A perspective on complementary/alternative medicine use among survivors of hematopoietic stem cell transplant: Benefits and uncertainties

Abstract

The widespread use of complementary and alternative medicine (CAM) in cancer survivors is well known despite a paucity of scientific evidence to support its use. The number of survivors of hematopoietic stem cell transplant (HCT) is growing rapidly and HCT clinicians are aware that many of their patients use CAM therapies consistently. However, due to a paucity of data regarding the benefits and harms of CAM therapies in these survivors, clinicians are reluctant to provide specific recommendations for or against particular CAM therapies. A systematic literature review was conducted with a search using PubMed, the Cochrane Database of Systematic Reviews, and Ovid online for each CAM therapy as defined by the National Center of Complementary and Alternative Medicine. The search generated 462 references, of which 26 articles were deemed to be relevant for the review. Due to extensive heterogeneity in data and limited randomized trials, a meta‐analysis could not be performed but a comprehensive systematic review was conducted with specified outcomes for each CAM therapy. In randomized controlled trials, certain mind and body interventions such as relaxation were observed to be effective in alleviating psychological symptoms in patients undergoing HCT, whereas the majority of the other CAM treatments were found to have mixed results. CAM use is an understudied area in HCT survivorship and clinicians should convey the benefits and uncertainties concerning the role of CAM therapies to their patients. Cancer 2015;121:2303–2313. © 2015 American Cancer Society.

National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Patient-Centered Outcomes Working Group Report

“…The most frequently tested interventions in randomized clinical trials include exercise (148, 157–161), cognitive behavioral therapy (149, 152, 162), and mind-body practices with stress management (161, 163–165). Multiple randomized trials of these interventions have shown small to moderate benefits in improving HRQOL, and reducing fatigue and psychological distress in HCT recipients.…”

“…Multiple randomized trials of these interventions have shown small to moderate benefits in improving HRQOL, and reducing fatigue and psychological distress in HCT recipients. However, interventions vary substantially in intensity from self-directed programs to highly supervised one-on-one specialist involvement (148, 149, 157, 160, 163). Notably, higher-intensity interventions with substantial interventionist input yielded larger and more significant and enduring benefits (149, 163).…”

Epidemiology of complementary and alternative medicine therapy use in allogeneic hematopoietic stem cell transplant survivorship patients in Australia

“…It is also possible that by increasing polypharmacy and the pill burden experienced by allogeneic HSCT survivors (a group already taking a large number of supportive care medications), CAM therapies may also increase the likelihood of nonadherence . Alternatively, several randomized controlled studies, particularly mind and body interventions were found to have potential benefits in this patient group . For example, Takatsuka et al.…”

“…It is also possible that by increasing polypharmacy and the pill burden experienced by allogeneic HSCT survivors (a group already taking a large number of supportive care medications), CAM therapies may also increase the likelihood of nonadherence [18]. Alternatively, several randomized controlled studies, particularly mind and body interventions were found to have potential benefits in this patient group [9]. For example, Takatsuka et al demonstrated a beneficial effect of fish oil on the incidence of graft-versus-host disease (GVHD) in patients after HSCT [19] and two studies have found a significant positive correlation between massage therapy and a decline in anxiety and depression level in patients after HSCT [20,21].…”

Biological Effects of Music in Cancer Patients: Contributing to an Evidence-Based Practice

“…15 A case-control study reported that patients with cancer facing stem-cells transplant affirmed reduction of pain after relaxation sessions with music. 11 A Hawaiian integrative review and a American systematic review described reduction of pain during venous and lumbar puncture, respectively, in children with cancer. 18,19 A German systematic review and meta-analysis reported results of pain easing due to use of music still in the preoperative period.…”