Matthias Rostock

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.

Zur pharmazeutischen Vergleichbarkeit von therapeutisch verwendeten Echinacea-Präparaten

Pharmaceutical Comparability of Different Therapeutically Used Echinacea Remedies Cichoric acid and Dodeca 2E,4E,8Z,10E/Z-tetraenoic acid isobutylamide (alkamides 8,9) are described as immunomodulating active components of Echinacea . We quantified both substances in 25 Echinacea -containing remedies customary in trade. Concerning both active components, we found highly concentrated remedies as well as remedies without any detectable cichoric acid or alkamides. The concentration of both active components varied extremely depending on the type of remedy (homeopathic mother tincture, pressed juice, tablets, spagyric tincture), on the Echinacea -species ( Echinacea angustifolia, Echinacea pallida, Echinacea purpurea ) and on the part of the plant (root, herb, whole plant). Moreover, we found large differences between comparable drugs of different manufacturers and between different charges of the same remedy. We recommend that preclinical and clinical studies with Echinacea -containing drugs should always include the quantification of the potentially active components. We are convinced, that in the long term this will help to clarify how the different active components contribute to the immunomodulating effect of Echinacea.

Multimorbidität und Multi-Target-Therapie in der Phytotherapie

The active components of herbal drugs and substances are pleiotropic multi-ingredient compounds with multitarget properties including antiinflammatory effects. A pleiotropic inhibition of inflammation could play an important role in mutlimorbide patients as an attempt of prevention or retardation of metastasis. A large number of experimental data for European and non-European herbal drugs as well as various herbal drug combinations suggest such a possibility. Despite the so far small number of clinical studies, such an experimental herbal treatment could appear to be reasonable and acceptable, provided that there are data available on quality and safety of these herbal drugs by treatments of patients with various diseases. Besides, herbal drugs and substances play a growing role the treatment of patients with multimorbidity. Many of these herbal drugs have antiinflammatory effects beside their proved symptomatic efficacy in a lot of other diseases. The specific selection of herbal drugs that are efficacious in specific indications and additionally showed antiinflammatory effects offers the possibility of simultaneous antiinflammatory and specific efficacy. St. Johns Wort and milk thistle belong to the oldest and to the best experimentally and clinically examined herbal remedies. The spectrum of internal and external uses of Hypercum perforatum as a multicompound herbal drug includes functional gastro-intestinal complaint and illness, skin disease, mucosal lesion, superficial injury, depressive upset and depression, somatoform disorders, restlessness, nervosity, convalescence, exhaustion and sleep disturbances respectively. The plurivalent character of the multicompound even enables a broad spectrum of activity. This might justify to prefer St. Johns Wort to other drugs in a wide range of treatments: In multimorbide patients with depression or in depressive patients with coronary heart disease the anti-inflammatory effects could mean an additional advantage. However, at present there is still a great need and demand for therapy-oriented clinical research.

Umsetzung integrativer Konzepte – eine Bestandsaufnahme

Die CAM-Beratung am Beispiel einer Patientin mit Brustkrebs Bei einer 39-jahrigen Patientin wurde aufgrund eines invasiven Mammakarzinoms eine Teilresektion der Mamma vorgenommen und anschliesend eine adjuvante Chemotherapie mit Fluoruracil, Epirubicin, Cyclophosphamid (FEC)/Paclitaxel eingeleitet. Die Patientin vertrug die Chemotherapie sehr schlecht und berichtete von anhaltender Ubelkeit, Appetitlosigkeit und starkem Gewichtsverlust von insgesamt 8 kg Korpergewicht sowie Schleimhautentzundungen, Depression und Fatigue. Sie erwog deshalb, die Therapie nach 2 Therapiezyklen abzubrechen, sofern sich die Vertraglichkeit nicht durch weitere, bisher nicht genutzte Masnahmen – namentlich eine Misteltherapie – deutlich verbessern liese. Wahrend ihr behandelnder Onkologe dezidiert von einer begleitenden Misteltherapie abgeraten hatte, war ihr von einem telefonischen Beratungsdienst empfohlen worden, die Chemotherapie abzubrechen und eine rein komplementarmedizinische Nachbehandlung vornehmen zu lassen. In dieser belastenden Situation suchte sie unsere Beratungsstelle auf und bat um sachliche Information und Unterstutzung. Die Frage nach dem Nutzen der Mistel insbesondere bei Brustkrebs ist durchaus berechtigt. Gemas Cochrane Review zur Misteltherapie, der auf einer Auswertung von 21 prospektiv-randomisierten Studien (davon 7 bei Mammakarzinom) beruht, gibt es Hinweise, dass die Misteltherapie sich uberwiegend gunstig auf bestimmte Aspekte der Lebensqualitat Integrative Onkologie im Kontext eines universitaren Cancer Centers Verantwortlicher Autor: Matthias Rostock, Hamburg

