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The benefits of vitamin A as a complementary treatment for oncology patients: a systematic review.
Retzlaff, T, Dörfler, J, Kutschan, S, Freuding, M, Hübner, J
Journal of cancer research and clinical oncology. 2023;(5):2157-2177
Abstract
PURPOSE Vitamin A and its derivatives positively influence the differentiation of epithelia and other tissues and prevent the proliferation of preneoplastic and neoplastic cells. Vitamin A is therefore taken into account as a potential supporting factor in cancer therapy. METHODS In November 2020, a systematic search was conducted searching five electronic databases (EMBASE, Cochrane, PsycINFO, CINAHL and Medline) to find studies looking at the effects of using vitamin A as a complementary therapy for cancer patients. From all 12,823 search results, 9 publications referring to 9 studies with 4296 patients were included in this systematic review. RESULTS The patients treated with vitamin A were diagnosed with various cancers and stages. Outcome variables were overall survival of cancer, progression-free survival, occurrence of second primary tumours and recurrences, improvement of chronic radiation-induced proctopathy and side effects of vitamin A. For the most part, the studies had a limited methodological quality. In summary, it can be said that due to the methodological deficiencies of the studies, no concrete statement can be made regarding the prolongation of overall survival and progression-free survival. There is also no evidence of the benefit of vitamin A in the treatment of chronic radiation-induced proctopathy, which can be attributed to methodological deficiencies in the study, as well. In the studies that report on side effects, it becomes clear that side effects, such as mucocutaneous symptoms, temporary increase in liver enzymes and gastrointestinal side effects occur more frequently in the group with vitamin A intervention. CONCLUSION The limited interpretability of the results due to the methodological deficiencies of the included studies does not allow a final statement on the benefits of vitamin A as a complementary treatment for cancer patients.
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[Complementary or alternative medicine in oncology : Chances or risks?].
Hübner, J, Münstedt, K, Micke, O, Prott, FJ, Schmidt, T, Büntzel, J, Keinki, C
Innere Medizin (Heidelberg, Germany). 2023;(1):3-9
Abstract
BACKGROUND Approximately half of all cancer patients use complementary or alternative medicine. AIM: The results of the German S3 guidelines on complementary oncology are presented and placed into the context of patient consultation. MATERIAL AND METHODS The core recommendations of the S3 guidelines are summarized including an overview of the evidence. RESULTS Selected methods of complementary medicine can be used with the aim of improving the quality of life and reducing side effects. Comprehensive data are available for physical activity with respect to survival, quality of life and supportive therapy. For most other methods the evidence is relatively low. Therefore, weighing up the benefits and risks more frequently resulted in negative recommendations in the guidelines, especially for methods based on substances. Exceptions to this are three micronutrients (vitamins B12, D and selenium), as even in the case of a well-balanced diet, deficiency symptoms are possible. Therefore, routine measurement of the blood levels of these micronutrients is recommended. CONCLUSION The questions from patients on what they can do by themselves should be answered respectfully and based on evidence. The benefits and risks of complementary methods must be carefully considered. To do this, regular questioning of patients on the interest in complementary methods is recommended. The decisive benefit of complementary medicine is the chance for patients to become active themselves. Therefore, all recommendations refer to the discussion with the patient, which do not formulate a therapy but are consultation recommendations: should be recommended instead of should be done.
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Fasting during cancer treatment: a systematic review.
Drexler, U, Dörfler, J, von Grundherr, J, Erickson, N, Hübner, J
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2023;(5):1427-1446
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Abstract
BACKGROUND Clinical data on the modern topic fasting among cancer patients are rare. This review aimed to summarise published clinical data on fasting and its effects on patients undergoing chemotherapy and therefore to give some directions in advising patients with the desire to fast. METHOD A systematic search was conducted searching five electronic databases (Embase, Cochrane, PsychInfo, CINAHL and Medline) to find studies concerning the use, effectiveness and potential harm of fasting during therapy on cancer patients. The main endpoints were quality of life, side effects and toxicities of the fasting intervention. RESULTS The search results totaled 3983 hits. After systematic sorting according to standardised pre-defined criteria, nine publications which covered eight studies with 379 patients were included in this systematic review. The majority of the patients included were diagnosed with breast- and gynaecological cancers. Fasting duration and timepoints ranged significantly (24-140 h before, and on the day of, chemotherapy to 56 h after chemotherapy). In one study patients were fasting before cancer surgery. The studies were mostly low to moderate quality and reported heterogeneous results. Overall, the studies were insufficiently powered to detect significant effects on the predefined endpoints. CONCLUSION Fasting for short periods does not have any beneficial effect on the quality of life of cancer patients during treatment. Evidence on fasting regimes reducing side effects and toxicities of chemotherapy is missing. In contrast, as the negative effects of unintentional weight loss are known to impact clinical outcomes severely, fasting is not indicated in this context.
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A Systematic Review of the Benefit of B-Vitamins as a Complementary Treatment in Cancer Patients.
