By Faith Franz. Oncologists use several different factors to determine how well a patient will respond to treatment. Surgeons evaluate the stage and borders of a patient’s tumor to determine which patients are good candidates for surgery, while medical oncologists look for certain biomarkers to estimate how well a patient will respond to chemotherapy. Now, a new study indicates that doctors can predict quality of life (QoL) outcomes based on the patient’s nutritional status.
Mravec et al. (2008). Neurobiology of Cancer and Mind-Body Medicine’s Hypnotherapy
In this paper Mravec, Gidron, & Hulin, (2008) discuss some of the known facts about the nervous system and tumorigenesis, but also ask if the brain is capable of monitoring and/or modulating the creation of cancer cells (tumorigenesis). This is crucial especially if we would like to consider the mind-body modality of hypnotherapy to be utilized by cancer patients.
The Abstract:
The interactions between the nervous, endocrine and immune systems are studied intensively. The communication between immune and cancer cells, and multilevel and bi-directional interactions between the nervous and immune systems form the basis for a hypothesis assuming that the brain might observe and regulate the processes associated with the development and progression of cancer. The aim of this article is to describe the data supporting this hypothesis.
The Bottom Line:
According to Yapko (2003) the premise of hypnotherapy is “…the client has valuable abilities that are present but hidden, abilities that can be uncovered and used in a deliberate way to overcome symptoms and problems” (p. 18).
Division 30 of the American Psychological Association has this to say about hypnotherapy: “When using hypnosis, one person (the subject) is guided by another (the hypnotist) to respond to suggestions for changes in subjective experience, alterations in perception, sensation, emotion, thought or behavior” (Division 30, APA, n.d.).
As part of an assignment in one of my graduate hypnosis courses, I was asked to come up with my own interpretation of hypnotherapy, given that there seems to be no definitive answer so far. Based on the readings of Hammond (1998), Krippner (2004) and Yapko (2003) my working definition of hypnosis would be:
“Clinical Hypnosis is a COMMUNICATIONS technique between hypnotist and subject to AMPLIFY (to a possible power of a gazillion) the subject’s AWARENESS of his/her innate ability to heal and thus directly impact the subject’s physiology in order to overcome deliberately symptoms and problems.”
A more academically correct term would be to the nth power! I guess I like a gazillion, because it illustrates the scope and impact of hypnosis much better than nth power.
To continue down this path, lets look if hypnotherapy has ever been used successfully to bring about physiological changes in the body. One such physiological change that comes to mind is accelerated healing. Two papers, Ginandes, Brooks, Sando, Jones, & Aker (2003) and Ginandes & Rosenthal (1999) shed more light on the possibility. The lead author of both papers, Dr. Ginandes of Harvard Medical School, showed that subjects hypnotherapy groups experienced accelerated healing for postsurgical wound healing (2003) and the healing of bone fractures (1999). Dr. Dabney Ewin, M.D. (1983) of Tulane University, on the other hand, has extremely compelling cases for the efficacy of hypnosis in burn patients.
This brings me back to the article “Neurobiology of cancer: Interactions between nervous, endocrine and immune systems as a base for monitoring and modulating the tumorigenesis by the brain by Mravec et al. (2008).
The authors start with a brief review of the neuro-endocrine-immune interaction as the base for the neurobiology of peripheral diseases such as cancer. Mravec et al. (2008) cite research that points towards the existence of a “sixth sense” so to speak, that is able to detect signals that otherwise are undetectable by the body’s five senses.
They say
“The role of the immune system in tumorigenesis is of relevance to the CNS [central Nervous system] since the nervous and immune systems can bi-directionally communicate by using a conventional chemical language employing peptide and non-peptide neurotransmitters, hormones, cytokines and common receptors” (p.151).
Then Mravec et al. (2008) go on to elaborate on known clinical and experimental data that substantiate the notion that the brain monitors and modulates the creation of cancer cells.
They cite different animal studies which“…might support the assumption that CNS receives signals related to tumorigenesis” (p. 152), before elaborating on human studies that show differences in the activity of brain regions, such as “… reduced prefrontal activation in cancer patients versus control…” (p. 152).
Mravec et al. (2008) then go on to explain their views on the impact of psychosocial factors and stress on cancer incidence and progression. I will elaborate on these in a future post, as they deserve independent analysis.
This brings us to part three of their paper (my favorite) titled “Nervous system and tumorigenesis: questions, assumptions, and hypotheses” (Mravec et al., 2008, p. 154).
The immune system’s sensory functions to detect and monitor tumor cells and Mravec et al. (2008) hypothesize that the cancer cells release molecules that might serve as messengers to directly “inform” (p. 154) the brain about the state of the creation of cancer cells.
Mravec et al. (2008) explore two indirect pathways, a slow, less informative, non-specific humoral pathway. Cytokines are part of this pathway and the authors go on to say that cytokines stimulate the production of prostaglandins, which in turn might be “…crucial messengers that constitute the links between circulatory cytokines and CNS” (p. 154).
The other indirect pathway mentioned by the authors is the neural pathway, which might be exceedingly location-specific and fast. In other words, the immune system can reach the CNS via peripheral nerves with cytokines playing a significant role, as well. This is illustrated by data that show “…vagal sensory neurons themselves express mRNA for IL-1 receptors, suggesting a direct reaction of afferent vagal fibers to peripheral IL-1” (Mravec et al., 2008, p. 154). This means that cytokines might activate the vagus nerve to disseminate information from the immune system to the CNS.
