Prevention and Treatment of Chemotherapy-Induced Peripheral Neuropathy (CIPN) with Non-Pharmacological Interventions: Clinical Recommendations from a Systematic Scoping Review and an Expert Consensus Process

Background: Most individuals affected by cancer who are treated with certain chemotherapies suffer of CIPN. Therefore, there is a high patient and provider interest in complementary non-pharmacological therapies, but its evidence base has not yet been clearly pointed out in the context of CIPN. Methods: The results of a scoping review overviewing the published clinical evidence on the application of complementary therapies for improving the complex CIPN symptomatology are synthesized with the recommendations of an expert consensus process aiming to draw attention to supportive strategies for CIPN. The scoping review, registered at PROSPERO 2020 (CRD 42020165851), followed the PRISMA-ScR and JBI guidelines. Relevant studies published in Pubmed/MEDLINE, PsycINFO, PEDro, Cochrane CENTRAL, and CINAHL between 2000 and 2021 were included. CASP was used to evaluate the methodologic quality of the studies. Results: Seventy-five studies with mixed study quality met the inclusion criteria. Manipulative therapies (including massage, reflexology, therapeutic touch), rhythmical embrocations, movement and mind–body therapies, acupuncture/acupressure, and TENS/Scrambler therapy were the most frequently analyzed in research and may be effective treatment options for CIPN. The expert panel approved 17 supportive interventions, most of them were phytotherapeutic interventions including external applications and cryotherapy, hydrotherapy, and tactile stimulation. More than two-thirds of the consented interventions were rated with moderate to high perceived clinical effectiveness in therapeutic use. Conclusions: The evidence of both the review and the expert panel supports a variety of complementary procedures regarding the supportive treatment of CIPN; however, the application on patients should be individually weighed in each case. Based on this meta-synthesis, interprofessional healthcare teams may open up a dialogue with patients interested in non-pharmacological treatment options to tailor complementary counselling and treatments to their needs

Prevention and treatment of chemotherapy-induced peripheral neuropathy (CIPN) with non-pharmacological interventions : clinical recommendations from a systematic scoping review and an expert consensus process

Background: Most individuals affected by cancer who are treated with certain chemotherapies suffer of CIPN. Therefore, there is a high patient and provider interest in complementary non-pharmacological therapies, but its evidence base has not yet been clearly pointed out in the context of CIPN. Methods: The results of a scoping review overviewing the published clinical evidence on the application of complementary therapies for improving the complex CIPN symptomatology are synthesized with the recommendations of an expert consensus process aiming to draw attention to supportive strategies for CIPN. The scoping review, registered at PROSPERO 2020 (CRD 42020165851), followed the PRISMA-ScR and JBI guidelines. Relevant studies published in Pubmed/MEDLINE, PsycINFO, PEDro, Cochrane CENTRAL, and CINAHL between 2000 and 2021 were included. CASP was used to evaluate the methodologic quality of the studies. Results: Seventy-five studies with mixed study quality met the inclusion criteria. Manipulative therapies (including massage, reflexology, therapeutic touch), rhythmical embrocations, movement and mind-body therapies, acupuncture/acupressure, and TENS/Scrambler therapy were the most frequently analyzed in research and may be effective treatment options for CIPN. The expert panel approved 17 supportive interventions, most of them were phytotherapeutic interventions including external applications and cryotherapy, hydrotherapy, and tactile stimulation. More than two-thirds of the consented interventions were rated with moderate to high perceived clinical effectiveness in therapeutic use. Conclusions: The evidence of both the review and the expert panel supports a variety of complementary procedures regarding the supportive treatment of CIPN; however, the application on patients should be individually weighed in each case. Based on this meta-synthesis, interprofessional healthcare teams may open up a dialogue with patients interested in non-pharmacological treatment options to tailor complementary counselling and treatments to their needs

Interpersonal factors impacting the decision to (continue to) use complementary and alternative medicine (CAM) in men with cancer: a mixed-methods study.