Preliminary Data of a HAMD-17 Validated Symptom Scale Derived from the ICD-10 to Diagnose Depression in Outpatients

Background: In outpatient settings diagnostic classification of depressive symptoms is mostly descriptive based on ICD-10. Depending on clinical experience and consultation time, diagnosis can be verified by validated scales. However, physicians working in primary care are familiar with ICD-10 criteria. Therefore, the aim of the present study was to examine the feasibility of the validation of an ICD-10-derived symptom scale for depression. Methods: For this preliminary trial we generated a symptom scale derived 1:1 from the diagnostic criteria for depression given in the ICD-10 with 10 items. The Hamilton Rating Scale for Depression (HAMD-17) was used as reference in a population of 226 outpatients suffering from depressive symptoms. Correlation between scales as well as sensitivity and specificity of the ICD-10 scale were calculated. Results: The generated ICD-10 symptom scale for depression could be analyzed in 219 patients and showed a significant and strong correlation with the HAMD-17 (p < 0.0001; ρ = 0.75). The best tradeoffs between specificity and sensitivity of the ICD-10 score were found at 10 points for the lower and 14 points for the upper cut-off. Overall sensitivity and specificity was 76.7 and 88.6%. Almost two thirds (i.e. 65.3%) of the patients were correctly classified by the ICD-10 scale. Conclusion: The ICD-10 symptom scale examined in the current population was found to have fair correlation with the HAMD-17 as well as, in face of the limited variance of the patients’ condition, acceptable sensitivity and specificity. Therefore, this preliminary study showed that the ICD-10-derived symptom scale seems appropriate to be investigated in a thorough validation trial.

Antiinflammatorisch wirksame Phytotherapeutika und ihr mögliches Potential bei tumorkranken Menschen

Die Wirkstoffe pflanzlicher Arznei- und Heilmittel sind pleiotrope Vielstoffgemische mit Multi-Target Eigenschaften einschlieβlich antiinflammatorischer Wirkungen. Eine pleiotrope Entzündungshemmung könnte bei tumorkranken Menschen als Versuch der Verhinderung bzw. Verzögerung der Metastasierung eine bedeutsame Rolle spielen. Zahlreiche experimentelle Daten für europäische wie auch auβereuropäische Pflanzen und verschiedene phytotherapeutische Kombinationen weisen auf eine solche Möglichkeit hin. Trotz der bislang nur geringen Anzahl klinischer Untersuchungen könnten derartige phytotherapeutische Behandlungsversuche vertretbar erscheinen, wenn für solche Arznei- und Heilpflanzen aus Anwendungsbereichen bei nicht tumorkranken Menschen gesicherte Daten über Qualität und Sicherheit dokumentiert sind und eine Übertragung solcher Daten auf die Situation tumorkranker Menschen unter kritischer Abwägung möglich erscheint. Phytotherapeutika spielen zudem in der Supportivtherapie eine zunehmende Rolle, wobei zahlreiche dieser Phytotherapeutika neben ihrer symptomatischen supportiven Wirksamkeit auch antiinflammatorische Wirkungen zeigen. Die gezielte Auswahl von supportiv wirksamen Phytotherapeutika mit zusätzlichen antiinflammatorischen Effekten könnte für tumorkranke Menschen neben der Symptomlinderung simultan die Möglichkeit einer antiinflammatorischen antitumoralen Wirksamkeit bieten als eine Art personalisierter Phytotherapie. Zurzeit besteht diesbezüglich noch ein groβer Bedarf an therapeutisch orientierter klinischer Forschung.

