NICM integrated healthcare grants announced
Media Release Date: Oct 28, 2009
Testing whether people can recover from heart surgery faster, to trialling herbal therapies alongside chemotherapy and the use of acupuncture with IVF, are among the six integrated healthcare* research grants just announced by the National Institute of Complementary Medicine (NICM **).
"There is currently no clear picture of how integrated care is being used by healthcare practitioners in Australia despite widespread practice in a range of settings," says NICM executive director Professor Alan Bensoussan. "Our research grants seek to provide major insights into the impact integrated care can make to our health system."
"Our international assessment panel has selected six projects to receive funding," continued Bensoussan. "Most of these projects address major disease areas and how a combination of conventional and complementary medicine may improve a patient's overall response to treatment. The potential economic benefits are exciting and deserve to be the focus of well structured research.
"We would like to acknowledge the funding received from the National Breast Cancer Foundation - this partnership meant we were able to provide six grants in total," Professor Bensoussan said.
"For our part, we're going to look at how well some commonly used herbal cancer treatments work in people with cancer and whether, when you use them with standard chemotherapy, there is any more or less toxicity," explains Dr Janette Vardy, a medical oncologist at the Sydney Cancer Centre a recipient of one the integrated care grants awarded by NICM.
"Our hope is that we can shorten the hospital stay of people undergoing major open heart surgery, reduce heart muscle damage and prevent a serious abnormalities in heart rhythm that can complicate the operations," explains Professor Frank Rosenfeldt, who's head of cardiac surgery research at the Alfred Hospital in Melbourne. "We've already shown in a prospective randomised trial that, so called metabolic therapy with various supplements including coenzyme Q and fish oils is beneficial, and now we're going to apply this therapy routinely in cardiac surgery patients in our hospital to assess the feasibility of this integrated complementary approach in a high tech hospital setting."
"We hope to help the 700,000 Australians whose quality of life is being compromised by chronic obstructive pulmonary disease," says Professor Charles Xue of RMIT University in Melbourne. "Current treatments do help but people's lives are still compromised. However, there is evidence that ginseng can help symptoms. We plan to test that rigorously."
In addition to looking at disease areas, the grants aim to evaluate multidisciplinary care in a clinical setting which will create vital data to develop practice guidelines.
"There's so much we don't know about complementary medicine, not the least of which is how it's used in regular medical practice alongside mainstream care," claims Professor Kerryn Phelps. "Our study will follow an Australian primary care clinic that integrates natural therapies with mainstream medicine as well as reviewing the quality of information collected by the clinic and pilot test questionnaires for measuring the outcomes of patients who attend the clinic. This work is an important first step towards measuring the effectiveness of integrative medicine practice in Australia."
"Complementary medicine is well integrated into the public health systems in many Asian nations and governments in Europe and America are conducting major studies in this area," said Bensoussan. "It is vital that Australia uses its strong conventional and complementary medicine resources to develop effective integrated health treatment options for future generations.
Background
Integrated healthcare
Complementary medicine used together with mainstream western medicine, with CM including health and medical systems, practices and products not currently recognised as part of conventional or mainstream western medicine practised by medical practitioners, nurses and allied health professionals.
NICM
NICM provides leadership and support for strategically directed research into complementary medicine and translation of evidence into clinical practice and relevant policy to benefit the health of all Australians. The Institute was established in 2007 with federal and state government grants and is hosted by the University of Western Sydney. However, in the absence of further Federal Government funding, NICM will cease full operations in the coming months.
The research projects
Cancer treatment
Dr Janette Vardy
Staff Specialist, Sydney Cancer Centre, Dept of Medical Oncology
Research Fellow / Conjoint Senior Lecturer, CeMPED, Dept of Cancer Medicine
The University of Sydney
Recent studies in cancer patients, show a progressive increase in the number of patients using complementary medicine (CM), with one recent study describing use in 84% of a female adjuvant breast cancer population. This use is frequently undertaken in addition to their prescribed conventional therapy, often without their physicians' knowledge.
Despite common perceptions, for systemically administered CM such as herbal medicines, there are significant risks of adverse drug interactions between herbal medicines and anti-cancer agents. These may result in adverse events, either as a result of increased drug toxicity or therapeutic failure.
Reviews to date demonstrate a paucity of high quality randomised study data that are available to cancer clinicians in regard to potential adverse interactions between standard therapy and commonly used herbal medicines.
The aim is to evaluate the effect of Ginkgo biloba and Coenzyme Q10 on:
- Standard anti-cancer agents including chemotherapy and hormonal treatment; and
- the effect of CM on the toxicity of standard anti-cancer agents.
Dr Vardy's grant was funded by the National Breast Cancer Foundation.
Integrative medicine (IM) in general practice
Professor Kerryn Phelps
This project will describe and document an Australian primary care clinic that integrates natural therapies with mainstream medicine. It will also review the quality of information routinely collected by the clinic and pilot test questionnaires for measuring the outcomes of patients who attend the clinic.
This work is an important first step towards measuring the effectiveness of integrative medicine practice in Australia.
The long-term aim of the research team is to develop an online database for use by multiple clinics to monitor health service use and patient outcomes. The database will provide a practical tool to support urgently needed evaluations of integrative medicine clinics in Australia.
