Background: Healing Touch (HT) and Oncology Massage (OM) are nonpharmacologic pain interventions, yet a comparative effectiveness study has not been conducted for pain in breast cancer. Purpose: This breast cancer subgroup analysis compared the effectiveness of HT vs. OM on pain. Setting: The research occurred at an outpatient setting at an academic hybrid, multi-site, community-based cancer institute and Department of Supportive Oncology across four regional locations. Participants: Breast cancer outpatients along the cancer continuum who experienced routine clinical, nonexperimentally manipulated HT or OM. Research Design: The study was an observational, retrospective, comparative effectiveness post hoc subanalysis of a larger dataset. Patients reporting pain < 2 were excluded. Pre- and posttherapy pain scores and differences were calculated. Logistic regression modeled posttherapy pain by modality, adjusting for pretherapy pain. The proportions experiencing ? 2-point (clinically significant) pain reduction were compared with chi-square tests. Intervention: The study focused on the first session of either HT or OM. Main Outcome Measures: Pre- and posttherapy pain (range: 0 = no pain to 10 = worst possible pain). Results: A total of 407 patients reported pre- and posttherapy pain scores, comprised of 233 (57.3%) who received HT and 174 (42.8%) who received OM. Pretherapy mean pain was higher in HT (M=5.1, ± 2.3) than OM (M=4.3, ± 2.1) (p < .001); posttherapy mean pain remained higher in HT (M=2.7, ± 2.2) than OM (M=1.9, ± 1.7) (p < .001). Mean difference in pain reduction was 2.4 for both HT and OM. Both HT (p < .001) and OM (p < .001) were associated
C ancer patients and survivors often experience high symptom burden well addressed by integrative oncology (IO) and palliative medicine (PM). IO is ''evidence-based cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications alongside conventional cancer treatments to optimize health, quality of life, and clinical outcomes.'' 1 IO is distinct from alternative medicine that is used instead of conventional treatments. 2 PM ''improves quality of life for patients and families during lifethreatening illness through prevention and relief of pain and other physical, psychosocial, and spiritual problems.'' 3 These definitions reveal common philosophies among both fields, which emphasize interdisciplinary person-centered care to enhance quality of life and reduce suffering. 4 Cancer and its treatments are often associated with fatigue, pain, neuropathy, nausea and vomiting, appetite changes, sleep disorders, hot flashes, shortness of breath, sexual and fertility issues, anxiety, and depression among other symptoms.
Objective Nurses are increasingly becoming involved in integrative oncology (IO) programs. This study examined the additive effect of nurse-provided guidance for self-administered IO therapies on cancer-related fatigue and quality of life (QoL). Methods The study was randomized and controlled, enrolling patients undergoing active oncology treatment with IO interventions for fatigue and other QoL-related outcomes. IO practitioner guidance on self-treatment with manual, relaxation, and/or traditional herbal therapies was provided to patients in both the intervention and control arms. However, patients in the intervention arms also received additional guidance on self-treatment by IO-trained palliative care nurses. All participants were assessed for fatigue and QoL at baseline and at 24-h follow-up, using the Edmonton Symptom Assessment Scale (ESAS) and the Measure Yourself Concerns and Wellbeing (MYCAW) questionnaire tools. Results Of 353 patients recruited, 187 were randomized to the intervention and 166 to the control group. Both groups had similar demographic and oncology-related characteristics. Patients in the intervention arm reported significantly greater improvement in ESAS scores for fatigue ( p = 0.026) and appetite ( p = 0.003) when compared to controls. Conclusion The addition of nurse-provided guidance on self-administration of IO treatments to that provided by IO practitioners further reduced short-term scores for fatigue and improved appetite. The relationship between palliative and IO-supportive cancer care requires further study.
