PRECEPTORSHIP ON SUPPORTIVE AND PALLIATIVE CARECAM issues in practice, when and how to include

Complementary and Integrative Specialists

Jann Arends, Freiburg University Medical Center, Germany

DISCLOSURE OF INTEREST

Honoraria for scientfic presentations from:

Baxter, B.Braun, Chugai, Danone/Nutricia, Fresenius Kabi, Seca

SESSION 7: MULTIMODAL AND MULTIPROFESSIONAL MANAGEMENTCAM issues in practice, when and how to include

Complementary and Integrative Specialists

Voodoo-Medicine. West Africa

Empirical Medicine: Liberia

Majno G. The Healing Hand 1975

Empirical Medicine

Majno G. The Healing Hand 1975

Comfort, support

Material Medicine

PRECISIONRADIO-ONCOLOGY

MOLECULARIMMUNE-ONCOLOGY

MODERNONCO-SURGERY

PRECISIONRADIO-ONCOLOGY

MOLECULARIMMUNE-ONCOLOGY

MODERNONCO-SURGERY

MAGICpowdersteasextractsanimal partsforeign foodsherbspillsstrange odors, burningetc.

Why are supplements so attractive?

Success of modern oncology

D: 425.000 new cases per year

50-60% not cured

Nutritional supplementsUSA 1993: some 50% of all adultsEurope 2007: 6 billion EuroGermany 2010: 0.9 billion Euro

28% of all adults

1993 - 97

1988 - 93

19651940

Diel V. Dtsch Ärzteblatt 2002

Breast Cancer: Relative Survival(Saarland 1980-88)

Robert-Koch-Institut 2002

Years after Diagnosis

Metastasiertes Mammakarzinommedianes Überleben

1942-50

1951-55

1956-60

1961-65

1966-70

1971-75

1976-80

1981-85

1986-90

1991-95

1996-2000

Me

dia

ne

Üb

erl

eb

en

sze

it (

Mo

na

te)

0

10

20

30

Patel et al.

Fountzilas et al.JCO 2001

Petru & Schmähl

J. A

ren

ds

Metastasized Breast CancerMedian Survival

Med

ian

Surv

ival

(mo

nth

s)

Patel et al. Petru & Schmähl

Fountzilas et alJCO 2001

Aaron Antonovsky. Health, stress, and coping 1979

Central question:

Why do some people become ill under stress and others stayhealthy?

→ Searching for the origins of health rather than the causesof disease.

Aaron Antonovsky1923-1994

Salutogenesis

„Sense of coherence“

Aaron Antonovsky 1923-1994; Zitat 1993

Salutogenesis

I assume, [...] to chose a [...] metapher, that we all are ridingdown a long ski trail, at the end of which there is an inevitableand endless abyss. The pathogenetic point of view primary dealswith those who have hit a rock, a tree, or another skier or who fellinto a crevasse. Further, it tries to convince us that it were bestnot to ski at all. The salutogenetic orientation focusses on howthe trail can be made less dangerous and how people can betaught to become excellent skiers.

Treat body and soul

Majno G. The Healing Hand 1975

You ought not to attempt to cure eyes

Without head,

Or head without body,

So you should not treat body

Without soul.

Thracian physician according to Plato, Charmides, 155-156

Healing requires the patient‘s will

Majno G. The Healing Hand 1975

Ch‘i Po answered: „The utmost in the art of healing can be achieved when there

is unity.“

The Emperor inquired: „What is meant by unity?“

Ch‘i Po answered: „When the minds of the people are closed and wisdom is

locked out they remain tied to disease. Yet their feelings and desires should be

investigated and made known, their wishes and ideas should be followed, and

then it becomes apparent that those who have attained spirit and energy are

flourishing and prosperous, while those perish who lose their spirit and energy.”

