Complementary and Alternative therapies Flashcards
1
Q
List different categories of CAM
A
- Mind-body (hypnosis, midnfulness, meditation)
- Biologically based (herbs, vitamins, nutraceuticals)
- Manipulative (massage, chiro)
- Energy therapies (reiki, qigong, acupuncture)
- Whole medical systems (chinese, ayurvedic, naturopathy)
2
Q
Who is likely to use CAM in cancer?
A
- women with gyne and breast cancers
- men with prostate ca
- younger age
- higher educational level
- higher SES
- perceived high risk of recurrence
- ethnocultural background with common mainstream alternative health systems
3
Q
Reasons why someone would use CAM
A
- treat side effects of cancer treatment
- restore balance
- energy
- wellness
- perceived benefit
- strong belief
- hope
- dissatisfaction with mainstream medicine
- sense of control
4
Q
List steps in discussing CAM with patients
A
- Ask pt about symptoms
- Ask patient to maintain sx diary (pre and post treatment)
- Discuss patient preferences and expectations re: CAM
- Review safety and efficacy of options
- Encourage pt to review credentials of CAM provider
- Provide pt with questions to ask CAM provider
- Schedule follow up to review
- Follow up
- Document
5
Q
How do you respond to patients asking about herbs being all natural and safe and accuracy of labels/content?
A
Quality control
- Quality and standardization vary
- need correct botanical ID, no contamination, adulteration, accuracy
- need standardization of dosage /potency
- botanicals / herbs : vary acc to growing conditions, harvesting, drying, extraction, etc
Regulation
- in Canada “natural health product” regulated
- Health Canada approval required
- Site licenses and manufacturing standards
- Natural Product Number (NPN) or Homeopathic Number (DIN-HM)
6
Q
General side effects of some naturopathic products
A
- antiplatelet activity
- interactions with steroids and CNS depressants
- hepatotoxicity
- nephrotoxicity
- analgesic interactions
- allergic reactions
7
Q
What about using natural products with chemotherapy or radiation therapy?
A
- Drug-herb interactions
- antioxidants reduce impact of radiation
- CYP interactions (inducing or inhibiting)
- Additive effects?
- may work WITH radiation/chemo to improve responsiveness
- decreased toxicity from chemo/rad
- Little is known, recommend AVOIDING CAM products during chemo/rad.
8
Q
How does acupuncture work to relieve pain?
A
- stimlates small afferent sensory muscle nerves that go to spinal cord
- relays to subcortical nuclei, limbic system adn pituitary gland
- activation of relay path blocks pain transmission
9
Q
What is the evidence for acupuncture for management of CINV and dyspnea?
A
- poor quality studies
- limited
- mixed
- most patients get some benefit, but duration of response variable
10
Q
When to avoid acupuncture?
A
- thrombocytopenia
- bleeding disorders
- cachexia
- low ANC not a Contraindication
- avoid in limbs with lymphedema
- avoid electroacupuncture if PM /ICD
- cellulitis
11
Q
Is there evidence for meditation, hypnosis, guided imagery?
A
- mixed
- good evidence for mind body therapies. mindfulness
- reduces anxiety, mood disturbancem chronic pain, inc QOL
12
Q
List components of relaxation techniques
A
- repetitive focus on word, wound, image, phrase, prayer, body sensation
- passive attitude toward intruding thoughts, then return to focus.
13
Q
What can meditation be useful for (evidence)
A
- pain
- distress
- sleep
- QOL
- anxiety, depression
14
Q
Use of hypnotherapy - evidence
A
- management of cancer pain
- CINV
15
Q
Massage
A
Systematic review:
- anxiety
- pain
- depression
- stress
- fatigue
lack of vigorous research
avoid deep pressure near lymph nodes or bone
if bleeding diathesis, light massage only
16
Q
Unproven therapies: metabolic therapies
A
- Gerson Institue:
- belief that toxic by products of cancer accumulate in liver
- cause liver failure and death
- goal to counteract liver failure:
- high K, low salt, coffee enemas, gallon of fruit and veg juice daily
- Megadose vitamin Tx
- Ozone Tx
NO EVIDENCE
17
Q
Unproven therapies : Dietary supplements
A
- shark cartilage
- anti angiogenic activity
- not absorbed in GI tract
- Cesium
- alkaline therapy slows tumour growth
- alkalinize body, kill cancer cells
- life threatening arhythmias have resulted
NO EVIDENCE
18
Q
Garlic
A
- cancer prevention, treatment
- interacts with CYP450
- antiplatelet effects
- interfered with hypoglycemic drugs
- AVOID if : thrombocytopenic, on AC or periop
19
Q
Gingko
A
- used for circulation disorders, dementia, hearing loss, tinnitus
- CYP450
- lowers seizure threshold (esp with antipsychotics)
- platelet dysfunction
- Anticoagulation effects
- AVOID if : low platelets, on AC, or peri op
20
Q
Ginseng
A
- used for cancer prevention and tx. DM, immunostimulation, strength
- may stimulate growth of hormon sensitive cancers
- AVOID :
- Anticoagulants (inc bleeding)
- Imatinib (inc hepatotoxicity)
- sulfonylureas (increased hypoglycemia)
21
Q
Green tea
A
- used for BP, cholesterl, cancer prevention/tx, heart disease, weight loss
- CYP 450 and UGT
- interacts with AC, antiplatelets
- diuretic effect
- nausea, GI upset
22
Q
Saw Palmetto
A
- Used for prostate cancer/prostatitis
- CYP450
- UGT
- additive AC effect
- pancreatitis and liver damage
- AVOID if peri op, on AC, antiplatelets
23
Q
St. John’s Wort
A
- Used for mood, sleep
- interacts with many drugs
- causes photosensitivity
- enhance toxicity of rad therapy
- may reduce efficacy of chemo
- may cause serotonin syndrome iwth antidpressants
24
Q
Turmeric
A
- used for cancer prevention, infection, inflammation
- CYP450
- UGT
- increased risk of bleeding
25
Q
Exercise
A
- may prevent chronic disease
- improve survival
- imrpove dyspnea
- relaxation
- fear
- improve mobility
- Tai CHI reduces falls in elderly
