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| Volume
14, Issue 3, October 2006 |
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| Coordinator's Message Mondays Are for Compliments  Charlene
“Gayle” Pattillo, BSN, RN, C, OCN®, CLL*Johnson City, TN patillocg@msha.com *Certified Laughter Leader In the Good Hearted Living Program of the World Laughter Tour, Mondays are for compliments. Merriam-Webster's Dictionary (2006) defines a compliment as "an admiring remark" or "best wishes." I encourage you, not just on Mondays, but every day, to share best wishes with your colleagues and patients. Our words are powerful tools that can be used to uplift others. Praise your patients' efforts and accomplishments in treatment. Praise your team members in their work to provide care and support to patients. Encourage patients and staff to use positive language. I try to avoid the phrase, "I'm just a nurse"; instead, share that "I am a nurse." In talking to or about patients, isolation or failed treatment may imply the need to protect others or failure on the part of the patient. Protective care or sharing that the treatment has not produced the desired results is more compassionate and takes the blame away from the patient. Even the term "survivor" may be misconstrued. Some do not want to be labeled survivors. Their lives are more than just surviving, they are living. Bernie Siegel (1986) called them "exceptional patients." Harold Benjamin (1989), founder of the Wellness Community, called them "victors" rather than cancer survivors. Years ago, Norman Cousins (1989) reported a conversation between two oncologists discussing their protocols. One used the acronym EPOH (etoposide, platinol, oncovin, and hydroxyurea) and had a 22% response rate. His colleague, using the same drugs but emphasizing the chance for success, named his protocol HOPE. He had a 74% response rate. Encouragement can be therapeutic and support hope as we provide complementary therapies (Altilio & Walsh-Burke, 2002). Compliment your patients, your colleagues, and yourself on your efforts. I would like to compliment our SIG members who made it a point to attend our annual meeting at Congress in Boston, our ONS members who attended the meeting to learn more about our SIG, and our leadership who worked on programs at Congress and throughout the year. Gwen Wyatt, RN, PhD, our ex officio, has led our SIG through a name change, encouraged us in developing presentations and publications and renewing our SIG poster, and led through the past two years to grow and nurture our membership. Alan Durtschi, BSN, RN, OCN®, created our SIG poster for Congress, a colorful and informative illustration of CAM programs. CDR Colleen Lee, RN, MS, AOCN®, along with Georgia Decker, RN, CS-ANP, AOCN®, and Marion Irwin Bergan, LAC, delivered a well-received one-day pre-Congress session on Cancer CAM Primer. Georgia is planning another session for IOL. Jody Owen, BSN, RN, again coordinated the Rejuvenation Room at Congress and is looking for someone to mentor to continue this work after the 2007 Congress in Las Vegas. Although our newsletter editor, Pamela Potter, ARNP, DNSc, and our virtual community Web administrator, Mary Beth Revak, RN, OCN®, were unable to be with us at Congress, they do a wonderful job of communicating our needs, accomplishments, and services throughout the year. To all of you, I offer my compliments for a job well done for the Complementary and Integrative Therapies SIG. References Altilio, T., & Walsh-Burke, K. (2002). The words we choose and the messages they convey. Oncology Issues, 17(1), 48. Benjamin, H.H. (1989). From victim to victor. New York: Dell. Cousins, N. (1989). Head first: The biology of hope. New York: E.P. Dutton. Merriam-Webster Online. (2006). Compliment. Retrieved September 18, 2006, from http://www.m-w.com/cgi-bin/dictionary Siegel, B. (1986). Love, medicine and miracles. New York: Harper and Row. |
The
Complementary & Integrative Therapies SIG Newsletter is produced
by members of the Complementary & Integrative Therapies SIG and ONS staff and is not a peer-reviewed publication. |
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| Special
Interest Group Newsletter October 2006 |
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Editor's Message Are you enjoying this newsletter? Is there some content that you would
like to see? Do you have an editorial commentary relevant to complementary
and integrative therapies (CIT)? Send a description of recently funded
research. Describe your program of research and include a list of your
publications. Give one of your students an opportunity to submit a CIT
and cancer-related paper (American Psychological Association references,
please). Let me know if you want to contribute. Copy is due to me by
October 20, 2006, for the winter newsletter. In this issue our Coordinator and Laughter Leader, Gayle Pattillo,
BSN, RN, C, OCN®, CLL, reminds us that "Mondays
Are for Compliments," tells us how to integrate praise into our
nursing practice with patients and colleagues, and compliments the contributions
of CIT SIG members. Gayle, we compliment you as well for the vibrancy
you bring to your coordinator position. Marilyn J. Hammer, DC, RN, BSN,
chiropractor and budding nurse researcher, writes about "Chiropractic
Care for Patients With Cancer: An Adjunct for Symptom Management"
and later introduces herself and her integrative philosophy in her "Elevator
Introduction." In this issue's "Research in Progress,"
we learn that Susan Bauer-Wu, DNSc, RN, received funding for studying
the biobehavioral effects of mindfulness with patients receiving autologous
stem cell transplants. In "Member Publications,"
the bibliography provided by Georgia Decker, RN, CS-ANP, AOCN®,
the current ONS president, demonstrates the contribution oncology nurses
are making to the integration of complementary therapies in cancer care.
