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Limited evidence in using homeopathic medicines to treat stomatitis and dermatitis in patients undergoing treatments for cancer Critical Summary Prepared by: Debra Ferraiolo DMD, FAGD; Silvia Spivakovsky DDS 

OVERVIEW

  • Systematic Review Conclusion:

    Preliminary data support the efficacy of topical calendula for acute dermatitis during radiotherapy and Traumeel S mouthwash in treating chemotherapy-induced stomatitis.

  • Critical Summary Assessment:

    A review of eight RCTs finds two homeopathic medicines beneficial in preventing/treating chemo and radiotherapy-induced side effects in patients undergoing cancer treatment.

  • Evidence Quality Rating:

    Limited

A Critical Summary of:

Homeopathic medicines for adverse effects of cancer treatments

Kassab S, Cummings M, Berkovitz S, van Haselen R, Fisher P. Cochrane Database of Systematic Reviews. 2009;(2):CD004845

  • Clinical Questions:

    Are homeopathic medicines effective and safe in the prevention and treatment of adverse effects associated with cancer treatments?

  • Review Methods:

    The authors searched 15 electronic databases for articles published to December of 2008. They also handsearched the Liga Medicorum Homeopathica Internationalis, an international homeopathic medical society that was established in 1925 with the purpose of linking medicine and homeopathy. Manufacturers were contacted as well as leading researchers with expertise in using homeopathic medicines for cancer patients.
    Selection criteria was any randomized controlled trials (RCTs) of homeopathic medicines in participants with a clinical or histological diagnosis of cancer (all stages) where intervention was aimed at preventing or treating symptoms associated with cancer treatments. Outcome search included any subjective or objective measure for assessing adverse effects of cancer treatment including quality of life, reports of adverse effects and interactions of homeopathic medicines with cancer treatment.

  • Main Results:

    The search yielded 11 studies of which eight (664 participants)met the inclusion criteria. They assessed methodological quality using two standardized tools.

    Calendula extract ointment demonstrated superiority in preventing dermatitis during radiation therapy against a non steroid cream in one study with 254 patients (odds ratio: 0.42, 95 percent confidence interval, 0.25 to 0.68,
    P <0.001). Another study with 32 participants demonstrated superiority of Traumeel S over placebo as a mouthwash for chemotherapy-induced stomatitis. Thirty percent of the patients in the treatment group reported difficulty to apply against 5%. Patient satisfaction was 65% with calendula against 46%
    Mucositis symptoms were reduced in 32 children with Traumeel S homeopathic mouthwash against placebo (symptom index 10.4 vs. 24.3, difference -14.24, 95% CI: -23.46 to -5.02, p< 0.001).
    No serious adverse events or interactions with conventional treatment were reported.

  • Conclusion:

    The authors suggest that calendula ointment may be considered for patients who develop radiation-induced dermatitis. The use of Traumeel S for treatment of chemotherapy induced mucositis also shows promising results.

  • Source of funding:

    Royal London Homeopathic Hospital, UK

Commentary:

  • Importance and Context:

    Patients undergoing cancer treatment suffer from a variety of complications that affect their quality of life. This review included diverse treatment modalities used for prevention or treatment of adverse effects in different settings. Homeopathic medicine may offer a safe alternative to prevent or treat cancer treatment-induced side effects.

  • Strengths and Weaknesses of the Systematic Review:

    The authors followed accepted methodological guidelines. They conducted a comprehensive search that included electronic and hand searching of unpublished data, missing data and foreign language data. Two independent reviewers assessed the studies for inclusion, two performed the data extraction. Disagreement was resolved by consensus. The clinical question was clearly presented using PICO, the acronym of the following four criteria: P (patient or problem), I (intervention), C (comparison) and O (outcome). The authors provided lists of the included and excluded studies. They assessed both the quality of individual studies and risk of bias.

  • Strengths and Weaknesses of the Evidence:

    The authors assessed different outcomes from different treatments in different patient populations. They found eight RCTs that evaluated a total of 10 interventions. Of the eight studies, three were judged to be of high quality with a low risk of bias. The individual studies were too different to be combined, but several PICO questions can be answered by using one comprehensive search. The review included quality of life and patient-centered outcomes.

  • Implications for Dental Practice:

    Although the authors concluded that more research is needed, two homeopathic medications showed positive effects for Calendula and Traumeel S. They improve quality of life and do not produce side effects. For this reason, the dental practitioner might consider initiating a discussion with the primary health care provider and the patient undergoing cancer treatment about using Traumeel S. for treatment of chemotherapy-induced mucositis and Calendula for the prevention of radiation-induced dermatitis.

  • Critical Summary Publication Date: 11/28/2010

These summaries are not intended to, and do not, express, imply, or summarize standards of care, but rather provide a concise reference for dentists to aid in understanding and applying evidence from the referenced systematic review in making clinically sound decisions as guided by their clinical judgment and by patient needs. American Dental Association ©

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