Translational research in cancer complementary and alternative medicine: the National Cancer Institute's Best Case Series Program

Public interest in CAM for cancer care likely will influence the need for continued scientific evaluation. The NCI BCS program evaluates case studies involving novel alternative therapies for cancer treatment. Through the NCI BCS program, meaningful data are generated that may lead to NCI-supported research projects, including prospective studies, clinical trials, and advances in scientific knowledge. Individuals interested in obtaining a submission packet for the NCI BCS program may access the official OCCAM Web site at http://www3.cancer.gov/occam/ or call 301-435-7980.     

Cancer: current research in alternative therapies

Apparent increases in the use of alternative medical interventions by patients with cancer represent a challenge and an opportunity for the conventional medical research establishment and medical practice communities. Conventional cancer researchers are beginning to investigate alternative medical interventions that are used by patients with cancer, and eventually this exploration will generate sufficient data to permit evidence-based recommendations about these modalities.     

Complementary and alternative medicine in cancer: a National Cancer Institute perspective

Background: Streptococcus salivarius K12 has been shown to inhibit the growth of Streptococcus pyogenes due to bacteriocins release. Because of its ability to colonize the oral cavity, we have tested the strain K12 for its efficacy in preventing streptococcal pharyngitis and/or tonsillitis in adults.

Methods: Forty adults with a diagnosis of recurrent oral streptococcal pharyngitis were enrolled in the study. Twenty of these subjects took for 90 days a tablet containing Streptococcus salivarius K12 (Bactoblis®). The other 20 subjects served as untreated controls. A 6-month follow-up was included to evaluate any persistent protective role.

Results: The 20 adults who completed the 90-day course of Bactoblis® showed a reduction in their episodes of streptococcal pharyngeal infection (about 80%). The 90 days treatment was also associated with an approximately 60% reduction in the incidence of reported pharyngitis in the 6-month period following use of the product. The product was well tolerated by the subjects with no treatment-related side effects or drop-outs reported.

Conclusion: Prophylactic administration of Streptococcus salivarius K12 to adults having a history of recurrent oral streptococcal pathology reduced the number of episodes of streptococcal pharyngeal infections and/or tonsillitis.     

The marriage of conventional cancer treatments and alternative cancer therapies

The terms "alternative" or "unconventional" have been used to describe any therapy used instead of conventional approaches. Conventional approaches, known as "standard" or "traditional" or "biomedical" approaches, have had broad application in Western medicine. Complementary and alternative medicine has been referred to as "integrative," "integrated," or "complementary" when therapies are combined with conventional approaches, such as those for cancer.     

Sustainability and performance of the National Cancer Institute's Community Clinical Oncology Program

IntroductionThe National Cancer Institute's (NCI) Community Clinical Oncology Program (CCOP) contributes one third of NCI treatment trial enrollment (“accrual”) and most cancer prevention and control (CP/C) trial enrollment. Prior research indicated that the local clinical environment influenced CCOP accrual performance during the 1990s. As the NCI seeks to improve the operations of the clinical trials system following critical reports by the Institute of Medicine and the NCI Operational Efficiency Working Group, the current relevance of the local environmental context on accrual performance is unknown.Materials and methodsThis longitudinal quasi-experimental study used panel data on 45 CCOPs nationally for years 2000–2007. Multivariable models examine organizational, research network, and environmental factors associated with accrual to treatment trials, CP/C trials, and trials overall.ResultsFor total trial accrual and treatment trial accrual, the number of active CCOP physicians and the number of trials were associated with CCOP performance. Factors differ for CP/C trials. CCOPs in areas with fewer medical school-affiliated hospitals had greater treatment trial accrual.ConclusionsFindings suggest a shift in the relevance of the clinical environment since the 1990s, as well as changes in CCOP structure associated with accrual performance. Rather than a limited number of physicians being responsible for the preponderance of trial accrual, there is a trend toward accrual among a larger number of physicians each accruing relatively fewer patients to trial. Understanding this dynamic in the context of CCOP efficiency may inform and strengthen CCOP organization and physician practice.     

The research agenda for protocol-based care

BACKGROUND: Protocol-based care is increasingly being used to deliver collaborative, integrated and improved patient-centred care, based on the best available evidence. This article provides an overview of key issues arising from protocol-based care literature to illustrate the research agenda for this important care delivery approach. CONCLUSION: Protocols provide great potential to deliver best practice. However, questions remain about the benefits of protocol-based care.     

The research agenda for trauma critical care

In this research agenda on the acute and critical care management of trauma patients, we concentrate on the major factors leading to death, namely haemorrhage and traumatic brain injury (TBI). In haemostasis biology, the results of randomised controlled trials have led to the therapeutic focus moving away from the augmentation of coagulation factors (such as recombinant factor VIIa) and towards fibrinogen supplementation and administration of antifibrinolytics such as tranexamic acid. Novel diagnostic techniques need to be evaluated to determine whether an individualised precision approach is superior to current empirical practice. The timing and efficacy of platelet transfusions remain in question, while new blood products need to be developed and evaluated, including whole blood variants, lyophilised products and novel red cell storage modalities. The current cornerstones of TBI management are intracranial pressure control, maintenance of cerebral perfusion pressure and avoidance of secondary insults (such as hypotension, hypoxaemia, hyperglycaemia and pyrexia). Therapeutic hypothermia and decompressive craniectomy are controversial therapies. Further research into these strategies should focus on identifying which subgroups of patients may benefit from these interventions. Prediction of the long-term outcome early after TBI remains challenging. Early magnetic resonance imaging has recently been evaluated for predicting the long-term outcome in mild and severe TBI. Novel biomarkers may also help in outcome prediction and may predict chronic neurological symptoms. For trauma in general, rehabilitation is complex and multidimensional, and the optimal timing for commencement of rehabilitation needs investigation. We propose priority areas for clinical trials in the next 10 years.     

