In this newsletter, I report on the National Institutes of Health Dietary Supplement Research Practicum 2008, and Colleen Lee, MS, CRNP, AOCN^®, our SIG coordinator, describes her research role in integrative oncology practice. Reports from Pre-Congress 2008 IN Philadelphia, PA, and the Rejuvenation Room at Congress 2008 describe our SIG’s efforts to bring integrative care options to the Annual ONS Congress.

National Institutes of Health Dietary Supplement Research Practicum 2008 Was Not to Be Missed

Pamela Potter, DNSc, APRN_BC
Portland, OR
potter@up.edu

This summer, as a representative of the University of Portland School of Nursing, I participated along with over 100 professors and graduate students from universities throughout the United States and Canada in the National Institutes of Health (NIH) Office of Dietary Supplements (ODS) course.

Dietary Supplement Research Practicum 2008 was held on the NIH campus in Bethesda, MD. ODS offers this annual intensive course to provide essential knowledge of dietary supplements to academic faculty and their doctoral or post-doctoral students with a serious interest in this subject. Experts from NIH, academic institutions, and federal regulatory agencies such as the U.S. Food and Drug Administration (FDA) served as speakers.

The ODS practicum provides a thorough overview of issues, concepts, unknowns, and controversies about dietary supplements and supplement ingredients. It also emphasizes the importance of scientific investigations to evaluate the efficacy, safety, and value of these products for health promotion and disease prevention and treatment as well as how to carry out this type of research.

This course was an excellent resource for everything you ever wanted to know about the definitions and regulations of dietary supplements and the conduct of research on dietary supplements. Distinctions were made among drugs, food, and dietary supplements that are subject to different regulations. Ensuring quality of supplements and good manufacturing practices also was described. Research considerations for standardizing products, measuring food and supplement intake, measuring biomarkers of exposure, and measuring safety and efficacy were presented. The practicum came full circle to public and regulatory policy (the source of the evolution of the ODS itself). I learned that the regulation of “functional foods,” foods considered to have enhanced health benefit, is much less stringent than regulating herbs and supplements. I also learned that aromatherapy oils are not considered under food or dietary supplement (which includes herbs) regulation. Upon searching, one is more likely to find regulatory information about them under cosmetics.

The gold mined from this conference was the session that focused on dietary supplement data bases. These data bases can be accessed to varying degrees by health professionals, researchers, and lay people.

NIH data bases and research resources related to dietary supplements include the following.

• Computer Access to Research on Dietary Supplements (CARDS) Provides access to information about federally funded research pertaining to dietary supplements.

• Clinical Trials Database Provides access to information about federal and private medical studies involving patients and others.

• Computer Retrieval of Information on Scientific Projects (CRISP) Provides information about federally funded biomedical research projects.

• International Bibliographic Information on Dietary Supplements (IBIDS) Provides access to bibliographic citations and abstracts from published, international, and scientific literature on dietary supplements.

• Dietary Supplement Ingredient and Labeling Databases

• Annual Bibliographies of Significant Advances in Dietary Supplement Research

• National Health and Nutrition Examination Survey (NHANES)

Another excellent benefit from attending this course was the network of professors and students who are interested in dietary supplements as complements (when appropriate) to conventional care.

Although we had a half-day meeting with the “stakeholders,” those who “study, advocate, regulate, or educate on dietary supplements in Washington, DC,” information on integrative approaches to dietary supplements and balanced input from professionals in the fields of oriental, natural, and herbal medicine was missing.

Coordinator Colleen Lee Explores Her Research Role in Integrative Oncology

Colleen Lee, MS, CRNP, AOCN^®
Bethesda, MD
leeco@mail.nih.gov

How did your oncology nursing career begin?
My oncology nursing career began in my undergraduate program when I would spend time visiting inpatients in a small hospital in South Bend, IN. I did this because I wanted to learn what it meant for people to face an unknown disease and continue to live life. In my senior year, my older sister was diagnosed with breast cancer, so I quickly was learning how to be first a sister to someone with cancer and second, a new oncology nurse. As a new graduate, I moved to Philadelphia, PA, to work at the University of Pennsylvania on a hematology and oncology inpatient unit. My heart’s desire always had been to work at the National Institutes of Health, and I began there in 1987. The cumulative life lessons that I have gained from my patients have humbled me and helped create who I am today.

