fatigue
The objective of this study was to “critically assess the evidence presented in randomized controlled trials (RCTs) about the effectiveness of acupuncture on fatigue in cancer patients”. In April 2024 a systematic search was conducted searching five electronic databases to find studies concerning the use, effectiveness and potential harm of acupuncture therapy on cancer patients.
From all (1599) search results, 15 studies with 1346 patients were included. Acupuncture methods varied – e.g., traditional-, electro-, mind-regulating and ATAS-acupuncture – and were compared to sham acupuncture, usual care, or other controls.
- Studies comparing acupuncture to sham acupuncture reported mixed results: while some found significant effects on cancer-related fatigue, others found no advantages.
- Studies comparing acupuncture to usual care or waitlist controls often reported positive effects. However, the reliability of these findings is limited, as 14 of 15 studies were rated as “high risk of bias” by the RoB-2 tool due to issues like insufficient blinding and incomplete data analysis.
- Only one study, with low risk of bias, showed a significant reduction in fatigue with acupuncture compared to sham acupuncture (p < 0.001).
- GRADE evaluation showed very low certainty of evidence.
The authors concluded that the heterogenous results and methodological limitations of the existing studies prevent us from drawing definitive conclusions about the effectiveness of acupuncture in the treatment of cancer-related fatigue. Despite the inclusion of 15 studies, the overall evidence remains insufficient due to widespread problems in study design and inconsistent results. This analysis highlights the need to use more rigorous designs and more comprehensive assessment tools in future studies to better understand the role of acupuncture in the management of fatigue after cancer treatment.
So, only one study, with low risk of bias, showed a significant reduction in fatigue with acupuncture compared to sham acupuncture. Let’s have a look at it:
Background: Cancer-related fatigue (CRF) is a distressing symptom that is the most common unpleasant side effect experienced by lung cancer patients and is challenging for clinical care workers to manage.
Methods: We performed a randomized, double-blind, placebo-controlled pilot trial to evaluate the clinical effect of acupuncture on CRF in lung cancer patients. Twenty-eight patients presenting with CRF were randomly assigned to active acupuncture or placebo acupuncture groups to receive acupoint stimulation (LI-4, Ren-6, St-36, KI-3, and Sp-6) twice per week for 4 weeks, followed by 2 weeks of follow-up. The primary outcome was the change in intensity of CFR based on the Chinese version of the Brief Fatigue Inventory (BFI-C). As the secondary endpoint, the Functional Assessment of Cancer Therapy-Lung Cancer Subscale (FACT-LCS) was adopted to assess the influence of acupuncture on patients’ quality of life (QOL). Adverse events and safety of treatments were monitored throughout the trial.
Results: Our pilot study demonstrated feasibility among patients with appropriate inclusion criteria and good compliance with acupuncture treatment. A significant reduction in the BFI-C score was observed at 2 weeks in the 14 participants who received active acupuncture compared with those receiving the placebo (P < 0.01). At week 6, symptoms further improved according to the BFI-C (P < 0.001) and the FACT-LCS (P = 0.002). There were no significant differences in the incidence of adverse events in either group (P > 0.05).
Conclusion: Fatigue is a common symptom experienced by lung cancer patients. Acupuncture may be a safe and feasible optional method for adjunctive treatment in cancer palliative care, and appropriately powered trials are warranted to evaluate the effects of acupuncture.
Fancy that! The only study to produce some apparently sound evidence turns out to be a pilot study. Such studies are supposed to test feasibility, not effectiveness! In view of all this, it is far, I think, to draw a definitive conclusion, after all:
At present there is no compelling evidence that acupuncture works for cancer-related fatigue.
Fatigue is one of the most common symptoms in patients with Multiple Sclerosis (MS). It can cause severe psychological problems and reduce their Quality of Life (QOL). Cupping therapy is known as a method of alternative medicine that can be used to treat or reduce patient symptoms. Thus, this randomized clinical trial was conducted to determine the effect of dry cupping therapy on the fatigue and QOL of women with MS.
