TIN+/-V still represents a very major concern for patients. Uncontrolled TIN+/-V often results in significant appetite and weight loss, leading to increased risk for malnutrition. Malnutrition and weight loss, in turn, are associated with poorer prognosis, treatment tolerance and response, performance status, QoL and survival. Consequently, a multiple symptom intervention approach focusing on N&V as core symptoms is recommended. Clinicians should genuinely consider combining essential antiemetic therapies with other evidence-based pharmacological (e.g. nausea: psychotropics, such as olanzapine) and non-pharmacological approaches (e.g. N&V: relaxation) in attempts to not only improve prevention and control of N&V for their patients, but also reduce the synergistic impact of cluster symptoms (e.g. N&V, appetite loss) as a whole and resultant QoL impairment likewise. Where associated symptoms are not adequately controlled by these antiemetic-based interventions, targeted evidence-based strategies should be supplemented.
Aim: Despite the paucity of controlled trials and possible interference with conventional treatments, complementary and alternative therapy (CAT) use is becoming increasingly popular and many patients do not discuss it with their physicians. Consequently, we examined the incidence and type of CAT use, perceived benefits of use, and the relationship between demographic, clinical or psychological factors and use in Western Australian patients. Methods: Two hundred newly diagnosed cancer patients beginning conventional multi-modal treatment participated. Health-related quality of life (HQOL), psychological adjustment and CAT use were assessed longitudinally at pretreatment, in treatment (at 8 weeks) and post-treatment. Results: Overall, 30% of patients reported CAT use in the course of treatment. CAT users were predominantly younger (P = 0.004), tertiary educated (P = 0.016), possessed comorbid conditions (P = 0.023), and underwent lengthy treatment (P = 0.004). Patients who underwent lengthy treatment (>6 months) were three times more likely to use CAT than those who did not. Overall, 64% of CAT users perceived benefit from their use, primarily citing enhanced physical and emotional well-being. CAT users, however, did not score significantly better than non-users on any measure of HQOL, physical health or psychological function. CAT users generally reported greater psychosocial distress than non-users across treatment, especially at pretreatment (baseline). However, with ongoing/new CAT use they significantly reduced their distress levels to that of non-users by 8 weeks in treatment (P = 0.042). Conclusion: Complementary and alternative therapies enhanced cancer patients' psychological well-being during the early stages of conventional treatment only. Use of CAT by cancer patients may be a clinical marker for psychosocial distress, and should trigger clinicians to inquire about physical symptoms, and concomitant anxiety and depression.
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