Use of Complementary and Alternative Medicine in Patients with Gynecologic Cancer: a Systematic Review

Purpose: Research carried out with gynecologic cancer patients using CAM was reviewed to provide a source for discussing which CAM method is used for which purpose, patients’ perceptions on the effects/side effects occurred during/after using CAM and their sources of information regarding CAM. Materials and Methods: This literature review was carried out for the period between January 2000 and March 2015 using Scopus, Dynamed, Med-Line, Science Dırect, Ulakbim, Research Starters, Ebscohost, Cinahl Complete, Academic Onefile, Directory of Open Access Journals, BMJ Online Journals (2007-2009), Ovid, Oxford Journal, Proquest Hospital Collection, Springer-Kluwer Link, Taylor & Francis, Up To Date, Web Of Science (Citation Index), Wiley Cochrane-Evidence Base, Wiley Online Library, and Pub-Med search databases with “complementary and alternative medicine, gynecologic cancer” as keywords. After searching through these results, a total of 12 full length papers in English were included. Results: CAM use in gynecologic cancer patients was discussed in 8 studies and CAM use in breast and gynecologic cancer patients in 4. It was determined that the frequency of CAM use varies between 40.3% and 94.7%. As the CAM method, herbal medicines, vitamins/minerals were used most frequently in 8 of the studies. When the reasons why gynecologic cancer patients use CAM are examined, it is determined that they generally use to strengthen the immune system, reduce the side effects of cancer treatment and for physical and psychological relaxation. In this review, most of the gynecologic cancer patients perceived use of CAM as beneficial. Conclusions: In order that the patients obtain adequate reliable information about CAM and avoid practices which may harm the efficiency of medical treatment, it is recommended that “ Healthcare Professionals” develop a common language.     

Use of Complementary and Alternative Medicine among Breast Cancer Survivors

Complementary and alternative medicine (CAM) use is prevalent among individuals with cancer, especiallybreast cancer survivors. This study was conducted among 394 breast cancer survivors in selected regions ofPeninsular Malaysia to identify the pattern and factors associated with CAM use. About 51% of the respondentsreported CAM use as complementary treatment. Vitamins (47.2%), spiritual activities (33.2%) and other dietarysupplements (30.7%) were the most commonly used CAM therapies. Common reasons for CAM use were toincrease the body’s ability to perform daily activities (70.9%), enhance immune function (58.3%) and improveemotional well-being (31.7%). Users obtained CAM information mainly from friends and family members(62.5%), physicians (25.0%) and mass media (13.9%). Ethnicity and years of education were significantlyassociated with CAM use. Although no adverse effects of CAM were reported, breast cancer survivors shoulddiscuss their CAM use with health professionals to prevent potential adverse effects of these therapies.     

Proportion of Gynecologic Cancer Patients Using Complementary and Alternative

Background and objectives: Complementary and alternative medicine (CAM) for treatment of cancer andfor supportive care of cancer patients must be clearly separated. There is encouraging evidence for CAM in thelatter area, such as acupuncture and progressive muscle relaxation for chemotherapy-related nausea and vomiting,and aromatherapy for decreasing anxiety and increasing quality of life. However, there are limited data aboutCAM used by gynecologic cancer patients, especially in Thai women. Therefore, the authors aimed to investigatethe proportion and types of CAM using in our gynecologic cancer patients. Methods: This cross-sectional surveywas conducted between October to December, 2008. Totals of 50 admitted and 50 walk-in gynecologic cancerpatients 1-month after diagnosis, aged more than 20 years and able to give informed consent, were selected forone-by-one interview by random walking survey. Results: Among the 100 interviewed patients, aged 21-69(mean=50.12), there were 46 cases of cervical cancers, 35 of ovarian cancers, 18 of endometrial cancers (two ofthese also had ovarian cancers), 2 of malignant gestational trophoblastic diseases, 1 of vulvar cancer, and 1 livercancer (in a patient with ovarian cancer). Some 67% (95% CI, 57.8-76.2%) of them used CAM. As dietmodifications, 11 used Chinese vegetarian, 8 common vegetarian, 5 Cheewajit, and 1 macrobiotics. Five ofthem used dietary supplements while colonic detoxification was emplyed in three. As herbal medicines, 27 usedThai herbs, 4 Chinese herbs, and 1 a herbal sauna. Twelve were receiving Thai massage. As exercises, 23 usedaerobics and 5 stretching. Interestingly, 62 of them used Buddhist praying while only 3 employed native magic.Conclusions: The three most common forms of CAM used by our gynecologic cancer patients were Buddhistpraying (62/67, 92.5%), followed by herbal medicines (27/67, 40.3%) and exercises (25/67, 37.3%).     

Predictors of Complementary and Alternative Medicine Use by Breast Cancer Patients in Bandung,Indonesia

Background: The study aimed to assess complementary and alternative medicine (CAM) use and their associated factors with breast cancer patients in Bandung, Indonesia. Materials and Methods: In total, 330 breast cancer patients were administered questionnaires on their CAM use and CAM predictive factors including socio-demographic parameters, clinical data and quality of life, trust in physicians, trust in hospitals, satisfaction and informational needs. Data were analyzed using univariate analysis and multivariate log regreesion analysis. Results: Overall 33.3% of patients reported use of CAM. Lower income, lower education, presence of metastasis, prolonged diagnosis, less trust in physician were found to be highly associated with CAM use. Conclusions: CAM use by breast cancer patients can be interpreted as an attempt to explore all possible options, an expression of an active coping style, or expression of unmet needs in the cancer care continuum. Physicians need to openly discuss the use of CAM with their patients and identify whether they have other unmet supportive needs.     