The actual number of Australian GPs and primary care clinics currently offering TCAM and IM is unknown. Internet searches of business directories and personal networking reveals that the setting, models and styles of PC/IM clinics is varied. They range from solo or small group practices of general practitioners (using one or more TCAM therapies) to clinics housing general practitioners (with or without TCAM experience) working either in a team or alongside TCAM practitioners. To the best of our knowledge none of these clinics is systematically evaluating their services. Developing an Australian minimum dataset that includes outcome measurement for use in research and routine health services evaluation would help co-ordinate and standardise the evaluation of Australian IM.
Metabolic therapy in cardiac surgery
Professor Frank Rosenfeldt, Head of Unit, Cardiothoracic Surgical Research, Monash University and Alfred Hospital
Patients presenting for cardiac surgery are increasingly elderly with many co-morbidities. The result is that hospital length of stay is prolonged and complication rates are increased. This study will evaluate the feasibility, practicability and benefits of broad-based implementation of an integrative cardiac wellness program consisting of metabolic supplementation in elective coronary artery bypass graft (CABG) patients at a busy, city hospital, the Alfred Hospital. The program is based on research previously conducted by this unit and aims to enhance patients' preparation and recovery from cardiac surgery, promote change towards life-long wellness and provide cost savings for the public hospital system.
Based on previous clinical studies conducted by this unit, it is anticipated that metabolic supplementation will reduce incidence of atrial fibrillation (the most common complication after cardiac surgery), 24 hour plasma troponin I release (indicating a reduction in cardiac damage) and decrease patients' time in hospital when compared to standard care. The study will additionally evaluate the feasibility and practicability of introducing metabolic therapy. Cost savings associated with metabolic supplementation and delivery of the service will also be evaluated.
Two hundred patients undergoing cardiac surgery at the Alfred Hospital will receive peri-operative metabolic therapy comprising coenzyme Q10, magnesium orotate, alpha lipoic acid, selenium and fish oils. Postoperatively they will be encouraged to participate in rehabilitation.
Potential benefits of the program will have short and long term implications for the individual patient and potentially reduce bed block and time spent on waiting lists for future elective CABG patients. There may also be cost savings for hospitals and society at large. The development of an evidence-based 'integrative' care program capable of implementation in Australian cardiac surgical units will be a major outcome of this research project.
A ginseng product for people with Chronic Obstructive Pulmonary Disease (COPD)
Professor Charlie Xue (Pronounced Shway)
Professor & Head Chinese Medicine
RMIT University
Chronic obstructive pulmonary disease (COPD) is a disease caused by smoking where the lungs are progressively damaged to the extent that the person becomes disabled and his or her life is shortened. It affects over 700,000 Australians and is a significant cause of suffering and cost.
Current treatments are only symptomatic and are far from satisfactory, with sufferers continuing to experience significantly diminished quality of life and COPD exacerbations. Herbal medicines are used by approximately one in five COPD patients. A recent systematic review of herbal therapies trials in COPD concluded that a ginseng preparation showed promising results. The overall objective of this research is to determine the therapeutic value and safety profile of a standardised extract of Panax ginseng, for symptomatic relief in individuals with moderate COPD. To achieve this objective, we will conduct a pilot randomized controlled clinical trial with a sample size of 60 patients with moderate COPD.
Acupuncture and reproductive health outcomes: Building evidence in an integrated care setting
Associate Professor Caroline Smith
Centre for Complementary Medicine,
University of Western Sydney
There is promising evidence that acupuncture improves pregnancy and live birth rates for women when administered as an adjunct to IVF on the day of embryo transfer.
The aim of this study is to build a research framework to further investigate the evidence for acupuncture administered within an integrated care setting in reproductive health care. The integrative care proposal is a partnership between IVF Australia, The Acupuncture IVF Support Clinic and The University of Western Sydney. We aim to evaluate the clinical effectiveness and safety for women receiving acupuncture as an adjunct to assisted fertility.
This project will improve data quality, provide infrastructure to collect and analyse data, provide guidelines to data sharing between institutions and undertake a comparative analysis of reproductive outcomes from the integrated care project with pregnancy outcomes from IVF Australia. They will also conduct early phase research to examine a potential mechanism for acupuncture when administered alongside IVF.
Randomized clinical trial: Impact of Medical Qigong on wellbeing of women with breast cancer after adjuvant chemotherapy
Professor Stephen Clarke
University of Sydney Department of Medicine,
Concord Repatriation General Hospital
Research suggests that up to 84% of people with breast cancer are using complementary medicine. This study aims to evaluate in a randomized controlled trial, to test potential effects of a set of Medical Qigong practices (mind/body medicine) on quality of life, fatigue, cognitive function, satisfaction with sexual life and inflammation in 170 women with breast cancer aged 18 years and over who complete chemotherapy treatment. The comparison intervention will participate in a supportive educational program for women with breast cancer.
This trial is urgently needed because at present many cancer patients invest much time and money in choosing to use complementary medicine. Further, these findings can be used to develop guidelines for comprehensive cancer care programs including complementary medicine in hospitals.
Professor Clarke's grant was funded by the National Breast Cancer Foundation.
Media Contact: Maggie Lanham Ph 02 9975 7569 or 0412 281277.