It 60 patients (30 patients in each group) with MS referred to the Medical Center of Special Diseases in southeast Iran. Patients in the intervention group received eight sessions of dry cupping therapy (plus standard care) twice a week over 4 weeks, while the control group received just standard care. Data were collected before and after the intervention by using the demographic information questionnaire, the Fatigue Severity Scale, and the Multiple Sclerosis Quality of Life questionnaire. Data were analyzed using SPSS 18. The significance level was 0.05.
Thirty patients entered the study; none of them were excluded from the study, and 30 patients were finally analyzed. Before the intervention, there was no statistically significant difference between the two groups in terms of fatigue (intervention group: 47.67) 7.83); control group: 47.63) 8.76)) and QOL (intervention group: 48.85) 9.55); control group: 49.64) 9.90) (t = 0.018, p = 0.98 and t = 0.31, p = 0.75, respectively)). After performing cupping therapy in the intervention group, a significant decrease and increase were observed in the mean (SD) score of fatigue (intervention group: 34.48) 6.16); control group: 46.85 (8.95)) and QOL (intervention group: 60.14) 7.46); control group: 51.96) 9.45)), respectively (p < 0.001).
The authors concluded that cupping therapy significantly reduced the patients’ fatigue and increased their QOL. This method is recommended for reducing fatigue and improving QOL in patients with MS.
Oh dear, where to begin?
One is spoilt for choice when criticising this study, e.g.:
- A controlled trial is meant to compare the outcomes BETWEEN groups and not to calculated within-groups changes.
- The results of a single study should never be the basis for far-reaching recommendations.
- The study followed the infamous ‘A + B versus B’ design. This does not control for placebo effects and thus does not permit conclusions about a therapy per se. (For those new to the subject, I have previously dealt with this study design as nauseam. Please do a simple search of previous explanations)
In view of this, I think I ought to re-phrase the conclusions as follows:
Like most treatments, cupping therapy is associated with significant placebo effects which can significantly reduce the patients’ fatigue and increased their QOL. Studies that fail to control for placebo effects cannot tell us about the sepcific effects of medical interventions and therefore are prone to mislead the public.
Fatigue is often one of the most commonly reported symptoms in cancer survivors, but it is also one of the least understood cancer-related symptoms. Fatigue is associated with psychological distress, disruptions in sleep quality, and impairments in health-related quality of life. Thus, elective treatments for fatigue in older male cancer survivors represent a current unmet need. Prior research has shown that Tai Chi Qigong (TCQ), a mind-body exercise intervention, can improve physical and emotional health. Therefore, this study compared the efficacy of Tai Chi Qigong (TCQ) versus exercise intensity-matched (EIM) and usual care in older, male cancer survivors with fatigue.
The researchers conducted a three-arm, single-blind randomized controlled trial where older (55 + years), male cancer survivors with fatigue participated in usual care or one of two supervised group exercise programs: TCQ or EIM twice weekly for 12 weeks. Participants were followed up for 12 months. The primary outcome was patient-reported fatigue at 3-months post-intervention.
A cohort of men (n = 113) were enrolled (mean age: 69.1 (±7.0) years. In the primary outcome analysis, there were no significant within-arm or between-arm differences in fatigue (p-value, NS). However, the TCQ and EIM arms showed significant within-arm improvement in fatigue immediately post-intervention (p-value < 0.05). There were no differences in class attendance for either TCQ or EIM, with an average attendance rate of 78.4% and 76.8%, respectively.
The authors concluded that they found no significant or clinically meaningful improvements in fatigue for TCQ or EIM relative to usual care at the 3-month follow-up. However, significant improvements in fatigue were observed immediately after completion of the 12-week TCQ and EIM programs. This study suggests that TCQ and light intensity activity may lead to improvements in fatigue immediately after the group exercise program among older, fatigued male cancer survivors. However, the observed improvements did not persist beyond the program, suggesting that long-term maintenance may be required. Further testing is warranted in larger trials that include strategies to sustain both the behavior and the effects.
Tai chi is currently much-hyped. I have repeatedly stated that it is plausible to assume that excercise as positive effects on several levels. I have also doubted that there are huge differences between different typs of excercise.
This study is one of the few trials that tested tai chi against an intensity-matched conventional form of exercise. The results speak for themselves.
