to the small size of this study, we really need to test a larger group of individuals to gain a better understanding of the specific benefits of this activity for patients who have been treated with chemotherapy and how significant these improvements might be."
###
The study was published recently in Complementary Therapies in Clinical Practice.
Tuesday, June 7, 2011
Monday, June 6, 2011
Yoga Helps Older Stroke Victims Improve Balance, Endurance
An Indiana University study that exposed older veterans with stroke to yoga produced promising results as researchers explore whether this popular mind-body practice can help stroke victims cope with their increased risk for painful and even deadly falls.
The pilot study involved 19 men and one woman, average age of 66. For eight weeks, they participated in a twice weekly hour-long group yoga class taught by a yoga therapist who dramatically modified the poses to meet the veterans' needs.
A range of balance items measured by the Berg Balance Scale and Fullerton Advance Balance Scale improved by 17 percent and 34 percent respectively by the end of the program. But equally exciting to lead researcher Arlene A. Schmid, rehabilitation research scientist at the Richard L. Roudebush VA Medical Center in Indianapolis, was the measurable gain in confidence the study participants had in their balance.
"It also was interesting to see how much the men liked it," said Schmid, assistant professor of occupational therapy in the School of Health and Rehabilitation Sciences at Indiana University-Purdue University Indianapolis. Many of the veterans wanted the study to continue or asked for a take-home exercise plan so they could continue the practice. "They enjoyed it so much partly because they weren't getting any other treatment. They had already completed their rehabilitation but felt there still was room for improvement."
Schmid discussed her findings at the American College of Sports Medicine meeting in Denver during her poster presentation, "Preliminary Evidence of Yoga on Balance and Endurance Outcomes for Veterans with Stroke" in the session for Fitness and Performance Testing for Posture, Stability and Balance.
Statistics concerning strokes and falls are grim, with studies showing that strokes can quadruple the risk of falling and greatly increase the risk of breaking a hip after a fall. An estimated 80 percent of people who have strokes will also have some degree of impaired balance.
The study participants performed poses initially while seated in chairs and then progressed to seated and standing poses. Eventually, they all performed poses on the floor, something Schmid considers significant because of a reluctance many older adults have to working on the floor.
"Everything was modified because we wanted them to be successful on day one," Schmid said. "Everyone could be successful at some level."
A score of less than 46 on the Berg Balance Scale indicates a fall risk. Schmid said the study participants on average began the study with a score of 40 and then improved to 47, moving them past the fall risk threshold. The study participants also showed significant improvements in endurance based on a seated two-minute step test and a six-minute walk test.
Schmid said research into therapeutic uses for yoga is "really taking off," particularly in mental health fields. Clinically, she has been watching a small trend of occupational therapists and physical therapists also becoming yoga therapists. The yoga performed in the study was modified to the extent that Schmid said it would be very difficult to find a comparable class offered publicly. Such a class should be taught by a yoga therapist who has had additional training in anatomy and physiology and how to work with people with disabilities. Schmid hopes to expand the study so she and her colleagues can explore whether such classes are effective on a larger scale.
The pilot study involved 19 men and one woman, average age of 66. For eight weeks, they participated in a twice weekly hour-long group yoga class taught by a yoga therapist who dramatically modified the poses to meet the veterans' needs.
A range of balance items measured by the Berg Balance Scale and Fullerton Advance Balance Scale improved by 17 percent and 34 percent respectively by the end of the program. But equally exciting to lead researcher Arlene A. Schmid, rehabilitation research scientist at the Richard L. Roudebush VA Medical Center in Indianapolis, was the measurable gain in confidence the study participants had in their balance.
"It also was interesting to see how much the men liked it," said Schmid, assistant professor of occupational therapy in the School of Health and Rehabilitation Sciences at Indiana University-Purdue University Indianapolis. Many of the veterans wanted the study to continue or asked for a take-home exercise plan so they could continue the practice. "They enjoyed it so much partly because they weren't getting any other treatment. They had already completed their rehabilitation but felt there still was room for improvement."
Schmid discussed her findings at the American College of Sports Medicine meeting in Denver during her poster presentation, "Preliminary Evidence of Yoga on Balance and Endurance Outcomes for Veterans with Stroke" in the session for Fitness and Performance Testing for Posture, Stability and Balance.
Statistics concerning strokes and falls are grim, with studies showing that strokes can quadruple the risk of falling and greatly increase the risk of breaking a hip after a fall. An estimated 80 percent of people who have strokes will also have some degree of impaired balance.
The study participants performed poses initially while seated in chairs and then progressed to seated and standing poses. Eventually, they all performed poses on the floor, something Schmid considers significant because of a reluctance many older adults have to working on the floor.
"Everything was modified because we wanted them to be successful on day one," Schmid said. "Everyone could be successful at some level."
A score of less than 46 on the Berg Balance Scale indicates a fall risk. Schmid said the study participants on average began the study with a score of 40 and then improved to 47, moving them past the fall risk threshold. The study participants also showed significant improvements in endurance based on a seated two-minute step test and a six-minute walk test.
Schmid said research into therapeutic uses for yoga is "really taking off," particularly in mental health fields. Clinically, she has been watching a small trend of occupational therapists and physical therapists also becoming yoga therapists. The yoga performed in the study was modified to the extent that Schmid said it would be very difficult to find a comparable class offered publicly. Such a class should be taught by a yoga therapist who has had additional training in anatomy and physiology and how to work with people with disabilities. Schmid hopes to expand the study so she and her colleagues can explore whether such classes are effective on a larger scale.
Wednesday, June 1, 2011
Veterans show a 50 percent reduction in PTSD symptoms after 8 weeks of Transcendental Meditation
Ω
Veterans of the Iraq/Afghanistan wars showed a 50 percent reduction in their symptoms of post-traumatic stress disorder (PTSD) after just eight weeks of practicing the stress-reducing Transcendental Meditation technique, according to a pilot study published in the June 2011 issue of Military Medicine (Volume 176, Number 6).
The study evaluated five veterans, ages 25- to 40-years-old, who had served in Iraq, Afghanistan or both from 10 months to two years involving moderate or heavy moderate combat.
The study found that Transcendental Meditation produced significant reductions in stress and depression, and marked improvements in relationships and overall quality of life. Furthermore, the authors reported that the technique was easy to perform and was well accepted by the veterans.
The Clinician Administered PTSD Scale (CAPS) was the primary measure for assessing the effectiveness of TM practice on PTSD symptoms. CAPS is considered by the Department of Veterans Affairs as the "gold standard" for PTSD assessment and diagnosis for both military Veteran and civilian trauma survivors.
The paper's senior researcher, Norman Rosenthal, M.D., is clinical professor of psychiatry at George
"Even though the number of veterans in this study was small, the results were very impressive," Rosenthal said. "These young men were in extreme distress as a direct result of trauma suffered during combat, and the simple and effortless Transcendental Meditation technique literally transformed their lives."
The findings were similar to those from a randomized controlled study of Vietnam veterans conducted by researchers at the University of Colorado School of Medicine. In that study, published in the Journal of Counseling and Development in 1985, after three months of twice-daily TM practice, the veterans had fewer symptoms than those receiving conventional psychotherapy of the day. In fact, most of the TM-treated subjects required no further treatment.
"Even though the combat experiences of OEF/OIF veterans and Vietnam veterans are quite different, the fact that our study corroborates the results of the previous study tells us that this technique has the potential to be an effective tool against PTSD and combat stress, regardless of combat situation," explained Sarina Grosswald, EdD, co-researcher on the study.
