30 april 2017: Er is een update beschikbaar van de richtlijnen zoals hieronder beschreven en gepubliceerd na een nieuw studierapport dat gratis is in te zien: Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment

Het studierapport is gedetailleerd en koppelt bewijzen aan studie rapporten. (zie meer informatie onder dit schema gehaald uit het rapport. Maar er is veel meer omschreven in dit studierapport. Referentielijst van ruim 400 studies waarmee de nummering in onderstaand document corresponderen staat onderaan artikel:

Table 3. Clinical Outcomes and Integrative Therapies With Insufficient Evidence to Form a Clinical Recommendation (I-Statement)a
OUTCOMEINTEGRATIVE THERAPIES

  1. Abbreviations: CoQ10, coenzyme 10Q; CYCLO 3 FORT, fluid extract of Ruscus aculeatus, hesperidin methyl chalcone, and vitamin C; LCS101, a botanical compound mixture; RG-CMH, a Chinese medicinal herb complex. aDefinition of the I Statement: Concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined. Read the Clinical Considerations section of the US Preventive Services Task Force Recommendation Statement. If the service is offered, then patients should understand the uncertainty about the balance of benefits and harms. bSuppliers for these topicals are as follows: Aquaphor (Beiersdorf AG, Hamburg, Germany), Biafine (Laboratoire Medix, Houdan, France), and RadiaCare (Medline Industries, Inc., Northfield, IL). cRayGel is a proprietary glutathione and anthocyanin gel.
Adherence Acupressure,[198] multimodal[199]
Anemia LCS101 combination botanical,[200] RG-CMH combination botanical,[201] shenqi fuzheng injection[202]
Anxiety/stress reduction Art therapy,[203, 204] comprehensive coping strategy,[205] electrical nerve stimulation,[206] healing touch,[94, 207] hypnosis,[208] myofascial release,[209] multimodal,[210, 211] reflexology,[138, 139, 212] reiki,[213] tai chi[214]
Cardiomyopathy N-acetylcysteine[215]
Chemotherapy-induced nausea and vomiting Acupressure,[216] aromatherapy,[217] Agaricus sylvaticus,[218] Cocculine (complex homeopathic Rx),[219] comprehensive coping strategy,[205] massage,[52] Nevasic audio program,[220] yoga[43]
Cognition Natural environment,[221] Ginkgo biloba,[222] meditation,[72] yoga[223]
Constipation Self-management program[224]
Depression/mood Art therapy,[203] Biofield Healing,[225] comprehensive coping strategy,[205] CoQ10,[226] electrical nerve stimulation,[206] Gandoderma lucidium,[227] guarana,[108] hypnosis,[228] multimodal,[199, 210, 229, 230] myofascial release,[209] qigong,[135] reflexology,[138, 139] tai chi[214]
Fatigue Acupressure,[198] acupuncture,[50, 231, 232] Biofield Healing,[225] comprehensive coping strategy,[205] CoQ10,[226] Gandoderma lucidium,[227] light treatment,[233] massage,[87] meditation,[72, 76] mind-body cognitive therapy,[234] movement,[235] multimodal,[230, 236, 237] multivitamin,[238] polarity therapy,[239, 240] stress management,[241] qigong,[135] reflexology,[139] relaxation,[242, 243] stress management,[36] yoga[40, 46-48, 79, 83]
Lymphedema CYCLO 3 FORT,[244] electrotherapy,[245] ginkgo forte,[246] pentoxifyline and vitamin E,[247, 248] yoga[249]
Neuropathy Omega 3 fatty acids,[250] vitamin E,[251, 252] acupuncture[130]
Neutropenia/leukopenia Cat's claw,[253] LCS101 combination botanical,[200] RG-CMH combination botanical,[201] mistletoe,[133, 134] shenqi fuzheng injection[202]
Pain Comprehensive coping strategy,[205] stress management,[36] vitamin D2,[254] electrical nerve stimulation,[206] cognitive and behavioral therapy,[255] hypnosis,[256] massage,[88] myofascial release,[209] reflexology[139, 212]
Quality of life Acupressure,[216] Biofield Healing[225] calendula cream,[257] cannabis,[258] chlorella extract,[259] CoQ10,[226] curcuminoids,[260] electrical nerve stimulation,[206] electrotherapy,[245] flaxseed,[261] Ganoderma lucidum,[227] gingko forte,[246] guided imagery,[262] healing touch,[94] homeopathy,[263-265] hypnosis,[97] laser therapy,[111] manual lymphatic draining,[113] massage,[87] meditation,[26, 72] movement,[235, 264] music therapy,[89] multimodal,[199, 210, 230, 236, 237, 267] multivitamin,[238] polarity therapy,[239, 240] relaxation,[69, 77] shenqi fuzheng,[202] shark cartilage,[268] soy,[149] supportive-expressive group therapy,[269] tai chi[214, 270-272]
Physical functioning Mind-body cognitive therapy,[234] music therapy,[33] multimodal,[199] myofascial release,[209] reflexology,[139] stress management,[37] tai chi,[270, 272] yoga[45, 79, 84, 273]
Radiation therapy-induced toxicity outcomes Adlay bran extract,[274] alpha ointment with henna,[275] Aquaphor-Biafine-Radiacare,[276]b boswellia cream,[277] calendula cream,[257, 278] chamomile,[279] curcumin,[280] glutamine,[281] homeopathic pills,[282] honey,[283, 284] hydration,[285] massage,[286] oil-in-water emulsion,[287], glutathione and anthocyanin gel,[288]c wheat grass extract,[289] pentoxifylline and vitamin E[290, 291]
Sleep disturbance Acupuncture,[49, 50, 129] calendula cream,[257] meditation,[72, 292-294] qigong,[135] stress-management techniques[36]
Vasomotor outcomes Black cohosh,[295, 296] flaxseed,[261] homeopathy,[264, 265] hypnosis,[297] magnetic therapy,[298] meditation,[73] peppermint,[299] vitamin E,[300] yoga[104, 301]