What matters most, I feel, is that patients find a form of exercise that suits them and is enjoyable. Whether this is an exotic or a conventional variation of the theme matters little. What counts is that patients are happy and therefore continue long-term.
This abstract caught my attention; it is unusual in that it reports not a trial but a protocol of a trial of homeopathy. I think it deserves a short comment:
Cancer-related fatigue (CRF) poses a significant challenge in cancer care and affects the quality of life of many patients. Despite the prevalence and impact of the condition, identifying effective therapies remains a challenge. Non-pharmacological remedies, such as complementary therapies including homeopathy, are under-researched. A clinical trial with n-of-1 design has therefore been planned to evaluate the potential of individualized homeopathic medicinal products (IHMPs) in the management of CRF.A series of double-blind, randomized, placebo-controlled, n-of-1 trials will be conducted. Each participant will undergo three rounds of two intervention phases in a randomly determined order. The study will be performed at the Oncology Outpatient Department of D. N. De Homoeopathic Medical College and Hospital. Participants with CRF who meet pre-defined eligibility requirements will be enrolled. The FACIT-F sub-scale is the primary outcome measure; Short Form-36 and the Wu Cancer Fatigue Scale are the secondary outcomes. All outcomes will be measured at baseline, on day 7 and then every 10 days for 2 months. The sample size will be the number of patients who can be recruited during the 18-month period of the trial. The Numerical Rating Scale (0-10) measuring fatigue severity will be used in screening and preliminary evaluation of the degree of fatigue. Comprehensive blood tests to evaluate various physiological factors related to CRF will also be performed. An assessment of the effect of the IHMPs will be obtained per individual and by aggregating the data of all participants via meta-analysis.The results of our study will clarify the possible therapeutic effects of IHMPs for patients with CRF, as well as improve our understanding of the n-of-1 study design as it is applied to homeopathy research.
‘N of one’ trials make sense for testing the hypothesis that a treatment reproducibly works not for all but only for some individuals. If that is the case, a conventional trial would produce a negative overall result by drowning the positive cases in the sea of negative findings.
Evidently, the Indian authors believe that this is true for homeopathy. Therefore the study design they probose seems reasonable.
Hold on!
Reasonable?
Skeptics would argue that there is nothing reasonable about the assumption that homeopathy can reduce cancer fatigue beyond placebo. They would thus predict that – provided the study is rigorously conducted and reported – the end result of this series of N=1 studies will be negative and that the whole excercise is a waste of resources.
I agree – but I still fear that the results will yield some positive findings and the authors will conclude that, indeed, some individuals do reproducibly benefit from homeopathy beyond placebo. I suspect this will happen because already the protocol was published in the journal ‘HOMEOPATHY’ rather than in a respected journal. What is even more concerning are the affiliations of the authors:
- 1Department of Pathology and Microbiology, D. N. De Homoeopathic Medical College and Hospital, Government of West Bengal, Kolkata, West Bengal, India.
- 2Department of Repertory, D. N. De Homoeopathic Medical College and Hospital, Government of West Bengal, Kolkata, West Bengal, India.
- 3Department of Radiation Oncology, North Bengal Medical College and Hospital, Government of West Bengal, Kolkata, West Bengal, India.
This, I fear, suggests that the above mentioned precondition might not be met and the study might not be rigorously conducted and reported.
WATCH THIS SPACE!
Common Harms of CSM
- Musculoskeletal discomfort: Temporary soreness, stiffness, or pain in the muscles or joints after treatment.
- Headaches: Some individuals may experience headaches following spinal manipulation.
- Fatigue: Feeling tired or experiencing fatigue after treatment.
These harms occur after CSM in about 50% of all patients. They impact on their quality of life and usually last 1-3 days.
Serious Harms of CSM
- Vertebral artery dissection (VAD) and stroke: A tear in the vertebral artery can lead to stroke; the harm can be permanent.
- Death: A stroke can be fatal.
- Atlantoaxial dislocation
- Spinal cord injury: Damage to the spinal cord, potentially resulting in numbness, weakness, or paralysis.
- Herniated discs: Manipulation can exacerbate existing disc issues or cause a new disc herniation.
- Fractures: Osteoporotic patients or those with bone conditions are at risk of vertebral fractures.