CDR Colleen Lee, RN, MS, AOCN®, reports on two
conferences the North American Research Conference on Complementary
and Integrative Medicine and the Cancer CAM Primer for Oncology Nurses,
the latter of which was presented as a one-day session at the ONS 31st
Annual Congress in Boston, MA. Finally, "Online Resources"
offers a variety of entries of possible interest to CIT SIG members.
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Pamela
Potter, ARNP, DNSc |
| Special
Interest Group Newsletter October 2006 |
| Integrative Therapies  Marilyn
J. Hammer, DC, RN, BSN University of Washington, Seattle, WA mjh40@u.washington.edu As many as 80% of patients with cancer use some form of complementary and alternative medicine (CAM), though often the use is not disclosed to allopathic healthcare providers (Roberts et al., 2005). When patients are forthcoming about CAM use, providers most often are supportive. Some of the more common forms of CAM therapies used that are noted in the literature include herbal remedies, nutrition, exercise, massage therapy, and prayer. A less-discussed CAM modality that serves a number of patients with cancer is chiropractic care. In particular, patients report that chiropractic spinal manipulation (CSM) is beneficial in the management of cancer-related pain (Evans & Rosner, 2005). Physiologic evidence exists as to why this modality is so effective in the treatment of pain. CSM triggers type III mechanoreceptors (Golgi tendons) of large diameter high-threshold fibers in ligaments, facet joints, tendons, and intervertebral discs (McLain, 1994; Mendel, Wink, & Zimmy, 1992). The firing of the mechanoreceptors competitively inhibits small-diameter pain fibers, thus causing an analgesic effect (Kirkaldy-Willis & Cassidy, 1985). Additionally, the triggering of the fibers leads to stimulation of serotonergic fibers, which causes a release of opioid peptides, thus further inhibiting nociceptive pathways (McLain). CSM does not require a great deal of force to trigger the cascade of events, and several low- or no-force techniques are equally effective. Chiropractic care can achieve benefits beyond pain control because CSM helps the nervous system function optimally to enhance functioning of all body systems. Treatments for cancer can include use of aggressive chemotherapeutic agents, radiation therapy, and hematopoietic stem cell transplantation along with ancillary medications needed to support these therapies and minimize some of the side effects. Symptom management can be overwhelming for patients and healthcare providers. Although formal research is lacking in this area, patients often report feeling less fatigued, having less nausea and vomiting, and being able to function better in their lives overall when they are receiving chiropractic care as an adjunct to their cancer treatments. Patients under chiropractic care also report being able to do things not thought possible based on their cancer treatments, such as attending family functions and participating in physical activities without feeling fully depleted. The role of nursing care lies in eliciting patient information about use of CAM therapies and educating patients on the risks and benefits. In terms of chiropractic care, oncology providers must work with chiropractors in assessing risk versus benefit. The risks would include the use of certain chemotherapeutic agents, high-dose steroids, and radiation treatments that could cause osteomalacia, leaving the patient susceptible to fractures. No-force techniques are indicated in those situations. Close monitoring by chiropractors and oncology team would ensure the safest and most effective benefits for patients. In addition to benefiting patients with cancer, chiropractic care is an excellent modality that can be enjoyed by healthcare providers themselves. Because nursing activity can be quite physical, CSM can help nurses and other direct patient care providers to maintain healthy musculoskeletal and nervous systems for enhancing work performance while minimizing injuries. Further research is needed in this area as well. Pertaining to patients with cancer, chiropractic care is underutilized and research is needed to enhance awareness, alleviate trepidations, and help bridge the gap between allopathic and CAM providers in order to fully optimize patient quality of life. References Evans, R.C. & Rosner, A.L. (2005). Alternatives in cancer pain treatment: the application of chiropractic care. Seminars in Oncology Nursing, 21, 184-189. Kirkaldy-Willis, W.H. & Cassidy, J.D. (1985). Spinal manipulation in the treatment of low-back pain. Canadian Family Physician, 31, 535-540. McLain, R.F. (1994). Cervical facet joints. Spine, 19, 495-501. Mendel, T., Wink, C.S., & Zimmy, M.L. (1992). Neural elements in human cervical intervertebral discs. Spine, 17, 132-135. Roberts, C.S., Baker, F., Hann, D., Runfola, J., Witt, C., Mcdonald, J. et al. (2005). Patient-physician communication regarding use of complementary therapies during cancer treatment. Journal of Psychosocial Oncology, 23(4), 35-36.