Rosenthal hypothesizes that Transcendental Meditation helps people with PTSD because regular practice produces long-term changes in sympathetic nervous system activity, as evidenced by decreased blood pressure, and lower reactivity to stress. "Transcendental Meditation quiets down the nervous system, and slows down the 'fight-or-flight' response," he said. People with PTSD show overactive fight-or-flight responses, making them excellent candidates for Transcendental Meditation.
Rosenthal points out that there is an urgent need to find effective and cost-effective treatments for veterans with combat-related PTSD. "The condition is common, affecting an estimated one in seven deployed soldiers and Marines, most of whom do not get adequate treatment. So far, only one treatment—simulation exposure to battleground scenes—has been deemed effective, but it requires specialized software and hardware, trained personnel and is labor intensive.
"Based on our study and previous findings, I believe Transcendental Meditation certainly warrants further study for combat-related PTSD," says Rosenthal.
FACT SHEET
Post-Traumatic Stress Disorder (PTSD)
A new report paints a stark picture of the toll on the U.S. military of almost a decade of war: higher stress and lower morale. The report, released Thursday, May 19, 2011, at the Pentagon, relied on questions to soldiers and Marines in Afghanistan in July and August of last year and compared responses with similar surveys in 2005 and 2009. The report noted "significant decline in reports of individual morale" as well as "acute stress rates significantly higher" than in earlier years. Source: CNN: New Pentagon study finds psychological toll from years of fighting.
"Research suggests that 18% to 30% of Vietnam veterans, 10% to 20% of Iraq War veterans, and 5% to 15% of Gulf War veterans have experienced PTSD," says U.S. Army Colonel Charles C Engel, Director of Deployment Health Clinical Center. Source: Britannica Blog: PTSD in War Veterans: 5 Questions for Psychiatrist and U.S. Army Col. Charles C. Engel.
A May 8, 2008 report said the number of suicides among veterans of wars in Iraq and Afghanistan may exceed the combat death toll because of inadequate mental health care, the U.S. government's top psychiatric researcher said. Source: Bloomberg: Post-War Suicides May Exceed Combat Deaths, U.S. Says (Update1).
VA's suicide hotline receives 10,000 calls per month from active and retired servicemen. There are 950 suicide attempts per month by veterans receiving care from the VA. 18 veterans commit suicide each day, 5 of them are under the care of the VA. Source: Army Times: 18 veterans commit suicide each day.
Every night, an estimated 63,000 veterans lay down to sleep in a county jail. Source: Syracuse.com: The Post-Standard: Syracuse VA Medical Center visits county jails, searches for military veterans who need assistance.
Each night, 107,000 veterans find their home on the street. Source: National Coalition for Homeless Veterans.
27% of returning OEF/OIF veterans meet criteria for alcohol abuse. Of returning soldiers, 20% of active duty and 42% of reservists are in need of mental health treatment. Source: NIDA: A Research Update from the National Institute on Drug Abuse.
The Rand Corporation's study "Invisible Wounds of War" revealed a disturbing truth about the health of our military as recently as 2008: Over 300,000 returning veterans from Iraq and Afghanistan suffer from PTSD or major depression. According to the Rand report, these "invisible wounds" take a high toll—impacting veterans' quality of life, hindering their performance at work, straining their families, and placing them at greater risk for violent and self-destructive behaviors. The economic cost of these disorders is equally great—reaching as high as $6 billion over 2 years. Yet, despite the heavy toll of PTSD and depression, only half of affected veterans seek care, and only a third of those who do, receive adequate treatment. Thus, over 80% of affected veterans remain without needed help.
Since October 31, 2007, over 1.6 million troops have been deployed in Iraq and Afghanistan. According to the Rand Corporation's study, 225,000 of the returning troops suffer from PTSD, 226,000 are diagnosed with major depression, and 303,000 develop either illness. Source: Rand Corporation: Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery, 2008.
The Transcendental Meditation Technique
The Transcendental Meditation technique is an effortless technique practiced 10-20 minutes twice a day sitting comfortably with the eyes closed.
TM is not a religion or philosophy and involves no new beliefs or change in lifestyle.
Over 350 peer-reviewed research studies on the TM technique confirm a range of benefits for mind, body and behavior.
Several studies have compared the effects of different meditation practices and found that Transcendental Meditation provides deeper relaxation and is more effective at reducing anxiety, depression and hypertension than other forms of meditation and relaxation. In addition, no other meditation practice shows the widespread coherence throughout all areas of the brain that is seen with Transcendental Meditation.
The Transcendental Meditation technique is taught in the United States by a non-profit, educational organization.
Veterans of the Iraq/Afghanistan wars showed a 50 percent reduction in their symptoms of post-traumatic stress disorder (PTSD) after just eight weeks of practicing the stress-reducing Transcendental Meditation technique, according to a pilot study published in the June 2011 issue of Military Medicine (Volume 176, Number 6).
The study evaluated five veterans, ages 25- to 40-years-old, who had served in Iraq, Afghanistan or both from 10 months to two years involving moderate or heavy moderate combat.
The study found that Transcendental Meditation produced significant reductions in stress and depression, and marked improvements in relationships and overall quality of life. Furthermore, the authors reported that the technique was easy to perform and was well accepted by the veterans.
The Clinician Administered PTSD Scale (CAPS) was the primary measure for assessing the effectiveness of TM practice on PTSD symptoms. CAPS is considered by the Department of Veterans Affairs as the "gold standard" for PTSD assessment and diagnosis for both military Veteran and civilian trauma survivors.
The paper's senior researcher, Norman Rosenthal, M.D., is clinical professor of psychiatry at George
"Even though the number of veterans in this study was small, the results were very impressive," Rosenthal said. "These young men were in extreme distress as a direct result of trauma suffered during combat, and the simple and effortless Transcendental Meditation technique literally transformed their lives."
The findings were similar to those from a randomized controlled study of Vietnam veterans conducted by researchers at the University of Colorado School of Medicine. In that study, published in the Journal of Counseling and Development in 1985, after three months of twice-daily TM practice, the veterans had fewer symptoms than those receiving conventional psychotherapy of the day. In fact, most of the TM-treated subjects required no further treatment.
"Even though the combat experiences of OEF/OIF veterans and Vietnam veterans are quite different, the fact that our study corroborates the results of the previous study tells us that this technique has the potential to be an effective tool against PTSD and combat stress, regardless of combat situation," explained Sarina Grosswald, EdD, co-researcher on the study.
Rosenthal hypothesizes that Transcendental Meditation helps people with PTSD because regular practice produces long-term changes in sympathetic nervous system activity, as evidenced by decreased blood pressure, and lower reactivity to stress. "Transcendental Meditation quiets down the nervous system, and slows down the 'fight-or-flight' response," he said. People with PTSD show overactive fight-or-flight responses, making them excellent candidates for Transcendental Meditation.
Rosenthal points out that there is an urgent need to find effective and cost-effective treatments for veterans with combat-related PTSD. "The condition is common, affecting an estimated one in seven deployed soldiers and Marines, most of whom do not get adequate treatment. So far, only one treatment—simulation exposure to battleground scenes—has been deemed effective, but it requires specialized software and hardware, trained personnel and is labor intensive.
"Based on our study and previous findings, I believe Transcendental Meditation certainly warrants further study for combat-related PTSD," says Rosenthal.