There has been an increase in the use of Complementary and Alternative Medicine (CAM) in cancer populations, with reported higher prevalence rates in women than in men. Men with a variety of cancers have been understudied in CAM research, as well as the contribution and involvement of their significant others, like close family members or/and close friends. The aim of this thesis was to investigate the use of CAM in men after a diagnosis of cancer. Specifically, the research aimed to explore how significant others impact on men’s decisions to (continue to) use CAM, how they negotiate, talk, and practice CAM in everyday life, and how this affects their interpersonal relationship. A mixed methodological approach with two independent but related studies addressed the research aims: one quantitative study (survey) and one qualitative study (semi-structured interviews). The results are presented in two published and three submitted papers that contribute to our understanding of CAM use in men affected with cancer and how their CAM uptake is shaped by their social networks. Paper one reports the results of an integrative review of the literature, and indicates that significant others of patients with cancer often act as information seekers, advocates, and/or role models in patients’ decision-making about CAM. Despite the limited number of reviewed studies about familial involvement available, the results suggest that there may be important interpersonal consequences following patients’ decision to use or not use CAM, that need to be further explored. Paper two reports the results from the Study 1 survey involving 403 Australian men affected with cancer, a convenience sample of consecutive patients visiting two public and two private outpatient cancer clinics in Metropolitan Adelaide. The results indicate that the majority of male cancer patients (61.5%) have experience with CAM at some point during their cancer treatment, while more than half of the study sample (52.9%) were currently using CAM whilst receiving conventional medical treatment. It was also shown that family were the most frequent providers of information about CAM, and were significantly more often involved in patients’ discussions about CAM use than medical professionals. Papers three, four, and five report the results of Study 2, involving qualitative analysis of 43 semi-structured interviews with 26 men and 24 significant others, thereby exploring in-depth participants’ perceptions and experiences of CAM. Paper three indicates that men with cancer use CAM for individual and social/interpersonal reasons, a unique category augmenting those previously discussed in the literature. Discourse analysis highlighted how the interpersonal dimension impact on men’s decisions to uptake CAM, and how the use of CAM functions to connect the male cancer patient with his social network. Paper four reports on the variations of significant others’ involvement in men’s CAM uptake and maintenance, and indicates that CAM is sometimes practised as a shared and/or private activity in everyday life. The shared practice of CAM was associated with interpersonal benefits, working to strengthen the bond between men and their significant others, but there were instances when men expressed a need to practice CAM as a private activity. It was found that CAM benefited both men and their significant others to reduce uncertainty and to regain control. Paper five reports on how regular and habitual male CAM users integrate CAM routines and CAM rituals in their everyday life. The discursive analysis illustrates how CAM routines provide male cancer patients with certainty and control. By contrast, CAM rituals function for cancer patients and their significant others as a means to create and maintain meaning, thereby working to counter fear and uncertainty consequent upon a diagnosis of cancer. In summary, the results of these studies have shown that the majority of men with a variety of cancers use CAM in addition to conventional cancer care. Family members and/or close friends are a significant source of influence in men’s CAM uptake and maintenance. The interactions about CAM between men and their significant others functioned to help them to connect with each other or strengthen their social bond, and constitute a beneficial effect of CAM use. In addition, it was found that regular CAM use helped men and their significant others to regain control and to reduce uncertainty. These findings may help healthcare professionals to better understand how interpersonal processes impact on men’s CAM decisions. The results might also be translated into clinical practice, for example, in designing supportive cancer care programmes tailored specifically to men affected with cancer, with or without involvement of their significant others.Thesis (Ph.D.) -- University of Adelaide, School of Psychology, 201

Findings from a three-round Delphi study: essential topics for interprofessional training on complementary and integrative medicine

BACKGROUND: Integrating complementary medicine into medical care promotes patient-oriented care. A well-informed and collaborative professional healthcare team is essential for effective and patient-safe implementation of these methods. At present, the skills for patient counseling, therapy and care regarding complementary medicine vary among the professional groups involved. Professionals generally feel that they are not sufficiently qualified in this area. Curricular concepts for Complementary and Integrative Medicine (CIM) are virtually non-existent in undergraduate interprofessional training. The aim of this study is to initiate a consensus-building process between various experts (professionals, students, patient and faculty representatives) in order to identify which topics should be the focus of such a curriculum. METHODS: A three-round Delphi study was carried out from March 2018 to March 2019 to compile the experience and knowledge of experts in the field of integrative patient care and interprofessional education. Sixty-five experts from Germany and German-speaking Switzerland with various professional backgrounds and experiences were asked to name general content, therapy methods and treatment reasons which should be addressed in interprofessional seminars. In the subsequent rounds these were rated on a seven-point Likert scale. The ratings were assigned to relevance groups and discussed in a final workshop in July 2019. RESULTS: The response rates for the three rounds were 76% (n = 50), 80% (n = 40) 90% (n = 36); and 21% (n = 11) for the final workshop. The experts suggested that topics could be aligned along the most common treatment reasons such as insomnia, generalized pain, fatigue and back pain. However, it is important that students also receive an overview of the evidence base for different therapeutic concepts, especially in the field of classical natural medicine, acupuncture and mind-body medicine, and that they get an overview of the effects and interactions of frequently used procedures. CONCLUSION: Consensus was reached among the various experts on the most important topics for an interprofessional CIM curriculum. The systematic evaluation of the topics in this study can help to create a curriculum that achieves a high level of acceptance among teachers, lecturers and students, and thus facilitates implementation at universities and medical faculties

Protocol for the process evaluation of a counselling intervention designed to educate cancer patients on complementary and integrative health care and promote interprofessional collaboration in this area (the CCC-Integrativ study).

