A Review of Integrative Medicine in Gynaecological Oncology

Abstract

In recent years complementary and alternative medicine (CAM) has increasingly been the focus of international research. Numerous subsidised trials (7903) and systematic reviews (651) have been published, and the evidence is starting to be integrated into treatment guidelines. However, due to insufficient evidence and/or insufficient good quality evidence, this has mostly not translated to practice recommendations in reviews by the Cochrane collaboration gynaecology group. There is nevertheless a not insignificant number of CAM providers and users. The percentage of oncology patients who use CAM varies between 5 and 90?%. Doctors have been identified as the main providers of CAM. Half of gynaecologists offer CAM because of personal conviction or on suggestion from colleagues. This must be viewed in a critical light, since CAM is mostly practiced without appropriate training, often without sufficient evidence for a given method ? and where evidence exists, practice guidelines are lacking ? and lack of safety or efficacy testing. The combination of patient demand and lucrativeness for doctors/alternative medicine practitioners, both based on supposed effectiveness CAM, often leads to its indiscriminate use with uncertain outcomes and significant cost for patients. On the other hand there is published, positive level I evidence for a number of CAM treatment forms. The aim of this article is therefore to review the available evidence for CAM in gynaecological oncology practice. The continued need for research is highlighted, as is the need to integrate practices supported by good evidence into conventional gynaecological oncology.

Evaluating the Demand for Integrative Medicine Practices in Breast and Gynecological Cancer Patients

“…Patients' characteristics significantly associated with the wish for integration of complementary healing approaches are mainly the same, namely age, education, employment, and usage of CAM. This is concordant with the literature [5,6,8,39] and suggests that patients inclined towards one of the supportive services are very likely to be interested in integrative medicine in general.…”

“…As conventional medical care does not always satisfactorily relieve these symptoms, patients frequently turn to complementary alternative medicine (CAM) concepts in their search for alleviation [5,6,7]. Research highlights various other reasons why cancer patients opt for health approaches which fall outside the sphere of conventional medical care: the wish to enhance the body's ability to fight the cancer, the desire to promote healing processes and to improve physical and emotional well-being, and the hope to augment the effectiveness of regular cancer therapy [5,6,7,8]. In response to that, the field of integrative oncology (IO) has emerged, a discipline that embraces conventional and evidence-based complementary therapies.…”

“…In response to that, the field of integrative oncology (IO) has emerged, a discipline that embraces conventional and evidence-based complementary therapies. IO represents a more holistic approach to oncological treatment [8,9,10] which considers all factors that affect health, including mind, emotions, lifestyle, and body [9,11]. The spectrum of IO is broad and may encompass supportive care services such as nutritional and psychological counseling or sports rehabilitation.…”

“…Especially in the case of CAM, simultaneous use alongside conventional therapy might interfere with or even compromise the effects of standard treatment, particularly since patients often do not disclose their CAM use to their oncologists [8,34]. …”

Analysis of Oncological Second Opinions in a Certified University Breast and Gynecological Cancer Center in Relation to Complementary and Alternative Medicine

“…The term "integrative medicine" is becoming increasingly common both in Anglo-American usage and in Germany. Integrative medicine implies the addition of scientifically tested complementary methods to evidence-based medicine [6]; for example, in the field of oncology, the Society of Integrative Oncology (SIO) uses the following definition for integrative oncology: "Integrative oncology is a patient-centered, evidence-informed field of cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside conventional cancer treatments. Integrative oncology aims to optimize health, quality of life, and clinical outcomes across the cancer care continuum and to empower people to prevent cancer and become active participants before, during, and beyond cancer treatment."…”