FACT SHEET
Post-Traumatic Stress Disorder (PTSD)
A new report paints a stark picture of the toll on the U.S. military of almost a decade of war: higher stress and lower morale. The report, released Thursday, May 19, 2011, at the Pentagon, relied on questions to soldiers and Marines in Afghanistan in July and August of last year and compared responses with similar surveys in 2005 and 2009. The report noted "significant decline in reports of individual morale" as well as "acute stress rates significantly higher" than in earlier years. Source: CNN: New Pentagon study finds psychological toll from years of fighting.
"Research suggests that 18% to 30% of Vietnam veterans, 10% to 20% of Iraq War veterans, and 5% to 15% of Gulf War veterans have experienced PTSD," says U.S. Army Colonel Charles C Engel, Director of Deployment Health Clinical Center. Source: Britannica Blog: PTSD in War Veterans: 5 Questions for Psychiatrist and U.S. Army Col. Charles C. Engel.
A May 8, 2008 report said the number of suicides among veterans of wars in Iraq and Afghanistan may exceed the combat death toll because of inadequate mental health care, the U.S. government's top psychiatric researcher said. Source: Bloomberg: Post-War Suicides May Exceed Combat Deaths, U.S. Says (Update1).
VA's suicide hotline receives 10,000 calls per month from active and retired servicemen. There are 950 suicide attempts per month by veterans receiving care from the VA. 18 veterans commit suicide each day, 5 of them are under the care of the VA. Source: Army Times: 18 veterans commit suicide each day.
Every night, an estimated 63,000 veterans lay down to sleep in a county jail. Source: Syracuse.com: The Post-Standard: Syracuse VA Medical Center visits county jails, searches for military veterans who need assistance.
Each night, 107,000 veterans find their home on the street. Source: National Coalition for Homeless Veterans.
27% of returning OEF/OIF veterans meet criteria for alcohol abuse. Of returning soldiers, 20% of active duty and 42% of reservists are in need of mental health treatment. Source: NIDA: A Research Update from the National Institute on Drug Abuse.
The Rand Corporation's study "Invisible Wounds of War" revealed a disturbing truth about the health of our military as recently as 2008: Over 300,000 returning veterans from Iraq and Afghanistan suffer from PTSD or major depression. According to the Rand report, these "invisible wounds" take a high toll—impacting veterans' quality of life, hindering their performance at work, straining their families, and placing them at greater risk for violent and self-destructive behaviors. The economic cost of these disorders is equally great—reaching as high as $6 billion over 2 years. Yet, despite the heavy toll of PTSD and depression, only half of affected veterans seek care, and only a third of those who do, receive adequate treatment. Thus, over 80% of affected veterans remain without needed help.
Since October 31, 2007, over 1.6 million troops have been deployed in Iraq and Afghanistan. According to the Rand Corporation's study, 225,000 of the returning troops suffer from PTSD, 226,000 are diagnosed with major depression, and 303,000 develop either illness. Source: Rand Corporation: Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery, 2008.
The Transcendental Meditation Technique
The Transcendental Meditation technique is an effortless technique practiced 10-20 minutes twice a day sitting comfortably with the eyes closed.
TM is not a religion or philosophy and involves no new beliefs or change in lifestyle.
Over 350 peer-reviewed research studies on the TM technique confirm a range of benefits for mind, body and behavior.
Several studies have compared the effects of different meditation practices and found that Transcendental Meditation provides deeper relaxation and is more effective at reducing anxiety, depression and hypertension than other forms of meditation and relaxation. In addition, no other meditation practice shows the widespread coherence throughout all areas of the brain that is seen with Transcendental Meditation.
The Transcendental Meditation technique is taught in the United States by a non-profit, educational organization.
Tuesday, May 31, 2011
Acupuncture of benefit to those with unexplained symptoms
Attending frequently with medically unexplained symptoms is distressing for both patient and doctor and effective treatment or management options are limited: one in five patients have symptoms that remain unexplained by conventional medicine. Studies have shown that the cost to the NHS of managing the treatment of a patient with medically unexplained symptoms can be twice that of a patient with a diagnosis.
A research team from the Institute of Health Services Research, Peninsula Medical School, University of Exeter, has carried out a randomised control trial and a linked interview study regarding 80 such patients from GP practices across London, to investigate their experiences of having five-element acupuncture added to their usual care. This is the first trial of traditional acupuncture for people with unexplained symptoms.
The results of the research are published in the British Journal of General Practice. They reveal that acupuncture had a significant and sustained benefit for these patients and consequently acupuncture could be safely added to the therapies used by practitioners when treating frequently attending patients with medically unexplained symptoms.
The patient group was made up of 80 adults, 80 per cent female with an average age of 50 years and from a variety of ethnic backgrounds who had consulted their GP at least eight times in the past year. Nearly 60 per cent reported musculoskeletal health problems, of which almost two-thirds had been present for a year.
In the three months before taking part in the study, the 80 patients had accounted for the following NHS experiences: 21 patient in-days; 106 outpatient clinic visits; 52 hospital clinic visits (for treatments such as physiotherapy, chiropody and counselling); 44 hospital visits for investigations (including 10 magnetic resonance imaging – MRI – scans); and 75 visits to non-NHS practitioners such as opticians, dentists and complementary therapists.
The patients were randomly divided into an acupuncture group and a control group. Eight acupuncturists administered individual five-element acupuncture to the acupuncture group immediately, up to 12 sessions over 26 weeks. The same numbers of treatments were made available to the control group after 26 weeks.
At 26 weeks the patients were asked to complete a number of questionnaires including the individualised health status questionnaire "Measure Yourself Medical Outcome Profile."
The acupuncture group registered a significantly improved overall score when compared with the control group. They also recorded improved wellbeing but did not show any change in GP and other clinical visits and the number of medications they were taking. Between 26 and 52 weeks the acupuncture group maintained their improvement and the control group, now receiving their acupuncture treatments, showed a 'catch up' improvement.
The associated qualitative study, which focused on the patients' experiences, supported the quantitative work.
This element identified that the participating patients had a variety of longstanding symptoms and disability including chronic pain, fatigue and emotional problems which affected their ability to work, socialise and carry out everyday tasks. A lack of a convincing diagnosis to explain their symptoms led to frustration, worry and low mood.
Participating patients reported that their acupuncture consultations became increasingly valuable. They appreciated the amount of time they had with each acupuncturist and the interactive and holistic nature of the sessions – there was a sense that the practitioners were listening to their concerns and, via therapy, doing something positive about them.
As a result, many patients were encouraged to take an active role in their treatment, resulting in cognitive and behavioural lifestyle changes, such as: a new self-awareness about what caused stress in their lives, and a subsequent ability to deal with stress more effectively; and taking their own initiatives based on advice from the acupuncturists about diet, exercise, relaxation and social activities.
Comments from participating patients included: "the energy is the main thing I have noticed. You know, yeah, it's marvellous! Where I was going out and cutting my grass, now I'm going out and cutting my neighbour's after because he's elderly"; "I had to reduce my medication. That's the big help actually, because medication was giving me more trouble…side effects"; and "It kind of boosts you, somehow or another."
Dr. Charlotte Paterson, who managed the randomised control trial and the longitudinal study of patients' experiences, commented: "Our research indicates that the addition of up to 12 five-element acupuncture consultations to the usual care experienced by the patients in the trial was feasible and acceptable and resulted in improved overall well-being that was sustained for up to a year.
"This is the first trial to investigate the effectiveness of acupuncture treatment to those with unexplained symptoms, and the next development will be to carry out a cost-effectiveness study with a longer follow-up period. While further studies are required, this particular study suggests that GPs may recommend a series of five-element acupuncture consultations to patients with unexplained symptoms as a safe and potentially effective intervention."
