Background: The aim of this study was to investigate the effects of mind-body therapy on neuroendocrine and cellular immune measures, health-related quality of life and disease activity in patients with ulcerative colitis (UC) in remission. Methods: Thirty UC patients in remission or with low disease activity were randomly assigned to an intervention group (n = 15) or a usual-care waiting control group (n = 15). Intervention consisted of a structured 60-hour training program over 10 weeks which included stress management training, moderate exercise, Mediterranean diet, behavioral techniques and self-care strategies. Quality of life, perceived stress and disease activity were assessed with standardized questionnaires (IBDQ, SF-36, PSS, CAI). In addition, the distribution of circulating lymphocytes and lymphocyte subsets as well as the β-adrenergic modulation of TNF-α production in vitro were analyzed. Urine catecholamines and plasma cortisol, prolactin and growth hormone were measured pre- and postinterventionally, and were compared with a healthy control group (n = 10). Results: In response to therapy, patients in the intervention group showed significantly greater improvement in the SF-36 scale Mental Health and the Psychological Health Sum score compared with changes observed in the usual-care waiting control group. Patients in the intervention group showed significantly greater improvement on the IBDQ scale Bowel Symptoms compared with the control group. However, no significant group differences in circulating lymphocyte subsets or endocrine parameters were observed in response to therapy. In addition, no significant effects of intervention on either the basal levels of TNF-α or the suppressive action of the β-adrenergic agonist isoproterenol on TNF-α production were observed. Conclusion: Mind-body therapy may improve quality of life in patients with UC in remission, while no effects of therapy on clinical or physiological parameters were found, which may at least in part be related to selective patient recruitment.

Pharmacotherapy in oncology is complex. It has a small therapeutic range, and is susceptible to errors. Medication errors – especially overdosage – often have serious effects while underdosage entails unnoticed impairment of the therapeutic success. Typical medications and procedures susceptible to errors are described: unintentional intrathecal injections, the application of platinum compounds and anthracyclines, confusion of total and single dose, errors of calculation and preparation, or in operation of infusion pumps. Suitable prevention strategies are standardisation, separation of intrathecal and intravenous chemotherapy, and use of specialized software for planning and calculating chemotherapy, as well as non-punitive notification and recording systems for errors and near-errors in treatment.

In recent years complementary and alternative medicine (CAM) has increasingly been the focus of international research. Numerous subsidised trials (7903) and systematic reviews (651) have been published, and the evidence is starting to be integrated into treatment guidelines. However, due to insufficient evidence and/or insufficient good quality evidence, this has mostly not translated to practice recommendations in reviews by the Cochrane collaboration gynaecology group. There is nevertheless a not insignificant number of CAM providers and users. The percentage of oncology patients who use CAM varies between 5 and 90?%. Doctors have been identified as the main providers of CAM. Half of gynaecologists offer CAM because of personal conviction or on suggestion from colleagues. This must be viewed in a critical light, since CAM is mostly practiced without appropriate training, often without sufficient evidence for a given method ? and where evidence exists, practice guidelines are lacking ? and lack of safety or efficacy testing. The combination of patient demand and lucrativeness for doctors/alternative medicine practitioners, both based on supposed effectiveness CAM, often leads to its indiscriminate use with uncertain outcomes and significant cost for patients. On the other hand there is published, positive level I evidence for a number of CAM treatment forms. The aim of this article is therefore to review the available evidence for CAM in gynaecological oncology practice. The continued need for research is highlighted, as is the need to integrate practices supported by good evidence into conventional gynaecological oncology.

Zusammenfassung Das Thema Komplementärmedizin ist im gynäkologisch-onkologischen Praxisalltag relevant. Patientinnen mit Brustkrebs und gynäkologischen Tumoren haben ein hohes Interesse an komplementären Therapien und wenden sich damit an ihr Behandlungsteam. Dem Wunsch kann man mit unterschiedlichen Angeboten nachkommen. Man kann Patientinnen Informationen zu dem Thema geben, mit Patientinnen komplementäre Therapien auswählen oder auch Patientinnen mit komplementären Therapien behandeln. Die internationale Society for Integrative Oncology (SIO) hat Kompetenzen für Fachpersonal im Bereich der Integrativen Onkologie definiert, dazu gehören spezifische Kompetenzen aus den Kategorien Wissen, Fertigkeiten und Fähigkeiten. Die Ergebnisse aus einer Studie im Rahmen des Kompetenznetzwerks Komplementärmedizin in der Onkologie (KOKON) zeigen, dass nach einem entsprechenden Training (KOKON-KTO) in einem systematisch geführten Gespräch Empfehlungen zum Thema Komplementärmedizin in nur 20 min erfolgen können. Im Beitrag werden Beispiele von seriösen Informationsquellen dargestellt, die Elemente eines KOKON-KTO Gesprächsablaufs dargelegt und Fortbildungsmöglichkeiten erläutert.

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