A Review of Integrative Medicine in Gynaecological Oncology

M. Kalder; T. Müller; D. Fischer; A. Müller; W. Bader; M. W. Beckmann; C. Brucker; C. C. Hack; V. Hanf; A. Hasenburg; A. Hein; S. Jud; M. Kiechle; E. Klein; D. Paepke; A. Rotmann; F. Schütz; G. Dobos; P. Voiß; S. Kümmel

doi:10.1055/s-0042-100208

GebFra - DGGG-Gesellschaftsausgaben, Table of Contents

Geburtshilfe Frauenheilkd 2016; 76(02): 150-155
DOI: 10.1055/s-0042-100208

Review

GebFra Science

Georg Thieme Verlag KG Stuttgart · New York

A Review of Integrative Medicine in Gynaecological Oncology

Evidenz Integrativer Medizin in der gynäkologischen Onkologie – Review

M. Kalder

¹Klinik für Frauenheilkunde und Geburtshilfe, Philipps-Universität Marburg, Marburg

,

T. Müller

²AGAPLESION Markus Krankenhaus, Abteilung für Gynäkologie und Geburtshilfe, Frankfurt am Main

,

D. Fischer

³Klinik für Gynäkologie und Geburtshilfe, Klinikum Ernst von Bergmann, Potsdam

,

A. Müller

⁴Frauenklinik, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe

,

W. Bader

⁵Zentrum für Frauenheilkunde, Klinikum Bielefeld Mitte, Bielefeld

,

M. W. Beckmann

⁶Universitäts-Brustzentrum Franken, Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen – Europäische Metropolregion Nürnberg, Nürnberg

,

C. Brucker

⁷Universitätsklinik für Frauenheilkunde und Geburtshilfe, Paracelsus Medizinische Privatuniversität, Nürnberg

,

C. C. Hack

⁶Universitäts-Brustzentrum Franken, Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen – Europäische Metropolregion Nürnberg, Nürnberg

,

V. Hanf

⁸Frauenklinik und Brustzentrum Nathanstift, Klinikum Fürth, Fürth

,

A. Hasenburg

⁹Klinik und Poliklinik für Geburtshilfe und Frauenkrankheiten, Universitätsmedizin Mainz, Mainz

,

A. Hein

⁶Universitäts-Brustzentrum Franken, Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen – Europäische Metropolregion Nürnberg, Nürnberg

,

S. Jud

⁶Universitäts-Brustzentrum Franken, Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen – Europäische Metropolregion Nürnberg, Nürnberg

,

M. Kiechle

¹⁰Frauenklinik des Klinikums rechts der Isar, Technische Universität München, München

,

E. Klein

¹⁰Frauenklinik des Klinikums rechts der Isar, Technische Universität München, München

,

D. Paepke

¹⁰Frauenklinik des Klinikums rechts der Isar, Technische Universität München, München

,

A. Rotmann

¹¹Praxis für Frauenheilkunde, Geburtshilfe und Naturheilkunde, Rodgau

,

F. Schütz

¹²Universitätsfrauenklinik, Universitätsklinikum Heidelberg, Heidelberg

,

G. Dobos

¹³Brustzentrum und Klinik für Senologie der Kliniken Essen-Mitte, Essen

,

P. Voiß

¹³Brustzentrum und Klinik für Senologie der Kliniken Essen-Mitte, Essen

,

S. Kümmel

¹³Brustzentrum und Klinik für Senologie der Kliniken Essen-Mitte, Essen

› Author Affiliations

Abstract

In recent years complementary and alternative medicine (CAM) has increasingly been the focus of international research. Numerous subsidised trials (7903) and systematic reviews (651) have been published, and the evidence is starting to be integrated into treatment guidelines. However, due to insufficient evidence and/or insufficient good quality evidence, this has mostly not translated to practice recommendations in reviews by the Cochrane collaboration gynaecology group. There is nevertheless a not insignificant number of CAM providers and users. The percentage of oncology patients who use CAM varies between 5 and 90 %. Doctors have been identified as the main providers of CAM. Half of gynaecologists offer CAM because of personal conviction or on suggestion from colleagues. This must be viewed in a critical light, since CAM is mostly practiced without appropriate training, often without sufficient evidence for a given method – and where evidence exists, practice guidelines are lacking – and lack of safety or efficacy testing. The combination of patient demand and lucrativeness for doctors/alternative medicine practitioners, both based on supposed effectiveness CAM, often leads to its indiscriminate use with uncertain outcomes and significant cost for patients. On the other hand there is published, positive level I evidence for a number of CAM treatment forms. The aim of this article is therefore to review the available evidence for CAM in gynaecological oncology practice. The continued need for research is highlighted, as is the need to integrate practices supported by good evidence into conventional gynaecological oncology.

Zusammenfassung

Komplementäre und alternative Medizin (CAM) stehen in den letzten Jahren zunehmend im Fokus der internationalen Forschung. Zahlreiche subventionierte Studien (7903) und systematische Reviews (651) wurden publiziert und Leitlinien beginnen, die nachgewiesene Evidenz zu integrieren. Dennoch bleiben Handlungsempfehlungen in den meisten Fällen der Reviews aus der Cochrane Collaboration Group in der Frauenheilkunde aus Mangel an ausreichender und/oder qualitativ guter Evidenz aus. Demgegenüber steht eine nicht zu vernachlässigende Gruppe von Anwendern und Anbietern. Unter den onkologischen Patienten schwanken die Zahlen der CAM-Anwendung zwischen 5 und 90 %. Als Hauptanbieter für diverse CAM-Methoden in der Onkologie wurden insbesondere Ärzte identifiziert. Die Hälfte der Frauenärzte wenden CAM aufgrund eigener Überzeugung oder durch Motivation von Kollegen an. Kritisch anzumerken ist, dass dies vielfach ohne fundierte Ausbildung, häufig bei nicht ausreichender Evidenz für die eingesetzten Methoden, fehlenden Handlungsempfehlungen bei vorhandener Evidenz und fehlendem Sicherheits- oder Wirksamkeitsnachweis durchgeführt wird. Das Zusammenspiel der Nachfrage durch Patienten und das lukrative Angebot von Ärzten und Heilpraktikern, basierend auf der vermuteten Wirksamkeit, führen damit nicht selten zur unkritischen Anwendung mit ungewissen Folgen für den Patienten und erheblichen Kosten. Für einige Therapieformen liegen dagegen publizierte, positive Level-I-Evidenz beinhaltende Ergebnisse vor, sodass Ziel dieses Reviews ist, die vorhandene Evidenz zur CAM in der gynäkologischen Onkologie darzustellen, den weiterhin bestehenden Forschungsbedarf aufzuzeigen und auf den Sinn der Integration von CAM-Methoden mit guter Evidenz in die konventionelle Medizin im Bereich der gynäkologischen Onkologie hinzuweisen.

Key words

integrative medicine - complementary medicine - evidence - gynecology - oncology

Schlüsselwörter

integrative Medizin - Komplementärmedizin - Evidenz - Gynäkologie - Onkologie

Full Text

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