Zie verder hieronder

5 april 2016  Klikt u op de volgende link voor het volledige studierapport: Clinical practice on the use of integrative therapies as supportive care in patients treated for breast cancer hieronder beschrijven we de inhoud van dit rapport welke zeker niet alleen geld voor borstkanker maar naar mijn mening voor bijna alle vormen van kanker al moet u dit wel bespreken met uw begeleidende complementair werkende arts.

Bron: the Journal of the National Cancer Institute Monographs.

Dat aanvullende niet-toxische behandelingen en middelen steeds meer terrein winnen bewijzen de nieuw gepubliceerde richtlijnen voor gebruik bij borstkanker. Let wel dit zijn richtlijnen voor toepassing in de reguliere oncologie. Maar zoals ook de onderzoekers opmerken zou er veel meer onderzoek moeten worden gedaan naar aanvullende niet-toxische middelen en behandelingen omdat veel bewijs simpelweg ontbreekt door te weinig grotere, kwalitatief goede studies. De meeste studies die werden gedaan waren te klein om echt als bewijs te dienen, aldus de onderzoekers. Onderaan dit artikel staat ook een link naar de richtlijnen voor fytotherapie (kruiden en plantenextracten enz.) bij kanker en specifiek aanvullende behandelingen en middelen voor longkanker.

U kunt ook zelf eens kijken in onze lijst voor borstkanker die we hebben geselecteerd uit de algemene literatuurlijst van arts-bioloog drs. Engelbert Valstar.  

acupuncture-s20-photo-of-sign-advertising-acupuncture

Een multidisciplinair team van auteurs van de Columbia's Mailman School of Public Health in New York City selecteerde 80 verschillende vormen van aanvullende behandelingen en 30 verschillende interventies en toetste deze op bewijs van effectiviteit. Afhankelijk van bewijs kregen de individuele behandelingen of middelen een graad A (de beste) graad B of graad C kwalificatie.  

"Dit verschafte ons een standaard instrument om de kracht van de data te meten en te interpreteren," aldus guideline first author Heather Greenlee, ND, PhD, assistant professor of epidemiology at Columbia's Mailman School of Public Health in New York City en president of the Society for Integrative Oncology.

Om de richtlijnen vast te stellen Dr Greenlee en haar collega's voerden een systematische review uit om gerandomiseerde studies naar Integrative Therapy (aanvullende niet-toxische behandelingen en middelen - complementair) te selecteren die als ondersteunende zorg voor borstkanker naast een reguliere behandeling waren uitgevoerd. Ze vonden 4900 studies in de periode van 1990 tot 2013. Slechts 203 studies voldeden aan de door hun gestelde criteria.

"Een probleem bij de beoordeling van de veiligheid en effectiviteit van aanvullende therapieën was het gebrek aan standaardisatie van interventies in studies met soortgelijke therapeutische benaderingen," aldus guideline coauthor Debu Tripathy, MD, professor and chair of breast medical oncology at MD Anderson Cancer Center in Houston, Texas. "Bovendien zijn sommige complementaire therapieën toegepast in verschillende stadia van de ziekte - beginnende versus gevorderde stadia van de ziekte en binnen een groot spectrum van de ernst van de symptomen - zodanig dat de klinische criteria voor een aantal andere therapieën niet zomaar daarmee kunnen worden vergeleken en toegepast." Aldus dr. Debu Tripathy.

