Download pdf Best of SIO - Society for Integrative Oncology

13th International Conference of the Society for Integrative Oncology November 5-7,
2016 in Miami, FL, USA
Best of SIO Abstracts
Abstract 6- Integrating Oncology
Massage into Chemo-Infusion Suites: A
Program Evaluation
Christina Seluzicki, MBE,1 Karen Wagner, MS, RD,2
Susan Li, MS,2 Audra Hugo, BS,2 Jun J Mao, MD,
MSCE1
1. Memorial Sloan Kettering Cancer Center, New
York, NY
2. Perelman School of Medicine, University of
Pennsylvania, PA
BACKGROUND: Breast cancer survivors
often experience significant symptom
distress during chemotherapy and many
desire integrative therapies to help them
cope with those symptoms. Massage, a
popular integrative therapy, can be a helpful
intervention. However, barriers including
cost, time, and transportation may prevent
women with breast cancer from utilizing
massage during cancer treatment. This
study reports on the development,
implementation, and evaluation of an
Integrative Clinical Oncology Massage
program for breast cancer patients
undergoing chemotherapy in a large
academic medical center setting.
METHODS: We described the development
and implementation of an oncology
massage program embedded into chemoinfusion suites. We used de-identified
program evaluation data to identify specific
reasons individuals refuse massage and to
evaluate the immediate impact of massage
treatments on patient reported outcomes
using a modified version of the distress
thermometer delivered via iPad.
RESULTS: Of the 1090 surveys responses,
692 (63%) accepted the massage. We
observed a significant decrease in selfreported anxiety (from 3.9 – 1.7), nausea
(from 2.5 – 1.2), pain (from 3.3 – 1.9), and
fatigue (from 4.8 – 3.0) pre- and postmassage, all p<0.001. Using conservative
estimates that treat missing data as not
endorsing massage, we found that 642
(93%) of the recipients of massage therapy
were either satisfied or very satisfied with
their massage and that 649 (94%) would
recommend it to another patient undergoing
treatment. Spontaneous patient responses
overwhelmingly endorsed that the massage
was “relaxing.” No adverse events were
reported. Among 398 (36%) who declined a
massage, the top reasons were time
concerns and lack of interest.
CONCLUSIONS: A clinical oncology
massage program can be safely and
effectively integrated into chemo-infusion
units to provide symptom control for breast
cancer patients. This integrative approach
overcomes the patient-level barriers of cost,
time, and travel, as well addressing the
institutional-level barrier of space.
Abstract 30- Fatigue Reduction Diet in
Breast Cancer Survivors: A Pilot
Randomized Clinical Trial
Suzie Zick, University of Michigan
Justin Colacino, University of Michigan
Zora Djuric, University of Michigan
Background: Fatigue is a prevalent and
burdensome late-term effect of breast
cancer associated with poor sleep. The
etiology of fatigue has been linked to
chronic inflammation, and diets high in antiinflammatory nutrients have been
associated with less severe fatigue. Clinical
trials are needed, however, to test if an antiinflammatory diet could improve fatigue.
Methods: Phase II, pilot, randomized, trial
conducted between January 2014 to April
2015, to investigate if a 3-month isocaloric
diet rich in fruit, vegetables, whole grains
and omega-3 fatty acid-rich foods, (Fatigue
Reduction Diet (FRD), improved fatigue and
sleep compared to an attention control,
(General Health Curriculum (GHC). 50
stage 0 to III breast cancer survivors, who
had completed cancer treatments > 12
months previously were screened, and 30
were randomized; 15 receiving the FRD,
and 15 GHC. Primary outcome was change
in fatigue, as measured by the brief fatigue
Inventory (BFI), from baseline to 3 months
analyzed using linear mixed models (LMM).
Secondary analyses were changes in sleep
quality, serum carotenoids and fatty acids.
Results: There was no change in body
mass index (BMI) in either group (p=0.70).
There was a significant visit by group
difference for fatigue and sleep quality
between the study groups at 3-months.
Fatigue improved by 44±39% in FRD group
compared to 8±34% in the GHC (p<0.01).
Sleep quality improved by 2.5±3.3 points in
FRD, and diminished by 0.9±2.3 in the GHC
(p=0.03). Serum total carotenoids (p<0.01),
13th International Conference of the Society for Integrative Oncology November 5-7,
2016 in Miami, FL, USA
Best of SIO Abstracts
β-cryptoxanthin (p=0.02), lutein (p=0.05),
zeaxanthin (p=0.01), lycopene (p=0.05),
omega-3 fatty acids (p<0.01), and ratio of
omega-3 to omega-6 fatty acids (p=0.02)
were significantly increased; and percent
saturated fatty acids were decreased
(p=0.04) at 3-months in the FRD. Ɣtocopherol was significantly increased in the
GHC (p=0.03). There was a significant visit
by group difference for α-carotene between
the study groups (p=0.05).