BackgroundConducting a process evaluation is essential to understand how health interventions work in different healthcare settings. Particularly in the case of complex interventions, it is important to find out whether the intervention could be carried out as planned and which factors had a beneficial or hindering effect on its implementation. The aim of this study is to present the detailed protocol of the process evaluation embedded in the controlled implementation study CCC-Integrativ aiming to implement an interprofessional counselling program for cancer patients on complementary and integrative health care (CIH).MethodsThis mixed methods study will draw upon the "Consolidated Framework for Implementation Research" (CFIR) combined with the concept of "intervention fidelity" to evaluate the quality of the interprofessional counselling sessions, to explore the perspective of the directly and indirectly involved healthcare staff, as well as to analyze the perceptions and experiences of the patients. The qualitative evaluation phase consists of analyzing audio-recorded counselling sessions, as well as individual and group interviews with the involved persons. The quantitative evaluation phase applies questionnaires which are distributed before (T0), at the beginning (T1), in the middle (T2) and at the end (T3) of the intervention delivery.DiscussionThis protocol provides an example of how a process evaluation can be conducted parallel to a main study investigating and implementing a complex intervention. The results of this mixed methods research will make it possible to identify strengths and weaknesses of the team-based intervention, and to target more specifically the key factors and structures required to implement healthcare structures to meet patients' unmet needs in the context of CIH. To our knowledge, this study is the first applying the CFIR framework in the context of interprofessional CIH counselling, and its results are expected to provide comprehensive and multidisciplinary management of cancer patients with complex supportive healthcare needs

Generierung von Evidenz zu naturheilkundlichen Pflegeinterventionen in der Onkologie : ein systematisches Verfahren

Background: Nurses working in oncology use a wide range of naturopathic interventions in their daily practice to alleviate symptoms and improve the quality of life of oncological patients. However, there is no external evidence for many of these interventions. Due to a lack of scientific studies in the field, the aim of the project described here is to develop a standardized procedure to generate evidence on naturopathic interventions, on the basis of which recommendations may be derived for nursing practice. Method: The systematic procedure presented here was developed by the working group (WG) Integrative Nursing in Oncology over a period of four years in an iterative process. This process is based on the expert panel members’ experience with the development of guidelines and/or quality instruments such as practice standards. Result: The systematic methodological approach presented here consists of three successive steps where internal and external evidence have been combined: a scoping review, a structured consensus process with oncology nurses to collect and evaluate naturopathic interventions, and finally a further supplementary literature review based on additional findings of the consensus conference. The procedure was successfully carried out for mucositis, insomnia, fatigue, hand-foot syndrome and chemotherapy-induced polyneuropathy. Conclusion: Through the step-by-step synthesis of internal evidence and the best available external evidence, the evidence base for naturopathic nursing interventions in oncology can be generated and practice recommendations derived. The procedure represents a successful theory-practice transfer through structured cooperation between (nursing) scientists and nursing practitioners. In terms of the AWMF classification, the practice recommendations developed in the process described fall somewhere in between an S1 guideline (informal consensus of an expert group) and an S2e guideline (evidence-based)

Nursing procedures for the prevention and treatment of mucositis induced by cancer therapies: Clinical practice guideline based on an interdisciplinary consensus process and a systematic literature search

Background: Patients with cancer receiving tumor therapy often suffer from oral mucositis. Objectives: The aim of this project was to summarize experiences with nursing procedures by experts in integrative oncology and to establish recommendations for nursing interventions that can prevent or cure mucositis. Methods: The study design was an interdisciplinary consensus process based on a systematic literature search. Results: The panel discussed and agreed on 19 nursing procedures, which included mouthwashes, such as teas, supplements, oil applications, and different kinds of ice cubes to suck, as well as flaxseed solution, propolis, and mare milk. Twelve interventions were classified as effective, with effectiveness for OraLife, propolis, sea buckthorn pulp oil, marshmallow root tea also for xerostomia, Helago chamomile oil, mare milk, and Saliva Natura rated as highly effective in clinical experience. In the systematic literature search, a total of 12 out of 329 randomized controlled trials and meta-analyses on chamomile (n = 3), Calendula (n = 1) and sage (n = 1), propolis (n = 2), and sucking ice cubes (cryotherapy; n = 5) met all inclusion criteria. Trial evidence for effectiveness in oral mucositis was revealed for propolis and cryotherapy. Conclusions: The current evidence supports the use of some nursing procedures (f.e. propolis for 2 and 3 grade mucositis) for improving oral mucositis during cancer therapies. There is still a need to define general clinical practice guidelines for the supportive treatment of mucositis, as well as for more interdisciplinary research in this area