מאמר מסכם על רפואה אלטרנטיבית ומשלימה - חלק א'

אודה לדר' ברנר אם יתרגם את עיקרי הדברים. להלן קטעים מהמאמר הארוך. Chest. 2007 Sep;132(3 Suppl):340S-354S. Complementary therapies AND integrative oncology in lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Cassileth BR, Deng GE, Gomez JE, Johnstone PA, Kumar N, Vickers AJ; American College of Chest Physicians. Laurance S. Rockefeller Chair in Integrative Medicine, Chief, Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center, 1429 First Ave at Seventy-Fourth St, New York, NY 10021, USA. [email protected] BACKGROUND: This chapter aims to differentiate between "alternative" therapies, often promoted falsely as viable options to mainstream lung cancer treatment, AND complementary therapies, adjunctive, effective techniques that treat symptoms associated with cancer AND its mainstream treatment, AND to describe the evidence base for use of complementary therapies.Methods AND design: A multidisciplinary panel of experts in oncology AND integrative medicine evaluated the evidence for complementary (not alternative) therapies in the care of patients with lung cancer. Because few complementary modalities are geared to patients with only a single cancer diagnosis, symptom-control research conducted with other groups of patients with cancer was also included. Data on complementary therapies such as acupuncture, massage therapy, mind-body therapies, herbs AND other botanicals, AND exercise were evaluated. Recommendations were based on the strength of evidence AND the risk-to-benefit ratio. RESULTS: Patients with lung AND other poor-outlook cancers are particularly vulnerable to heavily promoted claims for unproved OR disproved "alternatives." Inquiring about patients' use of these therapies should be routine because these practices may be harmful AND can delay OR impair treatment. Mind-body modalities AND massage therapy can reduce anxiety, mood disturbance, AND chronic pain. Acupuncture assists the control of pain AND other side effects AND helps reduce levels of pain medication required. Trials of acupuncture for chemotherapy-induced neuropathy AND postthoracotomy pain show promising results. Herbal products AND other dietary supplements should be evaluated for side effects AND potential interactions with chemotherapy AND other medications. CONCLUSIONS: Complementary therapies have an increasingly important role in the control of symptoms associated with cancer AND cancer treatment. Introduction A distinction between "complementary" AND "alternative" therapies is required. Complementary therapies, used as adjuncts to mainstream care, are supportive measures that help control symptoms, enhance well-being, AND contribute to overall patient care.1 Alternative therapies, conversely, are often unproved OR disproved, promoted for use instead of mainstream treatment, OR are offered as viable therapeutic options. This is especially problematic in oncology, when delayed treatment can diminish the possibility of remission AND cure.2 Over time, some complementary therapies are proven safe AND effective. These become integrated into mainstream care, producing integrative oncology, a combination of the best of mainstream cancer care AND rational, data-based, adjunctive complementary therapies.3 Most complementary therapies are not specific to a particular cancer diagnosis. Instead, they are used typically to treat symptoms shared by patients across most cancer diagnoses. This is generally appropriate because symptoms tend to stem less from the primary diagnosis than from involvement of a particular organ OR toxicities associated with treatment, which evoke similar symptoms in patients across cancer diagnoses. For example, bone metastases cause pain regardless of whether the primary lesion was from breast OR prostate; chemotherapy-induced nausea AND vomiting are associated more closely with the emetogenic potency of the drug used than with the underlying cancer diagnosis. In these guidelines, we summarize data relevant to clinical problems encountered by patients with lung cancer AND make practical recommendations based on the strength of the evidence. The use of complementary therapies is common among cancer patients. "Alternative therapies" draw a far smaller percentage of patients but remain a serious problem. The difference between "complementary" AND "alternative" therapies is important AND essential to recognize. "Alternative" therapies are typically promoted as literal, viable options for use in lieu of mainstream care. They are not. There are no viable "alternatives" to mainstream care. Instead, these are bogus products AND regimens that draw patients with unsubstantiated, often fanciful, claims of easy cure. Typically they are unproven OR disproved, invasive, AND biologically active. Such "alternatives" are heavily promoted to all patients with all cancer diagnoses, AND patients with lung AND other poor-outlook cancers are particularly vulnerable. Taking dietary supplements can be beneficial in some circumstances AND harmful in others. Supplementation of vitamin B12 AND folic acid is required in patients receiving pemetrexed treatment. A strong recommendation is made for dietary supplements used by patients, particularly herbal products, to be evaluated for side effects AND potential interaction with other drugs. Those that are likely to interact with chemotherapeutic agents should not be used during chemotherapy. It is strongly recommended that patients be advised to avoid the use of "alternative" therapies in lieu of mainstream care. Such practice can lead to significant harm to lung cancer patients because it delays effective treatment AND causes unpredictable adverse effects. Despite the long history of many complementary therapies, only a few have been evaluated with modern scientific research tools in a handful of indications. A large gap exists between our current level of scientific evidence AND what we need to provide evidence-based advice. More rigorous scientific research is being conducted to enrich our knowledge base. Meanwhile, the risk-to-benefit ratio associated with the strong recommendations noted is consistent with good clinical care. In the context of a devastating diagnosis that most patients do not survive, nontoxic complementary therapies can successfully provide symptom relief to lung cancer patients. 15. It is recommended that patients be advised to avoid therapies promoted as "alternatives" to mainstream care. Grade of recommendation, 1A Rationale AND Evidence: Alternative therapies that claim to improve survival have largely been demonstrated to be ineffective in clinical trials.106 Randomized trials have shown no benefit or, in some cases, shorter survival for high-dose vitamin C,107108 shark cartilage,109 hydrazine sulfate,110111112113 AND mistletoe extracts.114115116117 Cohort OR phase II studies have shown no benefit to DiBella therapy,118119 antineoplastons,120 Livingston-Wheeler therapy,121 amygdalin,122 AND Pau D’arco.123 In a population-based study,124 patients using alternative therapy have been shown to have shorter survival, after adjustment for known prognostic factors, than those avoiding such therapies.

