Chemotherapy-induced peripheral neuropathy in cancer patients : a four-arm randomized trial on the effectiveness of electroacupuncture

Purpose. Chemotherapy-induced peripheral neuropathy (CIPN) is a common and dose-limiting side effect of cytostatic drugs. Since there are no proven therapeutic procedures against CIPN, we were interested to define the role of electroacupuncture (EA) from which preliminary data showed promising results. Methods. In a randomized trial with a group sequential adaptive design in patients with CIPN, we compared EA (LV3, SP9, GB41, GB34, LI4, LI11, SI3, and HT3; n=14) with hydroelectric baths (HB, n=14), vitamin B1/B6 capsules (300/300 mg daily; VitB, n=15), and placebo capsules (n=17). The statistical power in this trial was primarily calculated for proving EA only, so results of HB and VitB are pilot data. Results. CIPN complaints improved by 0.8 +- 1.2 (EA), 1.7 +- 1.7 (HB), 1.6 +- 2.0 (VitB), and 1.3 +- 1.3 points (placebo) on a 10-point numeric rating scale without significant difference between treatment groups or placebo. In addition no significant differences in sensory nerve conduction studies or quality of life (EORTC QLQ-C30) were found. Conclusions. The used EA concept, HB, and VitB were not superior to placebo. Since, contrary to our results, studies with different acupuncture concepts showed a positive effect on CIPN, the effect of acupuncture on CIPN remains unclear. Further randomized, placebo controlled studies seem necessary. This trial is registered with DRKS00004448

Classical homeopathy in the treatment of cancer patients - a prospective observational study of two independent cohorts

BACKGROUND: Many cancer patients seek homeopathy as a complementary therapy. It has rarely been studied systematically, whether homeopathic care is of benefit for cancer patients. METHODS: We conducted a prospective observational study with cancer patients in two differently treated cohorts: one cohort with patients under complementary homeopathic treatment (HG; n = 259), and one cohort with conventionally treated cancer patients (CG; n = 380). For a direct comparison, matched pairs with patients of the same tumour entity and comparable prognosis were to be formed. Main outcome parameter: change of quality of life (FACT-G, FACIT-Sp) after 3 months. Secondary outcome parameters: change of quality of life (FACT-G, FACIT-Sp) after a year, as well as impairment by fatigue (MFI) and by anxiety and depression (HADS). RESULTS: HG: FACT-G, or FACIT-Sp, respectively improved statistically significantly in the first three months, from 75.6 (SD 14.6) to 81.1 (SD 16.9), or from 32.1 (SD 8.2) to 34.9 (SD 8.32), respectively. After 12 months, a further increase to 84.1 (SD 15.5) or 35.2 (SD 8.6) was found. Fatigue (MFI) decreased; anxiety and depression (HADS) did not change. CG: FACT-G remained constant in the first three months: 75.3 (SD 17.3) at t0, and 76.6 (SD 16.6) at t1. After 12 months, there was a slight increase to 78.9 (SD 18.1). FACIT-Sp scores improved significantly from t0 (31.0 - SD 8.9) to t1 (32.1 - SD 8.9) and declined again after a year (31.6 - SD 9.4). For fatigue, anxiety, and depression, no relevant changes were found. 120 patients of HG and 206 patients of CG met our criteria for matched-pairs selection. Due to large differences between the two patient populations, however, only 11 matched pairs could be formed. This is not sufficient for a comparative study. CONCLUSION: In our prospective study, we observed an improvement of quality of life as well as a tendency of fatigue symptoms to decrease in cancer patients under complementary homeopathic treatment. It would take considerably larger samples to find matched pairs suitable for comparison in order to establish a definite causal relation between these effects and homeopathic treatment

Die Misteltherapie in der Behandlung von Patienten mit einer Krebserkrankung

Mistletoe (Viscum album L.) continues to be the medical herb prescribed most frequently for cancer patients in German-speaking countries. Demand for this therapy often comes from patients themselves and requires careful consideration by the attending physician during consultation.In German-speaking countries, mistletoe extracts are available as approved drugs (based on monographs of the commissions C and E of the German Federal Institute for Drugs and Medical Devices). In Switzerland, treatment costs are generally covered by statutory health insurance. In Germany, coverage is limited to palliative care. In adjuvant cases, treating physicians can request coverage by the health insurance if patients suffer from side effects due to the antitumoral treatment.The spectrum of Viscum album extract includes mistletoe lectin I; II, and III, viscotoxins, flavonoids, amino acids, polysaccharides, and membrane lipids. Preclinical studies have demonstrated cytotoxic, apoptosis-inducing, and immunomodulatory effects.Many clinical studies indicate a supportive efficacy of mistletoe extracts in tumor patients, even though methodological quality is discussed controversially in many cases. Clinical data regarding effects on survival of patients is inconsistent; effects concerning quality of life as well as the tolerability of antitumoral treatments are evaluated more positively.In view of the high demand on the patient side and increasing scientific evidence, the general conditions for prescriptions should continue as well as the ongoing scientific evaluation

Klangschalenbehandlung bei Chemotherapie-induzierter peripherer Polyneuropathie

Deutsch:Tumorpatienten, die zur Entspannungsförderung mit einer Klangschalenbehandlung therapiert worden waren, hatten wiederholt über eine Besserung ihrer Beschwerden durch eine Chemotherapie induzierte periphere Polyneuropathie (CIPN) berichtet. Vor diesem Hintergrund führten wir eine unkontrollierte prospektive Beobachtungsstudie mit Patienten durch, die unter einer CIPN litten. Diese erhielten einmalig eine Klangschalenbehandlung. Sämtliche Patienten beschrieben eine subjektive Besserung ihrer Beschwerden, bei 10 von 20 Patienten für bis zu 3 Tage anhaltend. Diese vielversprechenden Ergebnisse sollten in einem Folgeprojekt, möglichst in Form einer randomisierten kontrollierten Studie mit längerfristiger Therapiephase weiter überprüft werden. English:Cancer patients who received singing bowl therapy (SBT) for the purposes of stress relief have repeatedly reported improvements regarding symptoms related to chemotherapy-induced peripheral neuropathy (CIPN). Against this background, we carried out an uncontrolled prospective observational pilot study with 20 cancer patients suffering from CIPN for eight weeks or longer. Patients were examined regarding symptom severity before and after a single 60 minute singing bowl treatment. All patients reported an improvement of CIPN-related symptoms. While 19 out of 20 patients reported improvements for the entire day of treatment, ten of them reported positive effects up to three days following the treatment. These promising results should be reviewed carefully in a follow-up project, preferably in a randomized controlled study with longer and more therapy phases