University of Texas, Houston, TX, USA.
Integr Cancer Ther. 2013 Sep;12(5):369-84. doi: 10.1177/1534735412473642. Epub 2013 Feb 25.
Many studies confirm that a majority of patients undergoing cancer therapy use self-selected forms of complementary therapies, mainly dietary supplements. Unfortunately, patients often do not report their use of supplements to their providers. The failure of physicians to communicate effectively with patients on this use may result in a loss of trust within the therapeutic relationship and in the selection by patients of harmful, useless, or ineffective and costly nonconventional therapies when effective integrative interventions may exist. Poor communication may also lead to diminishment of patient autonomy and self-efficacy and thereby interfere with the healing response. To be open to the patient's perspective, and sensitive to his or her need for autonomy and empowerment, physicians may need a shift in their own perspectives. Perhaps the optimal approach is to discuss both the facts and the uncertainty with the patient, in order to reach a mutually informed decision. Today's informed patients truly value physicians who appreciate them as equal participants in making their own health care choices. To reach a mutually informed decision about the use of these supplements, the Clinical Practice Committee of The Society of Integrative Oncology undertook the challenge of providing basic information to physicians who wish to discuss these issues with their patients. A list of leading supplements that have the best suggestions of benefit was constructed by leading researchers and clinicians who have experience in using these supplements. This list includes curcumin, glutamine, vitamin D, Maitake mushrooms, fish oil, green tea, milk thistle, Astragalus, melatonin, and probiotics. The list includes basic information on each supplement, such as evidence on effectiveness and clinical trials, adverse effects, and interactions with medications. The information was constructed to provide an up-to-date base of knowledge, so that physicians and other health care providers would be aware of the supplements and be able to discuss realistic expectations and potential benefits and risks.
许多研究证实，大多数接受癌症治疗的患者会选择使用补充疗法，主要是膳食补充剂。不幸的是，患者通常不会向医务人员报告他们使用补充剂的情况。医生未能就这些使用情况与患者进行有效沟通，可能会导致治疗关系中的信任丧失，并且患者选择有害、无用、无效和昂贵的非传统疗法，而实际上可能存在有效的综合干预措施。沟通不畅还可能导致患者自主权和自我效能感下降，从而干扰治疗反应。为了接受患者的观点，并对其自主和赋权的需求保持敏感，医生可能需要转变自己的观点。也许最佳方法是与患者讨论事实和不确定性，以达成共同知情的决策。如今有见识的患者真正重视那些将他们视为平等参与者，共同做出自己的医疗保健选择的医生。为了就使用这些补充剂达成共同知情的决策，综合肿瘤学学会临床实践委员会承担了向希望与患者讨论这些问题的医生提供基本信息的挑战。由具有使用这些补充剂经验的主要研究人员和临床医生构建了一份具有最佳获益建议的领先补充剂清单。这份清单包括姜黄素、谷氨酰胺、维生素 D、舞茸、鱼油、绿茶、水飞蓟、黄芪、褪黑素和益生菌。清单上列出了每种补充剂的基本信息，例如有效性和临床试验、不良反应以及与药物相互作用的证据。这些信息旨在提供最新的知识基础，以便医生和其他医疗保健提供者了解补充剂，并能够讨论现实的期望以及潜在的益处和风险。