- Cauda equina syndrome: Compression of nerves in the lower spine, potentially causing bowel or bladder dysfunction.
- Nerve damage: Injury to spinal nerves, leading to numbness, tingling, or weakness.
- Eye Injuries: these include central retinal artery occlusion, nystagmus, Wallenberg syndrome, ptosis, loss of vision, ophthalmoplegia, dipiopia and Horner’s syndrome.
The frequency of these harms is not known.
Other Risks
- Neglect: This happens whenever a chiropractor treats a condition that can more effectively be treated with another therapy.
- Misleading advice: This occurs whenever a chiropractor gives advice outside his area of competence, for instance, a recommendation against immunisations.
- False diagnoses: Chiropractors often diagnose a ‘vertebral subluxation’, a condition that exists only in their fantasy.
- Worsening of existing conditions: Manipulation may exacerbate underlying spinal problems or conditions like spinal instability.
- Waste of money: This occurs each time a patient pays for ineffective CSM.
The frequency of these risks is not well-documented but can be estimated to be very high.
_____________________________
I have often pointed out that the value of a therapy is not solely determined by its potential for harm. It depends crucially on the risk/benefit profile. The benefits of CSM are few and mostly uncertain. Thus the question arises:
DO THE BENEFITS OF CSM OUTWEIGH ITS RISKS?
I let you, the reader, answer this question.
PS
References for the above statements can be found in my book.
- pain,
- anxiety,
- fatigue,
- feelings (eg, happy, calm)
on 0- to 10-point numeric rating scales. Data were analyzed with Wilcoxon signed rank tests.
- What on earth is a ‘mixed-method, feasibility, pilot study’? A hallmark of pseudo-researchers seems to be that they think they can invent their own terminology.
- There is no objective, validated outcome measure.
- The conclusion that ‘Reiki is feasible‘ has been known and does not need to be tested any longer.
- The conclusion that ‘Reiki improved positive emotions and feelings and decreased negative measures’ is false. As there was no control group, these improvements might have been caused by a whole lot of other things than Reiki – for instance, the extra attention, placebo effects, regression towards the mean or social desirability.
- The conclusion that ‘implementing Reiki in clinical practice should be further explored to improve mental health and well-being’ is therefore not based on the data provided. In fact, as Reiki is an implausible esoteric nonsense, it is a promotion of wasting resources on utter BS.
Does it matter?
Why not let pseudo-scientists do what they do best: PSEUDO-SCIENCE?
I think it matters because:
- Respectable institutions like the Mayo Clinic should not allow its reputation being destroyed by quackery.
- The public should not be misled by charlatans.
- Patients suffering from mental health problems deserve better.
- Resources should not be wasted on pseudo-research.
- ‘Academic journals like ‘Glob Adv Integr Med Health’ have a responsibility for what they publish.
- ‘The ‘Academic Consortium for Integrative Medicine & Health‘ that seems to be behind this particular journal claim to be “the world’s most comprehensive community for advancing the practice of whole health, with leading expertise in research, clinical care, and education. By consolidating the top institutions in the integrative medicine space, all working in unison with a common goal, the Academic Consortium is the premier organizational home for champions of whole health. Together with over 86 highly esteemed member institutions from the U.S., Australia, Brazil, Canada and Mexico, our collective vision is to transform the healthcare system by promoting integrative medicine and health for all.” In view of the above, such statements are a mockery of the truth.
This review is entitled “A narrative review of the impact of reiki and therapeutic touch on sleep quality and health in women” and aimed to evaluate the application methods of energy therapies, specifically Reiki and Therapeutic Touch, their health effects, and their positive impact on sleep quality, particularly in women.
The author who is from the Osmaniye Korkut Ata University, Faculty of Health Sciences, Midwifery Department, Osmaniye, Turkey, states in her abstract that:
“energy therapies are holistic approaches designed to restore energy balance and enhance overall health. Reiki utilizes universal energy flow to promote physical, mental, and spiritual harmony. By balancing energy centers, Reiki helps alleviate stress, anxiety, and depression while being a generally safe practice with no reported side effects.”
The author continues by claiming that studies involving menopausal women suggest that Reiki improves sleep quality, reduces the time to fall asleep, and stabilizes sleep patterns.