She added: "Such intervention could not only result in potential resource savings for the NHS, but would also improve the quality of life for a group of patients for whom traditional biomedicine has little in the way of effective diagnosis and treatment."
A research team from the Institute of Health Services Research, Peninsula Medical School, University of Exeter, has carried out a randomised control trial and a linked interview study regarding 80 such patients from GP practices across London, to investigate their experiences of having five-element acupuncture added to their usual care. This is the first trial of traditional acupuncture for people with unexplained symptoms.
The results of the research are published in the British Journal of General Practice. They reveal that acupuncture had a significant and sustained benefit for these patients and consequently acupuncture could be safely added to the therapies used by practitioners when treating frequently attending patients with medically unexplained symptoms.
The patient group was made up of 80 adults, 80 per cent female with an average age of 50 years and from a variety of ethnic backgrounds who had consulted their GP at least eight times in the past year. Nearly 60 per cent reported musculoskeletal health problems, of which almost two-thirds had been present for a year.
In the three months before taking part in the study, the 80 patients had accounted for the following NHS experiences: 21 patient in-days; 106 outpatient clinic visits; 52 hospital clinic visits (for treatments such as physiotherapy, chiropody and counselling); 44 hospital visits for investigations (including 10 magnetic resonance imaging – MRI – scans); and 75 visits to non-NHS practitioners such as opticians, dentists and complementary therapists.
The patients were randomly divided into an acupuncture group and a control group. Eight acupuncturists administered individual five-element acupuncture to the acupuncture group immediately, up to 12 sessions over 26 weeks. The same numbers of treatments were made available to the control group after 26 weeks.
At 26 weeks the patients were asked to complete a number of questionnaires including the individualised health status questionnaire "Measure Yourself Medical Outcome Profile."
The acupuncture group registered a significantly improved overall score when compared with the control group. They also recorded improved wellbeing but did not show any change in GP and other clinical visits and the number of medications they were taking. Between 26 and 52 weeks the acupuncture group maintained their improvement and the control group, now receiving their acupuncture treatments, showed a 'catch up' improvement.
The associated qualitative study, which focused on the patients' experiences, supported the quantitative work.
This element identified that the participating patients had a variety of longstanding symptoms and disability including chronic pain, fatigue and emotional problems which affected their ability to work, socialise and carry out everyday tasks. A lack of a convincing diagnosis to explain their symptoms led to frustration, worry and low mood.
Participating patients reported that their acupuncture consultations became increasingly valuable. They appreciated the amount of time they had with each acupuncturist and the interactive and holistic nature of the sessions – there was a sense that the practitioners were listening to their concerns and, via therapy, doing something positive about them.
As a result, many patients were encouraged to take an active role in their treatment, resulting in cognitive and behavioural lifestyle changes, such as: a new self-awareness about what caused stress in their lives, and a subsequent ability to deal with stress more effectively; and taking their own initiatives based on advice from the acupuncturists about diet, exercise, relaxation and social activities.
Comments from participating patients included: "the energy is the main thing I have noticed. You know, yeah, it's marvellous! Where I was going out and cutting my grass, now I'm going out and cutting my neighbour's after because he's elderly"; "I had to reduce my medication. That's the big help actually, because medication was giving me more trouble…side effects"; and "It kind of boosts you, somehow or another."
Dr. Charlotte Paterson, who managed the randomised control trial and the longitudinal study of patients' experiences, commented: "Our research indicates that the addition of up to 12 five-element acupuncture consultations to the usual care experienced by the patients in the trial was feasible and acceptable and resulted in improved overall well-being that was sustained for up to a year.
"This is the first trial to investigate the effectiveness of acupuncture treatment to those with unexplained symptoms, and the next development will be to carry out a cost-effectiveness study with a longer follow-up period. While further studies are required, this particular study suggests that GPs may recommend a series of five-element acupuncture consultations to patients with unexplained symptoms as a safe and potentially effective intervention."
She added: "Such intervention could not only result in potential resource savings for the NHS, but would also improve the quality of life for a group of patients for whom traditional biomedicine has little in the way of effective diagnosis and treatment."
Thursday, April 21, 2011
Acupuncture relieves hot flashes from prostate cancer treatment
Acupuncture provides long-lasting relief to hot flashes, heart palpitations and anxiety due to side effects of the hormone given to counteract testosterone, the hormone that induces prostate cancer, according to a study published in the April issue of the International Journal of Radiation Oncology•Biology•Physics, an official journal of the American Society for Radiation Oncology (ASTRO).
The main treatments for men with metastatic prostate cancer are either surgery or hormone therapy to significantly reduce the level of testosterone in the body. Eliminating testosterone has been proven to keep the cancer in check by starving the cancer of hormones it needs to grow and spread. However, about half of the time, this therapy also causes very uncomfortable hot flashes similar to those women experience during menopause. The main way to combat hot flashes is to take antidepressants, but these drugs can cause side effects of their own, including nausea, dry mouth, sleeplessness, altered appetite and sexual changes.
In a prospective study conducted in the department of radiation oncology and the acupuncture section of New York Methodist Hospital and Weill Cornell Medical College of Cornell University, both in New York, researchers evaluated 14 men who were experiencing hot flashes due to hormone therapy for prostate cancer. Upon enrolling in the study, the men were given a hot flash score (HFS) to evaluate their discomfort from daily hot flashes. The mean initial HFS was 28.3.
Participants then received acupuncture twice a week for 30 minutes at a time for four weeks. Two weeks after receiving acupuncture, their HFS was measured again and had dropped more than half to 10.3. At six weeks post-treatment, their HFS was 7.5. After eight months, the men were evaluated again and their mean HFS was 7. "Our study shows that physicians and patients have an additional treatment for something that affects many men undergoing prostate cancer treatment and actually has long-term benefits, as opposed to more side effects," Hani Ashamalla, M.D., lead author of the study and a radiation oncologist at New York Methodist Hospital, said. "We are now designing a randomized clinical trial to further evaluate acupuncture after prostate cancer treatment. I encourage men suffering this symptom to talk to their doctors about enrolling."
The main treatments for men with metastatic prostate cancer are either surgery or hormone therapy to significantly reduce the level of testosterone in the body. Eliminating testosterone has been proven to keep the cancer in check by starving the cancer of hormones it needs to grow and spread. However, about half of the time, this therapy also causes very uncomfortable hot flashes similar to those women experience during menopause. The main way to combat hot flashes is to take antidepressants, but these drugs can cause side effects of their own, including nausea, dry mouth, sleeplessness, altered appetite and sexual changes.
In a prospective study conducted in the department of radiation oncology and the acupuncture section of New York Methodist Hospital and Weill Cornell Medical College of Cornell University, both in New York, researchers evaluated 14 men who were experiencing hot flashes due to hormone therapy for prostate cancer. Upon enrolling in the study, the men were given a hot flash score (HFS) to evaluate their discomfort from daily hot flashes. The mean initial HFS was 28.3.
Participants then received acupuncture twice a week for 30 minutes at a time for four weeks. Two weeks after receiving acupuncture, their HFS was measured again and had dropped more than half to 10.3. At six weeks post-treatment, their HFS was 7.5. After eight months, the men were evaluated again and their mean HFS was 7. "Our study shows that physicians and patients have an additional treatment for something that affects many men undergoing prostate cancer treatment and actually has long-term benefits, as opposed to more side effects," Hani Ashamalla, M.D., lead author of the study and a radiation oncologist at New York Methodist Hospital, said. "We are now designing a randomized clinical trial to further evaluate acupuncture after prostate cancer treatment. I encourage men suffering this symptom to talk to their doctors about enrolling."