One last example I’ll list here is a situation in which levels of pro-inflammatory cytokines are low, but nonetheless, somehow these low levels of cytokines are able to contribute to the formation of cancer cells. This involves paraganglia (visceral sensors) that support the transmission of data from the immune system to the brain via the vagus nerve. These structures contain cells that are able to manifest IL-1 receptors, providing a vital link between immune and nervous system (Mravec et al., 2008).
What about direct transmission of information about cancer to the brain?
Mravec et al. (2008) speculate that chemical compounds during tumorigenesis provide enough information to the brain in order for the brain to recognize cancer cells. While uncertain, Mravec et al. (2008) speculate that there might a signaling model specific to tumorigenesis at play, which would allow the brain to “detect” cancers.
Because of this “detection” Mravec et al. (2008) speculate that tumorigenesis could be modulated via neurotransmitters that act on cancer cells.
Then the authors go on into a long explanation (which will be explored in future posts) on how the brain might modulate tumorigenic activities. I am going to jump to the last two points Mravec et al. (2008) make, as it pertains directly to mind-body medicine and hypnosis.
Modulation of tumorigenesis by the brain as a new therapeutic approach.
Mravec et al. (2008) hypothesize and cite research that immunomodulation of the autonomic nervous system could represent a new approach to cancer therapy. This could be achieved by mapping areas of the brain, which regulate various immune functions. For example, natural-killer cell (NK) activity is germane to quash cancer cells, whereas elevated right-hemisphere activity is associated with reduced NK cell activity.
So, if one could then modify the activity of the specific brain regions and structures that are associated with the regulation of specific immune functions, as suggested by Mravec et al. (2008), one then could claim to use immunomodulation effectively as cancer treatment.
And finally, we have come full circle in the role of the CNS, tumor interactions, and mind-body medicine as a therapeutic approach.
Hypnotherapy has been shown to affect brain structures in many different shapes and forms (Halsband, 2006; Halsband, Mueller, Hinterberger, & Strickner, 2009; Rainville, Hofbauer, Bushnell, Duncan, & Price, 2002).
Hypnotherapy has also been used successfully in the cancer patients (Montgomery et al., 2007; Richardson, Smith, McCall, & Pilkington, 2006; Spiegel & Bloom, 1983) just to name a few.
Here, is the website of The Society of Psychological Hypnosis for a bunch of exceptionally reliable information about hypnosis. If you truly desire a front row seat to over one hundred interviews with the world’s greatest hypnosis researchers and clinicians, I encourage you to visit Dr. Eric Willmarth’s site featuring the Willmarth Hypnosis Interviews.
While there are exciting times ahead for hypnotherapy and its role in cancer treatment, please understand that hypnotherapy is used successfully with cancer patients already. As always, please discuss the pros and cons with your primary health care provider, and please, do your homework in finding a reputable hypnotherapist. You might want to start your search by visiting two organizations, which I am a member of The Society of Psychological Hypnosis and SCEH, the Society for Clinical & Experimental Hypnosis.
Image Credit:
Schönpflug, F. (1906). Der Hypnotizeur Fritz Schönpflug. Retrieved from Images from the History of Medicine (NLM) website at http://www.nlm.nih.gov/hmd/ihm/.
References:
Division 30, APA. (n.d.). The official Division 30 definition and description of hypnosis. Retrieved June 26, 2012, from http://psychologicalhypnosis.com/info/the-official-division-30-definition-and-description-of-hypnosis/
Ewin, D. M. (1983). Emergency Room Hypnosis for the Burned Patient. American Journal of Clinical Hypnosis, 26(1), 5–8. doi:10.1080/00029157.1983.10404130
Ginandes, C., Brooks, P., Sando, W., Jones, C., & Aker, J. (2003). Can medical hypnosis accelerate post-surgical wound healing? Results of a clinical trial. The American Journal of Clinical Hypnosis, 45(4), 333–351. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12722936
Ginandes, C., & Rosenthal, D. (1999). Using hypnosis to accelerate the healing of bone fraactures: A randomized controlled pilot study. Alternative Therapies in Health and Medicine, 5(2), 67–75. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=10069091&site=ehost-live&scope=site
Halsband, U. (2006). Learning in trance: Functional brain imaging studies and neuropsychology. Journal of Physiology-Paris, 99, 470–482. doi:10.1016/j.jphysparis.2006.03.015
Halsband, Ulrike, Mueller, S., Hinterberger, T., & Strickner, S. (2009). Plasticity changes in the brain in hypnosis and meditation. Contemporary Hypnosis, 26(4), 194–215. doi:10.1002/ch.386
Hammond, D. C. (1998). Hypnotic induction and suggestion. Chicago, IL: American Society of Clinical Hypnosis. Retrieved from http://asch.net/books.htm
Krippner, S. (2004). Hypnotic-like procedures used by indigenous healing practitioners. Presented at the Annual Convention of the American Society of Clinical Hypnosis, Anaheim, CA. Retrieved from http://stanleykrippner.com/papers/asch.2004.htm
Montgomery, G. H., Bovbjerg, D. H., Schnur, J. B., David, D., Goldfarb, A., Weltz, C. R., Schechter, C., et al. (2007). A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients. JNCI Journal of the National Cancer Institute, 99(17), 1304–1312. doi:10.1093/jnci/djm106
Mravec, B., Gidron, Y., & Hulin, I. (2008). Neurobiology of cancer: Interactions between nervous, endocrine and immune systems as a base for monitoring and modulating the tumorigenesis by the brain. Seminars in Cancer Biology, 18(3), 150–163. doi:10.1016/j.semcancer.2007.12.002
Rainville, P., Hofbauer, R. K., Bushnell, M. C., Duncan, G. H., & Price, D. D. (2002). Hypnosis modulates activity in brain structures involved in the regulation of consciousness. Journal of Cognitive Neuroscience, 14(6), 887–901. doi:10.1162/089892902760191117
Richardson, J., Smith, J. E., McCall, G., & Pilkington, K. (2006). Hypnosis for Procedure-Related Pain and Distress in Pediatric Cancer Patients: A Systematic Review of Effectiveness and Methodology Related to Hypnosis Interventions. Journal of Pain and Symptom Management, 31, 70–84. doi:10.1016/j.jpainsymman.2005.06.010
Spiegel, D., & Bloom, J. R. (1983). Group therapy and hypnosis reduce metastatic breast carcinoma pain. Psychosomatic Medicine, 45(4), 333–339. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/6622622
Yapko, M. (2003). Trancework : an introduction to the practice of clinical hypnosis (3rd ed.). New York: Brunner-Routledge.