The Emperor Huang Ti and his prime minister Ch‘i Po: Nei Ching, Su Wen, chapter 13, Veith version 151

Tierklinik Kaufungen, Webinar Reiki

Rodin, Michelangelo

2. Psyche and Body

Fever

Hypoglycemia

Corticosteroids

State of mind

Wellbeing

psycho-somatic disease

Conscience

Psyche

Body

Physis

Intervention

morepsychological

morephysical

Conscience

Psyche

Body

Physis

Intervention

Slatkin NE et al. Supp Oncol 2007

Fentanyl buccal tablet (FBT) vs placebo in 30 patients with cancer-related chronic pain

Hoenemeyer TW et al. Scientific Reports 2018

N=74 Cancer survivorsRCT: 2x2 placebo pills/d

vs no pillOpen label!

2000:53.4 Billion DM

2017:51.7 Billion Euro

Drug sales in Germany 2000 and 2017

Non-prescription drugs (Germany):6.5 Billion Euro

2000

2017

Robert-Koch-Institut 2002

Alternative

Outsider, paramedicne

Special concepts

Experience-based

Holistic

Complementary, COM, CAM

Natural

New treatments

Not-accepted

Soft, green, biological

Charlatanry

Unconventional

Folk, traditional, ethnic^

Classification of Complementary Medicine

Medicine Concepts

Science -based NO scientific basis

Clinical trials:exp. medicine

Experience-based Outsidertechniques

Academic medicine

Pharmacologic agentSpecial Therapies

PhytotherapyHomeopathyAnthroposophy

Traditional agents

Natural MedicineClassic

HydrotherapyBalneotherapyPhytotherapyPhysiotherapyNutritional therapyOrder therapy

TraditionalTCMAyurvedaDiverting techniques

Charlatanry

Stop

Supportive therapiesClinical nutritionSports medicinePsycho-oncologyPalliative medicine

Disease-specific therapies

Alternative Medicine

Integrative Medicine

Complementary vs Alternative Medicine

Academic Medicine

Complementary Medicine

Acupuncture

Eurythmia

Homeopathy follow-up

Ozone treatment

Homeopathy anamnesis

Hematogenic oxidation

Art, painting

Rhythmic massage

Blood reinfusion

Speech structure

Acupressure

Neural therapy

Other

All alternative

All medical treatment

Cases Costs in 1000 DM

Special therapies as reimbursed by one health insurer

Number of physicians trained in complementary techniques

Patient-reported examples

54 y women. Langerhans-Histiocytosisprimary site cranium, remission with radiationrepeated recurrences during 10 years, each incidence treated with radiotherap2006 switched to vegan foods: since this year no more recurrences

51 y man. Papillary thyroid cancer with diffuse metastases in both lungsTumor refractory to radio iodine. No chemotherapy accepted.Started to take modified citrus pectines: stable disease over several years

64 y women. Endometrial carcinoma, peritoneal carcinosis.After palliative chemotherapy: stable disease.6 months later: CT scan without visible tumor in the abdominal cavity.Patient ascribes effect to: intensive spiritual consultations and prayers

National Network to support complemetary medicine> Standardization> Counseling> Training> Quality control

Complementary Therapies (Mayo Clinic)

• Acupunctur/Acupressur

• Aroma therapy

• Physiotherapy

• Hypnosis

• Massage

• Meditation

• Music therapy

• Relaxation techniques

• Tai Chi

• Yoga

Acu-

punctur

/pressur

Aroma

therapy

Physio-

therapy

Hyp-

nosis

Mas-

sage

Medi-

tation

Music Relaxa-

tion

Tai Chi Yoga

Anxiety X X X X

Fatigue X X X X

Nausea X X X X

Pain X X X X X

Sleep X X X

Stress X X X X X X X

Complementary Therapies (Mayo Clinic)

Conclusions

Attention, assistance, support and communication are essential needs in cancer patients and survicors

Accompanying / complementary treatments meet these needs.However: Alternative therapies should be discouraged!

Complementary therapies should have only minor side effects and befinancially tolerable.

Large national and international projects are gathering and classifying theavailable evidence since a number of years. Guidelines with high methodological quality are being developed.

Medical Tribune 2018

IF THE PLACEBO RESULTS IN 20%IMPROVEMENT, WOULD FIVEPLACEBOS CURE MY ILL?