Hans Helge Bartsch

Classical homeopathy in the treatment of cancer patients - a prospective observational study of two independent cohorts

BackgroundMany cancer patients seek homeopathy as a complementary therapy. It has rarely been studied systematically, whether homeopathic care is of benefit for cancer patients.MethodsWe conducted a prospective observational study with cancer patients in two differently treated cohorts: one cohort with patients under complementary homeopathic treatment (HG; n = 259), and one cohort with conventionally treated cancer patients (CG; n = 380). For a direct comparison, matched pairs with patients of the same tumour entity and comparable prognosis were to be formed.Main outcome parameter: change of quality of life (FACT-G, FACIT-Sp) after 3 months.Secondary outcome parameters: change of quality of life (FACT-G, FACIT-Sp) after a year, as well as impairment by fatigue (MFI) and by anxiety and depression (HADS).ResultsHG: FACT-G, or FACIT-Sp, respectively improved statistically significantly in the first three months, from 75.6 (SD 14.6) to 81.1 (SD 16.9), or from 32.1 (SD 8.2) to 34.9 (SD 8.32), respectively. After 12 months, a further increase to 84.1 (SD 15.5) or 35.2 (SD 8.6) was found. Fatigue (MFI) decreased; anxiety and depression (HADS) did not change.CG: FACT-G remained constant in the first three months: 75.3 (SD 17.3) at t0, and 76.6 (SD 16.6) at t1. After 12 months, there was a slight increase to 78.9 (SD 18.1). FACIT-Sp scores improved significantly from t0 (31.0 - SD 8.9) to t1 (32.1 - SD 8.9) and declined again after a year (31.6 - SD 9.4). For fatigue, anxiety, and depression, no relevant changes were found.120 patients of HG and 206 patients of CG met our criteria for matched-pairs selection. Due to large differences between the two patient populations, however, only 11 matched pairs could be formed. This is not sufficient for a comparative study.ConclusionIn our prospective study, we observed an improvement of quality of life as well as a tendency of fatigue symptoms to decrease in cancer patients under complementary homeopathic treatment. It would take considerably larger samples to find matched pairs suitable for comparison in order to establish a definite causal relation between these effects and homeopathic treatment.

Black cohosh (Cimicifuga racemosa) in tamoxifen-treated breast cancer patients with climacteric complaints - a prospective observational study

Objective. The antihormonal therapy of breast cancer patients with the antiestrogen tamoxifen often induces or aggravates menopausal complaints. As estrogen substitution is contraindicated, herbal alternatives, e.g. extracts of black cohosh are often used. Design. A prospective observational study was carried out in 50 breast cancer patients with tamoxifen treatment. All patients had had surgery, most of them had undergone radiation therapy (87%) and approximately 50% had received chemotherapy. Every patient was treated with an isopropanolic extract of black cohosh (1–4 tablets, 2.5 mg) for 6 months. Patients recorded their complaints before therapy and after 1, 3, and 6 months of therapy using the menopause rating scale (MRS II). Results. The reduction of the total MRS II score under black cohosh treatment from 17.6 to 13.6 was statistically significant. Hot flashes, sweating, sleep problems, and anxiety improved, whereas urogenital and musculoskeletal complaints did not change. In all, 22 patients reported adverse events, none of which were linked with the study medication; 90% reported the tolerability of the black cohosh extract as very good or good. Conclusions. Black cohosh extract seems to be a reasonable treatment approach in tamoxifen treated breast cancer patients with predominantly psychovegetative symptoms.

Characteristics of cancer patients using homeopathy compared with those in conventional care: a cross-sectional study

BACKGROUND There are only few studies on cancer patients who are treated in complementary and alternative medicine clinics and comparing them with patients in conventional care. We will present the comparison of characteristics of two patient cohorts: one was treated in a homeopathic cancer care clinic and one was treated in a conventional oncology care (CC) outpatient clinic. PATIENTS AND METHODS Six-hundred and forty-seven patients were included in this cross-sectional cohort study and had to fill in questionnaires [health-related quality of life (QoL) (Functional Assessment of Cancer Therapy-General Scale), depression and anxiety (Hospital Anxiety and Depression Scale), fatigue (Multidimensional Fatigue Inventory) and expectancies toward treatment]. Clinical data were extracted from medical records. This study presents the comparison of both cohorts. RESULTS Patients in the homeopathy cohort are younger, better educated and more often employed than patients in the CC cohort. The most pronounced differences indicate longer disease histories and different diagnostic and clinical pretreatment variables. Despite the clinical differences, QoL as well as anxiety, depression and fatigue was similar in both the groups. CONCLUSIONS Homeopathic treatment is sought by cancer patients at a different phase during the course of the disease, which has particular implications for research. However, expectancies toward the benefit of the treatment as well as QoL data are similar.