Therapeutic Touch, the author explains:
“focuses on sensing and balancing the body’s energy fields, operating on the principle that energy imbalances contribute to illness. Research indicates that Therapeutic Touch alleviates stress, fatigue, anxiety, and pain, while enhancing sleep quality, relaxation, and overall quality of life. Studies in menopausal women confirm its effectiveness in addressing sleep disturbances and promoting well-being.”
The author concludes that energy therapies, particularly methods like Reiki and Therapeutic Touch, have garnered attention for their positive impact on women’s health and overall well being. These noninvasive, safe, and low-cost practices have shown promise, especially in areas such as sleep quality, stress management, and the alleviation of menopausal symptoms. However, the limited scientific literature in this field necessitates further research to solidify their efficacy.
The author also issues the following ecommendations:
• Theoretical and practical training on energy therapies should be integrated into nursing education
programs to enhance awareness and application.
• Randomized controlled trials should be conducted to investigate the effectiveness of energy
therapies across different age groups and health conditions.
• Research on women’s health should focus specifically on the effects of energy therapies on sleep
quality and menopausal symptoms.
• Public awareness of energy therapies should be increased, and their integration into healthcare systems
should be facilitated.
• Energy therapies should be recognized as complementary treatment options in health institutions,
contributing to patient satisfaction and stress management.
This paper is a good example to show why I have often warned that research of so-called alternative medicine (SCAM) is in serious danger to be no longer taken seriously. Scientists and rational healthcare professionals will simply dismiss it outright because it simply is pseudo-research masquarading as the real thing.
The review fails to contain a methods section which means we do not know on what evidence the conclusions are based. Once we have a closer look, we realize that the paper:
- relies on highly selected studies;
- does not even consider the implausibility of energy healing;
- fails to assess the methodological quality of the primaary studies.
All this is done so that the author – presumably a nurse who practices energy healing – can arrive at the conclusion she set out to draw.
Such papers are deeply disturbing because they mislead the reader and undermine trust in science.
PS
In case you are interested in a reasonable and evidence-based conclusion about energy healing, here is one I suggest:
A review of the evidence shows that energy healing flies in the face of science and is not supported by sound clinical evidence. Energy healing has therefore no place in rational healthcare.
- mind-body medicine (32.0%),
- massage (16.1%),
- chiropractic (14.4%),
- acupuncture (3.4%),
- naturopathy (2.2%),
- art and/or music therapy (2.1%).
Reporting post-COVID-19 was associated with an increased likelihood of using any SCAM in the last 12 months (AOR = 1.18, 95% CI [1.03, 1.34], p = 0.014) and specifically to visit an art and/or music therapist (AOR = 2.56, 95% CI [1.58, 4.41], p < 0.001). The overall use of any SCAM was more likely among post-COVID-19 respondents under 65 years old, females, those with an ethnical background other than Hispanic, African-American, Asian or Non-Hispanic Whites, having a higher educational level, living in large metropolitan areas and having a private health insurance.
I only just came across the announcements for two conferences that made me almost speachless:
No 1 Homeopathy in Cancer Care – Aug. 29, 2024
Hosted by the newly formed Special Interest Group (SIG) on Research in Homeopathy in Cancer Care, this webinar aims to shed light on the role of homeopathy in cancer care, focusing on both its research status and practical applications in supportive treatment.
Supportive and palliative care are pivotal components of cancer treatment, offering avenues to enhance quality of life and potentially extend survival rates. Homeopathy emerges as a prominent integrative modality embraced by patients worldwide, notably in Europe, India, and Latin America. Despite varying perspectives on its efficacy, homeopathy’s emphasis on empathic listening and its unique approach to symptom management garner significant attention.