Thursday, March 3, 2011
Acupressure Effective in Helping to Treat Traumatic Brain Injury, Study Suggests
A new University of Colorado Boulder study indicates an ancient form of complementary medicine may be effective in helping to treat people with mild traumatic brain injury, a finding that may have implications for some U.S. war veterans returning home.
The study involved a treatment known as acupressure in which one's fingertips are used to stimulate particular points on a person's body -- points similar to those stimulated with needles in standard acupuncture treatments, said CU-Boulder Professor Theresa Hernandez, lead study author. The results indicate a link between the acupressure treatments and enhanced cognitive function in study subjects with mild traumatic brain injury, or TBI.
"We found that the study subjects with mild traumatic brain injury who were treated with acupressure showed improved cognitive function, scoring significantly better on tests of working memory when compared to the TBI subjects in the placebo control group," said Hernandez, a professor in CU-Boulder's psychology and neuroscience department. "This suggests to us that acupressure could be an effective adjunct therapy for those suffering from TBI."
The acupressure treatment type used in the study is called Jin Shin. For the study, Hernandez and her colleagues targeted the 26 points on the human body used in standard Jin Shin treatments ranging from the head to the feet. The study subjects all received treatments by trained Jin Shin practitioners.
According to practitioners, Jin Shin acupressure points are found along "meridians" running through the body that are associated with specific energy pathways. It is believed that each point is tied to the health of specific body organs, as well as the entire body and brain, Hernandez said.
"Think of the meridians as freeways and the pressure points as towns along the way," she said. "When there is a traffic jam in Denver that causes adverse effects as far away as Boulder, clearing the energy blocks, or in this case traffic jams, helps improve flow and overall health."
The study involved 38 study subjects, each of whom was randomly assigned to one of two groups -- an experimental group that received active acupressure treatments from trained experts and a control group that received treatments from the same experts on places on the body that are not considered to be acupressure points, acting as a placebo. The study was "blinded," meaning the researchers collecting data and the study participants themselves did not know who was in the experimental group or the placebo group until the end of the study.
The team used a standard battery of neuropsychological tests to assess the results. In one test known as the Digit Span Test, subjects were asked to repeat strings of numbers after hearing them, in both forward and backward order, to see how many digits they could recall. Those subjects receiving active acupressure treatments showed increased memory function, said Hernandez.
A second standard psychology test used for the study, called the Stroop Task, measured working memory and attention. The test subjects were shown the names of colors like blue, green or red on a computer screen. When the names of the particular colors are viewed on the screen in a different color of ink -- like the word "green" spelled out in blue ink -- test subjects take longer to name the ink color and the results are more error-prone, according to Hernandez. The Stroop Test subjects in the CU-Boulder study wore special caps wired with electrodes to measure the brain activity tied to specific stimuli. The results showed those who received the active acupressure treatments responded to stimuli more rapidly than those who received the placebo treatments, Hernandez said.
"We were looking at synchronized neural activity in response to a stimulus, and our data suggest the brains of those in the active acupressure group responded differently when compared to those in the placebo acupressure group," she said.
A paper on the subject was published in the January issue of the Journal of Neurotrauma, a peer-reviewed publication on the latest advances in both clinical and laboratory investigations of traumatic brain and spinal cord injury. Co-authors on the study included CU-Boulder's Kristina McFadden, Kyle Healy, Miranda Dettman, Jesse Kaye and Associate Professor Tiffany Ito of psychology and neuroscience.
Funded by the Colorado Traumatic Brain Injury Trust Fund, the study is believed to be one of the first placebo-controlled studies ever published in a peer-reviewed medical journal showing the benefit of acupressure to treat patients with TBI, Hernandez said.
"We would like to see if the Jin Shin treatment is useful to military veterans returning home with traumatic brain injury, a signature wound prevalent in the wars in Iraq and Afghanistan," said Hernandez. The Jin Shin acupressure treatment can be taught to family and friends of those with TBI and can even be used as a self-treatment, which could allow for more independence, she said.
In a 2010 stroke study led by Hernandez, the researchers concluded that Jin Shin acupressure triggered a larger and faster relaxation response during active treatments and a decreased stress response following active treatments compared with what was seen in placebo treatments. Hernandez and her colleagues are embarking on a new study on the use of Jin Shin acupressure in athletes to see if the enhanced relaxation response and decreased stress seen in the stroke study can reduce the likelihood of athletic injury.
In 2002, Hernandez partnered with former Colorado Rep. Todd Saliman to initiate the Colorado Traumatic Brain Injury Trust Fund, a statute that has generated nearly $2 million to the state annually since 2004 from surcharges to traffic offenses like driving while impaired and speeding. Roughly 65 percent of the money goes toward rehabilitation and care services for individuals with TBI, about 30 percent goes for TBI research and 5 percent for TBI education. Because of the statute, nearly 4,000 Colorado citizens with TBI have received care and rehabilitation services for brain injuries.
The study involved a treatment known as acupressure in which one's fingertips are used to stimulate particular points on a person's body -- points similar to those stimulated with needles in standard acupuncture treatments, said CU-Boulder Professor Theresa Hernandez, lead study author. The results indicate a link between the acupressure treatments and enhanced cognitive function in study subjects with mild traumatic brain injury, or TBI.
"We found that the study subjects with mild traumatic brain injury who were treated with acupressure showed improved cognitive function, scoring significantly better on tests of working memory when compared to the TBI subjects in the placebo control group," said Hernandez, a professor in CU-Boulder's psychology and neuroscience department. "This suggests to us that acupressure could be an effective adjunct therapy for those suffering from TBI."
The acupressure treatment type used in the study is called Jin Shin. For the study, Hernandez and her colleagues targeted the 26 points on the human body used in standard Jin Shin treatments ranging from the head to the feet. The study subjects all received treatments by trained Jin Shin practitioners.
According to practitioners, Jin Shin acupressure points are found along "meridians" running through the body that are associated with specific energy pathways. It is believed that each point is tied to the health of specific body organs, as well as the entire body and brain, Hernandez said.
"Think of the meridians as freeways and the pressure points as towns along the way," she said. "When there is a traffic jam in Denver that causes adverse effects as far away as Boulder, clearing the energy blocks, or in this case traffic jams, helps improve flow and overall health."
The study involved 38 study subjects, each of whom was randomly assigned to one of two groups -- an experimental group that received active acupressure treatments from trained experts and a control group that received treatments from the same experts on places on the body that are not considered to be acupressure points, acting as a placebo. The study was "blinded," meaning the researchers collecting data and the study participants themselves did not know who was in the experimental group or the placebo group until the end of the study.
The team used a standard battery of neuropsychological tests to assess the results. In one test known as the Digit Span Test, subjects were asked to repeat strings of numbers after hearing them, in both forward and backward order, to see how many digits they could recall. Those subjects receiving active acupressure treatments showed increased memory function, said Hernandez.
A second standard psychology test used for the study, called the Stroop Task, measured working memory and attention. The test subjects were shown the names of colors like blue, green or red on a computer screen. When the names of the particular colors are viewed on the screen in a different color of ink -- like the word "green" spelled out in blue ink -- test subjects take longer to name the ink color and the results are more error-prone, according to Hernandez. The Stroop Test subjects in the CU-Boulder study wore special caps wired with electrodes to measure the brain activity tied to specific stimuli. The results showed those who received the active acupressure treatments responded to stimuli more rapidly than those who received the placebo treatments, Hernandez said.