Writing an essay, paper, or report? Cite this story:
APA: W Absenger. (2012.06.26). Mravec et al. (2008). Neurobiology of cancer and mind-body medicine [Web log post]. Retrieved from The Alternative Medicine Blog at http://amacf.org/2012/06/mravec-et-al-2008-neurobiology-of-cancer-and-mind-body-medicine.html
MLA: Absenger, Werner. ” Mravec et al. (2008). Neurobiology of Cancer and mind-body medicine.” The Alternative Medicine Blog. The Alternative Medicine Blog. 26 June. 2012. Web. Insert your date of access here.
Pilot Project: Quality Of Life Outcomes Following Mind-Body Skills Training For Cancer Patients Facilitated Either Face-To-Face Or Online Ends Today
I finished the final intervention session for the MBM Skills pilot project today. Now I will move on to “crunching the numbers.” Below is a brief overview of the pilot project.
Aim: To answer the questions of whether a Mind-Body Medicine (MBM) skills group facilitated face-to-face and online can improve measures of Quality of Life (QOL) in a population of cancer patients.
Value of Study: Technological advances have contributed to new venues for healthcare delivery. It is imperative that these new delivery methods, for individual and/or group psychological services are sufficiently tested and validated. Owen, Bantum, and Golant (2009) claim that there is very little knowledge about differences in communication styles between online and face-to-face groups, nor is there much knowledge on the overall efficacy of online group interventions.
Phenomenon Studied: Can MBM skills groups improve the quality of life of cancer patients? Is there a difference in outcome between a MBM skills group delivered face-to-face and a MBM skills group delivered online.
Reasons Leading to Proposing the Project: Despite encouraging research showing that psychosocial interventions have positive effects in the lives of cancer patients, more research is needed due to lack of use of technological advances such as use of video conferencing and relatively few existing studies on the effectiveness of MBM therapies in the oncological setting.
Hypothesis 1: There is no difference between baseline QOL measures and QOL measures at the end of face-to-face facilitated MBM skills groups (Operational null hypothesis).
Hypothesis 2: There is no difference between baseline QOL measures and QOL measures at the end of online facilitated MBM skills groups (Operational null hypothesis).
Hypothesis 3: Participation in either, online facilitated MBM skills groups or face-to-face facilitated MBM skills groups will improve QOL measures when compared to control group (Literary alternative).
Hypothesis 4: Patients in the control group (waitlisted control, care as usual group) will have no improvement on QOL measures (Operational Alternative).
Brief Description of the Research Design Study Type
Interventional Study Design: Supportive Care, Parallel Assignment, Open Label, Efficacy Study
Primary Outcome Measure: Change in Quality of Life as assessed by the World Health organization Quality of Life (WHOQOL-BREF) Instrument
Secondary Outcome Measure: Change in distress, anxiety, depression and need for help as assessed by the Emotion Thermometers Tool© (ET5)
Time Frame: Baseline, Week 4
Data Collection, Analysis, and Reporting: Data was collected at baseline and at week 4. Data analysis will be performed using IBM® SPSS® Statistics Software Version 19. Significance threshold is set a p < .05. Pre- and post-skills training comparisons of WHOQOL-BREF and ET5 scores will be performed.
Anticipated Value to the Larger Community: According to the National Center for Complementary and Alternative Medicine (NCCAM) “…there is a need for reliable, objective, evidence-based information regarding the usefulness and safety—or lack thereof—of CAM” (National Center for Complementary and Alternative Medicine, 2011, p.3). This study will add to general scientific knowledge of CAM.
Treatment Procedures: The mind-body skills group is a form of educational intervention, combining the learning of such mind-body skills as meditation, breath exercises, relaxation, and imagery, with a sharing of emotions and experiences in a small group (6-10 participants) setting. The mind-body skills group provides a setting for the development of increased self-awareness and self-discovery, along with the mastery of mind-body skills that are useful for personal health and wellness.
Risk-to-Benefit Ratio: Mind-Body interventions seem to carry with them relatively little risk when compared to the potential benefits. Thus the benefits of participation in this proposed research seem to outweigh the potential adverse events significantly.
