Palliative In-Patient Cancer Treatment in an Anthroposophic Hospital: I. Treatment Patterns and Compliance with Anthroposophic Medicine*

Abstract

Background: Complementary and alternative medicine (CAM) and most of all anthroposophic medicine (AM) are important features of cancer treatment in Switzerland. While the number of epidemiological investigations into the use of such therapies is increasing, there is a distinct lack of reports regarding the combination of conventional and CAM methods. Patients and Methods: 144 in-patients with advanced epithelial cancers were enrolled in a prospective quality-of-life (QoL) study at the Lukas Klinik (LK), Arlesheim, Switzerland. Tumor-related treatment was assessed 4 months prior to admission, during hospitalization and 4 months after baseline. Objective: We aimed at giving a detailed account of conventional, AM and CAM treatment patterns in palliative care, before, during and after hospitalization, with emphasis on compliance with AM after discharge. Results: Certain conventional treatments featured less during hospitalization than before but were resumed after discharge (chemotherapy, radiotherapy, sleeping pills, psychoactive drugs). Hormone therapy, corticosteroids, analgesics WHO III and antidepressants remained constant. AM treatment consisted of Iscador? (mistletoe), other plant- or mineral-derived medication, baths, massage, eurythmy, art therapy, counseling and lactovegetarian diet. Compliance after discharge was highest with Iscador (90%) and lowest with art therapy (14%). Many patients remained in the care of AM physicians. Other CAM and psychological methods were initially used by 39.9% of patients. After 4 months, the use had decreased with few exceptions. Conclusion: During holistic palliative treatment in an anthroposophic hospital, certain conventional treatments featured less whereas others remained constant. After discharge, chemotherapy returned to previous levels, AM compliance remained high, the use of other CAM therapies low.

Palliative In-Patient Cancer Treatment in an Anthroposophic Hospital: II. Quality of Life during and after Stationary Treatment, and Subjective Treatment Benefits*

“…In Switzerland and Central Europe, AM belongs to the most popular methods providing CAM cancer treatment. This relates not only to mistletoe preparations and their immunologic effects [19,20], but also to anthroposophic hospitals with their holistic spectrum of therapies [21,22]. The Lukas Klinik (LK) in Arlesheim, Switzerland, is a well known anthroposophic hospital specializing in oncology, that attracts patients from all areas of Switzerland and neighboring countries [22].…”

“…Concurrent with the basic concept of AM, the LK provides an integrative approach to AM and CCT [17,18]. In palliative cancer treatment, it puts a major emphasis on QoL improvement in global, physical, psychological and cognitivespiritual QoL domains [22,23]. Yet, so far, the effectiveness of its holistic therapeutic strategy has not been studied systematically.…”

“…Yet, so far, the effectiveness of its holistic therapeutic strategy has not been studied systematically. Therefore, the LK was included in a composite research project of the Swiss National Science Foundation Program NFP 34, which we reported about earlier [14,[22][23][24][25][26][27]. The aim was a first and thorough investigation of QoL development in patients with advanced cancer during and after holistic in-patient treatment at LK.…”

Probleme in der integrativmedizinischen Weiterbildung von Ärzten an anthroposophischen Kliniken Deutschlands und der Schweiz

“…Das ist angesichts der noch suboptimalen Evidenzlage für die Wirksamkeit der AM wenig erstaunlich [25]. Das Problem, dass anthroposophische Medizin Zeit brauche oder die Liegezeiten der Patienten für die Anwendung anthroposophischer Heilmittel zu kurz seien mag in den Hauptindikationen der AM begründet sein: diese lagen bisher im Bereich der chronischen Krankheiten [25]; die Aufenthalte der Patienten im stationären Bereich der anthroposophischen Klinken dienen hingegen auch bei chronischen Krankheiten meist akuten Interventionen [26]. …”

Lösungsvorschläge für Probleme in der integrativmedizinischen Weiterbildung von Ärzten an anthroposophischen Kliniken Deutschlands und der Schweiz

“…Deswegen kommt der ärztlichen Weiterbildung eine wesentliche Rolle für die Ausbildung in IM zu, denn dort kann die IM-Patientenversorgung konkret unter Supervision geübt und durch regelmäßige Fortbildungen über Konzepte, Wirksamkeit und Risiken therapeutischer Verfahren unterstützt werden. Die anthroposophische Medizin (AM) stellt ein etabliertes, auf der konventionellen Medizin (KON) beruhendes IM-Verfahren dar [6], und die anthroposophischen Kliniken enthalten nebst der üblichen konventionellen Diagnostik- und Therapie in der Regel ein umfassendes Angebot von medikamentösen und nichtpharmakologischen Therapieelementen der AM, die im Rahmen eines ganzheitlichen Medizinkonzepts eingesetzt werden [7]. Zudem sind diese Kliniken in Deutschland (DE) und in der Schweiz (CH) seit Jahren offiziell weiterbildungsberechtigt, sodass ihre Assistenzärzte in KON und AM weitergebildet werden.…”