Bianca Senf

Online survey of patients with breast cancer on complementary and alternative medicine.

About 50% of cancer patients use complementary and alternative medicine (CAM). Women with breast cancer use CAM more frequently than others. We linked a questionnaire to the largest internet portal for cancer patients in Germany. The questionnaire addresses attitude towards CAM, disclosure to the oncologist, source of information, and objectives for use of CAM. 80 patients with breast cancer took part in our study, 61 currently using CAM. Most frequently used CAM methods were selenium, relaxation techniques, prayer, vitamin C, and meditation. Satisfaction was highest with relaxation techniques, vitamin C, homeopathy, yoga and Chinese herbs, lowest with mistletoe and acupuncture. 70% of participants did not think their oncologist took time to discuss CAM. Only 16% believed that their oncologist was well-informed about CAM. 46% relied on naturopaths and non-medical practitioners concerning CAM. Objectives for the use of CAM were to reduce side effects, boost the immune system, and become active.

Attitude of employees of a university clinic to complementary and alternative medicine in oncology

BACKGROUND Cancer patients often use complementary and alternative medicine (CAM), yet discussion with the oncologist is often missing and oncologists lack knowledge in CAM. PATIENTS AND METHODS In order to learn more about the attitude of professionals in oncology toward CAM, a survey was conducted on employees of a German university clinic using a structured questionnaire. RESULTS In total, 547 employees took part in the survey. One-third would definitely use CAM on cancer patients. Female employees are more interested in CAM than males (80% versus 20%; P = 0.001); physicians are less interested than nurses (57% versus 72%; P = 0.008). 2.5% of physicians and 9% of nurses are convinced that CAM is as effective as conventional therapy in cancer. Fifty-two percent of physicians and 12% of nurses agree that adverse effects due to CAM may be possible. Seventy-three percent did not consider themselves adequately informed on CAM for their professional work. CONCLUSIONS As a substantial part of participants would use CAM on cancer patients and most are interested in but not trained on this topic, there is a need for training of professionals from different professions working in oncology.

Psychosocial distress in acute cancer patients assessed with an expert rating scale

PurposeThe identification of psychosocial stress in cancer patients has remained a challenging task especially in an acute care environment. The aims of the present study were to apply a short expert rating scale for the assessment of distress during the acute treatment phase and to identify potential sociodemographic and disease-related predictors.MethodsFour hundred seventy-eight ward cancer patients were assessed with the short form of the psycho-oncological basis documentation and its breast-cancer-specific version. In addition, they completed a self-rating questionnaire on stress in cancer patients. We recorded sociodemographic and disease-related variables and assessed their predictive value for psychosocial distress.ResultsAccording to the expert rating scale, 56.3% of patients were rated distressed. While only 31.3% of patients were classified as distressed according to a patient self-rating, both approaches showed a good degree of concurrence with a consistent classification of 69% of patients. Younger age, current psychotropic medication, and past psychological treatment were associated with higher distress levels. Patients with metastases and those with a poorer functional status were more distressed. Interestingly, having an operation was associated with a better psychological well-being.ConclusionsThis study demonstrated that a substantial proportion of cancer patients in acute care are psychosocially distressed. A short expert rating scale proved to be a feasible tool for the assessment of distress in an acute care setting.

Survey of German Non-Medical Practitioners Regarding Complementary and Alternative Medicine in Oncology

Background: In total, 40-70% of cancer patients use complementary or alternative medicine (CAM). Many of them ask for advice from non-medical practitioners (NMPs). Our aim was to investigate the attitude of NMPs regarding their treatments for cancer patients. Methods: A survey was performed on members of NMP associations, using an online questionnaire on diagnosis and treatment, goals for using CAM, communication with the oncologist, and sources of information. Results: Of the 1,500 members of the NMP associations, 299 took part. The treatments were found to be heterogeneous. Homeopathy is used by 45% of the NMPs; 10% believe it to be a treatment directly against cancer. Herbal therapy, vitamins, orthomolecular medicine, ordinal therapy, mistletoe preparations, acupuncture, and cancer diets are used by more than 10% of the NMPs. None of the treatments is discussed with the respective physician on a regular basis. Conclusions: Many therapies provided by NMPs are biologically based and therefore may interfere with conventional cancer therapy. Thus, patients are at risk of interactions, especially as most NMPs do not adjust their therapies to those of the oncologist. Moreover, risks may arise from these CAM methods as NMPs partly believe them to be useful anticancer treatments. This may lead to the delay or even omission of effective therapies.