e12504 Background: Breast cancer in young women portends a poorer prognosis and often results in more aggressive treatments, placing patients at a higher risk of adverse treatment effects. Small studies suggest that the use of integrative oncology (IO) as a complementary therapy during standard of care cancer treatment may help reduce adverse treatment effects, improve treatment compliance, and enhance patient well-being. However, the timing of therapies and usage patterns relative to standard treatment are unknown. We sought to offer young women with breast cancer a referral to IO physicians, describe timing of consultation, and identify recommended IO therapies. Methods: Retrospective review of women < 40 years with breast cancer from 2014-2019 in a young women’s breast cancer program at a large, single-institution, tertiary care center. Patients were referred to a fellowship-trained physician in the Department of IO who recommended various integrative therapies as adjunctive treatment to standard of care based on patient-reported concerns. Patient demographics, tumor characteristics, operative procedures, adjunctive medical treatments, reasons for seeking IO consultation, timing of consultation, and IO therapies were analyzed using descriptive statistics. Results: 64 young women (median age 39 years) received an IO consultation: 48 (75%) after starting standard care treatment, 16 (25%) before. Clinical stages Ia, IIa, or IIb, node negative, without metastatic disease were common. Hormone-positive, poorly differentiated, invasive ductal carcinoma was the most observed histology. 42 (65%) patients underwent mastectomy; 18 (29%) underwent breast conservation surgery. 91% of patients received chemotherapy as part of standard care; 70% of patients received chemotherapy prior to their IO consultation. Primary reasons women sought an integrative oncology consultation were cancer risk reduction (63%) and adverse treatment effects (54%). For the latter, patients reported vasomotor concerns (43%), insomnia (34%), weight gain/loss (29%), nutrition (25%), and gastrointestinal problems including chemotherapy-induced nausea/vomiting (20%). Recommended IO therapies were as follows: acupuncture (34%), massage (29%), and healing touch (28%). Conclusions: Breast cancer in young women tends to be more advanced and more aggressive; these patients are at a higher risk of adverse treatment effects. Our study suggests that young women who receive a consultation by an IO physician express concerns for adverse treatment effects and desire to decrease their future cancer risk. Although the extent to which IO therapies may effect a clinically relevant change in adverse effects or future cancer risk remains unknown, this study serves as preliminary data for more rigorous studies examining the optimal timing of IO therapies as well as specific therapies that may be associated with improved outcomes.
12096 Background: Cannabidiol (CBD) is a non-psychoactive component of cannabis touted for various therapeutic effects. The Federal Drug Agency has only approved one prescription CBD product for treatment of severe epilepsy. On December 17, 2020 the Federal Trade Commission announced legal consequences for deceptively marketed CBD products in the rapidly expanding market of various CBD products; the products’ unsupported claims included CBD as a cancer treatment. Little is known about survivors use of CBD. This study explores the prevalence and nature of CBD use by cancer survivors. Methods: A link to an anonymous, electronic survey was posted on the Levine Cancer Institute and SherryStrong (Martin Truex Jr. Foundation: philanthropy for ovarian cancer) Twitter and Facebook social media platforms. Data were managed in REDCap, a secure, web-based, electronic data capture tool. Survey responses were summarized and described with frequencies and compared using Fisher’s Exact tests; p < 0.1 was considered statistically significant. Results: N = 295 self-selected respondents were White (95%), female (86%), middle aged (45-64 years) (58%) and in the US (95%). Ninety percent indicated current (85%) or past (15%) use of CBD product; a third of these participants (N = 102) identified as cancer survivors. Gynecologic (31%) and breast (30%) cancers were the most recorded malignancies, and 38% report active treatment. Most survivors indicated using CBD products daily (77%) for a year or less (79%) and spent @$30 a week on products (70%). Common uses for CBD were easing pain (66%), anxiety (50%), and sleep (50%)—14% reported treating or preventing cancer. 41% learned about CBD from family/friends, fewer learned from the Internet (21%) or local store (11%). Only 12% received information from a physician. Liquid drops (58%) and topicals (19%) were popular products and reported side effects were sparse—sedation and/or euphoria were indicated by 10% and 2%, respectively. Over 82% of cancer survivors indicated that CBD product helped their conditions. CBD use to ease anxiety and stress declined with age; 71% of young survivors (aged 18-44) sought anxiety relief versus 45% and 36% of middle age (aged 45-64) and seniors (aged 65+), respectively (p = 0.05), and 58% of young survivors pursued stress relief versus 39% of middle age and 21% of seniors (p = 0.08). More young (25%) and middle age (37%) survivors indicated spending over $30 on products weekly than seniors (7%) (p = 0.08). No differences were seen in CBD use between cancer survivors by gender or treatment status. Conclusions: Cancer survivors commonly use CBD, yet infrequently under the guidance of a physician. Survivors largely rely on word of mouth and internet information about CBD. Despite lack of standardization of production and labeling of CBD products, the majority of patients reported positive improvements in symptoms. Future research should explore strategies to educate cancer patients and providers in safe CBD use.
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