In the United States, homeopathy’s popularity surged during the 1990s, with over 5 million people reported to have used it by 2015. While some attribute its effects to a placebo response, clinical studies suggest tangible benefits in cancer care, particularly in alleviating symptoms like fatigue, anxiety, and hot flashes. Homeopathy is one of the leading integrative oncology modalities in Europe. Observations from France reveal that homeopathy supplements conventional treatments in about 30% of cancer patients, yielding notable improvements in symptomatology. Homeopathy was the most commonly used integrative therapy in cancer care in Belgium and in the top five in six other countries Turkey, Czech Republic, Sweden, Italy, Spain, and Greece. (Molassiotis 2005)
The speakers are:
Dr. Moshe Frenkel is a clinical associate professor at the University of Texas and founder of the Integrative Medicine Clinic, at The University of Texas M. D. Anderson Cancer Center, Houston Texas where he served as a full faculty until he returned to Israel in 2010. Up to 2014 Dr Frenkel was chairing the clinical practice committee of The Society of Integrative Oncology and was acting as the chair of The Israeli Society of Complementary Medicine (A section of The Israel Medical Association) until 2016. Currently, Dr Frenkel is the medical director of the Integrative Oncology Service in RAMBAM Medical Center Oncology Department, a comprehensive oncology center and the largest in Northern Israel, as well as leading a feasibility study in homeopathy in cancer care.
Elio Rossi, MD will provide a brief overview of his practice and discuss symptom management, particularly focusing on radio dermatitis and leading homeopathic remedies that he utilizes. Director of the homeopathy outpatient clinic at the Campo di Marte public hospital in Lucca Italy, was established in 1998 and to date more than 7,500 patients have been consecutively examined. Of these 1100 are cancer patients who required an ‘integrated’ homeopathic treatment to reduce the adverse effects of anti-cancer therapies and improve their quality of life. Works as a homeopathic doctor and expert in integrative medicine, collaborating with a local oncologist. Collaborated as Co-Chair, in the organization of many national and international congresses on Integrative Oncology (2017, 2019), specific sessions within other congresses organized in Italy (ECIM 2012 Florence, WCIMH 2023 Rome) and regional workshops, which have been attended by hundreds of CIM experts and oncologists.
Jean Lionel Bagot, MD will share insights from his practice, focusing on homeopathic remedies for fatigue and potential remedies for skin afflictions. A specialist in integrative cancer supportive care treatments in private practice as well as coordinating doctor of the Outpatients Department for Integrative Care in Groupe Hospitalier Saint Vincent Strasbourg, France; President of the International Homeopathic Society of Supportive Care in Oncology (SHISSO); Scientific officer of the French Society for Integrative Oncology (SFOI); Associated Member of the University College of Integrative and Complementary Medicine (CUMIC); Lecturer in the Medicine and Pharmacy Faculty in Strasbourg University.
Elizabeth Thompson, MD will have the opportunity to briefly describe her previous NHS practice and discuss symptom management, specifically addressing hot flushes and leading homeopathic remedies. Homeopathic Physician in NHS, NCIM Founder, CEO & Integrative Medicine Doctor, National Centre for Integrative Medicine (NCIM) www.ncim.org.uk, Chair, Integrative and Personalized Medicine Congress, London, June 2022. Past President ECIM 2021 and Board Member European Society Integrative Medicine, Council Member British Society of Integrative Oncology, Council Member College of Medicine.
No 2: “Pushing the Boundaries” Yes to Life Annual Conference 2024, 28th September
Integrative Medicine is a living, rapidly expanding science, with new understandings and potential being unveiled on a daily basis. This year’s conferences – one online in the Summer, and one in-person in the Autumn – share the title ‘Pushing the Boundaries’, as we have decided to devote them both to looking at the latest developments in Integrative Medicine, across the board. So that includes new techniques, new scientific understandings, and new applications for existing therapies, and you’ll be hearing fresh insights from some of your most trusted clinicians and scientists, and led into unfamiliar territory by pioneering speakers who may be as yet unfamiliar. The conferences are being co-created by Patricia Peat from Cancer Options and the Peat Institute and Yes to Life, with the aim of sending our audiences home with a wealth of resources on which to be able to draw for their own needs. Both events will be priced for accessibility, and the in-person Autumn Conference will include an extensive Exhibition that will offer yet more knowledge and resources to delegates.