Conclusions: The FRD intervention
improved fatigue and sleep in breast cancer
survivors compared to the GHC. Diet
quality, independent of weight loss, could
provide a treatment strategy for persistent
fatigue.
Abstract 33- Predictors of Success of
Multisensory Dance/Movement Therapy
in Improving Pain Control Among
Children Treated with 3F8
Immunotherapy for Advanced
Neuroblastoma
B. Ehrmann1*, D. Tailor2*, S. Tortora2, J. Mao2, M.
Coleton2, and G. Deng2
1Department of Medicine, New York-Presbyterian
Hospital/Weill
Cornell Medical Center, New York, NY; 2Integrative
Medicine Service, Memorial-Sloan Kettering Cancer
Center, New York, NY; *Contributed equally to this
work
BACKGROUND: The anti-GD2 antibody
3F8 is often a component of neuroblastoma
treatment. Cross-reaction with pain fibers
makes severe pain common. Opiates are
often limited by ineffectiveness or sedation.
Multisensory Dance/Movement Therapy
(MSDMT) uses dance, music, touch,
imagery, and meditation to augment pain
control. Previous analyses suggest that
MSDMT produces variable responses, but
when effective, can be profoundly
beneficial. The aim was to characterize
predictors of positive versus negative pain
control responses to MSDMT.
METHODS: A retrospective cohort analysis
was conducted of neuroblastoma patients
receiving 3F8 and ≥1 MSDMT session at a
large cancer hospital in 2014. Pain control
was assessed by weight-standardized pain
medication doses and pain scores using the
Face, Legs, Activity, Cry, Consolability
(FLACC) scale. A positive pain control
response was a median decrease of two
pain doses and/or one FLACC scale point
between treatments with and without
MSDMT. Negative responses were
opposite in direction. Demographic,
treatment, physiologic variables, and
qualitative analyses of treatment notes were
extracted.
RESULTS: 62 children met selection
criteria and were analyzed. There were 18
positive responders and 8 negative
responders, the remainder not meeting
either definition. There was a trend toward
male predominance (63 vs. 44%) and more
3F8 treatments (23 vs.11) in negative
responders. MSDMT utilization appeared
higher in positive responders (23 vs. 17%).
Positive responders were more likely to
show strong engagement at treatment
initiation (73 vs. 33%), communicate
wants/needs (45 vs. 0%), and self-regulate
pain/emotion (73 vs. 50%). They were less
likely to display negative emotion at
treatment initiation (9 vs. 67%) and show
strong parental attachment (0 vs. 67%).
CONCLUSIONS: Among children receiving
3F8 for neuroblastoma, a positive pain
control response to MSDMT is associated
with patients who are engaged,
enthusiastic, have capacity to develop
coping skills, and are earlier in their
treatment. These findings inform future
research design and delivery of MSDMT.
Abstract 101- Using Software to Identify
Potential Medication Interactions with
Herbs and Supplements in Cancer
Patients Receiving Chemotherapy
Richard Lee, University Hospitals & Case Western
Reserve University, Nancy Kwon, Northwestern
University, Jimin Wu, MD Anderson Cancer Center
Mandira Ray, Harvard Vanguard Medical Associates,
Russell Szmulewtiz, University of Chicago, Holly
Holmes, University of Texas, Alyssa Rieber, MD
Anderson Cancer Center, Nishin Bhadkamkar, MD
Anderson Cancer Center, Gabriel Lopez, MD
Anderson Cancer Center, Diane Liu, MD Anderson
Cancer Center, Olufunmilayo Olopade, The
University Of Chicago Medicine, Jamie Von Roenn,
ASCO, Walter Stadler, University of Chicago, Farr
Curlin, Duke University
BACKGROUND: Cancer patients take a
variety of medications including herbs and
supplements (HS) while receiving
anticancer therapies. The ability of
available software to identify potential
13th International Conference of the Society for Integrative Oncology November 5-7,
2016 in Miami, FL, USA
Best of SIO Abstracts
medication interactions (PMI) has not been
well evaluated.
METHODS: Breast and prostate cancer
patients who completed systemic
anticancer therapy participated in a phone
interview. Data collected included all
medicines taken (including anticancer
therapies, prescription (RX), over-thecounter (OTC), and HS and timing of use.
Micromedex (MM) 2.0 and Natural Medicine
Comprehensive Database (NMCD)
interaction software were used to identify
PMI.
RESULTS: Sixty-eight eligible patients
(72%) completed the phone survey.