Attitude of oncology/hematology nurses from German speaking countries towards complementary and alternative medicine

Objective: 40 – 50% of cancer patients use complementary or alternative medicine (CAM). While oncologists are skeptical regarding CAM, no data has been published with respect to nurses. The objective of our study was to learn about the attitude of nurses with a specialization in cancer care towards CAM. Subjects and methods: A survey was performed on nurses in Germany, Switzerland and Austria using an online questionnaire, which addressed attitude towards, and experiences with CAM. Results: 877 participants filled in the questionnaire. 61% have a very positive or positive attitude towards complementary (CM) and 20% towards alternative medicine (AM). 71% rate their knowledge as high to moderate regarding CM. 43% use some source of information on CAM and 48% would like more training on CAM. The most important reason to use CM is the patient becoming active (50%). CM is a means for reducing side effects (46%), increasing coping (42%), or quality of life (47%). For AM, less than 20% give positive statements. Risks as a result of interactions and side effects are anticipated by 40 (CM) and 50% (AM). Conclusion: In sum, many but not all participants are aware of the pros and cons of CAM. In general, they have a positive attitude towards CM. In order to make CM safer, a structured training should be offered.

The Basic Documentation for Psycho‐Oncology Short Form (PO‐Bado SF)—an expert rating scale for distress screening: development and psychometric properties

The aim of this study is to validate the Basic Documentation for Psycho‐Oncology Short Form (PO‐Bado SF), a six item interview‐based expert rating scale for distress screening in cancer patients.

Online information on complementary and alternative medicine for cancer patients: evidence-based recommendations.

Background: Many cancer patients use complementary and alternative medicine (CAM). Most websites offering online information on CAM are not helpful for them. Methods: We extracted decisive elements for online information on CAM by analyzing the literature on the information needs of cancer patients and on counseling cancer patients on CAM. Results: Key issues for online information on CAM are the qualification of the authors, transparency and accountability of the information, description of the aims, a scientific approach, description of treatment alternatives, support for the patient-physician relationship, individualized information, a summary of the information, disclosure of funding, and the privacy policy. Conclusions: The communicative challenge will be to convey information without destroying hope and motivation. We suggest that CAM topics should be integrated into broader information provided on cancer (etiology, conventional treatment). By also providing information for physicians, such a website could promote shared decision-making. Online information will gain the status of independent expert knowledge if provided by a well-known scientific organization as, e.g., a national cancer society.

Brustkrebs als Auslöser von psychosozialen Belastungen, Angst und Depression sowie Angebote, Methoden und Effekte psychoonkologischer Interventionen

Brustkrebs ist die haufigste Krebserkrankung bei Frauen – eine Erkrankung, die weit mehr betrifft als nur die weibliche Brust. Eine erkrankte Frau ist in ihrem ganzen Menschsein und Frausein betroffen. Unsicherheiten und Angste beziehen sich auf alle Aspekte des Lebens und bringen Belastungen mit sich, die zu psychischen Storungen fuhren konnen. Die Psychoonkologie erkennt und beschreibt typische Belastungen und stellt Losungsmoglichkeiten bereit. Ziel ist eine erfolgreiche Krankheitsanpassung, um die Lebenszufriedenheit der Patientinnen zu verbessern.

Analysis of the Contents of German Magazines for Tumor Patients

Background: Cancer patients have high information needs. Besides direct discussion with the physician, media provide important access to information. In the age of the internet, print media are still being used by many patients. In Germany, several magazines for cancer patients are distributed at no cost to cancer institutions for display. The aim of our study was to assess the content of these magazines. Methods: In a first step, a search of the literature concerning patient information needs and evaluation of patient information was done. This search revealed important criteria for evaluation. 2 instruments are recognized internationally as appropriate in evaluating and certifying patient information: HONcode and DISCERN. As we did not find an instrument for the evaluation of patient magazines, we combined the central items from both instruments. With this new instrument, we assessed the 2010 issues of all 5 magazines . Results: The Krebsmagazin offers a vast range of different topics in cancer and thus aims at general patient education, irrespective of the level of knowledge. Befund Krebs offers a wider variety of topics in each issue. Understanding the articles requires basic knowledge. The same applies to Leben? Leben! which specifically addresses the topic of breast cancer. All 3 journals provide information in line with evidence-based medicine. K Journal - Mensch & Krebs provides information on conventional as well as alternative treatments, the latter not being evidence-based. Several issues contained both advertisements and articles by providers of alternative therapies. Signal only deals with alternative medicine in cancer care and does not provide scientifically proven data. Conclusion: As our analysis shows, content and evidence vary greatly in the magazines currently distributed in Germany. Physicians should familiarize themselves with the characteristics of the different journals before recommending them.

Title Page / Contents / Imprint / Guidelines

S. Al-Batran, Frankfurt/M. C. Berking, München C. Bokemeyer, Hamburg M. Borner, Bern T. Cerny, St. Gallen H. T. Eich, Münster A. Engert, Köln M. Fassnacht, München B. Groner, Frankfurt/M. V. Heinemann, München M. Hentrich, München R. D. Issels, München W. Janni, Ulm U. R. Kleeberg, Hamburg H. Lang, Mainz M. Moehler, Mainz M. Schuler, Essen R. Stupp, Zürich M. Theobald, Mainz R. Thomas, Köln U. Wedding, Jena J. A. Werner, Marburg O. Zivanovic, New York