Effect of complementary alternative medical (CAM) therapy on pain and fatigue in pancreatic cancer patients
T. C. Birdsall, R. D. Levin, L. Alschuler, M. Daehler, S. M. Birdsall, J. Martin, L. Dounaevskaia, C. G. Lis and D. P. Braun
Cancer Treatment Centers of America, Zion, IL
Background: Pain and fatigue are frequent, difficult to manage, and negatively impact quality of life (QOL) in pancreatic adenocarcinoma patients (PCpts) causing some to seek CAM therapy in place of or in conjunction with conventional analgesics. But the efficacy of CAM on pain and fatigue has not been adequately tested in controlled trials. We employed an alternative strategy by abstracting pain and fatigue scores from the EORTC-QLQ-C30 questionnaire administered to PCpts treated at Midwestern Regional Medical Center, an integrative oncology center offering conventional and CAM treatment.
Methods: 50 PCpts treated with chemotherapy and/or radiation clinically appropriate for advanced PC + CAM were evaluated. The CAM group (n=36) had 70%, 11%, and 19% and the nonCAM group (n=14) 71%, 14%, and 15% Stage IV, III, and II tumors respectively. PCpts received narcotic and anti-inflammatory agents consistent with ASCO and NCCN guidelines. CAM treatments included Green Tea Extract; Melatonin; and high-potency multivitamins. Baseline, 3 month(M), and 6M data were analyzed.
Results: Median baseline, 3M and 6M pain scores were: 50; 0; 33.3 and 75; 16.6; 83.3 for CAM and nonCAM respectively; not significant (NS) CAM vs nonCAM at any time point by non-parametric tests. Pain control at 3M was improved significantly vs baseline levels for each cohort; p=0.02 (CAM) and 0.03 (nonCAM) by paired 2 tail t tests. The relative numbers of PCpts with manageable pain ( 33) were comparable for CAM vs nonCAM at baseline (41% vs 36%) and 3 M (81% vs 90%), but not at 6M (67% vs 22% CAM vs nonCAM respectively, (p<0.05 by ?2 test). Median baseline, 3M and 6M fatigue scores were: 55.5; 33.3; 33.3 and 44.4; 33.3; 66.6 for CAM and nonCAM respectively (NS, CAM vs nonCAM at any time point). By paired 2-tail t tests, 3M (p=0.01) and 6M (p=0.02) values were improved significantly vs baseline in CAM but not nonCAM cohorts.
Conclusion: This exploratory study shows that CAM treatment may improve fatigue and extend the period of effective pain control by conventional analgesics in PCpts. Given the negative impact exerted by pain and fatigue on QOL in this difficult to manage malignancy, CAM