Karsten Muenstedt

Online Survey of Cancer Patients on Complementary and Alternative Medicine

Introduction: Complementary and alternative medicine (CAM) is often used by cancer patients, yet, communication with the oncologist is poor. The objective of our study was to gather information on patients usage of CAM, source of information, and aims, in order to derive strategies to improve the communication between physicians and patients on this topic. Materials and Methods: An online survey was conducted by linking a standardized questionnaire to the largest internet portal for cancer patients in Germany. The questionnaire addresses CAM usage, disclosure to physicians, source of information, objectives for using CAM, and perceived reasons for cancer. Results: Of 170 participants, 77% were currently using CAM. Disclosure to a physician was rather high with 63% having informed their oncologist. Asked whether the oncologist took time to discuss CAM, 74% answered ‘no. Most frequently used are biologically based therapies, relaxation techniques, prayer, and meditation. Most patients want to reduce side effects, boost their immune system, and get active. Almost half the participants had positive experiences with some type of CAM before they fell ill. Conclusion: Understanding patients concepts of the etiology of cancer and accepting their goals for using CAM may help oncologists communicate with their patients and guide them to a safe use of CAM.

Attitudes of members of the German Society for Palliative Medicine toward complementary and alternative medicine for cancer patients

AbstractBackgroundnA high proportion of cancer patients use complementary and alternative medicine (CAM). In oncology, risks of CAM are side effects and interactions.ObjectiveOur aim was to conduct a survey on professionals in palliative care regarding attitudes toward CAM.Design and subjectsAn internet-based survey with a standardized questionnaire was sent to all members of the German Society for Palliative Care.MeasurementsThe questionnaire collected data on attitude toward CAM and experiences.ResultsSix hundred and ninety questionnaires (19xa0%) were returned (49xa0% physicians, 35xa0% nurses, 3xa0% psychologists). Acceptance of CAM is high (92xa0% for complementary and 54xa0% for alternative medicine). Most participants had already been asked on CAM by patients (95xa0%) and relatives (89xa0%). Forty-four percent already had used complementary methods and 5xa0% alternative methods. Only 21xa0% think themselves adequately informed. Seventy-four percent would use complementary methods in a patient with advanced tumor, and 62xa0% would use alternative therapy in patients if there was no other therapy. Even from those who are skeptical 45xa0% would treat a patient with alternative methods.ConclusionsIn order to inform patients on CAM and to further patients’ autonomy, evidence on benefits and harms of CAM must be provided. As awareness of risks from CAM is low and critical appraisal especially of alternative medicine missing, but interest on information on CAM is high, experts should provide evidence-based recommendations for CAM in palliative care to members of different professions. This could be done by a curriculum focusing on the most often used CAM methods.

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.