Complementary and Alternative Medicine (CAM) in Uro-Oncology

The West German Comprehensive Cancer Center is confronted with more than 30 000 questions per year concerning unconventional anti-cancer strategies. Unconventional or complementary drugs are not to be compared with placebos. Similar to cytotoxic drugs, unconvetional drugs have to be tested according to the guidelines of (GCP). An adjuvant treatment with unconventional drugs is not indicated. Because an possible immunomodulating effect, long-term results have to be considered - especially related to tumor progression. Right now a routine application of unconventional drugs is not indicated in the field of urological oncology.     

Fertility-Sparing Approaches in Gynecologic Cancers: A Review of ESGO Task Force Activities

Preservation of fertility has become a very important issue in gynecologic oncology of the young. Owing to the clinical importance of appropriate management of young patients with gynecologic cancer, the European Society of Gynecological Oncology (ESGO) decided in 2007 to launch the Task Force for Fertility Preservation in Gynecologic Cancer. This task force is supposed to promote knowledge of infertility induced by treatment of gynecologic cancers among health care workers and the public through national and international collaboration among oncologists, reproductive specialists, and allied health workers to promote research and education and to develop new strategies for fertility preservation. This article summarizes all the past and current activities of this task force.     

Use of Complementary and Alternative Medicine in breast cancer patients and their experiences: A cross-sectional study

Complementary and Alternative Medicine (CAM) refers to various treatments not considered as part of conventional care. CAM is used by a high number of breast cancer patients.This is a cross-sectional study employing a validated questionnaire with the aim of studying CAM use and of exploring the needs of information and communication in female breast cancer patients.Experiences associated with discussing CAM within a conventional oncology setting were examined. Answers of patients not using CAM were also elicited.Predictors for CAM use were a higher degree of education and being of a younger age. The study demonstrated that patients were reluctant to initiate communication within standard oncology care. They rather relied on family and friends (49%), on the general practitioner (40%) or media sources (39%) for information. Reasons for not talking about CAM were not having been asked (25%) or not having perceived the inpatient physician to be the adequate person to talk to (11%). Reasons for not using CAM were mainly considering conventional therapy as sufficient (34%) and not having thought about CAM (31%).Particularly within conventional oncological care it is important to train physicians to have knowledge of supportive CAM options as this is what patients look for, but restrain from seeking within the speciality system.     

Effects of Complementary and Alternative Medicine on Chemotherapy Delivery in Thai Patients

Background: Complementary and Alternative Medicine (CAM) is widely used among cancer patients worldwide. This prospective observational study aimed to show the effect of CAM use on chemotherapy delivery in Thai patients. Methods: During March 2014 to February 2015, the patients with breast, lung or colorectal cancer receiving first cycle chemotherapy at King Chulalongkorn Memorial Hospital were enrolled. The correlation between CAM using and chemotherapy schedule delay and dose reduction, dose intensity, quality of life and adverse event rates were analyzed. Results: There were 80 (44.20%) patients using CAM among 181 enrolled patients.  Seventy six CAM users and 97 non-CAM users receiving 2nd cycle of chemotherapy were included for primary analysis. The chemotherapy schedules were delayed and/or reduced in 40 (52.6%) and 48 (49.5%) in CAM users and non-CAM users, respectively, p =0.681. The mean relative dose intensity (RDI) were 92.4% and 94.1% in CAM and non-CAM users, respectively, p=0.244. However, there were significantly more CAM users receiving chemotherapy less than 90% RDI (34.8% vs 19.8%, p=0.033). As compared to first cycle, at third cycle, the mean QOL score changes were -4.63 (95% CI -2.49-9.27) and -8.02 (-2.36- 9.142) in CAM user and non-CAM user, respectively (p=0.255). There were significantly higher rates of grade 3 or 4 anemia (5.1% vs 0%, p=0.024), and grade 2 malaise (19.0% vs 5.1%, p=0.004) in CAM users. Conclusions: There were similar overall rates of chemotherapy schedule delay and dose reduction between CAM- and non-CAM users. However, there were less CAM-users achieving 90% chemotherapy RDI.     

Expression of Tumor-rejection Antigens in Gynecologic Cancers

We recently reported the four tumor-rejection antigens (SART1₂₅₉ SART2, SART3, and ART4) that possess tumor epitopes capable of inducing HLA-A2402-restricted cytotoxic T lymphocytes (CTLs) in cancer patients. This study investigated the expression of these tumor antigens in gynecologic cancers, including 33 ovarian cancers, 38 cervical cancers, and 40 endometrial cancers. SART1₂₅₉ antigen was detected in 56%, 35%, and 30% of ovarian, cervical and endometrial cancers, while SART2 antigen was detected in 46%, 66%, and 30% of these cancers, respectively. Both SART3 and ART4 antigens were detectable in the majority of these gynecologic cancers tested. In contrast, none of these antigens was detectable in any of the normal ovarian and uterine tissues tested. Peripheral blood mononuclear cells (PBMCs) of HLA-A24⁺ patients with gynecologic cancers were found to produce significant levels of interferon-γ in response to HLA-A24⁺ SART3⁺ gynecologic cancer cells after having been stimulated three times in vitro with either SART3_109–118 or SART3_315–323 peptide. These PBMCs lysed HLA-A24⁺ SART3⁺ gynecologic cancer cells, but not HLA-A24^- SART3⁺ gynecologic cancer cells or HLA-A24⁺ normal cells. Therefore, these four antigens and their peptides, including SART3 peptides, would be appropriate molecules for use in specific immunotherapy of HLA-A24⁺ gynecologic cancer patients.