The Bottom Line: As mentioned above, today was the last day for group intervention with final collection of data. Over the next couple of weeks, I’ll crunch the numbers and write up a final report. I will announce the final outcomes of this pilot project right here on The Alternative Medicine Blog. I am also looking to have the data scrutinized via peer review by locating an appropriate scientific journal.
In the meantime, if you are a cancer patient, loved one/caretaker of a cancer patient or a health care professional wanting to participate in an Online MBM Skills group, please go to my cancer support group page or check out the entry titled “Dealing with Cancer is Crazy Enough; Attending a Support Group Shouldn’t Be!” right here on The Alternative Medicine Blog.
On the other hand, if you are a fellow researcher interested in investigating Mind-Body Medicine modalities in the oncological setting, please do not hesitate to contact me for possible research collaboration for existing projects or to develop, plan and implement future research projects.
Image Credit:
National Institutes of Health (U.S.). Medical Arts and Photography Branch. (1994). Mind-body interactions and disease a symposium on the relationships between mental states, immune function, and health. Retrieved from Images from the History of Medicine (NLM) website at http://www.nlm.nih.gov/hmd/ihm/
References:
National Center for Complementary and Alternative Medicine. (2011). NCCAM’s Third Strategic Plan: Exploring the Science of Complementary and Alternative Medicine (No. Third Strategic Plan) (p. 62).
Owen, J. E., Bantum, E. O., & Golant, M. (2009). Benefits and challenges experienced by professional facilitators of online support groups for cancer survivors. Psycho-Oncology, 18(2), 144–155. doi:10.1002/pon.1374
Writing an essay, paper, or report? Cite this story:
APA: W Absenger. (2012.06.25). Pilot Project: Quality of life outcomes following mind-body skills training for cancer patients facilitated either face-to-face or online ends today [Web log post]. Retrieved from The Alternative Medicine Blog at http://amacf.org/2012/06/pilot-project-quality-of-life-outcomes-following-mind-body-skills-training-for-cancer-patients-facil.html
MLA: Absenger, Werner. ” Pilot Project: Quality of Life Outcomes Following Mind-Body Skills Training for Cancer Patients Facilitated either Face-To-Face or Online Ends Today.” The Alternative Medicine Blog. The Alternative Medicine Blog. 25 June. 2012. Web. Insert your date of access here.
de Valois et al. (2012). Assessing the Feasibility of Using Acupuncture and Moxibustion to Improve Quality of Life for Cancer Survivors with Upper Body Lymphoedema
Lymphedema is caused by damage to the lymphatic system due to cancer treatment and is a common side effect for breast and head & neck cancers. Due to the generally considered incurable nature of lymphedema, the authors of this paper argue for multi-disciplinary strategies to reduce onset, progression and complications of lymphedema.
The Abstract (de Valois et al., 2012, p. 301).
Purpose: Within a three-step mixed-methods study to investigate using acupuncture and moxibustion (acu/moxa) in the management of cancer treatment-related upper body lymphoedema, Step 2 obtained preliminary data about: 1) whether acu/moxa can improve quality of life, 2) the most troublesome symptoms, and 3) adverse effects.
Methods and sample: An exploratory single-arm observational clinical study included breast (BC) and head and neck cancer (HNC) survivors with mild-to-moderate uncomplicated lymphoedema for ≥3 months, ≥3 months post active-cancer treatment, no active cancer disease, undergoing routine lymphoedema maintenance. Participants received seven individualised treatments (S1), and six optional additional treatments (S2). MYMOP, SF-36 and PANAS were administered at baseline, during each series, and at follow-up 4 and 12 weeks after end-of-treatment. The primary outcome was change in MYMOP scores at the end of each series.
Key results: Of 35 participants recruited, 30 completed S1 and S2, 3 completed S1, 2 were lost to the study. Mean MYMOP profile change scores for BC participants were 1.28 points improvement on a 7-point scale (sd = 0.93, p < 0.0001, n = 25) for S1; and 1.41 for S2 (sd = 0.94, p < 0.0001, n = 24). S1 HNC change scores were 2.29 points improvement (sd = 0.62, p < 0.0001, n = 7); and 0.94 for S2 (sd = 0.95, p = 0.06, n = 6). Changes in some SF-36 scores for BC participants were significant to 4 weeks after treatment. No serious adverse effects were reported.
Conclusion: This small study suggests acu/moxa is an acceptable adjunct to usual care for cancer survivors with lymphoedema. Further rigorous research is warranted to explore the effectiveness of acu/moxa in reducing the symptom burden.
de Valois et al. (2012). Assessing the Feasibility of Using Acupuncture and Moxibustion to Improve Quality of Life for Cancer Survivors with Upper Body Lymphoedema
Lymphedema is caused by damage to the lymphatic system due to cancer treatment and is a common side effect for breast and head & neck cancers. Due to the generally considered incurable nature of lymphedema, the authors of this paper argue for multi-disciplinary strategies to reduce onset, progression and complications of lymphedema.
The Bottom Line:
Cancer patients at risk of developing lymphedema want to learn how to recognize early signs and symptoms, and once diagnosed, treatment aims to reduce size, physical dysfunction and complications (de Valois et al., 2012).
de Valois et al. (2012) cites research showing that lymphedema has negative psychosocial effects for women and is “One of the most troublesome and feared consequences of breast cancer surgery” (Ganz 1999, as cited in de Valois et al., 2012, p. 302).