"We were looking at synchronized neural activity in response to a stimulus, and our data suggest the brains of those in the active acupressure group responded differently when compared to those in the placebo acupressure group," she said.
A paper on the subject was published in the January issue of the Journal of Neurotrauma, a peer-reviewed publication on the latest advances in both clinical and laboratory investigations of traumatic brain and spinal cord injury. Co-authors on the study included CU-Boulder's Kristina McFadden, Kyle Healy, Miranda Dettman, Jesse Kaye and Associate Professor Tiffany Ito of psychology and neuroscience.
Funded by the Colorado Traumatic Brain Injury Trust Fund, the study is believed to be one of the first placebo-controlled studies ever published in a peer-reviewed medical journal showing the benefit of acupressure to treat patients with TBI, Hernandez said.
"We would like to see if the Jin Shin treatment is useful to military veterans returning home with traumatic brain injury, a signature wound prevalent in the wars in Iraq and Afghanistan," said Hernandez. The Jin Shin acupressure treatment can be taught to family and friends of those with TBI and can even be used as a self-treatment, which could allow for more independence, she said.
In a 2010 stroke study led by Hernandez, the researchers concluded that Jin Shin acupressure triggered a larger and faster relaxation response during active treatments and a decreased stress response following active treatments compared with what was seen in placebo treatments. Hernandez and her colleagues are embarking on a new study on the use of Jin Shin acupressure in athletes to see if the enhanced relaxation response and decreased stress seen in the stroke study can reduce the likelihood of athletic injury.
In 2002, Hernandez partnered with former Colorado Rep. Todd Saliman to initiate the Colorado Traumatic Brain Injury Trust Fund, a statute that has generated nearly $2 million to the state annually since 2004 from surcharges to traffic offenses like driving while impaired and speeding. Roughly 65 percent of the money goes toward rehabilitation and care services for individuals with TBI, about 30 percent goes for TBI research and 5 percent for TBI education. Because of the statute, nearly 4,000 Colorado citizens with TBI have received care and rehabilitation services for brain injuries.
Monday, February 21, 2011
Complementary and Alternative Medicine in Cancer Treatment (PDQ®
Questions and Answers About Complementary and Alternative Medicine in Cancer Treatment
1. What is complementary and alternative medicine?
Complementary and alternative medicine (CAM), as defined by the National Center for Complementary and Alternative Medicine (NCCAM), is a group of different medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Complementary medicine is used together with conventional medicine. Alternative medicine is used in place of conventional medicine. Conventional medicine is medicine that is practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and by health professionals who work with them, including physical therapists, psychologists, and registered nurses. Other terms for conventional medicine include allopathy; Western, mainstream, orthodox, and regular medicine; and biomedicine. Some conventional medical practitioners are also practitioners of CAM.[1]
This summary answers some frequently asked questions about the use of CAM therapies among the general public and about how CAM therapies are evaluated, and suggests sources for more information.
2. What is integrative medicine?
NCCAM defines integrative medicine as treatment that combines conventional medicine with CAM therapies that have been reported to be safe and effective after being studied in patients. In practice, many CAM therapies used in along with conventional medicine have not yet been well tested.
3. Are complementary and alternative therapies widely used?
Yes. Many CAM approaches are used by a large percentage of people in the general public and cancer patients.
The 2007 National Health Interview Survey reported about 4 out of 10 adults used CAM therapy in the past 12 months, with the most commonly used treatments being natural products and deep breathing exercises.[2]
One large survey of cancer survivors reported on the use of complementary therapies.[3] The therapies used most often were prayer and spiritual practice (61%), relaxation (44%), faith and spiritual healing (42%), and nutritional supplements and vitamins (40%). CAM therapies are used by 31-84% of children with cancer, both in and outside of clinical trials.[4] CAM therapies have been used in the management of side effects caused by cancer or cancer treatment.
4. How are CAM approaches evaluated?
It is important that CAM therapies be evaluated with the same long and careful research process used to evaluate conventional treatments. The National Cancer Institute (NCI) and the Office of Cancer Complementary and Alternative Medicine (OCCAM) are sponsoring a number of clinical trials (research studies) at medical centers to evaluate CAM therapies for cancer. A listing of these trials is available at the OCCAM Clinical Trials Web page.
Conventional cancer treatments have generally been studied for safety and effectiveness through a rigorous scientific process that includes clinical trials with large numbers of patients. Less is known about the safety and effectiveness of many CAM therapies. Research of CAM therapies has been slower for a number of reasons:
* Time and funding issues.
* Problems finding institutions and cancer researchers to work with on the studies.
* Regulatory issues.
Some CAM therapies have undergone careful evaluation. A small number of CAM therapies originally meant to be alternative treatments are finding a place in cancer treatment as complementary therapies that may help patients feel better and recover faster. One example is acupuncture. According to a panel of experts at a National Institutes of Health (NIH) Consensus Conference in November 1997,[5] acupuncture has been found to be effective in the management of chemotherapy -associated nausea and vomiting and in controlling pain associated with surgery. In contrast, some approaches, such as the use of laetrile, have been studied and found ineffective or possibly harmful.
5. What is the NCI Best Case Series Program?
The NCI Best Case Series Program, which was started in 1991, is one way CAM approaches that are being used in practice are being investigated. The program is overseen by NCI’s Office of Cancer Complementary and Alternative Medicine (OCCAM). Health care professionals who offer alternative cancer therapies submit their patients’ medical records and related materials to OCCAM. OCCAM conducts a critical review of the materials and develops follow-up research strategies for approaches that warrant NCI-initiated research.
6. Are NCI and NCCAM sponsoring clinical trials in complementary and alternative medicine?
NCI and NCCAM are currently sponsoring or cosponsoring various clinical trials to study complementary and alternative treatments for cancer. Some of these trials study the effects of complementary approaches used in addition to conventional treatments, while others compare alternative therapies with conventional treatments. Current trials include the following:
* Electroacupuncture to treat delayed chemotherapy -induced nausea and vomiting in patients diagnosed with pediatric sarcoma, neuroblastoma, nasopharyngeal carcinoma, germ cell tumors, or Hodgkin lymphoma (NCT00040911).
* Effect of Coenzyme Q10 on doxorubicin blood levels in women undergoing treatment of breast cancer (NCT00976131).
* Flaxseed in postmenopausal women with hot flashes with a history of cancer (NCT00956813).
* Reiki/energy healing in prostate cancer patients (NCT00065208).
* Yoga for fatigue in breast cancer survivors (NCT00727662).
Patients who are interested in taking part in these or any clinical trials should talk with their doctor.
Several clinical trials databases offer patients, family members, and health professionals information about research studies that use CAM. Clinical trials can be found by searching the following:
* The NCI’s PDQ Clinical Trials Database, which can be searched by using criteria such as cancer type, type of trial, geographic region, trial sponsorship, and/or drug name. This information is also available by calling the NCI’s Cancer Information Service (1–800–4–CANCER [1–800–422–6237]; TTY: 1–800–332–8615).
* The NCCAM Clinical Trials Web page, which can be searched by the type of treatment or disease.
* The OCCAM Clinical Trials Web page, which provides links to NCI’s PDQ Clinical Trials Database.
* The Clinical Trials.Gov Web page, which can be searched by the type of medical condition or intervention.