Counseling cancer patients on complementary and alternative medicine

Background and purposeComplementary and alternative medicine (CAM) is of high relevance in oncology. Only a minority of professionals feel competent in CAM. Our aim was to provide a strategy for establishing evidence-based counseling on CAM in oncology in the German health system.MethodsWe performed a systematic search of the literature on patient counseling concerning CAM. Of 811xa0articles identified in this search 51xa0met our inclusion criteria. Data from these articles were analyzed and adapted to the needs of German patients by a group of experts of the DEGRO (“Deutschen Gesellschaft für Radioonkologie”) and the German Cancer Society. In the next step a strategy about how to integrate evidence-based counseling on CAM at cancer centers and oncological institutions was developed.ResultsFirst, evidence-based recommendations on CAM counseling were derived. The core of our strategy combines two levels of information provision: levelxa01 will be oncologists, radiotherapists and other specialists and levelxa02 oncological CAM experts. The latter group will serve as trainers and backup for complicated or advanced questions and for individual counseling of patients with complex needs. Professionals in levelxa01 will be offered special training.ConclusionEvidence-based counseling on CAM is not only possible but also mandatory in order to meet patient information needs. Our proposal would allow for integrated counseling available at all oncological institutions and guarantee a high quality. Furthermore, provision of information on two different levels allows the effective use of resources (manpower and financing).ZusammenfassungHintergrundKomplementäre und alternative Medizin (KAM) hat eine hohe Bedeutung in der Onkologie. Nur eine Minderheit der Onkologen fühlt sich kompetent bei KAM. Unser Ziel war es, eine Strategie zu entwickeln, wie innerhalb des deutschen Gesundheitssystems evidenzbasierte Beratungen zu KAM aufgebaut werden können.MethodenIn einer systematischen Literaturrecherche zum Thema Beratung zu KAM wurden 811xa0Artikel gefunden, von denen 51 inhaltlich dem Thema unserer Arbeit entsprachen. Aus ihnen wurde von einer Expertengruppe der Deutschen Gesellschaft für Radioonkologie und der Deutschen Krebsgesellschaft eine Strategie entwickelt, wie evidenzbasierte Beratung zu KAM in Tumorzentren und anderen onkologischen Institutionen integriert werden kann.ErgebnisseAls erstes wurden evidenzbasierte Empfehlungen zur KAM-Beratung erarbeitet. Der Kern der Strategie besteht in 2xa0Stufen der Informationsvermittlung. Auf Stufexa01 befinden sich Onkologen, Strahlentherapeuten und andere Fachärzte, Stufexa02 bilden Fachärzte mit onkologischem Hintergrund und Expertise in KAM. Diese stehen sowohl als Ausbilder aber auch als Hintergrund für komplizierte und fortgeschrittene Fragen und für die individuelle Beratung von Patienten mit besonderen Bedürfnissen zur Verfügung. Fachärzte erhalten ein spezielles Training.SchlussfolgerungenEvidenzbasierte Beratung zu KAM ist möglich und notwendig, um den Informationsbedarf von Patienten zu befriedigen. Unser Vorschlag ermöglicht es, diese Beratungen in allen onkologischen Institutionen zu integrieren und eine hohe Qualität zu garantieren. Durch das Angebot der Informationen auf 2 unterschiedlichen Stufen werden menschliche und finanzielle Ressourcen gespart.

Counseling cancer patients on complementary and alternative medicine. Background, theory, and implementation of nationwide counseling facilities.

Background and purposeComplementary and alternative medicine (CAM) is of high relevance in oncology. Only a minority of professionals feel competent in CAM. Our aim was to provide a strategy for establishing evidence-based counseling on CAM in oncology in the German health system.MethodsWe performed a systematic search of the literature on patient counseling concerning CAM. Of 811xa0articles identified in this search 51xa0met our inclusion criteria. Data from these articles were analyzed and adapted to the needs of German patients by a group of experts of the DEGRO (“Deutschen Gesellschaft für Radioonkologie”) and the German Cancer Society. In the next step a strategy about how to integrate evidence-based counseling on CAM at cancer centers and oncological institutions was developed.ResultsFirst, evidence-based recommendations on CAM counseling were derived. The core of our strategy combines two levels of information provision: levelxa01 will be oncologists, radiotherapists and other specialists and levelxa02 oncological CAM experts. The latter group will serve as trainers and backup for complicated or advanced questions and for individual counseling of patients with complex needs. Professionals in levelxa01 will be offered special training.ConclusionEvidence-based counseling on CAM is not only possible but also mandatory in order to meet patient information needs. Our proposal would allow for integrated counseling available at all oncological institutions and guarantee a high quality. Furthermore, provision of information on two different levels allows the effective use of resources (manpower and financing).ZusammenfassungHintergrundKomplementäre und alternative Medizin (KAM) hat eine hohe Bedeutung in der Onkologie. Nur eine Minderheit der Onkologen fühlt sich kompetent bei KAM. Unser Ziel war es, eine Strategie zu entwickeln, wie innerhalb des deutschen Gesundheitssystems evidenzbasierte Beratungen zu KAM aufgebaut werden können.MethodenIn einer systematischen Literaturrecherche zum Thema Beratung zu KAM wurden 811xa0Artikel gefunden, von denen 51 inhaltlich dem Thema unserer Arbeit entsprachen. Aus ihnen wurde von einer Expertengruppe der Deutschen Gesellschaft für Radioonkologie und der Deutschen Krebsgesellschaft eine Strategie entwickelt, wie evidenzbasierte Beratung zu KAM in Tumorzentren und anderen onkologischen Institutionen integriert werden kann.ErgebnisseAls erstes wurden evidenzbasierte Empfehlungen zur KAM-Beratung erarbeitet. Der Kern der Strategie besteht in 2xa0Stufen der Informationsvermittlung. Auf Stufexa01 befinden sich Onkologen, Strahlentherapeuten und andere Fachärzte, Stufexa02 bilden Fachärzte mit onkologischem Hintergrund und Expertise in KAM. Diese stehen sowohl als Ausbilder aber auch als Hintergrund für komplizierte und fortgeschrittene Fragen und für die individuelle Beratung von Patienten mit besonderen Bedürfnissen zur Verfügung. Fachärzte erhalten ein spezielles Training.SchlussfolgerungenEvidenzbasierte Beratung zu KAM ist möglich und notwendig, um den Informationsbedarf von Patienten zu befriedigen. Unser Vorschlag ermöglicht es, diese Beratungen in allen onkologischen Institutionen zu integrieren und eine hohe Qualität zu garantieren. Durch das Angebot der Informationen auf 2 unterschiedlichen Stufen werden menschliche und finanzielle Ressourcen gespart.

