Integrating Complementary Therapies in the Care of Children with Cancer
اسلاید 1: www.tabaye.ir
اسلاید 2: Kara Kelly, M.D.Integrating Complementary Therapies in the Care of Children with Cancer: Research and Clinical Practice
اسلاید 3: What is CAM?Group of diverse medical and health care systems, practices and products that are not presently considered to be part of conventional medicine
اسلاید 4: Complementary: Used together with conventional medicineAlternative: Used in place of conventional medicineIntegrative: Combines mainstream medical therapies and CAM therapies for which there is some high quality scientific evidence of safety and efficacy
اسلاید 5: NCCAM Classification Alternative medical systems (Traditional Chinese Medicine, Ayurveda, homeopathy)Mind-body interventions (yoga, imagery, meditation, prayer)Biological based therapies (herbs, high dose vitamins, antioxidants, mushrooms, enzymes )Body based therapies (chiropractic or osteopathic manipulation, massage)Energy therapies (Reiki, therapeutic touch, magnets)nccam.nih.gov
اسلاید 6: Children with Cancer are using CAMYear of Survey%
اسلاید 7: Reasons for CAM Useto try everything possible”to reduce stress of illnessimprove quality of lifesymptom care managementsometimes for cure Columbia survey: Perceived effectiveness is high- 86% very or somewhat effective for intended purpose
اسلاید 8: How are Patients Using CAM?
اسلاید 9: 73% of children were enrolled on clinical trials for treatment of their malignancy85% were using some form of CAM:Herbs 25%Nutritional supplements 34%J Pediatr Hematol Oncol 22:412,2000
اسلاید 10: Why the Controversy?Few clinical trials of safety and efficacy, especially in childrenRegulation of herbs and dietary supplements varies world wide, although most are not subject to the same regulations that apply to conventional drugs
اسلاید 11: Adverse EffectsPharmacologic therapies: Direct effect Contamination Interactions with conventional medications
اسلاید 12: Adverse Effects
اسلاید 13: Contamination of herbsEur J Pediatr 162:72, 2003
اسلاید 14: Herb-Drug Interactions: Sources of InformationHerbalGram 49:2000.
اسلاید 15: Fig. 1. Effect of St. Johns wort on the plasma concentration of the active irinotecan metabolite SN-38 over time.JNCI 94:1247,2002
اسلاید 16: Chemotherapy/Herb Interactions
اسلاید 17: Oxidative Stress and Chemotherapy Drugs HighAnthracyclinesPt-complexesAlkylating agentsEpipodophyllotoxinsCamptothecinsPurine/PyrimidineAntimetabolites LowTaxanesVinca alkaloids
اسلاید 18: Observational Studies: The Effect of Cancer Therapy on Antioxidant Levels (n=31)JCO 22:517, 2004
اسلاید 19: The Effect of Supplementation with Antioxidants in combination with Cancer Therapy on Antioxidant Levels (n=9)JCO 22:517, 2004
اسلاید 20: ImmunostimulantsMistletoe, Asian mushrooms (maitake, reishi, shiitake, coriolus versicolor, PSK), AstralagusActions: Increase cytotoxic T-cells or NK cells activity, increase endogenous production of interferon, interleukins, or cytokinesDiscourage in patients with: Hematologic malignancies, Stem cell transplants
اسلاید 21: Warning signs of Possible InteractionsTolerance to conventional drug administration that is better or worse than expected:Unexpected refractoriness to treatmentUnusual toxic effects from treatmentLabriola D, Livingston R. Oncology 13:1999
اسلاید 22: Non-pharmacologic TherapiesChiropractic cerebrovascular accidents, acute necrosis of holocord astrocytoma, vertebral artery dissectionAcupuncture cardiac tamponade, epidural abscess formation, HIV infection overall underlying adverse event rate: 0-1.1 per 10,000 treatments
اسلاید 23: Practitioner Licensure varies from state to stateChiropractors: every state, Washington DCMassage therapists: ~25 statesTCM practitioners: ~25 statesNaturopathic physicians: 12 statesHomeopathic physicians: 3 statesDermatologic Therapy 16:77,2003
اسلاید 24: Barriers to ResearchDifficulties in conducting studies of complex therapeutic systemsEmotional issues leading to biases in patient recruitmentLack of standardization of herbs/dietary supplementsDifficulty in determining an adequate placeboCAM providers may have little incentive for scientific evaluation of CAM therapies
اسلاید 25: Active Randomized Clinical Trials in Pediatric Cancer and CAMTRAUMEEL S (Homeopathy) for prevention and treatment of Mucositis in SCT (COG)Electroacupuncture for Chemotherapy induced Delayed Nausea/Vomiting in Pediatric Solid Tumors (NCI)Silymarin in Maintenance therapy in Children with ALL and Abnormal LFTs (Columbia)Aromatherapy for Reduction of Anxiety/Nausea during SCT (Columbia)Massage Therapy and Childhood Cancer (Childrens Minneapolis)Aromatherapy as an Intervention for Nausea and Vomiting in Children receiving Chemotherapy for Cancer (Childrens Minneapolis)
اسلاید 26: Clinical Services
اسلاید 27: Nausea/VomitingHerbs Ginger, Peppermint, FennelChamomile CompressesAromatherapyCitrus (Bergamont, Mandarin, Citrus Mixtures)AcupressureP-6 Point (Acupressure bands)
اسلاید 28: Palliative CareAlternative medical systems: acupunctureMind-body medicine: Meditation, prayer, music therapyBody-based therapies: MassageEnergy therapies: Reiki, Therapeutic touch
اسلاید 29: Screening for child CAM use:Do you give your child any herbal or plant products?Do you give your child any homeopathic products?Do you use any unconventional/alternative types of care or therapies for your child?Do you use any special vitamin therapy for your child?Do you use any unconventional treatments, alternative types of care, or therapies for yourself to stay healthy or to manage a health problem?J Pediatr Health Care 17:58,2003Questions only identified 24% of parents using CAM
اسلاید 30: www.integrativetherapiesprogram.org
اسلاید 31: The Bottom Line…Children with cancer are using CAM therapiesPhysicians need to inquire about CAM useBiologically active therapies including herbs and dietary supplements are often usedAdverse effects and especially interactions with conventional drugs are possibleCAM therapies may be especially useful for symptom management
نقد و بررسی ها
هیچ نظری برای این پاورپوینت نوشته نشده است.