Assessment of Complementary and Alternative Medicine (CAM) Therapies Being Utilized by Cancer Patients at the End of Life and Communication of CAM Usage Between Patients and Physicians Open Access

Lecours, Carolina (2017)

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Dying patients experience a heavy symptom burden. Cancer patients, especially those with advanced disease, may be more likely to face extremely frightening and less manageable circumstances than patients with other chronic or life-limiting diseases. In cancer patients, pain is one of the most feared and burdensome symptoms. Not only do patients with cancer commonly report fears of a prolonged death consumed by uncontrolled pain, they often fear the process of dying more than death itself. Quality of life (QOL) issues are particularly relevant for terminally ill cancer patients receiving palliative care. Side effects from chemotherapy or radiation therapy can cause an array of traumatic side effects, such as fatigue, sleep disturbance, anxiety, depression, nausea and vomiting. Not finding adequate relief from these side effects with traditional medicine, cancer patients are seeking the aid of Complementary and Alternative Medicine (CAM). CAM is defined as a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. Despite the emergent literature supporting the efficacy of specific CAM modalities for managing side effects and symptoms associated with cancer treatments, the exact nature of CAM usage in chronically ill cancer patients (e.g., the characteristics of patients who use CAM, and who don't, what type of CAM is used, and whether they inform their physician) is not well documented. Although the study of CAM use among the general population is relatively wide-spread, less attention has been given to the study of CAM use among patients receiving palliative care. This is a grant proposal that will assess CAM therapies being utilized by end-stage cancer patients receiving palliative care and communication about CAM usage between the patients and physicians.

Table of Contents

Table of Contents Chapter I: Introduction 1 Problem Statement 2 Purpose Statement 2 Significance Statement… 2 Definition of Terms 3 Chapter II: Review of the Literature 5 Introduction 5 Review of the Literature 6 Summary of Current Problem and Study Relevance 13 Chapter III: Methodology 14 Review of Funding Agencies 14 Description of Grant Announcement 15 Review Criteria 18 Investigators 19 Institutional Environment 22 Methodology of the Grant Review Process 25 Description of Grant Reviewers 26 Protection of Human Subjects 27 Chapter IV: Incorporation of Reviewer Comments 32 Reviewer 1 comments 32 Reviewer 2 comments 35 Reviewer 3 comments 40 Reviewer 4 comments 41 Reviewer 5 comments 42 Chapter V: Final Version of Grant Proposal 54 Specific Aims 56 Research Strategy 58 Data Analysis 69 Investigators 71 Institutional Environment 74 Literature Cited 77 Appendix A: Informed Consent 84 Appendix B: Informed Consent Documentation 89 Appendix C: HIPAA Identifiers 90 Appendix D: CAM Questionnaire 92 Appendix E: RFA-AT-01-002 94 Appendix F: Instructions for Review Process 104 Appendix G: External Review Evaluation Scoring Sheet 105 Appendix H: Conflict of Interest 109 Appendix I: Assessment of Quality of Life at the End of Life Questionnaire (AQEL) 112 Appendix J: ECOG Scale of Performance Status 113

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