Interdisciplinary Screening, Diagnosis, Therapy and Follow-up of Breast Cancer. Guideline of the DGGG and the DKG (S3-Level, AWMF Registry Number 032/045OL, December 2017) – Part 1 with Recommendations for the Screening, Diagnosis and Therapy of Breast Cancer

Purpose The aim of this official guideline coordinated and published by the German Society for Gynecology and Obstetrics (DGGG) and the German Cancer Society (DKG) was to optimize the screening, diagnosis, therapy and follow-up care of breast cancer. Methods The process of updating the S3 guideline dating from 2012 was based on the adaptation of identified source guidelines which were combined with reviews of evidence compiled using PICO (Patients/Interventions/Control/Outcome) questions and the results of a systematic search of literature databases and the selection and evaluation of the identified literature. The interdisciplinary working groups took the identified materials as their starting point to develop recommendations and statements which were modified and graded in a structured consensus procedure. Recommendations Part 1 of this short version of the guideline presents recommendations for the screening, diagnosis and follow-up care of breast cancer. The importance of mammography for screening is confirmed in this updated version of the guideline and forms the basis for all screening. In addition to the conventional methods used to diagnose breast cancer, computed tomography (CT) is recommended for staging in women with a higher risk of recurrence. The follow-up concept includes suggested intervals between physical, ultrasound and mammography examinations, additional high-tech diagnostic procedures, and the determination of tumor markers for the evaluation of metastatic disease.

Körperliche Aktivitäten in der onkologischen Rehabilitation

In Deutschland hat sich – ausgehend von der Kurmedizin des 18. und 19. Jahrhunderts – in den letzten beiden Jahrzehnten des vergangenen Jahrhunderts eine hochspezialisierte onkologische Rehabilitationsmedizin entwickelt, die sich heute neben Pravention und Akuttherapie als eigenstandige wichtige und unverzichtbare Saule des Gesundheitssystems prasentiert.

Die Therapieentscheidung als ökonomische Zwangshandlung

ZusammenfassungDie ärztliche Versorgung erkrankter Menschen ist sowohl in der ambulanten wie stationären Behandlung in ein leistungsbezogenes Korsett geschnürt, in dem nur vergütet wird, was möglichst in metrischen Systemen dokumentiert werden kann. Die Portionierung ärztlicher Leistungen in Abrechnungsziffern bzw. DRG-relevante Prozeduren hat erhebliche Konsequenzen für Qualität und Quantität der Versorgung. Aus der anteilnehmenden Hilfe, die Leiden lindern soll, wird eine zweckrationale Dienstleistungsbeziehung, die an der Einhaltung von Standards und dem ökonomischen Erfolg gemessen wird. Die Kostenentwicklung im Gesundheitswesen belegt, dass dadurch eine Leistungsausweitung befördert wird. Noch verheerender ist aber der Vertrauensverlust von Menschen, die in gesundheitliche Not geraten sind und die uneigennützige Hilfe der konsultierten Ärzte erwarten. Denn eine Kultur des Heilens benötigt Vertrauen, fachliche Kompetenz, hohe Kommunikationsqualität und Zeit, in der eine adäquate Begegnung mit dem Kranken möglich ist. Sind diese Voraussetzungen aufgrund des ökonomischen Zwangs nicht mehr gegeben, ist das grundlegende Selbstverständnis ärztlichen Denkens und Handelns gefährdet. Nicht zuletzt darin ist einer der Gründe zu sehen, warum sich wachsende Nachwuchsprobleme in der ärztlichen Versorgung offenbaren.AbstractThe outpatient and inpatient medical treatment is laced in a performance-oriented corset closely linked to metric systems, calculating every step or activity to measure the cost-effectiveness of the work. Assigning a monetary value to any medical procedure has a tremendous impact on the quality and quantity of medical treatment. The concept of sympathetic care converts to a goal-controlled provision of service adapted to standard operating procedures (SOP) and evaluated as economic profit. The increasing expenses in the healthcare system are partially due to the expansion of medical performance. Even more devastating is the loss of confidence by seriously ill patients, who expect empathic care from physicians. To provide an optimal healthcare environment, confidence, scientific and clinical competence, communication skills and time to care are necessary. If these prerequisites are displaced by economic requirements, fundamental ethical aspects in medical care will disappear. However, this might be one of the reasons why students and young doctors feel alienated and frustrated, causing increasing deficits in the medical infrastructure.