A Review of Integrative Medicine in Gynaecological Oncology

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

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