Complementary medicine (CM) is used by one third to one half of cancer patients throughout the world. The objective of this study was to describe the prevalence of CM use and the potential for interactions with cancer treatments in an academic oncology centre. A cross-sectional study was conducted among patients undergoing current cancer treatment. Among 132 included patients, 56% had used CM since their cancer diagnosis and 45% were using CM during cancer treatment at the time of the survey. The main CM used were green tea (35%), herbal tea (35%), homeopathy (27%), dietary supplements (27%), and herbal medicines (27%). A small majority of patients (58%) spontaneously mentioned the use of CM to their oncologist. Of 42 identified combinations of concomitant use of biologically based CM and anticancer agents among the study patients, the potential for pharmacokinetic interactions of clinical relevance was not expected in 17 combinations (40%), hypothetical and deemed unlikely in 23 (55%), and of probable low clinical relevance in 2 (5%). Considering the high prevalence of CM use, active enquiries should be made by healthcare professionals to detect symptoms that may relate to CM tolerance and effects or that suggest interactions between CM and cancer treatments.

Medically unexplained symptoms (MUS) are common among adolescents and an important cause of clinical visits. This study sought to understand the experiences with, and perceptions of, the healthcare of adolescents who have MUS and their parents. Using a qualitative approach, six focus groups and two individual interviews were conducted with a total of ten adolescents and sixteen parents. The participants were recruited in a university hospital in Switzerland. A thematic analysis was conducted in accordance with the Grounded Theory. Six main themes emerged: needing a label for the symptoms, seeking an etiology to explain the symptoms, negotiating the medical system, medication and treatments, interactions with doctors, and the inclusion of parents during consultations. Transcending these themes, however, was the need for good communication between the adolescents, their parents and the clinicians. When explaining the symptoms, clinicians should make sure to discuss the results, investigations and lack of organic origin.

BackgroundComplementary medicine (CM) is utilized in a growing number of academic centers despite the debate concerning its value, risks and benefits. Healthcare professionals often feel uncomfortable discussing CM with patients, and little is known about their sources of knowledge in the field of CM.ObjectiveTo assess healthcare professionals’ sources of knowledge and attitude toward CM in an academic hospital.Design and participantsThe cross-sectional web-based survey took place from October to December 2013. A total of 4,925 healthcare professionals working at Lausanne University Hospital, Switzerland, were invited to answer the questionnaire.Main measuresFactors influencing healthcare professionals’ opinion toward CM, knowledge and communication about CM.Key resultsThe questionnaire was answered by 1,247 healthcare professionals. The three key factors influencing professionals’ opinion toward CM were personal experience, clinical experience and evidence demonstrating the physiological mechanism of CM. Personal experience was more associated with nurses’ and midwives’ opinion compared to physicians’ (80.8% vs 57.1%, OR = 3.08, [95% CI: 2.35–4.05], P<0.001 and 85.3% vs 57.1%, OR = 3.83, [95% CI: 1.95–7.53], P<0.001, respectively) as well as with professionals trained in CM compared to non-trained professionals (86.0% vs 73.2%, OR = 2.60, [95% CI: 1.92–3.53], P<0.001). Physicians relied more on randomized controlled clinical trials compared to nurses (81.3% vs 62.9%, OR = 0.43, [95% CI: 0.33–0.57], P<0.001). A majority of the respondents (82.5%) agreed that they lacked knowledge about CM and 65.0% noted that it was the patient who initially started the discussion about CM.ConclusionsDifferent professionals used different strategies to forge opinions regarding CM: physicians relied more on scientific evidence, while nurses and midwives were more influenced by personal experience. Regardless of preferred information source, most respondents did not feel prepared to address patient questions regarding CM. Enhancing interprofessional education opportunities is an important strategy to help providers become empowered to discuss CM with patients. This in turn will help patients making informed decisions in their healthcare.

Background The prevalence of complementary and alternative medicine (CAM) use and the modalities used by pediatric oncology patients vary widely across studies. In addition, the changes in the use of CAM over the course of treatment are understudied. Thus, this study aimed to explore (1) CAM use by pediatric oncology patients in relation to specific time intervals and (2) communication about CAM use between parents and oncologists. Methods This retrospective cross-sectional study was conducted among parents of children diagnosed with cancer at a Swiss pediatric hematology-oncology center by means of an online questionnaire. Questions were related to their child’s CAM use over different time intervals, sources of information about CAM use, and communication with the oncologists. Results Among 140 respondents, CAM was used by 54.3% of patients before diagnosis and 69.3% of patients after diagnosis. During each defined time interval, between 50 and 58.8% of the patients used at least one CAM. Homeopathy was the most popular CAM modality used during oncology treatment, during the first year after treatment, and between 1 and 5 years after the end of treatment. Osteopathy was the most popular CAM ≥5 years after the end of oncology treatment. Forty percent of respondents did not discuss CAM with their oncologist. Conclusions The high prevalence of CAM use and the different trends of use during the oncology care pathway and afterward underline the need to increase communication about CAM in the pediatric oncology setting, notably regarding benefits and risks of interaction with oncology treatment.

