支持性癌症治疗结合患者个体化辅助医疗减轻胃肠症状和顾虑

Clin Nutr. 2015 Dec;34(6):1215-23.

Alleviating gastro-intestinal symptoms and concerns by integrating patient-tailored complementary medicine in supportive cancer care.

Ben-Arye E, Aharonson ML, Schiff E, Samuels N

Clalit Health Services, Haifa and Western Galilee District, Israel.

Technion-Israel Institute of Technology, Haifa, Israel.

Bnai-Zion Hospital, Haifa, Israel.

The International Center for Health, Law and Ethics, Haifa University, Israel.

Sheba Medical Center, Tel Hashomer, Israel.

BACKGROUND & AIMS: Chemotherapy-induced gastrointestinal (GI) toxicities often impair quality-of-life (QOL) and require reduction of the chemotherapy dose intensity. We explored the effects of a complementary integrative medicine (CIM) therapeutic process, administered in conjunction with conventional supportive care, on GI-related symptoms and concerns in patients undergoing chemotherapy.

PATIENTS AND METHODS: We conducted a prospective, pragmatic study among patients undergoing chemotherapy referred by their healthcare providers to a CIM-trained integrative physician (IP) for consultation, followed by CIM treatments. Symptom severity and patient concerns were assessed at baseline and at an IP follow-up visit at 6-12 weeks, using the Edmonton Symptom Assessment Scale (ESAS) and the Measure Yourself Concerns and Wellbeing (MYCAW) questionnaires. Adherence to the integrative care (AIC) program was defined as attendance of ≥4 CIM treatments, with ≤30 days between sessions.

RESULTS: Of the 308 patients referred to the IP consultation, 275 (89.3%) expressed GI symptoms and concerns, 189 of whom attended the follow-up IP assessment. Of these, 144 (46%) were found to be adherent to the treatment plan (AIC group). Repeated measure analysis indicated a statistical interaction between baseline and follow-up scores, for ESAS (appetite, p = 0.005; drowsiness, p = 0.027; shortness of breath, p = 0.027; and sleep, p = 0.034) and for MYCAW outcomes. This when comparing the AIC to the non-AIC group responses. Reduction of GI concerns (p = 0.024) was greater among patients in the AIC group (MYCAW questionnaire), with significantly less chemotherapy-related hospitalizations found in this group (p = 0.008). The participation of a registered dietitian during CIM treatments led to greater reduction in nausea (from 4.24 to 1.85 vs. 2.73 to 1.36, respectively; p = 0.017).

CONCLUSIONS: Integration of CIM with standard supportive care, especially in patients adhering to the CIM treatment regimen, may help reduce chemotherapy-induced GI symptoms and concerns, as well as QOL-related non-GI symptoms. Further research is needed in order to explore the effects of specific CIM modalities on GI symptoms and concerns during chemotherapy.

KEYWORDS: Appetite; Chemotherapy; Complementary and alternative medicine; Integrative medicine; Nutrition; Quality of life

PMID: 25556349

DOI: 10.1016/j.clnu.2014.12.011