The treatment should address quality of life, physiological and psychosocial problems associated with lymphedema. Complementary and Alternative Medicine (CAM) is increasingly desired by cancer patients (de Valois et al., 2012).
Acupuncture, part of Traditional Chinese Medicine, is a CAM modality cancer patients are drawn to for improvement of symptoms and better physiological and psychosocial coping (de Valois et al., 2012).
Based on previous research by one of the authors with breast cancer patients that demonstrated “…measurable improvements in wellbeing, improved quality of life, and symptom relief…” when using acupuncture de Valois et al. (2012) set out to investigate if acupuncture could be successful in the management of lymphedema asking the questions (p. 302):
- Can acu/moxa improve wellbeing in cancer survivors with lymphoedema?
- What symptoms are most troublesome for these individuals?
- Is acupuncture a safe intervention for people with lymphoedema?
Because of the nature of lymphedema, acupuncture is considered a controversial treatment. People with lymphedema should focus on reducing the possibility of further infection and swelling via accidental or non-accidental (as in acupuncture) skin punctures in the affected area (de Valois et al. 2012). Many practitioners suggest that it is considered a good idea for lymphedema patients to avoid acupuncture altogether. However, this is not the case according to de Valois et al. (2012, p. 302) who state “In lymphoedema and cancer policy documents, acupuncture is not contraindicated, and guidance is the same as for all NASP [non-accidental skin punctures] interventions, in that needling the affected area should be avoided.”
De Valois et al. (2012) selected to use the following three validated instruments to use as outcome measures:
Medical Outcome Profile (MYMOP) “…is widely used for evaluating interventions based on holistic and participative principles, and allows patients to define and evaluate outcomes that are pertinent to them” (de Valois et al., 2012, p. 303).
The Medical Outcomes Study Short Form (SF-36) “…is a generic 36- item functional status questionnaire that assesses eight domains of physical and psychological health” (de Valois et al., 2012, p. 303).
The Positive and Negative Affect Schedule (PANAS) “…is a 20-item validated measure used to assess mood states” (de Valois et al., 2012, p. 303).
The acupuncture protocol was designed to replicate “usual clinical practice,” (de Valois et al., 2012, p. 303) with treatments focusing on “presenting signs, symptoms and priorities” (de Valois et al., 2012, p. 303) of the patients, as this “real-world” acupuncture study design has high external validity.
de Valois et al. (2012) mention in their paper that, for further studies, they will eliminate the PANAS questionnaire due to higher than expected proportion of missing data. The authors also make a note of some limitations of their study, which are: uncontrolled study design, single setting, small number of head & neck cancer patients participants, and research acupuncturist acted as principal investigator as well (de Valois et al., 2012).
The authors also point out that they never set out to cure lymphedema, rather they wanted to show that patients with lymphedema can use acupuncture safely to address “…a range of physical and emotional conditions, and reduce symptom burden (de Valois et al., 2012, p. 307).
Because of the significant improvements (as mentioned in the abstract) further research is warranted to investigate the effects of acupuncture in lymphedema. The authors have plans for a randomized controlled trial investigating the effects of acupuncture in breast cancer related lymphedema.
What do the study results mean for a cancer patient wanting to use acupuncture addressing lymphedema?
This trial can not be generalized, due to some of the limitations mentioned above. It was simply not designed to this. It was designed as a pilot trial to determine if further research might be warranted.
That does not mean you should not discuss this option with your primary health care provider. She/he might be open to working with an expert acupuncturist to see if acupuncture could be a viable treatment, to address the physical and emotional conditions and to reduce the symptom burden you might be experiencing, especially if lymphedema is the result of breast cancer treatment.
References:
de Valois, B. A., Young, T. E., & Melsome, E. (2012). Assessing the feasibility of using acupuncture and moxibustion to improve quality of life for cancer survivors with upper body lymphoedema. European Journal of Oncology Nursing, 16(3), 301–309. doi:10.1016/j.ejon.2011.07.005
Ganz, P.A. (1999). The quality of life after breast cancer – solving the problem of lymphedema. New England Journal of Medicine 340 (5), 383-385.
Image Credit:
École supérieur d’acupuncture française. (n.d.). Images from the History of Medicine (NLM): Acupuncture. Retrieved from Images from the History of Medicine (NLM) website at http://ihm.nlm.nih.gov/luna/servlet/view/all.
Writing an essay, paper, or report? Cite this story:
APA: W Absenger. (2012.06.23). de Valois et al. (2012). Assessing the feasibility of using acupuncture and moxibustion to improve quality of life for cancer survivors with upper body lymphoedema [Web log post]. Retrieved from The Alternative Medicine Blog at http://amacf.org/2012/06/de-valois-et-al-2012-assessing-the-feasibility-of-using-acupuncture-and-moxibustion-to-improve-quali.htm
MLA: Absenger, Werner. “de Valois et al. (2012). Assessing the Feasibility of Using Acupuncture and Moxibustion to Improve Quality of Life for Cancer Survivors with Upper Body Lymphoedema.” The Alternative Medicine Blog. The Alternative Medicine Blog. 23 June. 2012. Web. Insert your date of access here.
Bhattacharjee & Khuda-Bukhsh. (2012). Two Homeopathic Remedies Provide Protective Effects Against Hepatotoxicity Induced by Carcinogens…
This team of researchers looked at the effects of potentized cholesterinum used with another homeopathic remedy, Natrum Sulphuricum on carcinogen-induced hepatotoxicity. In other words, the researchers wanted to see if these two homeopathic remedies could reduce damage of cancer causing agents fed to mice.