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BackgroundChronic pain patients often use complementary medicine (CM) to alleviate their pain; however, little is known about the use of CM by chronic low back pain (cLBP) patients. We investigated the frequency of use of CM by cLBP patients, the perceived effects of these therapies, patients’ knowledge regarding CM, and patient-physician communication regarding CM.MethodA cross-sectional survey was conducted from November 2014 to February 2015. A questionnaire was distributed by physicians to 238 consecutive patients consulting for cLBP at the Pain Center of Lausanne University Hospital, Switzerland. Poisson regression model was used to analyze patients’ level of knowledge regarding various CMs, and the logistic regression model was used to assess CM use for cLBP.ResultsThe questionnaire was returned by 168 cLBP patients (response rate: 70.6%). Lifetime prevalence of CM use for cLBP was 77.3%. The most commonly used therapies were osteopathy (48.8%), massage (45.2%) and acupuncture (31.6%), rated for their usefulness on a 0–10 scale as a mean ± SD of 5.4 ± 2.7, 5.9 ± 2.5 and 3.8 ± 3.2, respectively. The CM treatment best known by patients was osteopathy, followed by massage and acupuncture. If their doctors proposed CM as a treatment for cLBP, 78% of participants reported being very or somewhat likely to try CM. Respondents with CM health insurance were more likely to use CM (OR = 2.26; 95%CI: 1.07–4.78; p = 0.031) for cLBP. Respondents having experienced cLBP for more than five years were more likely to use CM to treat their cLBP than respondents having experienced cLBP for one year or less (OR = 2.84; 95%CI: 1.02–7.88; p = 0.044).ConclusionsMore than three-quarters of cLBP patients in our sample did use CM to treat their cLBP. The results showed that the most commonly used therapies were not necessarily the highest rated in terms of perceived usefulness. These results highlight the importance of developing integrative pain centers in which patients may obtain advice regarding CM treatments.Electronic supplementary materialThe online version of this article (doi:10.1186/s12906-017-1708-1) contains supplementary material, which is available to authorized users.

Medically unexplained symptoms (MUS) are common among adolescents and are frequently encountered in primary care. Our aim was to explore how these adolescents and their parents experience the condition and its impact on their daily lives and to provide recommendations for health professionals. Using a qualitative approach, six focus groups and two individual interviews were conducted. These involved a total of ten adolescents with different types of MUS and sixteen parents. The respondents were recruited in a university hospital in Switzerland. A thematic analysis was conducted according to the Grounded Theory. The analysis of the data highlighted four core themes: disbelief, being different, concealing symptoms, and priority to adolescent's health. Transcending these themes was a core issue regarding the discrepancy between the strategies that adolescents and their parents use to cope with the symptoms. Health professionals should be made aware of the emotional needs of these patients and their families.

Side effects are frequent in pharmacological pain management, potentially preceding analgesia and limiting drug tolerability. Discussing side effects is part of informed consent, yet can favor nocebo effects. This study aimed to test whether a positive suggestion regarding side effects, which could act as reminders of the medication having been absorbed, might favor analgesia in a clinical interaction model. Sixty-six healthy males participated in a study “to validate pupillometry as an objective measure of analgesia”. Participants were unknowingly randomized double-blind to positive vs control information about side effects embedded in a video regarding the study drugs. Sequences of moderately painful heat stimuli applied before and after treatment with diclofenac and atropine served to evaluate analgesia. Atropine was deceptively presented as a co-analgesic, but used to induce side effects. Adverse events (AE) were collected with the General Assessment of Side Effects (GASE) questionnaire prior to the second induced pain sequence. Debriefing fully informed participants regarding the purpose of the study and showed them the two videos.The combination of medication led to significant analgesia, without a between-group difference. Positive information about side effects increased the attribution of AE to the treatment compared to the control information. The total GASE score was correlated with analgesia, i.e., the more AEs reported, the stronger the analgesia. Interestingly, there was a significant between-groups difference on this correlation: the GASE score and analgesia correlated only in the positive information group. This provides evidence for a selective link between AEs and pain relief in the group who received the suggestion that AEs could be taken as a sign “that help was on the way”. During debriefing, 65% of participants said they would prefer to receive the positive message in a clinical context. Although the present results cannot be translated immediately to clinical pain conditions, they do indicate the importance of testing this type of modulation in a clinical context.