Including the Patient Voice in Patient-Centered Outcomes Research in Integrative Oncology

MacLeod, Jodi; Wolff, Edward N.; McAllister, A.; Mao, Jun J.; Garland, Sheila N.

doi:10.1093/jncimonographs/lgx008

Cited by 7 publications

(7 citation statements)

References 6 publications

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“…How to integrate acupuncture into pain and symptom management plans for patients with cancer remains a challenge. With the move to patient-centered care and personalized medicine in cancer therapy, oncological practice and palliative care services need to provide information about treatment options and ways to access them, which can include evidence-based nonpharmacological approaches . Given that pain is a common reason that patients with cancer visit emergency departments, often followed by hospital admission, hospitals need to establish appropriate acupuncture services.…”

Section: Discussionmentioning

confidence: 99%

Clinical Evidence for Association of Acupuncture and Acupressure With Improved Cancer Pain

et al. 2020

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IMPORTANCE Research into acupuncture and acupressure and their application for cancer pain has been growing, but the findings have been inconsistent. OBJECTIVE To evaluate the existing randomized clinical trials (RCTs) for evidence of the association of acupuncture and acupressure with reduction in cancer pain.DATA SOURCES Three English-language databases (PubMed, Embase, and CINAHL) and 4 Chinese-language biomedical databases (Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, and Wanfang) were searched for RCTs published from database inception through March 31, 2019.STUDY SELECTION Randomized clinical trials that compared acupuncture and acupressure with a sham control, analgesic therapy, or usual care for managing cancer pain were included.DATA EXTRACTION AND SYNTHESIS Data were screened and extracted independently using predesigned forms. The quality of RCTs was appraised with the Cochrane Collaboration risk of bias tool. Random-effects modeling was used to calculate the effect sizes of included RCTs. The quality of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation approach.MAIN OUTCOMES AND MEASURES The primary outcome was pain intensity measured by the Brief Pain Inventory, Numerical Rating Scale, Visual Analog Scale, or Verbal Rating Scale. RESULTS A total of 17 RCTs (with 1111 patients) were included in the systematic review, and data from 14 RCTs (with 920 patients) were used in the meta-analysis. Seven sham-controlled RCTs (35%) were notable for their high quality, being judged to have a low risk of bias for all of their domains, and showed that real (compared with sham) acupuncture was associated with reduced pain intensity (mean difference [MD], −1.38 points; 95% CI, −2.13 to −0.64 points; I 2 = 81%). A favorable association was also seen when acupuncture and acupressure were combined with analgesic therapy in 6 RCTs for reducing pain intensity (MD, −1.44 points; 95% CI, −1.98 to −0.89; I 2 = 92%) and in 2 RCTs for reducing opioid dose (MD, −30.00 mg morphine equivalent daily dose; 95% CI, −37.5 mg to −22.5 mg). The evidence grade was moderate because of the substantial heterogeneity among studies. CONCLUSIONS AND RELEVANCEThis systematic review and meta-analysis found that acupuncture and/or acupressure was significantly associated with reduced cancer pain and decreased use of analgesics, although the evidence level was moderate. This finding suggests that more rigorous trials are needed to identify the association of acupuncture and acupressure with specific types of cancer pain and to integrate such evidence into clinical care to reduce opioid use. Research Original InvestigationAssociation of Acupuncture and Acupressure With Improved Cancer Pain 37. Tao WW, Jiang H, Tao XM, Jiang P, Sha LY, Sun XC. Effects of acupuncture, tuina, tai chi, qigong, and traditional Chinese medicine five-element music therapy on symptom management and quality of life for cancer patients: a meta...

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Section: Discussionmentioning

confidence: 99%

Clinical Evidence for Association of Acupuncture and Acupressure With Improved Cancer Pain

et al. 2020

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“…In addition, appropriate retrospective and prospective cohort studies incorporating validated patient‐reported outcomes and relevant clinical outcomes can inform how these treatments impact populations in real‐world settings and potentially generate more specific testable hypotheses that can then be confirmed in clinical trials 216 . Consistent with patient‐centered outcomes research, engaging patients and relevant clinical and policy stakeholders in defining research questions and facilitating dissemination efforts are key to generating evidence that actually matters to patients in their specific cultural and societal settings 217,218 …”

Section: Challenges and Opportunities In Researchmentioning

confidence: 99%

Integrative oncology: Addressing the global challenges of cancer prevention and treatment