The speakers are:
- Dr Penny Kechagioglou MBBS (Honours), MRCP, CCT (Clin Onc), MPH, MBA Clinical oncologist
- Dr Britt Cordi PhD
- Dr Robert Verkerk MSc DIC PhD FACN
- Robin Daly Yes to Life Founder and Chairman
- Patricia Peat Founder of Cancer Options
- Mark Sean Taylor Patient Led Oncology Founder
_____________________________
Yes, you remembered correctly: some of the speakers have in the past featured on this blog, e.g.:
- Dr Elizabeth Thompson, NCIM Holistic Doctor & Clinical Lead, says she has had the coronavirus and recommends homeopathy
- When orthodox medicine has nothing more to offer
- Homeopathy in Bristol: from bad to dismal
- Robert Verkerk (Alliance for Natural Health) at his finest
- Corona pandemic: What Quacks Don’t Tell You
Crucially, we have encountered the YES TO LIFE charity:
- Survive cancer, but not thanks to this charity called ‘SURVIVE CANCER’
- Is the promotion of dubious therapies a charitable activity? The Charity Commission wants to know
- Uncharitable charities? The example of ‘YES TO LIFE’
But please do not let me spoil your enthusiasm of attending these meetings!
I do mean it: can someone please attend?
I offter a guest post to any critical thinker who wants to write up his/her experience.
GOOD LUCK
The American Society of Clinical Oncology (ASCO) and the Society for Integrative Oncology have collaborated to develop guidelines for the application of integrative approaches in the management of:
- anxiety,
- depression,
- fatigue,
- use of cannabinoids and cannabis in patients with cancer.
These guidelines provide evidence-based recommendations to improve outcomes and quality of life by enhancing conventional cancer treatment with integrative modalities.
All studies that informed the guideline recommendations were reviewed by an Expert Panel which was made up of a patient advocate, an ASCO methodologist, oncology providers, and integrative medicine experts. Panel members reviewed each trial for quality of evidence, determined a grade quality assessment label, and concluded strength of recommendations.
The findings show:
- Strong recommendations for management of cancer fatigue during treatment were given to both in-person or web-based mindfulness-based stress reduction, mindfulness-based cognitive therapy, and tai chi or qigong.
- Strong recommendations for management of cancer fatigue after cancer treatment were given to mindfulness-based programs.
- Clinicians should recommend against using cannabis or cannabinoids as a cancer-directed treatment unless within the context of a clinical trial.
- The recommended modalities for managing anxiety included Mindfulness-Based Interventions (MBIs), yoga, hypnosis, relaxation therapies, music therapy, reflexology, acupuncture, tai chi, and lavender essential oils.
- The strongest recommendation in the guideline is that MBIs should be offered to people with cancer, both during active treatment and post-treatment, to address depression.
The authors concluded that the evidence for integrative interventions in cancer care is growing, with research now supporting benefits of integrative interventions across the cancer care continuum.
I am sorry, but I find these guidelines of poor quality and totally inadequate for the purpose of providing responsible guidance to cancer patients and carers. Here are some of my reasons:
- I know that this is a petty point, particularly for me as a non-native English speaker, but what on earth is an INTEGRATIVE THERAPY? I know integrative care or integrative medicine, but what could possibly be integrative with a therapy?
- I can vouch for the fact that the assertion “all studies that informed the guideline recommendations were reviewed” is NOT true. The authors seem to have selected the studies they wanted. Crucially, they do not reveal their selection criteria. I have the impression that they selected positive studies and omitted those that were negative.
- The panel of experts conducting the research should be mentioned; one can put together a panel to show just about anything simply by choosing the right individuals.
- The authors claim that they assessed the quality of the evidence, yet they fail to tell us what it was. I know that many of the trials are of low quality and their results therefore less than reliable. And guidance based on poor-quality studies is misguidance.
- The guidelines say nothing about the risks of the various treatments. In my view, this would be essential for any decent guideline. I know that some of the mentioned therapies are not free of adverse effects.
- They also say nothing about the absolute and relative effect sizes of the treatments they recommend. Such information would ne necessary for making informed decisions about the optimal therapeutic choices.
- The entire guideline is bar any critical thinking.
Overall, these guidelines provide more an exercise in promotion of dubious therapies than a reliable guide for cancer patients and their carers. The ASCO and the Society for Integrative Oncology should be ashamed to have given their names to such a poor-quality document.