How did you arrive at your current position?
Ten years ago, I earned my graduate degree in advanced practice oncology nursing from the University of Maryland and made a transition from inpatient to outpatient care to round out my clinical knowledge of the care spectrum. The science of oncology and the art of caring for patients and families are stimulating intellectually and emotionally. I was at a point where I was ready to test my knowledge and expand my experience, and so I responded to a position posted in the National Cancer Institute’s (NCI) Office of Cancer Complementary and Alternative Medicine (CAM). I knew close to nothing about CAM but a lot about conventional care, especially in the clinical trials setting, and therefore could approach CAM from a solid research foundation and without bias.

Can you describe the many facets of your role?
Several years ago, I returned to graduate school to earn my nurse practitioner (NP) certification. So, with oncology clinical nurse specialist and NP certification and years of inpatient and outpatient clinical trials experience under my belt, I brought many hats to my present position. On an average day, I compile case summaries of patients who have used CAM to treat cancer, coordinate the review of the these cases (including 2nd pathology and radiology review), serve as an associate investigator on a prospective international study, browse the table of contents of major conventional and CAM journals, and respond to inquiries from CAM practitioners around the world. I nurture my NP skills by volunteering in one of the NCI clinics during the week. My most current project is coordinating a pre-Congress session in Philadelphia, PA, called, “Cancer CAM: Principles and Practice of Common Modalities” in collaboration with an esteemed faculty. I enjoy speaking, writing, and collaborating with my colleagues.

As an officer in the United States Public Health Service (USPHS), I bring another flavor to my nursing career. USPHS emergency response teams are managed by the Office of the Surgeon General and are trained and equipped to respond to public health crises and national emergencies, such as natural disasters, disease outbreaks, or terrorist attacks. Our teams are multidisciplinary and capable of responding to domestic and international humanitarian missions. My most recent deployment was to the state of Louisiana following Hurricanes Katrina and Rita where I served on an Immunization and Primary Care Strike Team that traveled between shelters across the state.

What do you find intriguing about complementary and alternative medicine?
CAM is a diverse, rapidly changing, rapidly advancing area in today’s world. Daily, researchers are exploring mechanisms in the discovery of novel therapeutics and assessing the impact of CAM interventions in supportive care. Practitioners are exploring ways to validate effective interventions for wider acceptance clinically. The most intriguing aspects are that the field has barely touched the surface in defining CAM, building bridges between the CAM practice and research, and formulating a widely-accepted scientific basis for practice. Plus, people exist who fully advocate CAM, fully oppose CAM, and are sitting on the fence with feet in both. Oncology nurses are in the crux of the arena between patients’ preferences and the balance between safety and efficacy between CAM and conventional care. Our goal should be to become knowledgeable about where to acquire the information that we need to reply to patients and colleagues from a standpoint of being fully informed. CAM is here to stay, and oncology nurses have a strategic role in assisting to define and practice within this arena.

Did You Miss the Pre-Congress 2008 in Philadelphia, PA?

“Cancer Complementary and Alternative Medicine: Principles and Practices of Common Modalities (PPCM)” was the name of this year’s Complementary and Integrative Therapies SIG-sponsored, pre-Congress session in Philadelphia, PA, in May 2008. The curriculum for this session was built over the course of several years based on input from the SIG and ONS membership. Multiple three-hour institute sessions have been dedicated to complementary and alternative medicine (CAM): Pittsburgh, PA (2006), Nashville, TN (2004), and Philadelphia, PA (2003). A half-day pre-Congress session on Cancer CAM was well-received at the ONS Congress in Orlando, FL, in 2005. A basic “Primer” format was successfully presented at the ONS Congress in Boston, MA, in 2006. An intermediate “Primer” format was successfully presented at the ONS Congress in Las Vegas, NV, in 2007. Cumulatively, the total participants to date in these sessions are over 1,000 nurses. Session coordinator and SIG coordinator, Colleen Lee, RN, MS, AOCN^®, commented that two useful pieces of feedback from the audiences continue to be (1) “This was the best session I have ever attended at an ONS conference” and (2) “We want more experiential sessions.” To meet the needs of the membership, Lee and past ONS President Georgia Decker, MS, RN, APRN-BC, AOCN^®, expanded prior content and added more faculty.

