Article type
Abstract
Objective: This study aimed to determine the quantity of complementary and alternative medicine (CAM) recommendations and their quality across clinical practice guidelines (CPGs) for treating and managing cancer pain and identify research gaps using recommendations mapping.
Method: A systematic review was conducted to identify CAM guidelines. PubMed, Web of Science, Embase, CNKI, Wanfang Data, CBM, and guideline databases were systematically searched from inception to January 2024 to identify eligible CPGs. Eligible guidelines containing recommendations
for the treatment and management of cancer pain were assessed with the Appraisal of Guidelines,
Research and Evaluation II (AGREE II) instrument. We used bubble plots to show recommendations in CPGs.
Results: Based on the AGREE-II assessment, ten CPGs have been recommended for use following modifications, while two are not recommended. The evaluated CPGs received high scores in the "independence" and "scope and purpose" domains. Collectively, they provide 54 recommendations for CAM therapy in cancer pain management, with acupuncture and psychological interventions being the most frequently recommended (80.77%). However, these recommendations vary in evidence types, target populations, and expert opinions, leading to inconsistencies. Of the 39 evidence-based recommendations(72.22%), 36 (66.67%) were derived from systematic reviews and randomized controlled trials (RCTs). Notably, 45 recommendations (83.33%) did not specify the type of cancer pain. For patients experiencing moderate to severe cancer pain, six recommendations, including acupuncture, yoga, and massage, were supported by systematic reviews and RCTs, with three being strong recommendations based on moderate-confidence evidence and three being weak recommendations with low confidence. Additionally, for chronic cancer pain in breast cancer patients, there is a strong recommendation supported by a systematic review with meta-analysis (SRMA). Weak recommendations for postoperative, peripheral, and central pain were provided based on systematic reviews (SR) and RCTs.
Conclusions: Traditional Chinese medicine and psychotherapy recommendations were favorably recommended across nearly all CPGs. Patients and healthcare professionals can use CPGs that scored highly as the basis for discussing CAM therapies for cancer pain treatment/management.
Method: A systematic review was conducted to identify CAM guidelines. PubMed, Web of Science, Embase, CNKI, Wanfang Data, CBM, and guideline databases were systematically searched from inception to January 2024 to identify eligible CPGs. Eligible guidelines containing recommendations
for the treatment and management of cancer pain were assessed with the Appraisal of Guidelines,
Research and Evaluation II (AGREE II) instrument. We used bubble plots to show recommendations in CPGs.
Results: Based on the AGREE-II assessment, ten CPGs have been recommended for use following modifications, while two are not recommended. The evaluated CPGs received high scores in the "independence" and "scope and purpose" domains. Collectively, they provide 54 recommendations for CAM therapy in cancer pain management, with acupuncture and psychological interventions being the most frequently recommended (80.77%). However, these recommendations vary in evidence types, target populations, and expert opinions, leading to inconsistencies. Of the 39 evidence-based recommendations(72.22%), 36 (66.67%) were derived from systematic reviews and randomized controlled trials (RCTs). Notably, 45 recommendations (83.33%) did not specify the type of cancer pain. For patients experiencing moderate to severe cancer pain, six recommendations, including acupuncture, yoga, and massage, were supported by systematic reviews and RCTs, with three being strong recommendations based on moderate-confidence evidence and three being weak recommendations with low confidence. Additionally, for chronic cancer pain in breast cancer patients, there is a strong recommendation supported by a systematic review with meta-analysis (SRMA). Weak recommendations for postoperative, peripheral, and central pain were provided based on systematic reviews (SR) and RCTs.
Conclusions: Traditional Chinese medicine and psychotherapy recommendations were favorably recommended across nearly all CPGs. Patients and healthcare professionals can use CPGs that scored highly as the basis for discussing CAM therapies for cancer pain treatment/management.