Gastrointestinale Symptome bei tumorkranken Menschen - phytotherapeutische Behandlungsmöglichkeiten

Eine Reihe von pflanzlichen Arzneimitteln lassen sich bei den verschiedenen gastrointestinalen Beschwerden und Symptomen von tumorkranken Menschen (Halitosis, Übelkeit, Erbrechen, dyspeptische Beschwerden, Reizdarmsymptome, Obstipation, Diarrhoe) sinnvoll einsetzen als palliative und supportive Behandlung. Die Basis fÜr die Anwendung bilden einerseits therapeutische Empirie und andererseits wissenschaftlich erhobene Daten und klinische Studien, wobei derzeit nur ein kleinerer Teil mit Tumorpatienten durchgefÜhrt wurde. Unter diesen Gesichtspunkten stehen vielfÄltige Arzneidrogen, phytotherapeutische Zubereitungen und Kombinationen zur VerfÜgung: Ätherische Öle (z.B. Pfefferminze, Salbei, australischer Teebaum), Bitterstoff-Drogen (z.B. Wermut, Enzian, Artischocke, Iberis), Teezubereitungen und Tinkturen (z.B. Kamille, Brombeere, Frauenmantel, GÄnsefinger, Tormentill, Uzara, Szygium, Heidelbeere, Schwarztee), Laxanzien (z.B. Rhabarber, Faulbaum, Senna, Aloe, Leinsamen, Flohsamen) und Fertigarzneimittel wie z.B. Padmed Laxan und Iberogast. Die vorhandenen Erfahrungen und die bisherigen klinischen Studien lassen die mÖglichen Vorteile, die geringe HÄufigkeit unerwÜnschter Wirkungen, aber auch die EinschrÄnkungen der phytotherapeutischen Therapien deutlich hervortreten. Insgesamt scheint es, dass das Potential der symptomorientierten Therapie mit pflanzlichen Arzneimitteln in der Behandlung gastrointestinaler Beschwerden bei Patienten mit Tumorerkrankungen unterschÄtzt wird.

Schleimhautschäden unter antitumoraler Behandlung: Präventive und therapeutische Möglichkeiten mit pflanzlichen Zubereitungen

Tumorpatienten unter Strahlen- und/oder Chemotherapie sind hÄufig von SchleimhautschÄden, insbesondere im Mund- und Rachenraum, als sehr belastender Dosis- bzw. Therapielimitierender Nebenwirkung betroffen. In PrÄvention und Therapie derartiger Mucositiden werden vielfÄltige und unterschiedlich aufwÄndige BehandlungsansÄtze verwendet, ohne dass offensichtlich ein allgemein anerkannter oder gar befriedigender Standard existiert. Bei Mucositiden im onkologischen Bereich spielt die Anwendung pflanzlicher Zubereitungen eine grosse Rolle, sei es als prophylaktische oder begleitende Massnahme. In der vorliegenden Arbeit wird eine Auswahl der derzeitigen phytotherapeutischen Empfehlungen dargestellt. Diese Empfehlungen beruhen zu einem grossen Teil auf Erfahrungen aus der therapeutischen Praxis. Der Einsatz pflanzlicher Therapeutika sollte sich an der vorherrschenden Mukositis-Symptomatik, aber auch an den PrÄferenzen der Patienten orientieren. Bei lokaler Anwendung sind keine unerwÜnschten Interaktionen mit den Tumortherapien zu erwarten. Zweifelsohne besteht fÜr die phytotherapeutischen BehandlungsansÄtze Forschungs- und Evaluationsbedarf.