The goals of the workshops were to create a learning experience that provided hands-on exposure to common CAM and related information, encourage questioning and interaction, and stimulate synthesis of new information from the workshop to the individual’s clinical practice fields. Nurses unfamiliar with CAM will begin to explore and examine their views, distinguish among modalities, clarify misconceptions, and emerge with new ways of viewing and approaching CAM in cancer care. Participants rotated through the workshops for a period of 90 minutes. The topics were selected based on a preliminary assessment by the Complementary and Integrative Therapies SIG of what CAM information and clinical exposure would be most useful to oncology nurses. Workshop Sessions were (1) “Biofield Therapies” led by Beverly Pierce, (2) “Acupuncture” led by Marion Irwin-Bergan, (3) “Aromatherapy” led by Cherie Perez, and (4) “Bodywork” led by Alyssa Coe.

Complementary and Integrative Therapies Find a Space at Congress 2008

Karen O`Driscoll, RN, OCN^®
Salt Lake City, UT
karen.odriscoll@hci.utah.edu

The Rejuvenation Room was open Thursday, Friday, and Saturday from 11:30 am–1 pm during the Annual ONS Congress. The offerings this year were Tai Chi, Yoga, Reiki, Healing Touch, Massage (chair), and Indian (Ayurvedic) Head Massage. We also had information about and samples of Mandalas to color and "finger" labyrinths to trace while nurses were waiting for a therapist to become available. The Mandalas and finger labyrinths were able to be taken home for use in their professional or personal lives. The woman who’s mandalas we used donated items to us, and we gave away 16 mandala books, "Compliments of the Complementary and Integrative Therapies SIG" with the membership info also provided.

Approximately 90 nurses were served during the hours of operation. A few nurses peeked in and then left to do other things; most stayed to experience at least one modality. Almost 100% of the nurses attending had not heard of the Rejuvenation Room at ONS and most had only experienced massage as a complementary therapy. Many had heard of some of the therapies and were eager to see what they were about. The comments I overheard or that were directed to me included "valuable opportunity," "a welcome break from all the science information," "very thankful for the room," etc.

I think a place exists for the Rejuvenation Room at Congress. This truly seemed to be an eye-opener for most nurses and was appreciated by those who attended, not only for ideas to take back to their work environment but for a rejuvenating break during the ONS Congress.

ONS members who have general interest and clinical expertise in any CAM area are encouraged to contact Coordinator Colleen Lee,  RN, MS, AOCN^®, and share ideas on how best to use, advertise, and sponsor the Rejuvenation Room at Congress 2009.

Time to Talk About Complementary and Alternative Medicine: Healthcare Providers and Patients Need to Ask and Tell

U.S. Department of Health and Human Services
National Institutes of Health News
National Center for Complementary and Alternative Medicine*
http://www.nccam.nih.gov

The National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health (NIH), has launched “Time to Talk,” an educational campaign to encourage patients—particularly those ages 50 or older—and their healthcare providers to openly discuss the use of complementary and alternative medicine (CAM). CAM is a group of diverse medical and healthcare systems, practices, and products that are not presently considered to be part of conventional medicine, such as herbal supplements, meditation, naturopathy, and acupuncture.

According to a national consumer survey conducted by NCCAM and AARP, almost two-thirds of people aged 50 or older are using some form of CAM, yet less than one-third of these CAM users talk about it with their providers. The NCCAM and AARP survey revealed some reasons why this doctor-patient dialogue about CAM does not occur. The most common reasons survey respondents cited were

• The physician never asked
• They did not know they should discuss CAM
• There was not enough time during the office visit.

More than one-half of respondents who had talked about CAM with their physician said they (not their physician) initiated the CAM discussion.

