Jutta Huebner

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.

Multicenter, Phase III Trial Comparing Selenium Supplementation With Observation in Gynecologic Radiation Oncology: Follow-Up Analysis of the Survival Data 6 Years After Cessation of Randomization

Purpose. In 2010, we reported that selenium (Se) supplementation during radiation therapy (RT) is effective for increasing blood Se levels in Se-deficient cervical and uterine cancer patients, and reduced the number of episodes and severity of RT-induced diarrhea. In the current study, we examine whether of Se supplementation during adjuvant RT affects long-term survival of these patients. Patients and Methods. Former patients were identified and questioned with respect to their health and well-being. Results. A total of 81 patients were randomized in the initial supplementation study, 39 of whom received Se (selenium group, SeG) and 42 of whom served as controls (control group, CG). When former patients were reidentified after a median follow-up of 70 months (range = 0-136), the actuarial 10-year disease-free survival rate in the SeG was 80.1% compared to 83.2% in the CG (P = .65), and the actuarial 10-year overall survival rate of patients in the SeG was 55.3% compared to 42.7% in the CG (P = .09). Conclusions. Our extended follow-up analysis demonstrates that Se supplementation had no influence on the effectiveness of the anticancer irradiation therapy and did not negatively affect patients’ long-term survival. In view of its positive effects on RT-induced diarrhea, we consider Se supplementation to be a meaningful and beneficial adjuvant treatment in Se-deficient cervical and uterine cancer patients while undergoing pelvic radiation therapy.

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.

Complementary and Alternative Medicine in German Cancer Centers

Background: Complementary and alternative medicine (CAM) is used by many cancer patients in Germany. Yet, no data exist on CAM at certified cancer centers. Methods: We performed a survey at 44 certified oncology centers, 11 comprehensive cancer centers, and 746 certified organ cancer centers using a standardized questionnaire asking for meaning attributed to CAM, counseling on CAM, and CAM methods used. Results: 50 oncology and comprehensive cancer centers (90.9%) and 186 organ cancer centers (25.5%) returned the questionnaire. 95% of the oncology and 83% of the organ cancer centers state that complementary medicine (CM) has a high impact on mental health. 56% of the oncology and 64% of the organ cancer centers make the same statement with regard to alternative medicine (AM). At 62% of the oncology and 54% of the organ cancer centers, counseling on CAM is offered. 9% of the oncology and 20% of the organ cancer centers state that CM is associated with risks. Conclusion: In certified cancer centers there is a high interest in CAM, and a substantial part of the centers offer counseling and treatment. The awareness of risks is relatively low. Education on CAM in oncology is mandatory in order to improve the safety of CAM use in cancer patients.

Survey on the worldwide Chronic Myeloid Leukemia Advocates Network regarding complementary and alternative medicine

PurposeMany cancer patients use complementary and alternative medicine (CAM). However, data in hematological cancers are lacking on which types of CAM are being used, what information sources on CAM patients use and to what extent CAM is being addressed in the consultation with the hematologist.MethodsWe developed a standardized questionnaire on CAM which was provided online to the representatives of the worldwide Chronic Myeloid Leukemia Advocates Network.ResultsA total of 53 leaders of patients’ advocacy groups for chronic myeloid leukemia (CML) patients from 35 countries responded to the survey. In almost all countries, CAM is important for CML patients and is widely used in addition to conventional leukemia treatment. Mostly, patients have to pay by themselves. General practitioners, herbalists, healers and naturopaths are the main sources for CAM treatments. Information on CAM is derived most frequently from the Internet, and family and friends, but rarely provided by the oncologist. Disclosure of CAM use to the oncologist is low, but increases if oncologists offer CAM.ConclusionsIn spite of very different health care systems, the features of CAM usage are similar in the different countries. We suggest extending the cooperation of self-help and scientists in order to provide training of oncologists on CAM and quality-controlled, evidence-based information on CAM on the Internet both for patients as well as health professionals as a promising strategy to increase safe use of CAM in patients with CML.

Use of complementary medicine in metastatic melanoma patients treated with ipilimumab within a clinical trial.

In Germany, 40–90 % of all cancer patients use complementary and alternative medicine (CAM). So far, no data are available on the use of CAM by melanoma patients. The objective of our study was to gather data on CAM use, sources of information, and goals of patients with metastatic melanoma.

Selenium supplementation in radiotherapy patients: do we need to measure selenium levels in serum or blood regularly prior radiotherapy?

Considering the review by Puspitasari and colleagues, an additional discussion of the endpoints of the Se supplementation studies described would be helpful. In our view, selenium can safely be given to selenium-deficient cancer patients prior to and during radiotherapy. Therefore, in order to help the radiation oncologist in decision making, we strongly advocate to determine the selenium status prior to and during a potential adjuvant selenium supplementation, e.g. when trying to ease the side-effects of radiation treatment or in the aftercare situation when the selenium status may become insufficient.