7. What should patients do when using or considering complementary and alternative therapies?
Cancer patients using or considering complementary or alternative therapy should discuss this decision with their doctor or nurse, as they would any therapeutic approach. Some complementary and alternative therapies may interfere with standard treatment or may be harmful when used with conventional treatment. It is also a good idea to become informed about the therapy, including whether the results of scientific studies support the claims that are made for it. Some resources for this information are provided in Question 9.
8. When considering complementary and alternative therapies, what questions should patients ask their health care providers?
* What benefits can be expected from this therapy?
* What are the risks associated with this therapy?
* Do the known benefits outweigh the risks?
* What side effects can be expected?
* Will the therapy interfere with conventional treatment?
* Is this therapy part of a clinical trial? If so, who is sponsoring the trial?
* Will the therapy be covered by health insurance?
Further information on evaluating CAM therapies and practitioners is available from NCCAM.
9. What federal agencies can provide more information about CAM therapies?
Patients, their families, and their health care providers can learn about CAM therapies from the following government agencies and resources:
NCCAM
* NCCAM is the federal government’s lead agency for scientific research on CAM. NCCAM is dedicated to exploring complementary and alternative healing practices in the context of rigorous science, training CAM researchers, and disseminating authoritative information to the public and professionals.
* The NCCAM Clearinghouse provides information on NCCAM and on CAM, including fact sheets, other publications, and searches of federal databases of scientific and medical literature. Publications include the following:
o Are You Considering CAM?
o Selecting a CAM Practitioner
o Paying for CAM Treatment
* The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.
NCCAM Clearinghouse
Post Office Box 7923
Gaithersburg, MD 20898–7923
Toll-free in the United States: 1–888–644–6226
International: 301–519–3153
Callers with TTY equipment: 1–866–464–3615
Fax-on-Demand service: 1–888–644–6226
E-mail: info@nccam.nih.gov
Web site: http://nccam.nih.gov
NCI
* OCCAM
NCI's OCCAM coordinates the activities of NCI in the area of complementary and alternative medicine. OCCAM supports CAM cancer research and provides information about cancer-related CAM to health providers and the general public on the NCI Web site.
* NCI Cancer Information Service
U.S. residents may call the NCI Cancer Information Service toll free at 1–800–4–CANCER (1–800–422–6237) Monday through Friday from 9:00 am to 4:30 pm EST. Deaf and hearing-impaired callers with TTY equipment may call 1–800–332–8615. A trained Cancer Information Specialist is available to answer your questions.
* PDQ
NCI’s PDQ, a comprehensive cancer information database, contains peer-reviewed summaries of the latest information about the use of CAM in the treatment of cancer. Each summary contains background information about the specific treatment, a brief history of its development, information about relevant research studies, and a glossary of scientific and medical terms. CAM summaries can be found on NCI's Web site.
U.S. Food and Drug Administration (FDA)
The FDA regulates drugs and medical devices to ensure that they are safe and effective. This agency provides a number of publications for consumers, including information about dietary supplements.
U.S. Food and Drug Administration
5600 Fishers Lane
Rockville, MD 20857
Telephone: 1–888–463–6332 (toll free)
Web site: http://www.fda.gov
FDA’s Dietary Supplements Web page: http://www.cfsan.fda.gov/~dms/supplmnt.html
Federal Trade Commission (FTC)
The FTC enforces consumer protection laws and offers publications to guide consumers. The FTC also collects information about fraudulent claims.
Consumer Response Center
Federal Trade Commission
CRC–240
Washington, DC 20580
Telephone: 1–877–FTC–HELP (1–877–382–4357) (toll free)
Callers with TTY equipment: 202–326–2502
Web site: http://www.ftc.gov
CAM on PubMed
CAM on PubMed, a database accessible via the Internet, was developed jointly by NCCAM and the NIH National Library of Medicine (NLM). It contains bibliographic citations (from 1966 to the present) to articles on CAM published in scientifically based, peer-reviewed journals. These citations are a subset of NLM's PubMed system, which contains more than 11 million journal citations from the MEDLINE database and additional life science journals important to health researchers, practitioners, and consumers. CAM on PubMed also displays links to many publisher Web sites, which may offer the full text of articles.
References
1. White JD: Complementary, alternative, and unproven methods of cancer treatment. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 6th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2001, pp 3147-57.
2. Barnes PM, Bloom B, Nahin RL: Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Report (12): 1-23, 2009. [PUBMED Abstract]
3. Gansler T, Kaw C, Crammer C, et al.: A population-based study of prevalence of complementary methods use by cancer survivors: a report from the American Cancer Society's studies of cancer survivors. Cancer 113 (5): 1048-57, 2008. [PUBMED Abstract]
4. Kelly KM: Complementary and alternative medical therapies for children with cancer. Eur J Cancer 40 (14): 2041-6, 2004. [PUBMED Abstract]
5. NIH Consensus Conference. Acupuncture. JAMA 280 (17): 1518-24, 1998. [PUBMED Abstract]
1. What is complementary and alternative medicine?
Complementary and alternative medicine (CAM), as defined by the National Center for Complementary and Alternative Medicine (NCCAM), is a group of different medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Complementary medicine is used together with conventional medicine. Alternative medicine is used in place of conventional medicine. Conventional medicine is medicine that is practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and by health professionals who work with them, including physical therapists, psychologists, and registered nurses. Other terms for conventional medicine include allopathy; Western, mainstream, orthodox, and regular medicine; and biomedicine. Some conventional medical practitioners are also practitioners of CAM.[1]
This summary answers some frequently asked questions about the use of CAM therapies among the general public and about how CAM therapies are evaluated, and suggests sources for more information.
2. What is integrative medicine?
NCCAM defines integrative medicine as treatment that combines conventional medicine with CAM therapies that have been reported to be safe and effective after being studied in patients. In practice, many CAM therapies used in along with conventional medicine have not yet been well tested.
3. Are complementary and alternative therapies widely used?
Yes. Many CAM approaches are used by a large percentage of people in the general public and cancer patients.
The 2007 National Health Interview Survey reported about 4 out of 10 adults used CAM therapy in the past 12 months, with the most commonly used treatments being natural products and deep breathing exercises.[2]
One large survey of cancer survivors reported on the use of complementary therapies.[3] The therapies used most often were prayer and spiritual practice (61%), relaxation (44%), faith and spiritual healing (42%), and nutritional supplements and vitamins (40%). CAM therapies are used by 31-84% of children with cancer, both in and outside of clinical trials.[4] CAM therapies have been used in the management of side effects caused by cancer or cancer treatment.
4. How are CAM approaches evaluated?
It is important that CAM therapies be evaluated with the same long and careful research process used to evaluate conventional treatments. The National Cancer Institute (NCI) and the Office of Cancer Complementary and Alternative Medicine (OCCAM) are sponsoring a number of clinical trials (research studies) at medical centers to evaluate CAM therapies for cancer. A listing of these trials is available at the OCCAM Clinical Trials Web page.
Conventional cancer treatments have generally been studied for safety and effectiveness through a rigorous scientific process that includes clinical trials with large numbers of patients. Less is known about the safety and effectiveness of many CAM therapies. Research of CAM therapies has been slower for a number of reasons:
* Time and funding issues.
* Problems finding institutions and cancer researchers to work with on the studies.
* Regulatory issues.