The Abstract
The purpose of the study was to evaluate whether potentized cholesterinum (Chol) intermittently used with another homeopathic remedy, Natrum Sulphuricum (Nat Sulph) can provide additional benefits in combating hepatotoxicity generated by chronic feeding of carcinogens, p-dimethylaminoazobenzene (p-DAB), and phenobarbital (PB).
Mice were categorized into subgroups: normal untreated (Gr-1); normal + alcohol “vehicle” (Alc) (Gr-2), 0.06% p-DAB + 0.05% PB (Gr-3), p-DAB + PB + Alc (Gr-4), p-DAB + PB + Nat Sulph-30 (Gr-5), p-DAB + PB + Chol-200 (Gr-6), p-DAB + PB + Nat Sulph-30 + Chol-200 (Gr-7), p-DAB + PB + Nat Sulph-200 (Gr-8), and DAB + PB + Nat Sulph-200 + Chol-200 (Gr-9).
Hepatotoxicity was assessed through biomarkers like aspartate and alanine aminotransferases (AST and ALT), acid and alkaline phosphatases (AcP and AlkP), reduced glutathione content (GSH), glucose 6-phosphate dehydrogenase (G6PD), gamma glutamyl transferase (GGT), lactate dehydrogenase (LDH), and analysis of lipid peroxidation (LPO) at 30, 60, 90, and 120 days and antioxidant biomarkers like superoxide dismutase (SOD), catalase (CAT), and glutathione reductase (GR) were assayed.
Electron microscopic studies (scanning and transmission) and gelatin zymography for matrix metalloproteinases were conducted in liver. The feeding of the homeopathic drugs showed intervention in regard to the increased activities of AST, ALT, AcP, AlkP, GGT, LDH, and LPO and decreased activities of G6PD, SOD, CAT, GR, and GSH noted in the intoxicated mice, more appreciable in Groups 7 and 9. Thus, combined therapy provided additional antihepatotoxic and anticancer effects (Bhattacharjee & Khuda-Bukhsh, 2012, p. 1).
The Bottom Line:
If you are unfamiliar with homeopathy, here is a little more information to become familiarized with the principles of homeopathy. The Western medical tradition generally frowns up homeopathy. That is because remedies are usually diluted to the point at which one could say that too few molecules remain of the original substance in the heavily diluted remedy. In other words, the remedy has been subjected to trituration, dynamization and succession, sometimes beyond Avogadro’s limit (Bhattacharjee & Khuda-Bukhsh, 2012), thus causing great controversy among scientist.
The authors of this paper talk about Natrum Sulphuricum (Nat Sulph) -30 and 200 and cholesterinum (Chol) -200.
To put this in perspective here is a paragraph from Creighton University School of Medicine:
“Supposing 40g of calcium (one mole) were diluted by homeopathic principles starting from 100% pure substance. Avogadro’s number tells us that we have 6.02×1023 molecules per mole. By 7C the remedy would be expected to contain about 6 billion calcium molecules, and by about 11C, it would be expected to have only about 60 ((1/100)11 x 6.02×1023 = 60.2). At the 12C (or 24X) dilution, there is a 50/50 chance of one molecule being present. The dilution at which one would expect to have only one molecule does depend upon the starting number of molecules, but assuming that we started with all the atoms estimated to be in the universe, about 6×1079 then we end up with a 50% chance to have one molecule left at 40C (or 80X), still far more concentrated than the 200C dilutions that are commonly dispensed (Creighton University School of Medicine, n.d.).
To add to the dilemma of understanding and providing evidence for homeopathic remedies is the clinical trials are plagued with problems. Pitari (2007) points out that, amongst others, homeopathic research requires more rigorous trials and more specific trail methodology. The author presents and illustration in her paper on how to more effectively design research in homeopathic medicine in order to provide credible evidence either for or against efficacy.
Having show that homeopathy is not without controversy, lets look at the results from Bhattacharjee & Khuda-Bukhsh (2012). Because this research was performed on mice, it was possible to tightly control the experiment’s condition.
Observers were blinded as to whether the samples came from the homeopathic remedy groups or placebo treated group and mice were randomized into 9 groups (24 animals in each group), each group receiving a different diet consisting of (Bhattacharjee & Khuda-Bukhsh, 2012, p. 2):
- Group 1- Diet 1: Normal
- Group 2 – Diet 2: Normal + Alc
- Group 3 – Diet 3: p-DAB+PB
- Group 4 – Diet 4: p-DAB + PB + Alc
- Group 5 – Diet 5: p-DAB + PB + Nat Sulph-30
- Group 6 – Diet 6: p-DAB + PB + Chol-200
- Group 7 – Diet 7: p-DAB + PB + Nat Sulph-30 + Chol-200
- Group 8 – Diet 8: p-DAB + PB + Nat Sulph-200
- Group 9- Diet 9: p-DAB + PB + Nat Sulph-200 + Chol-200
In the result section Bhattacharjee & Khuda-Bukhsh (2012) report that on autopsy groups 1 and 2 showed healthy liver, while all the other animals showed tumor growth who received the carcinogens for 60 days or more.