Impact of treatment planning target volumen (PTV) size on radiation induced diarrhoea following selenium supplementation in gynecologic radiation oncology - a subgroup analysis of a multicenter, phase III trial

BackgroundIn a previous analysis (Int J Radiat Oncol Biol Phys 70:828-835,2010), we assessed whether an adjuvant supplementation with selenium (Se) improves Se status and reduces the radiation-induced side-effects of patients treated by adjuvant radiotherapy (RT) for cervical and uterine cancer. Now, a potential relation between the planning target volume (PTV) of the RT and the Se effect concerning radiation induced diarrhoea was evaluated in detail.MethodsWhole blood Se concentrations had been measured in patients with cervical (n=11) and uterine cancer (n=70) after surgical treatment, during, and at the end of RT. Patients with initial Se concentrations of less than 84 μg/l were categorized as Se-deficient and randomized before RT to receive Se (as sodium selenite) per os on the days of RT, or to receive no supplement during RT. Diarrhoea was graded according to the Common Toxicity Criteria system (CTC, Version 2a). The evaluation of the PTV of the RT was ascertained with the help of a specialised computer-assisted treatment planning software used for radiation planning procedure.ResultsA total of 81 patients had been randomized for the initial supplementation study, 39 of which received Se [selenium group, SeG] and 42 serving as controls [control group, CG]. Mean Se levels did not differ between SeG and CG upon study initiation, but were significantly higher in the SeG compared to the CG at the end of RT. The actuarial incidence of at least CTC 2 radiation induced diarrhoea in the SeG was 20.5% compared to 44.5% in the CG (p=0.04). The median PTV in both groups was 1302 ml (916–4608). With a PTV of <= 1302 ml (n=41) the actuarial incidence of at least CTC 2 diarrhoea in the SeG was 22.3% (4 of 18 patients) compared to 34.8% (8 of 23 patients) in the CG (p=0.50). In patients with a PTV of > 1302 ml (n=40) the actuarial incidence of at least CTC 2 diarrhoea in the SeG was 19.1% (4 of 21 patients) versus 52.6% (10 of 19 patients) in the CG (p=0.046).ConclusionsSe supplementation during RT was effective to improve blood Se status in Se-deficient cervical and uterine cancer patients, and reduces episodes and severity of RT-induced diarrhoea. This effect was most pronounced and significant in patients with large PTV (> 1302 ml).

Selenium and hypertension: do we need to reconsider selenium supplementation in cancer patients?

W e have read with great expectations the study of Berthold et al. [1] and would like to thank the authors for another interesting analysis on selenium and hypertension. However, in our view, the publication fell short in several respects, that is, the number of selenium biomarkers analyzed, characterization of study participants with respect to reason for hospital admission, information on trace element supplementation, nutrition estimates (as in Germany, dietary selenium intake is dominated by hypertensinogenic nutrition, i.e. red meat, eggs, milk and so on, but not by fruits or vegetables) and a critical discussion on potential reasons for the unexpected findings presented. What might underlie this uncommon sex-difference in serum selenium concentrations in the patients of the Lipid analytic cologne (LIANCO) cohort, and why do only the LIANCO women display significant interactions? Judging from the interactionsbetween seleniumandhypertension, as graphically depicted in Fig. 1, the only obvious and significant effects appear restricted to the small number of women with serum selenium concentrations above 100 mg/l, which clearly represent an unusual subgroup of Germans. One wonders about their clinical oddities, health, multivitamin and trace element self-supplementation, and other potential reasons for a relatively high serum selenium status. Surprisingly, for us the data suggest that even in a population with a relative selenium deficiency higher serum selenium concentrations may be associated with higher blood pressure and a higher prevalence of hypertension in women [1]. These findings are thought-provoking and are raising new questions on the safety of selenium supplementation, even in selenium-deficient populations like in Germany [2,3]. Until now, there was a widespread belief in the scientific community that correcting a selenium deficit in marginally supplied individuals provides health benefits; the study by Berthold et al. [1] implies the opposite with respect to cardiovascular disease. This result is surprising as the majority of published analyses in this respect report a positive correlation or no interaction [1,4,5,7,8]. For example, Nawrot et al. [5] in 2007 concluded that a relative selenium deficit might constitute an underestimated risk factor for the development of high blood pressure, especially in European men [6], and Lubos et al. [8] reasoned in 2010 that low selenium concentrations were associated with risk of future cardiovascular death in patients with acute coronary syndrome. These findings can only hardly be aligned to the study of Berthold et al. [1].