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| Special
Interest Group Newsletter October 2006 |
| Research in Progress
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Complementary and Integrative Therapies SIG member Susan Bauer-Wu, DNSc,
RN, has been awarded a five-year grant totaling approximately $2.5 million
from the National Institutes of Health to study the effects of mindfulness
meditation in patients with cancer. For more information on Susan's
study, check out the |
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| Special
Interest Group Newsletter October 2006 |
| Member Publications  Georgia
Decker, RN, CS-ANP, AOCN®Albany, NY jorja@att.net I have had the privilege to be able to participate in some very exciting publishing opportunities during the past six years: first the birth of the Integrated Care column in the Clinical Journal of Oncology Nursing and then several chapters in a variety of books. For me, it has been heartening to know that complementary and alternative medicine (CAM) has come into its own. Nurses were the first to respond to the potential of appropriately indicated CAM therapies. Our recent pre-Congress workshop at the ONS Congress in Boston, MA, was validating and great fun. The group was very interactive and brought their questions and concerns to each session. There is CAM Handbook in the works. We had hoped to have it available at Congress but did not make the deadline to be able to do so. Watch for it this fall. Bibilography Decker, G. (2004). Complementary and alternative medicine (CAM) therapies—Indications, contraindications, opportunities. In B. Hoffman (Ed.), National Coalition for Cancer Survivorship: A cancer survivor's almanac. New York: Wiley and Sons. Decker, G. (2005). The use of complementary and alternative (CAM) therapies in men with prostate cancer. In J. Held-Warmkessel (Ed.), Contemporary issues in prostate cancer: A nursing perspective (2nd ed.). Sudbury, MA: Jones and Bartlett. Decker, G. (2006). Complementary and alternative medicine (CAM) therapies. In D. Cope & A. Reb (Eds.), An evidenced-based approach to the treatment and care of the older adult with cancer. Pittsburgh, PA: Oncology Nursing Society. Decker, G., & Lee, C. (2005). Complementary and alternative medicine (CAM) therapies. In C.H. Yarbro, M. Frogge, & Goodman (Eds.), Cancer nursing: Principles and practice (6th ed.). Sudbury, MA: Jones and Bartlett. Decker, G. (2005). Integrating complementary and alternative medicine therapies into an oncology practice. In P. Buchsel (Ed.), Oncology nursing in the ambulatory setting. Sudbury, MA: Jones and Bartlett. Decker, G. (in press). Complementary and alternative medicine (CAM) therapies in radiation therapy. In T. Gosselin, M. Haas, W. Hogle, & G. Moore-Higgs (Eds.), Radiation therapy: A guide to patient care. Philadelphia: Elsevier. Decker, G. (in press). Complementary and alternative medicine therapies. In K.H. Dow (Ed.), Women and cancer. Philadelphia: Elsevier.