Some CAM therapies have undergone careful evaluation. A small number of CAM therapies originally meant to be alternative treatments are finding a place in cancer treatment as complementary therapies that may help patients feel better and recover faster. One example is acupuncture. According to a panel of experts at a National Institutes of Health (NIH) Consensus Conference in November 1997,[5] acupuncture has been found to be effective in the management of chemotherapy -associated nausea and vomiting and in controlling pain associated with surgery. In contrast, some approaches, such as the use of laetrile, have been studied and found ineffective or possibly harmful.
5. What is the NCI Best Case Series Program?
The NCI Best Case Series Program, which was started in 1991, is one way CAM approaches that are being used in practice are being investigated. The program is overseen by NCI’s Office of Cancer Complementary and Alternative Medicine (OCCAM). Health care professionals who offer alternative cancer therapies submit their patients’ medical records and related materials to OCCAM. OCCAM conducts a critical review of the materials and develops follow-up research strategies for approaches that warrant NCI-initiated research.
6. Are NCI and NCCAM sponsoring clinical trials in complementary and alternative medicine?
NCI and NCCAM are currently sponsoring or cosponsoring various clinical trials to study complementary and alternative treatments for cancer. Some of these trials study the effects of complementary approaches used in addition to conventional treatments, while others compare alternative therapies with conventional treatments. Current trials include the following:
* Electroacupuncture to treat delayed chemotherapy -induced nausea and vomiting in patients diagnosed with pediatric sarcoma, neuroblastoma, nasopharyngeal carcinoma, germ cell tumors, or Hodgkin lymphoma (NCT00040911).
* Effect of Coenzyme Q10 on doxorubicin blood levels in women undergoing treatment of breast cancer (NCT00976131).
* Flaxseed in postmenopausal women with hot flashes with a history of cancer (NCT00956813).
* Reiki/energy healing in prostate cancer patients (NCT00065208).
* Yoga for fatigue in breast cancer survivors (NCT00727662).
Patients who are interested in taking part in these or any clinical trials should talk with their doctor.
Several clinical trials databases offer patients, family members, and health professionals information about research studies that use CAM. Clinical trials can be found by searching the following:
* The NCI’s PDQ Clinical Trials Database, which can be searched by using criteria such as cancer type, type of trial, geographic region, trial sponsorship, and/or drug name. This information is also available by calling the NCI’s Cancer Information Service (1–800–4–CANCER [1–800–422–6237]; TTY: 1–800–332–8615).
* The NCCAM Clinical Trials Web page, which can be searched by the type of treatment or disease.
* The OCCAM Clinical Trials Web page, which provides links to NCI’s PDQ Clinical Trials Database.
* The Clinical Trials.Gov Web page, which can be searched by the type of medical condition or intervention.
7. What should patients do when using or considering complementary and alternative therapies?
Cancer patients using or considering complementary or alternative therapy should discuss this decision with their doctor or nurse, as they would any therapeutic approach. Some complementary and alternative therapies may interfere with standard treatment or may be harmful when used with conventional treatment. It is also a good idea to become informed about the therapy, including whether the results of scientific studies support the claims that are made for it. Some resources for this information are provided in Question 9.
8. When considering complementary and alternative therapies, what questions should patients ask their health care providers?
* What benefits can be expected from this therapy?
* What are the risks associated with this therapy?
* Do the known benefits outweigh the risks?
* What side effects can be expected?
* Will the therapy interfere with conventional treatment?
* Is this therapy part of a clinical trial? If so, who is sponsoring the trial?
* Will the therapy be covered by health insurance?
Further information on evaluating CAM therapies and practitioners is available from NCCAM.
9. What federal agencies can provide more information about CAM therapies?
Patients, their families, and their health care providers can learn about CAM therapies from the following government agencies and resources:
NCCAM
* NCCAM is the federal government’s lead agency for scientific research on CAM. NCCAM is dedicated to exploring complementary and alternative healing practices in the context of rigorous science, training CAM researchers, and disseminating authoritative information to the public and professionals.
* The NCCAM Clearinghouse provides information on NCCAM and on CAM, including fact sheets, other publications, and searches of federal databases of scientific and medical literature. Publications include the following:
o Are You Considering CAM?
o Selecting a CAM Practitioner
o Paying for CAM Treatment
* The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.
NCCAM Clearinghouse
Post Office Box 7923
Gaithersburg, MD 20898–7923
Toll-free in the United States: 1–888–644–6226
International: 301–519–3153
Callers with TTY equipment: 1–866–464–3615
Fax-on-Demand service: 1–888–644–6226
E-mail: info@nccam.nih.gov
Web site: http://nccam.nih.gov
NCI
* OCCAM
NCI's OCCAM coordinates the activities of NCI in the area of complementary and alternative medicine. OCCAM supports CAM cancer research and provides information about cancer-related CAM to health providers and the general public on the NCI Web site.
* NCI Cancer Information Service
U.S. residents may call the NCI Cancer Information Service toll free at 1–800–4–CANCER (1–800–422–6237) Monday through Friday from 9:00 am to 4:30 pm EST. Deaf and hearing-impaired callers with TTY equipment may call 1–800–332–8615. A trained Cancer Information Specialist is available to answer your questions.
* PDQ
NCI’s PDQ, a comprehensive cancer information database, contains peer-reviewed summaries of the latest information about the use of CAM in the treatment of cancer. Each summary contains background information about the specific treatment, a brief history of its development, information about relevant research studies, and a glossary of scientific and medical terms. CAM summaries can be found on NCI's Web site.
U.S. Food and Drug Administration (FDA)
The FDA regulates drugs and medical devices to ensure that they are safe and effective. This agency provides a number of publications for consumers, including information about dietary supplements.
U.S. Food and Drug Administration
5600 Fishers Lane
Rockville, MD 20857
Telephone: 1–888–463–6332 (toll free)
Web site: http://www.fda.gov
FDA’s Dietary Supplements Web page: http://www.cfsan.fda.gov/~dms/supplmnt.html
Federal Trade Commission (FTC)
The FTC enforces consumer protection laws and offers publications to guide consumers. The FTC also collects information about fraudulent claims.
Consumer Response Center
Federal Trade Commission
CRC–240
Washington, DC 20580
Telephone: 1–877–FTC–HELP (1–877–382–4357) (toll free)
Callers with TTY equipment: 202–326–2502
Web site: http://www.ftc.gov
CAM on PubMed
CAM on PubMed, a database accessible via the Internet, was developed jointly by NCCAM and the NIH National Library of Medicine (NLM). It contains bibliographic citations (from 1966 to the present) to articles on CAM published in scientifically based, peer-reviewed journals. These citations are a subset of NLM's PubMed system, which contains more than 11 million journal citations from the MEDLINE database and additional life science journals important to health researchers, practitioners, and consumers. CAM on PubMed also displays links to many publisher Web sites, which may offer the full text of articles.
References
1. White JD: Complementary, alternative, and unproven methods of cancer treatment. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 6th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2001, pp 3147-57.
2. Barnes PM, Bloom B, Nahin RL: Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Report (12): 1-23, 2009. [PUBMED Abstract]
3. Gansler T, Kaw C, Crammer C, et al.: A population-based study of prevalence of complementary methods use by cancer survivors: a report from the American Cancer Society's studies of cancer survivors. Cancer 113 (5): 1048-57, 2008. [PUBMED Abstract]
4. Kelly KM: Complementary and alternative medical therapies for children with cancer. Eur J Cancer 40 (14): 2041-6, 2004. [PUBMED Abstract]
5. NIH Consensus Conference. Acupuncture. JAMA 280 (17): 1518-24, 1998. [PUBMED Abstract]
Subscribe to:
Posts (Atom)