The telephone survey was administered to a nationally representative group of 1,559 people aged 50 or older.

"In an era of genomics and personalized medicine, we need to remember that a key ingredient to good health care is the dialogue you, as a patient, have with your providers," said Elias A. Zerhouni, MD, NIH director. "And talking about what CAM therapies you use is an important part of that discussion. This is important for people of all ages."

The “Time to Talk” campaign is aimed at addressing the need for this dialogue to help ensure safe, coordinated care among all conventional and CAM therapies. Talking not only allows integrated care, it also minimizes risks of interactions with a patient's conventional treatments. When patients tell their providers about their CAM use, they can more effectively manage their health. When providers ask their patients about CAM use, they can ensure that they are fully informed and can help patients make wise health care decisions.

"As frequent users of CAM, people 50 and older need to understand the importance of discussing CAM use with their providers to ensure coordinated, safe care. Simply put, it's time to talk," said Josephine P. Briggs, MD, NCCAM director. "Giving your healthcare providers a full picture of what you do to manage your health helps you stay in control."

NCCAM's “Time to Talk” campaign encourages patients to tell their providers about CAM use and providers to ask about it by offering tools and resources—such as wallet cards, posters, and tip sheets—all of which are available for free on the NCCAM Web site or can be ordered from NCCAM's information Clearinghouse (1-888-644-6226).

NCCAM is reaching out to professional associations and consumer organizations to help educate their members about the importance of this dialogue and the availability of NCCAM's campaign materials. As the federal government's lead agency for scientific research on CAM, NCCAM is committed to educating both consumers and healthcare providers about the importance of discussing CAM and providing evidence-based information to help with health care decision making.

Patient tips for discussing CAM with providers include the following.

• When completing patient history forms, be sure to include all therapies and treatments you use. Make a list in advance.
• Tell your healthcare providers about all therapies or treatments—including over-the-counter and prescription medicines, as well as herbal and dietary supplements.
• Take control. Don't wait for your providers to ask about your CAM use.
• If you are considering a new CAM therapy, ask your healthcare providers about its safety, effectiveness, and possible interactions with medicines (both prescription and over-the-counter).

Provider tips for discussing CAM with patients include the following.

• Include a question about CAM use on medical history forms.
• Ask your patients to bring a list of all therapies they use, including prescriptions, over-the-counter, herbal therapies, and other CAM practices.
• Have your medical staff initiate the conversation.

NCCAM's mission is to explore CAM practices in the context of rigorous science, train CAM researchers, and disseminate authoritative information to the public and professionals.

For more information on “Time to Talk,” to order or download materials, or to read the full NCCAM and AARP report on CAM use communication, please visit this Web site.

*For Immediate Release: Friday, June 6, 2008
CONTACT: NCCAM Press Office, 301-496-7790, nccampress@mail.nih.gov
This NIH News Release is available online at
http://www.nih.gov/news/health/jun2008/nccam-06.htm

Check Out Cancer Complementary and Alternative Modalities Clinical Trials

Looking for complementary and alternative modalities (CAM) that now are under study in clinical trials settings for cancer prevention, symptom management, or treatment? Are you curious about results of closed cancer CAM clinical trials? The National Cancer Institute (NCI) Office of Cancer Complementary and Alternative Medicine (OCCAM) displays these trials in an easy-to-access, frequently-updated format.

Active and closed clinical trial listings are available for the following common cancers.

• Adenocortical
• Bladder
• Breast
• Colon and rectal
• Esophageal
• Endometrial
• Head and neck
• Leukemia
• Lung
• Lymphoma
• Melanoma
• Mesothelioma
• Neuroendocrine cancer
• Pancreatic cancer
• Prostate cancer

Active and closed clinical trial listings are available for the following common symptoms.

• Anorexia
• Hot flashes
• Fatigue
• Nausea
• Oral complications
• Pain

References

Lee, C. (2004). Clinical trials in cancer part 1: Biomedical, complementary, and alternative medicine: Finding active trials and results of closed trials. Clinical Journal of Oncology Nursing, 8(5), 531–535.

