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1.
[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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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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[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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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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Abstract
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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Bee products and their role in cancer prevention and treatment.
Münstedt, K, Männle, H
Complementary therapies in medicine. 2020;:102390
Abstract
OBJECTIVES Apitherapy, a method from the field of complementary and alternative medicine, promises better survival and even cure in cases of cancer. DESIGN 129 books on apitherapy in English, French and German languages were analysed regarding the recommendations concerning cancer. The recommendations were compared to the results from clinical studies in the literature. RESULTS Eighteen books recommend apitherapy for cancer prevention, thirty-nine for complementary cancer treatment and seventeen books considered apitherapy able to cure cancer. Pollen and Propolis were mainly recommended in order to stimulate the immune system and/or to improve cancer nutrition. Interestingly, few books provided specific information and no book provided adequate information in comparison to what is known from clinical studies on bee products. Data on relevant aspects of cancer treatment were not mentioned. This especially refers to data of bee products and radiotherapy, chemotherapy and radio-chemotherapy-induced oral mucositis, radiotherapy-induced skin toxicity, radiotherapy-induced xerostomia, cancer-related fatigue, febrile neutropenia, cisplatin-induced nephrotoxicity, tyrosine kinase inhibitor-induced toxicity, side effects of antihormonal treatment and cancer-related wounds. CONCLUSIONS Apitherapeutic books are not good advisors regarding all aspects of cancer. However, the potential of some bee products justifies further trials, especially on cancer prevention and complementary 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.
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Small cell carcinoma of the ovary of the hypercalcaemic type: an analysis of clinical and prognostic aspects of a rare disease on the basis of cases published in the literature.
Estel, R, Hackethal, A, Kalder, M, Münstedt, K
Archives of gynecology and obstetrics. 2011;(5):1277-82
Abstract
PURPOSE Ovarian small cell carcinoma of the hypercalcaemic type is a very rare and highly aggressive malignant disease, mainly affecting young women. Due to the rarity of this tumour entity, prospective randomised trials are unlikely to be conducted, and the only retrospective analysis based on a large case series is from 1994. Since diagnostic and treatment modalities may have changed, we initiated this analysis. METHODS The aim of our study was to review and analyse cases published since 1975 to validate former findings and to gather more information about therapy options, diagnostic and prognostic factors. A systematic literature search of the PubMed/Medline database was performed assessing all articles until September 2010. All retrieved articles were evaluated and cross-checked for references on the topic. In total, 135 cases were included, selected from 62 case reports and smaller case studies. RESULTS Small cell carcinoma mostly affects women with a mean age of 23.4 years. They present with unspecific symptoms like abdominal pain or palpable mass, sometimes accompanied by an elevated calcium or CA-125 serum concentration. The tumour appears nearly almost unilaterally, mostly affecting the right ovary. Tumour stage is a clearly prognostic factor. Adjuvant chemotherapy consisting of etoposide, cisplatinum/carboplatinum or vinca alkaloids has shown improved survival, whereas radiotherapy has not. CONCLUSIONS In spite of limitations this analysis provides new insights especially with respect to therapeutic aspects. This review underlines the importance of case reports in rare tumour entities in order to answer open questions.
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Effects of basswood honey, honey-comparable glucose-fructose solution, and oral glucose tolerance test solution on serum insulin, glucose, and C-peptide concentrations in healthy subjects.
Münstedt, K, Sheybani, B, Hauenschild, A, Brüggmann, D, Bretzel, RG, Winter, D
Journal of medicinal food. 2008;(3):424-8
Abstract
Studies suggest that honey has less influence on serum glucose concentrations than monosaccharides and disaccharides. This study aimed to confirm these findings conclusively by comparing directly the effects of honey, an identical sugar solution, and oral glucose tolerance (OGT) test solution on serum glucose, insulin, and C-peptide values in healthy subjects. Twelve healthy men with a mean age of 27.7 years, a mean body mass index of 23.2 kg/m(2), and no history of metabolic disorders participated in the study. Subjects underwent OGT testing to establish values and exclude preclinical diabetes. One week later they were randomly assigned to basswood honey or a glucose-fructose solution (honey-comparable glucose-fructose solution). The following week subjects were given the other solution. All solutions contained 75 g of glucose. Serum glucose was measured before drinking test solutions and every 10 minutes for 120 minutes afterwards. C-peptide and insulin were measured at 60 and 120 minutes. Serum insulin and C-peptide values at 60 minutes were significantly lower for honey. The mean serum glucose concentration was also lower for honey, but direct comparisons at the various times showed no statistically significant differences between solutions. However, the area under the concentration-time profile for glucose response was lower for the honey than the honey-comparable glucose-fructose solution. Honey had less effect on serum glucose, C-peptide, and insulin values than the honey-comparable glucose-fructose solution. Further study to elucidate underlying mechanisms may be worthwhile, as may investigation of the implications of these findings for diabetic patients.
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9.
Angiogenesis and vasculogenesis in pregnancy.
Zygmunt, M, Herr, F, Münstedt, K, Lang, U, Liang, OD
European journal of obstetrics, gynecology, and reproductive biology. 2003;:S10-8
Abstract
An adequate nutrient and substrate supply is essential for normal intrauterine development of the fetus. Disturbances in uterine blood supply are associated with higher perinatal morbidity and mortality caused by preterm delivery, pre-eclampsia or intrauterine growth restriction. Adaptation of the uterine vasculature to the rising needs of the fetus occurs through both vasodilation and development of new vessels. Angiogenesis is the process of neovascularization from pre-existing blood vessels in response to hypoxia or substrate demands of tissues. The endometrium, decidua and placenta are sources rich of angiogenic growth factors. In general, the angiogenic process is initiated by growth factors such as bFGF, VEGF, or placental growth factor (PlGF). Through a complex signal transduction machinery mediated by respective receptor-tyrosine kinases, an increase in the permeability of the maternal vessels is achieved to permit growth and invasion of endothelial cells. Their chemotactic migration, formation of a vessel lumen, and functional maturation of new capillaries complete the angiogenic process that involves the expression of specific adhesion receptors and extracellular matrix-degrading proteases. During vasculogenesis, endothelial progenitor cells--angioblasts--form a primitive vascular network. This process occurs mainly during fetal development, although recruitment of angioblasts from bone marrow and peripheral blood in response to ischemic insult have been described in adults. Our recent data indicate a novel function for human chorionic gonadotropin (hCG), a hormonal factor of trophoblastic origin in uterine adaptation to early pregnancy as well as in tumor invasion and underline the importance of hCG as an yet unrecognized angiogenic factor. Although there are striking similarities between, on the one hand, tumor invasion and tumor-induced vascularization and, on the other hand, trophoblast invasion and placental development, our understanding of the different molecular and functional aspects of these two different processes, in particular, the self-limitation of the trophoblastic invasion and vessels formation during gestation might allow the establishment of new therapeutic strategies for the treatment of both tumor and pregnancy related pathology.