Interestingly enough though the authors report that
As compared to all carcinogen fed mice showing distinct sign of tumor formation in the form of pale reddish multiple nodules, the incidence and intensity of tumor was found to be greater in the carcinogen fed mice (more pronounced in the p-DAB+PB and p-DAB+PB+Alc fed series) at 60, 90, and 120 days, the incidence and growth of tumors found in the drug fed series was less, both numerically and qualitatively. Further, in the conjoint drug fed series, the number of tumors was also lesser than in the single drug fed series (Bhattacharjee & Khuda-Bukhsh, 2012, p.5).
Differences were statistically significant and Nat Sulph-30 plus Chol-200 fed mice positive activities were most pronounced at the 90 day and the 120 intervals, with Nat Sulph-200 alone showing considerable ameliorative effect, while a combination of Nat Sulph-200 and Chol-200 showed the greatest effects (Bhattacharjee & Khuda-Bukhsh, 2012, p. 5).
Here is table 1 from their paper:
In their conclusion the authors reiterate that we don’t know the mechanism of action involved for homeopathic remedies, but proposed a hypothesis that
…Potentized homeopathic drugs might have the ability to act as a ‘molecular trigger’ for switching ‘on and ‘off’ certain relevant gene action/interaction, a series of biochemical changes could follow, that in turn could bring about the alteration observed in the parameters of the present study (Bhattacharjee & Khuda-Bukhsh, 2012, p. 9).
Furthermore the authors point towards nanoparticle research that demonstrated alteration of the “…physico-chemical property of the drug and its biological action during the process of homeopathic dynamization” (Bhattacharjee & Khuda-Bukhsh, 2012, p. 9).
Based on this research one could speculate that both homeopathic remedies could be used to treat human liver disorders associated with cancerous lesions (Bhattacharjee & Khuda-Bukhsh, 2012, p. 9).
But there is one caveat of course, more studies should be performed by other researchers to either confirm or refute these most peculiar findings.
Why peculiar? Remember, based on the tenets of classical physics, chemistry and other know facts about the universe these results should have NOT manifested in the first place.
References:
Bhattacharjee, N., & Khuda-Bukhsh, A. R. (2012). Two homeopathic remedies used intermittently provide additional protective effects against hepatotoxicity induced by carcinogens in mice. Journal of Acupuncture and Meridian Studies, In Press. doi:10.1016/j.jams.2012.05.004
Creighton University School of Medicine. (n.d.). Dynamization. Retrieved June 21, 2012, from http://altmed.creighton.edu/Homeopathy/philosophy/dilution.htm
Pitari, G. (2007). Scientific Research in Homeopathic Medicine: Validation, Methodology and Perspectives. Evidence-Based Complementary and Alternative Medicine, 4(2), 271–273. doi:10.1093/ecam/nel085
Image Credit:
Writing an essay, paper, or report? Cite this story:
APA: W Absenger. (2012.06.21). Bhattacharjee & Khuda-Bukhsh. (2012). Two homeopathic remedies provide protective effects against hepatotoxicity induced by carcinogens [Web log post]. Retrieved from The Alternative Medicine Blog at http://amacf.org/2012/06/bhattacharjee-khuda-bukhsh-2012-two-homeopathic-remedies-provide-protective-effects-against-hepatoto.html
MLA: Absenger, Werner. “Bhattacharjee & Khuda-Bukhsh. (2012). Two homeopathic remedies provide protective effects against hepatotoxicity induced by carcinogens ” The Alternative Medicine Blog. The Alternative Medicine Blog. 21 June. 2012. Web. Insert your date of access here.
Antioxidant Supplements and Cancer Chemotherapy
There is much debate whether or not antioxidant supplementation during cancer chemotherapy alters the efficacy of chemotherapy drugs. The review by Block et al. (2007), evaluating Randomized Clinical Trials (RCT), looks at RCTs that measured survival and/or treatment response levels of patients who took antioxidants while on chemotherapy in order to see if antioxidants amplify or impinge on the efficacy of the chemotherapy…
Introduction
Block et al. (2007) start their review by citing no less than ten references about the use of Complementary and Alternative Medicine (CAM), showing that an estimated 13% to 87% of cancer patients use antioxidant supplements.
Antioxidants, while taken during chemotherapy are thought to
- a) hinder the cytotoxicity of chemotherapy by quenching the reactive oxygen species (ROS, a.k.a. free radicals), thus rendering the drug less effective, or
- b) help protect healthy cells from the onslaught of free radicals during chemotherapy (Block et al. (2007).
The Catch-22 for a cancer patient then is to understand if antioxidant therapy can improve Quality of Life (QoL) by protecting healthy tissue or gravely interfere with the outcome of cancer.
On the other hand, antioxidants might improve clinical outcomes by helping patients tolerate an uninterrupted treatment regimen with full doses of chemotherapy (Block et al., 2007).
Methods
Patients in the studies were either on an orally or intravenously administered antioxidants and chemotherapy. Block et al. (2007) make it clear that all types of cancers were included and chemotherapies that use ROS generating mechanism, while studies using whole herbs, multi-component herbals, and synthetic antioxidants were excluded. Trials were given Jadad scores to distinguish between weak and strong study designs. A limitation pointed out by Block et al. (2007) is the fact that “…bias in preferential publication of positive trials cannot be excluded” (p. 409).
Brief Overview of Outcomes
Out of 845 trials 19 were included in their review, using antioxidants Glutathione (7), Melatonin (4), Vitamin A (2), Mixed (2), Vitamin C (1), N-Acetylcysteine (1), Vitamin E (1), and Ellagic Acid (1).