Heilfort, L, Kutschan, S, Dörfler, J, Freuding, M, Büntzel, J, Münstedt, K, Hübner, J
Nutrition and cancer. 2023;(1):33-47
Abstract
B-vitamins act as enzymatic co-factors in immune functions, therefore they are considered to reduce chemotherapy-induced side effects in cancer patients. We conducted a systematic search, screening five electronic databases (Embase, Cochrane, PsychInfo, CINAHL and Medline) to find studies on the effectiveness and potential harm of B-vitamin therapy on cancer patients. Out of the 7465 search results, 11 RCTs about vitamin B6, B12 and B-vitamins in combination were included in this systematic review. A total of 1546 patients with diverse types of cancer were evaluated. Overall, most studies were of acceptable quality and reported consistent results. Studies examining the effectiveness of vitamin B6 reported that there is no significant impact on decreasing the incidence and severity of chemotherapy-induced side effects (e.g., hand-foot syndrome), the necessity of chemotherapy dose-modifications or improving patients' quality of life, tumor response/progression, and overall survival. Two studies reported that vitamin B12 could be effective in the alleviation of symptoms resulting from chemotherapy; it might decrease motor, sensory and pain symptoms of peripheral neuropathy. However, a combination of B vitamins may not reduce the incidence of chemotherapy-induced peripheral neuropathy. All in all, the evidence on B-vitamins in cancer patients is low and supplementation cannot be recommended.
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Phytotherapy known and applied by head-neck cancer patients and medical students to treat oral discomfort in Germany: an observational study.
Ritschel, ML, Hübner, J, Wurm-Kuczera, R, Büntzel, J
Journal of cancer research and clinical oncology. 2023;(5):2057-2070
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BACKGROUND Plant remedies are often used next to conventional standard of care by cancer patients. However, user rates are often underestimated and physicians usually feel not equipped to counsel patients. Hence, routinely recording the use of phytotherapy and sufficient knowledge on herbal medicine of the medical staff are required to improve the situation. Appraising the current state of knowledge of medical students may offer insight if education on herbals needs improvement. Here, we propose a simple anamnesis tool to assess knowledge and usage pattern of medical plants and demonstrate how to extrapolate symptom cluster participants associated with plants investigated in this study focussing on the common symptom of oral discomfort. METHODS By screening German literature (popular science, specialist's literature, books for the interested layman) on medical plants used for treating oral discomfort, we were able to deviate a list of plants most often recommended for treating oral discomfort and to develop an anamnesis tool to assess knowledge and usage of 16 different plants. A group of 120 head-neck cancer patients (under surveillance, after receiving treatment) and 168 medical students were questioned at a collaborating out-patient clinic and via an online survey, respectively, in 2020. Students were additionally asked to write down indications of the plants they used in daily life. Knowledge and usage pattern were compared between both groups. Primary component analysis and heat-map analysis were used to visualize common and distinguishing features. Network analysis and VENN diagrams were used to extrapolate data of the medical students' cohort. RESULTS Head-neck cancer patients and students show similar knowledge. However, students used significantly more plants in daily life than patients (p < 0.001). Overall, the user rate of patients and students were 82.50 and 93.94%, respectively. The top five most commonly known plants were similar in both groups (Marticaria recutita L., Zingiber offinicale ROSCOE, Taraxacum Wigg. Calendula officinalis L.) with the exception of Salvia officinalis L. (patients' cohort) and Carum carvi/Cuminum cyminum L. (students' cohort). Despite this slight difference, usage pattern of the top five most commonly used plants was the same between the groups. Students' indications were compared to indications found in the literature, unmasking several differences between commonly practiced and written knowledge on German phytotherapy. Network analysis revealed, that students associated certain plants with corresponding symptom clusters (e.g., coughing, oral mucositis). CONCLUSION The majority of surveyed cancer patients as well as medical students use phytotherapy for treating oral discomfort. Both groups know and use similar plants. However, indications of written folk medicine differ from the lived and practiced tradition.
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[Alternative medicine in uro-oncology].
Hübner, J, Keinki, C, Münstedt, K
Urologie (Heidelberg, Germany). 2023;(1):34-40
Abstract
BACKGROUND Alternative medicine is used instead of conventional therapy. Some patients use it in parallel with conventional medicine. OBJECTIVE Narrative compilation of the evidence on alternative medicine in the (uro)oncological context. MATERIALS AND METHODS A selective literature search in MEDLINE via PubMed was performed. RESULTS The data on 3‑bromopyruvate, Miracle Mineral Supplement (MMS), insulin-potentiated therapy, base therapy, hyperthermia, Artemisia annua, amygdalin (vitamin B17), Amanita therapy, homeopathy, apitherapy, dendritic cells, galavit, Germanic new medicine, and spiritual healing show either no or little clinical evidence of efficacy or clearly exhibit a negative benefit-risk profile. CONCLUSIONS Alternative medicine is pseudo-medicine that may have a positive effect on mental well-being in the short term, but is mostly associated with disadvantages for the patient in the long term.
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The Vitamin E Isoform α-Tocopherol is Not Effective as a Complementary Treatment in Cancer Treatment: A Systematic Review.