Conference Announcement
Integration Across the Spectrum of Cancer Care

Society for Integrative Oncology
Hyatt Regency Atlanta, Georgia, November 20-21, 2008
www.integrativeonc.org

The Society for Integrative Oncology (SIO) has a yearly conference with an evidence-based focus. This organization very much wants more nursing involvement and is a great place for those who want to be involved in a national organization. The following is a welcome from the brochure from Donald Abrams, MD.

“On behalf of the SIO Conference Committee, I want to extend our invitation for you to join us in Atlanta, GA, this November for the Fifth International Conference. This year's meeting has as its theme ‘Integration across the Spectrum of Cancer Care.’ As well as focusing on the integration of complementary modalities during acute cancer treatment, we are devoting more of the conference to the needs of cancer survivors. More people are surviving cancer than ever before. It is estimated that there are over 10 million cancer survivors in the United States alone. Attributed to better and earlier cancer detection and advances in treatment, the increase in survivorship means that millions of people are living longer after cancer diagnosis and treatment and many face unique challenges. The emerging field of integrative oncology plays a vital role in all aspects of cancer survivorship. Complementary treatment modalities are integrated into the survivorship plan with goals of decreasing recurrence of disease, reducing the risk of a second primary cancer, managing symptoms related to the cancer or its treatment and improving quality of life. Once again, we have assembled an outstanding array of exciting speakers to discuss the controversies and challenges of integrative oncology across the spectrum of care. We are delighted to have Dr. Josephine Briggs, PhD, Director of the National Center for Complementary and Alternative Medicine as our opening keynote speaker, addressing the complexities of researching integrative interventions. On Friday morning, we will hear an update on survivorship research from Dr. Ann C. Mertens of the Aflac Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta followed by a session on nutrition and survivorship by Dr. John A. Milner, Chief of the Nutritional Science Research Group, Division of Cancer Prevention, National Cancer Institute. Following the success of last year's meeting, we will offer clinically-oriented workshops in addition to the abstract-driven sessions presenting the latest scientific evidence emerging in our fast-growing field. There is ample opportunity throughout the meeting for you, the investigator, to present your data either as an oral or poster presentation. We invite you to submit new data in abstract form for Committee review.”

Check Out These Online Resources

Physician’s Data Query (PDQ) Cancer Information Summaries: Complementary and Alternative Medicine

ONS Position Statements

Did you Know

• You can download ONS events directly from the Virtual Community to your outlook calendar?
• Columns in the SIG newsletter are considered for the annual SIG Best Newsletter prize?

Reports

HHS Secretary and Chinese Minister of Health Sign Memorandum of Understanding on Traditional Chinese Medicine Research (6/16/08)

HHS Secretary Mike Leavitt signed a memorandum of understanding with Chinese Vice Minister of Health Wang Guoqiang to foster collaboration between scientists in both countries in research on integrative and traditional Chinese medicine. The signing marks the opening of a two-day traditional Chinese medicine Research Roundtable at the National Institutes of Health (NIH). Read the rest of the report.

Beware of Online Cancer Fraud (6/17/08)

While health fraud is a cruel form of greed, fraud involving cancer treatments can be particularly heartless – especially because fraudulent information can travel around the Web in an instant. Read the rest of the report.

From the NCI Nealon Digest June 20, 2008.

Article of Interest
Complementary and Integrative Therapies Members May Enjoy This Recently Published Article

Check out the Oncology Nursing Forum (ONF) for interesting articles about complementary and integrative therapies.

• “Effects of Curcumin on Tumor Growth and Muscle Mass in a Mouse Model of Cancer Cachexia,” by Donna McCarthy Beckett, PhD, RN, FAAN, Katrina Pycha, BS, RN, and Thomas Berg, BS, RN (Vol. 35, pp.455–459).

For access to the full-text versions of these and other ONF and CJON articles, visit the Publications area of the ONS Web site.

CJON Seeks Reviewers

Put your knowledge and expertise to work by becoming a reviewer for the Clinical Journal of Oncology Nursing. For more information, click here.

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