Block et al. (2007) did not find any evidence that substantiated the concern that antioxidant supplementation given while on ROS generating chemotherapy lessened the efficacy of chemotherapy in a population of advanced or relapsed patients. On the contrary, 17 of the 19 reviews established
“…statistically significant advantage or non- significantly higher survival and/or treatment response in those patients given antioxidants. Specifically, of 13 reports on survival, all showed similar or better (four being statistically significant) survival rates for the antioxidant group over the control group” (Block et al., 2007, p. 415).
Block et al. (2007) continue with their findings:
“Additionally, while one study reported similar survival results between the antioxidant arm and control overall, the largest subgroup (stage III patients taking antioxidants) was found to have a statistically significant survival advantage compared to the control group” (p. 415).
And possibly the most reassuring statement:
“No studies reported significantly worse survival or response in the antioxidant supplement group” (Block et al., 2007, p. 415).
Limitations of the Block et al. (2007) Paper
Because of the small size of studies, these studies should be construed as treatment response data, and can’t be yet generalized to a wider population. Larger trials would be needed for such a generalization.
And because statistical power calculations performed either before or after trials, one can not say of important clinical effects were missed in these smaller trials.
The Bottom Line
This paper by Block et al. (2007) hints towards evidence that antioxidant supplementation helps reduce side effects of chemotherapy such as “…neurotoxicity, thrombocytopenia, diarrhea” (p. 416) and because of that, patients who probably would have dropped out of chemotherapy were able to complete their drug regimen.
Block et al. (2007) point to research by Neugut et al. (2006) studying colon cancer patients over age 65 and the effects of the entire five to seven months of chemotherapy regimen. These patients had higher survival rates than those who only received one to four months of treatment.
Also worthwhile considering is the finding that “…among the 30% of patients who dropped out of chemotherapy treatment early, mortality rates were twice those of the group who completed therapy” (Block et al. (2007, p. 416).
In other words, whether or not to use antioxidant supplementation during chemotherapy should probably be a conversation you and your primary care provider or oncologist should have.
However, just in case you are wondering going out to your local health food store to stock up on the antioxidants mentioned in this blog entry consider the following:
Block et al. (2007) clearly make mention of antioxidants administered intravenously, right? So this should give the reader pause and consider the dosages needed to achieve the desired effects.
References:
Block, K. I., Koch, A. C., Mead, M. N., Tothy, P. K., Newman, R. A., & Gyllenhaal, C. (2007). Impact of antioxidant supplementation on chemotherapeutic efficacy: A systematic review of the evidence from randomized controlled trials. Cancer Treatment Reviews, 33(5), 407–418. doi: 10.1016/j.ctrv.2007.01.005
Neugut, A. I., Matasar, M., Wang, X., McBride, R., Jacobson, J. S., Tsai, W.-Y., Grann, V. R., et al. (2006). Duration of adjuvant chemotherapy for colon cancer and survival among the elderly. Journal of clinical oncology: official journal of the American Society of Clinical Oncology, 24(15), 2368–2375. doi:10.1200/JCO.2005.04.5005
Cancer the killer. (n.d.). Description: A comic book on the history of the disease and warning signs of cancer. Retrieved from the Images From The History Of Medicine website at http://ihm.nlm.nih.gov/luna/servlet/view/search?q=A024304
Writing an essay, paper, or report? Cite this story:
APA: W Absenger. (2012.06.16). Block et al. (2007). Impact of antioxidant supplementation on chemotherapeutic efficacy [Web log post]. Retrieved from The Alternative Medicine Blog at http://amacf.org/2012/06/block-et-al-2007-impact-of-antioxidant-supplementation-on-chemotherapeutic-efficacy.html
MLA: Absenger, Werner. “Block et al. (2007). Impact of antioxidant supplementation on chemotherapeutic efficacy” The Alternative Medicine Blog. The Alternative Medicine Blog., 16 JUNE. 2012. Web. Insert your date of access here.
Shu-Chuan Lin & Ming-Feng Chen (2010). Increased Yin-Deficient Symptoms and Autonomic Nervous System Function in Patients with Metastatic Cancer
The objectives of this study were to investigate the differences in severity of yin-deficient symptoms (YDS) and function of the autonomic nervous system (ANS) between patients with cancer with metastasis and those without metastasis.
Recruiting Soon: A Pilot Study To Assess Guidance in and Subsequent Use of Mind-Body Techniques on the Quality of Life of Cancer Patients
I am soon starting to recruit (Saybrook University Institutional Review Board approval is pending) for a pilot study, to begin on May 21, 2012, dealing with distress and Quality of Life of cancer patients/survivors titled:
A Pilot Study To Assess Guidance in and Subsequent Use of Mind-Body Techniques on the Quality of Life of Cancer Patients
Clinical Trials.Gov Identifier: NCT01586546
I am hoping to enlist your help in spreading the word about this important research to let eligible, would-be-participants know about this opportunity to add to scientific knowledge. More importantly, participants will learn about Mind-Body Medicine (MBM) skills and how to better deal with the distress associated with a wide variety of stressors at different stages of cancer and cancer treatment.
How the Mind and Body Communicate (part XXIII)
Metastatic Breast Cancer and Mood State
In a trial with 125 women(1), suffering from metastatic breast cancer, were divided into two groups. The control group receiving educational materials on cancer only. The women in the other group were offered 1 year of weekly supportive-expressive group therapy.