כנ"ל. Conclusion The use of CAM is common among cancer patients. These therapies are very diverse in their origin, theory, practice, safety, AND efficacy. Some of the therapies have been shown in studies to be helpful in reducing symptoms experienced by cancer patients. These complementary therapies (used as adjuncts to mainstream cancer treatment) are increasingly integrated into regular oncologic care, leading to integrative oncology. Dietary supplements, herbs, AND other botanicals can be problematic because of their adverse effects OR interactions with chemotherapy, radiotherapy, OR surgery. There are those therapies promoted as "alternative" to mainstream cancer treatment. Patients who use these "alternative" therapies are at risk for missing the window of opportunity for effective treatment. It is important for all involved in the care of cancer patients to help patients distinguish between the two, AND to approach complementary AND alternative therapies appropriately to receive benefit while avoiding harm. Specific advice should be provided after considering the level of evidence AND the risk-to-benefit ratio. Health-care professionals should know where to find reliable sources of information. SUMMARY OF RECOMMENDATIONS 1. It is recommended that all patients with lung cancer be specifically asked about the use of CAM. Grade of recommendation, 1C 2. It is recommended that all patients with lung cancer be given guidance about the advantages AND disadvantages of complementary therapies in an open, evidence-based, AND patient-centered manner by a qualified professional. Grade of recommendation, 1C 3. In lung cancer patients, mind-body modalities are recommended as part of a multimodality approach to reduce anxiety, mood disturbances, OR chronic pain. Grade of recommendation, 1B 4. In lung cancer patients experiencing anxiety OR pain, massage therapy delivered by an oncology-trained massage therapist is recommended as part of a multimodality treatment approach. Grade of recommendation, 1C 5. The application of deep OR intense pressure is not recommended near cancer lesions OR anatomic distortions, such as postoperative changes, as well as in patients with a bleeding tendency. Grade of recommendation, 2C 6. For lung cancer patients, therapies based on putative manipulation of bioenergy fields are not recommended. Grade of recommendation, 1C 7. Acupuncture is recommended as a complementary therapy when pain is poorly controlled OR when side effects, such as neuropathy OR xerostomia from other modalities, are clinically significant. Grade of recommendation, 1A 8. Acupuncture is recommended as a complementary therapy when nausea AND vomiting associated with chemotherapy are poorly controlled. Grade of recommendation, 1B 9. Electrostimulation wristbands are not recommended for managing chemotherapy-induced nausea AND vomiting. Grade of recommendation, 1B 10. When the patient with lung cancer does not stop smoking despite use of other options, a trial of acupuncture is recommended to assist in smoking cessation. Grade of recommendation, 2C 11. In patients with lung cancer with symptoms such as dyspnea, fatigue, chemotherapy-induced neuropathy, OR postthoracotomy pain, a trial of acupuncture is recommended. Grade of recommendation, 2C 12. In patients with a bleeding tendency, it is recommended that acupuncture be performed by qualified practitioners AND used cautiously. Grade of recommendation, 1C 13. It is recommended that dietary supplements, particularly herbal products, be evaluated for side effects AND potential interactions with other drugs. Those that are likely to interact with other drugs, such as chemotherapeutic agents, should not be used concurrently during chemotherapy OR radiation, OR before surgery. Grade of recommendation, 1B 14. In patients with lung cancer who either do not respond to OR decline antitumor therapies, it is recommended that use of botanical agents occur only in the context of clinical trials. Grade of recommendation, 1C 15. It is recommended that patients be advised to avoid therapies promoted as "alternatives" to mainstream care. Grade of recommendation, 1A

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