Retzlaff, D, Dörfler, J, Kutschan, S, Freuding, M, Büntzel, J, Hübner, J
Nutrition and cancer. 2022;(7):2313-2336
Abstract
The term vitamin E describes tocopherols and tocotrienols, whose chemical variations result in different biological activities including antioxidants. Neuroprotective effects of alpha-tocopherol against different toxins are assumed, therefore, it is discussed as a possible protective factor for adverse effects in cancer treatment. In July 2020, a systematic search was conducted searching five databases (Embase, Cochrane, PsychInfo, Cinahl, Medline) to find studies concerning the impact of α-tocopherol application and its potential harm on cancer patients. From 7546 search results, 22 publications referring to 20 studies with 1941 patients were included. Included patients were diagnosed with various cancer types and stages. Outcome variables were overall survival of cancer, symptom management of mucositis and chemotherapy-induced peripheral neuropathy (CIPN). The studies had different methodological qualities (mainly acceptable) and reported heterogeneous results: some reported significant improvement of mucositis and CIPN while others did not find changes concerning these endpoints. Due to heterogeneous results and methodical limitations of the included studies, a clear statement regarding the effectiveness of α-tocopherol as complementary treatment for cancer patients is not possible. Despite findings regarding reduction of oral side effects, usage of α-tocopherol during therapy must be discouraged because of potential negative influence on survival rates.
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Clinical efficacy and safety of oral and intravenous vitamin C use in patients with malignant diseases.
Hoppe, C, Freuding, M, Büntzel, J, Münstedt, K, Hübner, J
Journal of cancer research and clinical oncology. 2021;(10):3025-3042
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BACKGROUND Vitamin C, also called ascorbic acid, is a water-soluble antioxidant and free radical scavenger. It is required in the body for numerous metabolic functions and is involved in the development of proteins and connective tissue. METHODS In April 2020, a systematic search was carried out on five electronic databases (Medline, Embase, Cochrane, Cinahl, PsycINFO) to find studies on the use, efficacy and safety of a complementary therapy with vitamin C in oncological patients. RESULTS Out of the initial 23,195 search results, 21 studies with 1961 patients were included in this review. Five of the included studies (n = 417) were randomized controlled trials (RCTs). The remaining 16 studies belonged to a lower class of evidence. The patients who were treated with vitamin C suffered from various malignant diseases, some in an advanced and palliative stage. Vitamin C was applied intravenously or orally. It was either the only treatment or was combined with chemo- or radiotherapy. Endpoints included the development of the disease-related symptoms, quality of life, mortality, progression-free survival and safety of vitamin C. The studies were of moderate quality and showed either no effect of vitamin C or a positive trend, although this has rarely been statistically proven in group comparisons. No or only slight side effects with both oral and intravenous administration of vitamin C were reported. CONCLUSION Oral intake of vitamin C does not appear to have any effect in patients with malignancies. Data are heterogeneous for intravenous administration. There are no RCTs with statistical group comparisons.
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[Complementary medicine in uro-oncology].
Hübner, J
Der Urologe. Ausg. A. 2020;(6):695-699
Abstract
Modern concepts such as patient empowerment stand for the selection of appropriate concomitant treatment procedures from a scientific point of view and for placing these in the hands of the patient, thereby demanding and encouraging personal responsibility. It is important to distinguish between the terms complementary and/or alternative medicine. If we look at the motivation of patients to use complementary and/or alternative procedures, this is divided into the desire to do something directly against the tumor and on the other hand to strengthen the body's own resources, support the immune system, and reduce side effects in a concrete manner. The crux of modern oncology is that many specialists no longer have sufficient time for detailed patient information talks and multiple good physician-patient talks. The importance of complementary medicine in addition to nutrition and exercise lies above all in its targeted use as a concomitant supportive therapy. Complementary medicine primarily offers the chance to meet the desire of those affected to actively participate in their treatment.
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Honey in the management of side effects of radiotherapy- or radio/chemotherapy-induced oral mucositis. A systematic review.
Münstedt, K, Momm, F, Hübner, J
Complementary therapies in clinical practice. 2019;:145-152
Abstract
BACKGROUND and purpose: In spite of several trials, systematic reviews and meta-analyses, honey is not considered as a viable candidate for the prophylaxis and treatment of radiotherapy-induced oral mucositis in the practice guidelines for supportive care. The purpose of this study was to analyse the value of honey in this treatment situation based on randomized trials acknowledging the fact that manuka honey which is used in some trials distinguishes itself from other honey due to the presence of methylglyoxal. METHODS On the basis of a literature search, we identified and analysed 17 randomized trials on the topic. Participants in these trials received radiotherapy or a combination of radiotherapy and chemotherapy for head and neck cancer. RESULTS Studies using manuka honey found little rationale for the medicinal use of honey (n = 4) in this field, whereas trials using conventional honey presented data on its usefulness (n = 13). Thus, the type of honey may explain the divergent results of trials in this area. CONCLUSION Conventional honey is likely to be effective in the prophylaxis and treatment of radiation- and chemoradiation-induced oral mucositis.