Characteristics: mean age 57 (range, 3977), 85% breast cancer, 15% prostate
cancer, stages I-II (66%) III-IV (34%).
Subjects took a median of 9 medications,
and 69% had used at least one HS during
the study period. A total of 975 PMI were
identified with 70% involving HS
interactions. One-third of the identified
PMI were categorized as major or
contraindicated interactions, and 56% were
categorized as moderate interactions. The
risk of PMI more than tripled from before
chemotherapy to during chemotherapy –
178 to 561. Although the use of HS
declined during chemotherapy (104 to 79),
the risk of HS related PMI still increased
from 122 to 351. MM identified 337 PMI
with 12% involving HS while NMCD
identified 638 PMI, all of which involved HS.
Overall the number of RX related PMI
almost equaled those of HS related PMI
during and after chemotherapy – 368 vs
351 and 197 vs 196, respectively.
CONCLUSIONS: Patients with breast and
prostate cancer are commonly at risk of HS
related PMI. A dedicated medication
interaction software focused on HS may
help identify additional HS related
interactions not identified by a commonly
used medication software. Oncologists
need to be aware of these interactions and
discuss them with their patients.
Abstract 161- Integrative therapies for
breast cancer patients and survivors:
The latest evidence
H. Greenlee1,2, MJ. DuPont-Reyes1, LG. Balneaves3,
LE. Carlson4, MR. Cohen5,6, G. Deng7, JA. Johnson8,
M. Mumber9, D. Seely10,11, S. Zick12-14, L. Boyce15, D.
Tripathy16
Department of Epidemiology, Mailman School of
Public Health1, Herbert Irving Comprehensive Cancer
Center2, Columbia University Medical Center
Library15, Columbia University, New York, NY; Centre
for Integrative Medicine, University of Toronto,
Toronto, ON, Canada3; Department of Oncology,
University of Calgary, Calgary, AB, Canada4; Institute
for Health and Aging, University of California San
Francisco, CA5; Chicken Soup Chinese Medicine,
San Francisco, CA6; Department of Medicine,
Memorial Sloan Kettering Cancer Center, New York,
NY7; Department of Psychology, University of
Calgary, Calgary, AB, Canada8; Harbin Clinic, Rome,
GA9; Ottawa Integrative Cancer Center, Ottawa, ON,
Canada10; Canadian College of Naturopathic
Medicine, Toronto, ON, Canada11; Department of
Family Medicine, University of Michigan Health
System12, Department of Nutritional Sciences, School
of Public Health13, and Department of Family
Medicine14, University of Michigan, Ann Arbor, MI;
Department of Breast Medical Oncology, The
University of Texas MD Anderson Cancer Center,
Houston, TX16
BACKGROUND: Breast cancer (BC)
patients and survivors commonly use
integrative therapies as supportive care
during and after cancer treatment.
However, knowledge of the existing
evidence supporting the use of such
therapies in the oncology setting is limited.
This report provides updated clinical
practice guidelines from the Society for
Integrative Oncology on the use of
integrative therapies applied to specific
clinical indications during and after BC
treatment, including anxiety/stress,
depression/mood, fatigue, impaired quality
of life/physical functioning, and
chemotherapy-induced nausea and
vomiting.
METHODS: Clinical practice guidelines are
based upon a systematic literature review
from 1990 through 2015 searching the
following databases: Embase, MEDLINE,
PsychINFO, and CINAHL. Trials were
included if they met the following criteria: (1)
peer-reviewed published randomized
controlled trial; (2) available in English; (3)
included ≥ 50% and/or reported results
separately for BC patients; (4) used an
integrative therapy as an intervention during
standard treatment, or addressed long-term
symptoms and side effects resulting from
diagnosis and/or treatment; and (5) had a
clinical indication of interest. Each article
13th International Conference of the Society for Integrative Oncology November 5-7,
2016 in Miami, FL, USA
Best of SIO Abstracts
was scored for quality of study design and
reporting. Each therapy was graded for
sample and effect size and other
benefit/harm ratio indices using a modified
version of the U.S. Preventive Services
Task Force Grading System.
RESULTS: Music therapy, meditation,
stress management and yoga are
recommended for anxiety and stress
reduction. Meditation, relaxation, yoga,
massage and music therapy are
recommended for depression and mood
disorders. Energy conservation is
recommended for fatigue. Meditation and
yoga are recommended to improve quality
of life. Acupressure and acupuncture are
recommended for reducing chemotherapyinduced nausea and vomiting. Dietary
supplements to manage BC treatmentrelated side effects are not supported with
available high-level evidence.
CONCLUSIONS: There is a growing body
of evidence that integrative therapies,
especially mind-body therapies, can be
used effectively to manage side effects
during BC treatment.