Weinig graad A of B kwalificaties:

Van de vele onderzochte behandelingen en middelen kregen alleen meditatie, yoga en ontspanningstherapie de hoogste aanbeveling graad A voor behandelingen van angst en stemmingswisselingen. Deze zelfde behandelingen kregen ook graad B mee voor vermindering van stress, depressie en moeheid. ook acupunctuur kreeg graad B kwalificatie voor tegengaan van misseljkheid en overgeven bij chemotherapie. Muziektherapie en massage kregen ook graad B voor vermindering van angst en stemmingswisselingen.

In de richtlijnen staan weinig voedingsupplementen, omdat zoals eerder gezegd, er te weinig grotere kwalitatief goed opgezette studies zijn gepubliceerd.

Hier de richtlijnenlijst met de graad A en B kwalificaties zoals die door de Sopciety of Integrative Oncology is gepubliceerd:

Table. Grade A and B Recommendations

Modality Clinical Application Strength of Evidence
Meditation Recommended for treating mood disturbance and depressive symptoms in patients undergoing radiation therapy A
  Recommended for improving quality of life A
  Recommended for reducing anxiety in breast cancer patients and in those undergoing radiation therapy B
Relaxation Recommended for improving mood and depressive symptoms when added to standard care A
Yoga Recommended for improving mood in women undergoing radiation therapy and/or chemotherapy, and for fatigue in addition to standard care A
  Recommended for improving anxiety in the same group of patients (see above) B
Massage Recommended for improving mood disturbance posttreatment B
Music therapy Recommended for improving mood in newly diagnosed patients B
  Recommended for reducing anxiety during radiation and chemotherapy B
Stress management Recommended for reducing anxiety during treatment B
Energy conservation Recommended for treatment of fatigue B
Acupressure Can be considered for patients receiving chemotherapy as an addition to antiemetics to help control nausea and vomiting B
Electroacupuncture Can be considered for patients as an addition to antiemetics to control vomiting during chemotherapy B

 

Op de website van de SIO staat de volledige lijst: Clinical Practice Guidelines on the Use of Integrative Therapies as Supportive Care in Patients Treated for Breast Canceras Supportive Care in Patients Treated for Breast Cancer in een PDF file, dus ook de graad C en D en andere kwalificaties. Alles is gratis in te zien.

Andere richtlijnen op het gebied van aanvullende niet-toxische behandelingen en middelen (Integrative therapy) zijn deze twee. 1 over fytotherapie en 1 over Integrative therapy bij longkanker:

Al in 2009 gepubliceerd: SIO Guidelines, Evidence-Based Clinical Practice Guidelines for Integrative Oncology: Complementary Therapies and Botanicals.

En in 2013 SIO richtlijnen bij longkanker, Complementary therapies and integrative medicine in lung cancer: Diagnosis and management of lung cancer.

Hieronder het persbericht over de richtlijnen voor borstkanker en integrative therapy:

Specific integrative therapies can be recommended as evidence-based supportive care options during breast cancer treatment. Most integrative therapies require further investigation via well-designed controlled trials with meaningful outcomes.

Source: Integrative Oncology News

Report Card on Complementary Therapies for Breast Cancer

November 7, 2014 — Over eighty percent of breast cancer patients in the United States use complementary therapies following a breast cancer diagnosis, but there has been little science-based guidance to inform clinicians and patients about their safety and effectiveness. In newly published guidelines from the Society for Integrative Oncology, researchers at Columbia University’s Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center with colleagues at MD Anderson Cancer Center, University of Michigan, Memorial Sloan Kettering, and other institutions in the U.S. and Canada, analyzed which integrative treatments appear to be most effective and safe for patients. They evaluated more than 80 different therapies. 

Meditation, yoga, and relaxation with imagery were found to have the strongest evidence supporting their use. They received an “A” grade and are recommended for routine use for anxiety and other mood disorders common to breast cancer patients.  The same practices received a “B” grade for reducing stress, depression, and fatigue, but are also endorsed for most breast cancer patients. Acupuncture received a “B” grade for controlling chemotherapy induced nausea and vomiting and can be recommended to most patients.  More than 30 interventions, including some natural products and acupuncture for other conditions, had weaker evidence of benefit due to either small study sizes or conflicting study results, and received a “C” grade. Seven other therapies were deemed unlikely to provide any benefit and are not recommended.  One therapy was found to be harmful: acetyl-l-carnitine, which is marketed to prevent chemotherapy-related neuropathy, and actually increased risk for the condition.

Read more>>>>>http://www.integrativeonc.org/index.php/news/556-report-card-on-complementary-therapies-for-breast-cancer-2

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voedingsuppletie, dieet, voeding, Qijong, maretakinjecties, ginseng, acupunctuur, aanvullende behandelingen, complementair, borstkanker


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