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.

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.

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

Counseling cancer patients on complementary and alternative medicine@@@Beratung von Krebspatienten zu komplementärer und alternativer Medizin: Background, theory, and implementation of nationwide counseling facilities@@@Hintergrund, Theorie und Umsetzung bundesweiter Beratungshilfen

Background and purposeComplementary and alternative medicine (CAM) is of high relevance in oncology. Only a minority of professionals feel competent in CAM. Our aim was to provide a strategy for establishing evidence-based counseling on CAM in oncology in the German health system.MethodsWe performed a systematic search of the literature on patient counseling concerning CAM. Of 811xa0articles identified in this search 51xa0met our inclusion criteria. Data from these articles were analyzed and adapted to the needs of German patients by a group of experts of the DEGRO (“Deutschen Gesellschaft für Radioonkologie”) and the German Cancer Society. In the next step a strategy about how to integrate evidence-based counseling on CAM at cancer centers and oncological institutions was developed.ResultsFirst, evidence-based recommendations on CAM counseling were derived. The core of our strategy combines two levels of information provision: levelxa01 will be oncologists, radiotherapists and other specialists and levelxa02 oncological CAM experts. The latter group will serve as trainers and backup for complicated or advanced questions and for individual counseling of patients with complex needs. Professionals in levelxa01 will be offered special training.ConclusionEvidence-based counseling on CAM is not only possible but also mandatory in order to meet patient information needs. Our proposal would allow for integrated counseling available at all oncological institutions and guarantee a high quality. Furthermore, provision of information on two different levels allows the effective use of resources (manpower and financing).ZusammenfassungHintergrundKomplementäre und alternative Medizin (KAM) hat eine hohe Bedeutung in der Onkologie. Nur eine Minderheit der Onkologen fühlt sich kompetent bei KAM. Unser Ziel war es, eine Strategie zu entwickeln, wie innerhalb des deutschen Gesundheitssystems evidenzbasierte Beratungen zu KAM aufgebaut werden können.MethodenIn einer systematischen Literaturrecherche zum Thema Beratung zu KAM wurden 811xa0Artikel gefunden, von denen 51 inhaltlich dem Thema unserer Arbeit entsprachen. Aus ihnen wurde von einer Expertengruppe der Deutschen Gesellschaft für Radioonkologie und der Deutschen Krebsgesellschaft eine Strategie entwickelt, wie evidenzbasierte Beratung zu KAM in Tumorzentren und anderen onkologischen Institutionen integriert werden kann.ErgebnisseAls erstes wurden evidenzbasierte Empfehlungen zur KAM-Beratung erarbeitet. Der Kern der Strategie besteht in 2xa0Stufen der Informationsvermittlung. Auf Stufexa01 befinden sich Onkologen, Strahlentherapeuten und andere Fachärzte, Stufexa02 bilden Fachärzte mit onkologischem Hintergrund und Expertise in KAM. Diese stehen sowohl als Ausbilder aber auch als Hintergrund für komplizierte und fortgeschrittene Fragen und für die individuelle Beratung von Patienten mit besonderen Bedürfnissen zur Verfügung. Fachärzte erhalten ein spezielles Training.SchlussfolgerungenEvidenzbasierte Beratung zu KAM ist möglich und notwendig, um den Informationsbedarf von Patienten zu befriedigen. Unser Vorschlag ermöglicht es, diese Beratungen in allen onkologischen Institutionen zu integrieren und eine hohe Qualität zu garantieren. Durch das Angebot der Informationen auf 2 unterschiedlichen Stufen werden menschliche und finanzielle Ressourcen gespart.