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| Special
Interest Group Newsletter October 2006 |
| Conference Highlights  CDR
Colleen Lee, RN, MS, AOCN®Bethesda, MD leeco@mail.nih.gov The North American Research Conference on Complementary and Integrative Medicine was held in Edmonton, Canada on May 24–27, 2006, bringing in 650 delegates from 28 countries and combining exciting scientific content and warm collegiality. The sponsor of this first-of-its-kind conference is the Consortium of Academic Health Centers for Integrative Medicine, a group of 32 centers across North America, with dedicated clinical and/or scientific programs in complementary and alternative medicine (CAM). For more information, visit the consortium's Web site at www.imcorsortium.org. The planning committee included reputable experts such as Susan Folkman, PhD, Aviad Haramati, PhD, David Eisenberg, MD, Sunita Vohra, MD, and Sara Warber, MD, whose careful work in developing the plenary, symposium, discussion, and workshop session format was evident throughout the three-day conference. The poster sessions held twice daily, with a new category on display each time, focused on basic science, clinical research, health service research, research methodology, and education research. The sessions provided the opportunity to meet with researchers and discuss areas of mutual interest and potential future collaboration. David Moher, PhD, called attention to the progress and barriers in generating, communicating, and synthesizing research evidence in complementary and integrative medicine. He proposed the "SWAT" team approach to research: mandated proposals to address specific questions, develop collaborative centers, design a useable electronic data infrastructure, and assure agreement on primary research outcomes. A common theme emerging from his session that reappeared in nearly every other session was the emphasis on the four-letter word "FUND," reiterating the acute need for well-funded, well-powered, clinically significant research. Margaret Chesney, PhD, inspired delegates to "be bold in what you try and be cautious in what you claim." In "being bold," she spoke to the building momentum and parallel transformation in health care today that brings in complementary and integrated medicine to clinical care and to research. In "being cautious," she emphasized that research is not perfect; problems exist in design, results may be caused by chance alone, and inherent risks exist for types I and II errors. She proposed the expansion of current research to include younger and older populations, whole-system interventions, individualized or personalized approaches, optimized adherence, and maintained progress made over time. Richard Davidson, PhD, highlighted his work with the field of neuroplasty (brain changes in response to emotion), specifically with inquiry into to area of personal happiness. He raised three important points.
He emphasized that statistical analysis has shown than neither marriage nor money can guarantee happiness. Overall, the salient point was that some people are not as good as others in downregulating the negative emotions that we experience and not letting those emotions impact our core happiness. Brian Berman, MD, spoke of his and his colleagues' work supporting the use of acupuncture for the treatment of osteoarthritis from conception to pilot study, clinical trial, and proposed effective therapy during the past decade. Members of the clinical trial team included a physician, complementary and alternative medicine expert, licensed acupuncturist, rheumatologist, biostatistician, research methodologist, and research coordinator. In designing studies, he recommended appropriate staging of the trial design, ensuring that the treatment is adequate and the control group is appropriate to the question(s) asked, and following good clinical trial guidelines. Finally, he emphasized that at this point in history, we have the unique opportunity to change practice based on quality research findings that had not previously been available. Peter Lipsky, MD, in his talk titled "Thundergod Vine: From Countryside to the Bedside to the Bench," traced 15 years of work across continents to determine the mechanism of action, determine active components, optimize the manufacturing, confirm the efficacy, and maintain collaboration with the original investigators involving the herb tripterygium wilfordii Hook F (TwHF), otherwise known as thundergod. This herb is grown naturally in China, Taiwan, and Burma and has been shown to exert efficacy as an immune modulating agent without hormonal effects and is considered a safe glucocorticoid. In Phase II clinical trials, TwHF was shown to be superior to sulfasalazine in inducing the American College of Rheumatology's 20% response in patients with active rheumatoid arthritis at six months. Future studies with this herb are planned. I also presented during the symposium session, "Exceptional Disease Courses Defined by Patients and Experts: Registration and Research in an International Perspective." I presented the goals, criteria, and outcome measures of the National Cancer Institute's (NCI's) Best Case Series program as a part of my role as the manager of the program at the NCI Office of Cancer Complementary and Alternative Medicine (OCCAM). The premise of the symposium was to highlight international adoption of the criteria and the established registries that exist in Norway and Sweden involving best and worse cases. An additional presentation was the project development pathway, adoption, and eventual publication of a best case series conducted at Hufeland Klink in Germany. This session grew out of a collaborative effort between National Research Center in Complementary and Alternative Medicine at the University of Tromso in Norway and the NCI OCCAM. Abstracts from the verbal presentations were published in the May/June 2006 issue of Alternative Therapies in Health and Medicine. A Cancer Complementary and Alternative Medicine Primer for Oncology Nurses ONS hosted its first all-day session on cancer CAM therapies in conjunction with the 31st Annual Congress in Boston, MA, in May 2006. ONS President Georgia Decker and I (as session coordinator from the NCI Office of Cancer Complementary and Alternative Medicine), developed the all-day session in response to ONS members' requests for comprehensive programming at a national level designed specifically for oncology nurses. Content was tailored to nurses whose practices include community, hospital, and research-based facilities involving the care of patients with cancer in acute, chronic, and supportive care settings. The ONS Complementary and Integrated Therapies SIG sponsored this session, as well as similar half-day sessions by these speakers at previous ONS conferences. The design of Cancer CAM Primer for Oncology Nurses involved didactic and experiential sessions. In the didactic session, the following topics were explored.
