Integrative Oncology Program, The Oncology Service, Lin Medical Center, Clalit Health Services, 35 Rothschild St., Haifa and Western Galilee District, Israel.
Graduate Studies Authority, Haifa University, Haifa, Israel.
Support Care Cancer. 2017 Oct;25(10):3181-3190. doi: 10.1007/s00520-017-3726-4. Epub 2017 Apr 22.
Despite the growing evidence supporting the use of complementary/integrative medicine (CIM) in the treatment of chemotherapy-induced toxicities, little is known on CIM impact of these therapies regarding the use of medications for supportive cancer care. In this study, we examined the impact of CIM on the need for supportive cancer care-related medications.
Patients with breast or gynecological cancer referred to and attending an integrative physician (IP) consultation for gastrointestinal (GI) concerns were designated as the treatment group; those not attending as controls. Adherence to the integrative care program (AIC) was defined as attending ≥4 CIM interventions. The need for conventional supportive care-related medications and doses was determined from patients' medical files, as well as the implications on the potential for cost reduction.
Of the 205 patients diagnosed with GI concerns, 116 attended the IP consultation and weekly CIM treatments (56.6%; treatment group), of which 85 (73.3%) were adherent to the program (AIC subgroup); 89 did not undergo an IP consultation (43.4%; controls). Within-group analysis found a greater decrease in the use of non-opioid analgesics (NOAs) at 6 weeks in the treatment group (P = 0.01), more so in the AIC subgroup (P = 0.02). A cost analysis suggests that reduced NOA use in the treatment group reduced the cost of supportive care, covering 27.1% of the overall expense of CIM treatments. Controls were less likely to require anti-emetics (P = 0.007). Between-group analysis showed a trend for reduced use of anxiolytics (P = 0.06) and NOAs (P = 0.08) among treated patients, with lower dose equivalents for NOAs than controls (P < 0.001).
CIM treatments may reduce the need for NOAs among patients with breast or gynecological cancer.
尽管越来越多的证据支持在化疗引起的毒性治疗中使用补充/整合医学(CIM),但对于这些疗法对支持性癌症护理药物的使用,关于 CIM 的影响知之甚少。在这项研究中,我们研究了 CIM 对支持性癌症护理相关药物需求的影响。
患有乳腺或妇科癌症并因胃肠道(GI)问题接受整合医师(IP)咨询的患者被指定为治疗组;未接受咨询的患者为对照组。整合护理计划(AIC)的依从性定义为接受≥4 次 CIM 干预。从患者的病历中确定常规支持性护理相关药物的需求和剂量,以及对潜在成本降低的影响。
在 205 名被诊断为 GI 问题的患者中,有 116 名接受了 IP 咨询和每周的 CIM 治疗(56.6%;治疗组),其中 85 名(73.3%)遵守了该计划(AIC 亚组);89 名未接受 IP 咨询(43.4%;对照组)。组内分析发现,治疗组在 6 周时非阿片类镇痛药(NOA)的使用减少(P=0.01),AIC 亚组更为明显(P=0.02)。成本分析表明,治疗组减少 NOA 的使用降低了支持性护理的成本,占 CIM 治疗总费用的 27.1%。对照组不太可能需要止吐药(P=0.007)。组间分析显示,治疗患者中阿片类药物和 NOA 的使用呈减少趋势(P=0.06 和 P=0.08),NOA 的等效剂量低于对照组(P<0.001)。
CIM 治疗可能会减少乳腺或妇科癌症患者对 NOA 的需求。