14.6 (4.17) Integrative oncology in PM Flashcards
What is complementary and alternative medicine (CAM)?
Therapies being provided in parallel or as an alternative to mainstream medicine
What is CIM?
How does the oxford text book define CAM vs CIM?
- Complementary and integrative medicine
- Oxford text uses CAM to describe patient-initiated use of complementary medicine
AND
CIM as the use of research-based practices as provided within an integrative context of care
Define integrative oncology
The idea and practice of adding complementary and alternative medicine (CAM) approaches to options for cancer patients in previously strictly conventional medical environments
- How does integrative oncology (IO) differ from alternative medicine treatments?
- How do IO services provide a range of CIM (complementary and integrative medicine) modalities? (Ie who would be involved)
- Alternative medicine treatments typify what is being practised outside of conventional medicine.
IO services are situated GEOGRAPHICALLY and CONCEPTUALLY within conventional oncology/pall care
- Via multidisciplinary teams of CIM-trained physicians (IPs), nurses, paramedical therapists AND non-CIM practitioners (accupuncturists, mind-body, art therapists)
What are complementary and alternative therapies and how do they differ from one another
(this question/definitions are from 5th edition)
alternative therapies - promoted for use instead of standard tx (despite no alternatives existing), schemes
complementary therapies - used to control symptoms (eg pain), enhance wellbeing (physical, mental, spiritual), optimize QOL for patients and families
- List 2 ways in which integrative oncology (IO) is similar to palliative care
- What is the goal of IO?
- How do the 2 fields work together?
1.
a) patient-centered
b) holistic biopsychosocialspiritual perspective
- to provide individualized CIM treatment plan which will help reduce suffering and improve QOL
- Varies between oncology centres - some provide each domain separately, others collaborate
List five modalities of complementary therapy that are acceptable in PC
1. acupuncture 2. accupressure 3. manual and movement therapies (reflexology, qigong) 4. Mind body techniques 5. spiritual approaches (guided imagery, yoga, meditation) 6. Music 7. fitness/physical activity 8. nutrition
- What is the evidence for CIM (complementary and integrative medicine) in cancer settings
- List 5 scenarios in which CIM could be helpful*
- Large body of evidence supporting effectiveness and safety of CIM for relief of symptoms and improving QOL
- i) patients for whom conventional care is not enough or too difficult
ii) supportive care in neo-adjuvant/adjuvant settings
iii) throughout survivorship
iv) metastatic cancer/end of life care
v) “fill the gap” in patients with suboptimal response to pall care
vi) patients unwilling to adhere to conventional pall care drugs/psych-onc interventions
List 3 different types of CAM popular in 3 different areas of the world
- US/West - dietary supplement use
- Central Europe - anthroposophic + homeopathy
- Asia/Middle East - traditional herbal medicine
List 3 groups of people that may be more likely to use CAM
- In the U.S. , Caucausian patients more likely than non-white patients
- Patients with more advanced disease or worse QOL
- Refugee/immigrants from developing countries (rural/low SES) where herbal medicine is also popular
List 4 safety-related concerns with use of non-conventional medicine by oncology patients
- When treatment claims to be alternative to conventional care but not established as such
- Extreme dietary changes
- High expense leading to debt
- False belief that “natural” non-conventional treatments are without risk
- Negative effect on conventional oncology Rx or drug-herb interactions
Drug drug interactions, benefits, risks, cost
Tension may rise between patients and conventional medicine HCP’s (underlined by principle of autonomy, true informed consent and paternalism).
List 3 patient-centered ways in which HCP’s can approach discussions about safety-related concerns
- Respect patient autonomy, including wish to seek out alternative options
- Try to understand patient’s decision within their health-belief models (rather than the herb etc)
- Understand the expectations & goals in the search for the alternative
Trust + what when where who + why + how
List 4 steps to establishing a patient-centered dialogue on the use of CAM during cancer care
Table 14.6.1:
- Establish Trust
Respectful, non-judgemental, emphasize pt rights - Discuss present CAM Use
(which products, who is advising use, document) - Explore patient expectations and concerns
(what are expectations, “favourable” response) - Discuss issues of safety re: CAM + supplement use
(concerns, pt idea of “harm”, does pt want advice? IP consult?)
Trust, what/when/where/who + why + how
List 4 goals of integrative oncology
- Treat symptoms and improve QOL
- Increase patient adherence to planned conventional oncology treatments
- Provide expertise of IP to minimize herb-drug interactions
- Reduce need/costs of symptomatic pharmacotherapy
*IP = integrative physician
You are following a patient in the community as a PC provider. The patient has met lung can and is scheduled to receive pall XRT to the chest wall.
The pt’s daughter pulls you aside at the visit and tells you the patient is taking supplements that have a high dose of cancer fighting enzymes. She tells you her mother is not health literate and wants to know some things to she should tell her mother to get her to avoid using these potentially harmful pills.
What are three important issues you can discuss with the patient and daughter re these supplements
herb drug interactions may be underreported
can interfere with prescription drug metabolism through P450 enzyme/glycoprotein inhibition
may increase bleeding when taken with anticoagulants
cause unwanted interactions with anesthetics
increase skin toxicity and decrease efficacy radiation
FS:
- drug interactions
- radiation interactions
- side effects