Three experiential sessions were offered on a rotating basis for all participants. Workshop 1, facilitated by Marion Bergan Irwin, LAc, from Albany, NY, integrated a discussion of the common anatomical points for acupuncture and acupressure and proper application in the clinical setting with a demonstration of indirect moxibustion and vibrational acupuncture. Workshop 2, facilitated by Georgia Decker, promoted a discussion of the role of vitamins, herbal supplements, and biologicals in cancer care focusing on inconsistencies that exist, such as variability in dosing, duration, and timing of supplementation in addition to known contraindications. A unique feature of the workshop was the detailed description of how to read a label. Workshop 3, which I facilitated, comprised a discussion of the many sources of CAM information and focused on techniques to identify the quality of this information. The use of several reputable databases was demonstrated, and participants were granted temporary access by the database managers for the duration of the conference. An expansive display of printed materials was available for review. An overview of existing integrated programs in NCI comprehensive cancer centers also was presented. The CAM primer was well received by the 100 participants because of the volume of useful and pertinent information, access to databases during the conference, and especially the engaging didactic-experiential balance. Future plans by ONS are twofold: (a) publication of a cancer CAM supplement to the Society's two peer-reviewed journals, the Oncology Nursing Forum and Clinical Journal of Oncology Nursing, which will include the best published articles from these journals on this topic, and (b) publication of a pocket guide highlighting the evidence-based conventional and CAM interventions for the symptoms discussed in the Primer session. Georgia Decker and I have submitted a proposal to repeat the primer at the 32nd ONS Annual Congress in 2007 with an advanced tier offering more experiential sessions.
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| Special
Interest Group Newsletter October 2006 |
| Elevator Introduction  Marilyn
J. Hammer, DC, RN, BSN University of Washington, Seattle, WA mjh40@u.washington.edu I am a chiropractor currently working on a master of nursing degree and PhD in oncology research. Ultimately, through integrative medicine research, I wish to help bridge the gap between Western medicine and complementary and alternative medicine for patients with cancer. Neither avenue is mutually exclusive in curing cancer or completely optimizing quality of life. One of the reasons that the incidence and prevalence of cancer has not dramatically declined or been eradicated—even with valiant efforts and billions of dollars over many years of research—appears to be because of our advances in industry and technology at large. That is, the production of carcinogens from the structures we build, the vehicles that transport us, the processed foods we eat, etc., all affect our bodies and the earth and its atmosphere (not to mention what alterations we are doing beyond our planet with so many advances in aeronautics). This, coupled with medical technology that allows us to live with acute and chronic diseases, may affect our gene pool so that offspring are born with certain genetic predispositions to cancer (initiators), which then are manifested through the promoting factors of environmental exposure. So, what is our best defense? Our best defense is awareness, prevention, and optimizing quality of life in every stage of life—through the dying process—and given any set of circumstances. I believe that to optimize quality of life, we must use all resources and integrating complementary health care with allopathic medicine will provide the best outcomes. More research—and perhaps new paradigms in research—is needed to make this concept mainstream.
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| Special
Interest Group Newsletter October 2006 |
| Patients With Cancer May Benefit From Yoga
National Cancer Institute Supports Yoga Study
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Yoga
May Improve the Health of Patients With Breast Cancer |
| Special
Interest Group Newsletter October 2006 |
| Membership Information SIG Membership Benefits
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| Special
Interest Group Newsletter October 2006 |
| Complementary & Integrative Therapies SIG Officers
Know
someone who would like to receive a print copy of this newsletter? To view past newsletters, click here. ONS Membership/Leadership Team Contact Information Angie Stengel, MS, CAE, Director of Membership/Leadership Diane Scheuring, MBA, Manager of Member Services Carol DeMarco, Membership/Leadership Administrative Assistant The Oncology Nursing Society (ONS) does not assume responsibility for the opinions expressed and information provided by authors or by Special Interest Groups (SIGs). Acceptance of advertising or corporate support does not indicate or imply endorsement of the company or its products by ONS or the SIG. Web sites listed in the SIG newsletters are provided for information only. Hosts are responsible for their own content and availability. Oncology Nursing Society
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