Nature-based therapeutics: A collaborative research agenda promoting equitable access and environmental stewardship

BackgroundGiven the duration and intensity of the COVID-19 pandemic, with strict emphasis on social distancing, many individuals and families are experiencing social isolation. The need to explore effective strategies for health promotion and wellness is clear.AimThe purpose of this report is to highlight evidence supporting the health benefits of nature-based therapeutics and to describe the exploratory and translational research agenda for a nurse-led program entitled RxPLORE^TM: Prescribing Life Outdoors and Real Exploration.MethodsIntegrative review of the current state of evidence for nature-based therapeutics and operationalisation of a nature-based health promotion framework as the foundation of a PhD-DNP collaborative program of research.DiscussionAmidst the unfolding crisis of the COVID-19 pandemic, the value of nature-based therapeutics is becoming more widely recognised, as are layers of disparities in access to nature. A nurse-led team proposes a program of research outlining priorities for the translation of current evidence into practice and for the investigation of gaps in the evidence base that will inform future recommendations for nature-based health promotion. The initial population of focus is children and families.ConclusionPrescribing nature is a strategy to promote health and wellness throughout the lifespan. For all populations to experience the health-promoting benefits of nature, nurses engage community members and collaborate across sectors to advocate for equitable access to nature and environmental stewardship through conservation practices.     

The use of complementary and alternative therapies

The National Center for Complementary and Alternative Medicine (NCCAM) was created by Congress in 1998 as part of the National Institutes of Health. As interest in alternative and complementary therapies among healthcare providers and consumers has increased in recent years, the NCCAM has provided research funding to determine the efficacy of various types of unconventional treatments. The Center also provides research training and acts as a clearing-house for information dissemination to practitioners and the general public. Inclusion and exclusion criteria for alternative and complementary medicine as defined by the NCCAM are provided. Interest in these non-traditional treatments will likely continue to increase over the next few years. The NCCAM is playing a vital role as it provides avenues to determine how these therapies can lead to enhanced quality of life for individuals as we enter the new millennium.     

The alternative therapies for preventing osteoporosis in menopausal women

Due to the influence of endocrine, menopausal women are easily affected by osteoporosis. Nowadays, with the popularity of preventive medicine, the proportion of the public willing to accept alternative therapies has increased. In this study alternative therapies, including Chinese medicine, diet, exercise, aromatherapy, acupressure and acupuncture were integrated, to prevent osteoporosis in menopausal women. It is expected that this study will enhance the quality of nursing and expand the prospects of nursing care in this field.     

Survey of parents of children with cancer who look for alternative therapies

Alternative therapies are regimens that run counter to the mainstream of Western medicine. The main purpose of this study was to investigate and evaluate the alternative medicine with which parents of children with cancer seek to have their children treated. The research took as its subjects the parents of children with cancer who were outpatients or inpatients in six medical centers from September to December, 1999. Data were collected by questionnaire and 110 copies were effective. The results showed that 69.1% of the parents had been seeking alternative therapies. The most popular form of alternative therapy identified by this research was folk and religious therapy (68.4%), followed by Chinese medical treatment (57.9%), followed by special diets (50.0%). Other forms were used, such as herbal and arcanum therapy (13.2%), human electricity (3.9%), meditation (1.3%), and aromatherapy (1.3%). The results also showed that 61.8% of the parents had not discussed the use of the alternative therapies with the children's doctors. Hospital workers, therefore, should try to understand the situations of pediatric patients using alternative therapies, and provide appropriate suggestions to parents of pediatric patients as well as more humane, thoughtful medical care.     

The ICM research agenda on extracorporeal life support

Purpose

This study aimed to concisely describe the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to extracorporeal membrane oxygenation (ECMO).

Methods

Narrative review based on a systematic analysis of the medical literature, national and international guidelines, and expert opinion.

Results

The use of venovenous ECMO (VV-ECMO) is increasing in the most severe forms of acute lung injury. In patients with cardiogenic shock, short-term veno-arterial ECMO (VA-ECMO) provides both pulmonary and circulatory support. Technological improvements and recently published studies suggest that ECMO is able to improve patients’ outcomes. There are, however, many uncertainties regarding the real benefits of this technique both in hemodynamic and respiratory failure, the territorial organization to deliver ECMO, the indications and the use of concomitant treatments.

Conclusions

Although there have been considerable advances regarding the use of ECMO in critically ill patients, the risk/benefit ratio remains underinvestigated. ECMO indications, organization of ECMO delivery, and use of adjuvant therapeutics need also to be explored. Ongoing and future studies may be able to resolve these issues.