Mao

Pillai

Andrade

et al. 2021

CA A Cancer J Clinicians

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202

103

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The increase in cancer incidence and mortality is challenging current cancer care delivery globally, disproportionally affecting low‐ and middle‐income countries (LMICs) when it comes to receiving evidence‐based cancer prevention, treatment, and palliative and survivorship care. Patients in LMICs often rely on traditional, complementary, and integrative medicine (TCIM) that is more familiar, less costly, and widely available. However, spheres of influence and tensions between conventional medicine and TCIM can further disrupt efforts in evidence‐based cancer care. Integrative oncology provides a framework to research and integrate safe, effective TCIM alongside conventional cancer treatment and can help bridge health care gaps in delivering evidence‐informed, patient‐centered care. This growing field uses lifestyle modifications, mind and body therapies (eg, acupuncture, massage, meditation, and yoga), and natural products to improve symptom management and quality of life among patients with cancer. On the basis of this review of the global challenges of cancer control and the current status of integrative oncology, the authors recommend: 1) educating and integrating TCIM providers into the cancer control workforce to promote risk reduction and culturally salient healthy life styles; 2) developing and testing TCIM interventions to address cancer symptoms or treatment‐related adverse effects (eg, pain, insomnia, fatigue); and 3) disseminating and implementing evidence‐based TCIM interventions as part of comprehensive palliative and survivorship care so patients from all cultures can live with or beyond cancer with respect, dignity, and vitality. With conventional medicine and TCIM united under a cohesive framework, integrative oncology may provide citizens of the world with access to safe, effective, evidence‐informed, and culturally sensitive cancer care.

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“…This dualcenter, parallel group, randomized, comparative effectiveness trial was conducted at the University of Pennsylvania's Abramson Cancer Center in Philadelphia, PA, and at the Memorial Sloan Kettering Cancer Center in New York, NY (ClinicalTrials.gov Identifier: NCT02356575, https://clinicaltrials.gov/ct2/show/NCT02356575). Patient partners, not enrolled in the study, were involved in formulating the research question, selecting interventions and outcomes, recruitment (particularly minority outreach), and data interpretation (14). The pragmatic trial design sought to directly inform patient and clinician decision-making in the real world (15).…”

Section: Pragmatic Trial Designmentioning

confidence: 99%

Acupuncture Versus Cognitive Behavioral Therapy for Insomnia in Cancer Survivors: A Randomized Clinical Trial

Garland¹,

Xie²,

DuHamel³

et al. 2019

JNCI: Journal of the National Cancer Institute

112

155

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Background Insomnia is a common and debilitating disorder experienced by cancer survivors. Although cancer survivors express a preference for using nonpharmacological treatment to manage insomnia, the comparative effectiveness between acupuncture and Cognitive Behavioral Therapy for Insomnia (CBT-I) for this disorder is unknown. Methods This randomized trial compared 8 weeks of acupuncture (n = 80) and CBT-I (n = 80) in cancer survivors. Acupuncture involved stimulating specific points on the body with needles. CBT-I included sleep restriction, stimulus control, cognitive restructuring, relaxation training, and education. We measured insomnia severity (primary outcome), pain, fatigue, mood, and quality of life posttreatment (8 weeks) with follow-up until 20 weeks. We used linear mixed-effects models for analyses. All statistical tests were two-sided. Results The mean age was 61.5 years and 56.9% were women. CBT-I was more effective than acupuncture posttreatment (P < .001); however, both acupuncture and CBT-I produced clinically meaningful reductions in insomnia severity (acupuncture: −8.31 points, 95% confidence interval = −9.36 to −7.26; CBT-I: −10.91 points, 95% confidence interval = −11.97 to −9.85) and maintained improvements up to 20 weeks. Acupuncture was more effective for pain at the end of treatment; both groups had similar improvements in fatigue, mood, and quality of life and reduced prescription hypnotic medication use. CBT-I was more effective for those who were male (P < .001), white (P = .003), highly educated (P < .001), and had no pain at baseline (P < .001). Conclusions Although both treatments produced meaningful and durable improvements, CBT-I was more effective and should be the first line of therapy. The relative differences in the comparative effectiveness between the two interventions for specific groups should be confirmed in future adequately powered trials to guide more tailored interventions for insomnia.

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Including the Patient Voice in Patient-Centered Outcomes Research in Integrative Oncology

Cited by 7 publications

References 6 publications

Clinical Evidence for Association of Acupuncture and Acupressure With Improved Cancer Pain

Clinical Evidence for Association of Acupuncture and Acupressure With Improved Cancer Pain

Integrative oncology: Addressing the global challenges of cancer prevention and treatment

Acupuncture Versus Cognitive Behavioral Therapy for Insomnia in Cancer Survivors: A Randomized Clinical Trial

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