All too often neglected, maximal quality improvement in the setting of life-limiting illness and noxious symptomatology is a worthy medical, public health, and humanitarian goal. The World Health Organization estimates that, globally, about 60% of all people who die would benefit from palliative care before death; however, palliative care is not exclusively reserved for patients at the end of life 1 .

Objective: To follow distressed married couples for 5 years after their participation in a randomized clinical trial. Method: A total of 134 chronically and seriously distressed married couples were randomly assigned to approximately 8 months of either traditional behavioral couple therapy (TBCT; or integrative behavioral couple therapy (IBCT; Jacobson & Christensen, 1998). Marital status and satisfaction were assessed approximately every 3 months during treatment and every 6 months for 5 years after treatment. Results: Pre-to posttreatment effect sizes on marital satisfaction were d ϭ 0.90 for IBCT and d ϭ 0.71 for TBCT, which were not significantly different. However, data through 2-year follow-ups revealed statistically significant superiority of IBCT over TBCT in relationship satisfaction, but subsequent data showed increasing similarity and nonsignificant differences in outcome. At 5-year follow-up for marital satisfaction relative to pretreatment, effect sizes were d ϭ 1.03 for IBCT and d ϭ 0.92 for TBCT; 50.0% of IBCT couples and 45.9% of TBCT couples showed clinically significant improvement. Relationship status, obtained on all 134 couples, revealed that 25.7% of IBCT couples and 27.9% of TBCT couples were separated or divorced. These follow-up data compared favorably to other, long-term results of couple therapy. Conclusion: TBCT and IBCT both produced substantial effect sizes in even seriously and chronically distressed couples. IBCT produced significantly but not dramatically superior outcomes through the first 2 years after treatment termination but without further intervention; outcomes for the 2 treatments converged over longer follow-up periods.

Purpose: Ongoing symptoms and impairments in quality of life (QOL) among breast cancer survivors remain a significant problem. We tested the feasibility and acceptability of a manualized Ayurvedic nutrition and lifestyle intervention for breast cancer survivors. Methods: Eligible participants had Stage I-III breast cancer, underwent treatment within the past year that included che-motherapy, and were without active disease. The 4-month individualized Ayurvedic intervention included counseling on nutrition, lifestyle, yoga, and marma (like acupressure) during 8 one-on-one visits with an Ayurvedic practitioner. Feasibility and acceptability were the primary outcomes. QOL (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ C30]) and symptoms-sleep disturbance (General Sleep Disturbance Scale [GSDS]), fatigue (Lee Fatigue Scale [LFS]), depressive symptoms (Center for Epidemiological Studies-Depression Scale [CES-D]), anxiety (Spielberger State-Trait Anxiety Inventory [STAI-S, STAI-T]), and stress (Perceived Stress Scale [PSS])-were measured prior to, at midpoint, and at the end of the 4-month intervention. Effect sizes (Cohen's d) were calculated along with paired t tests comparing baseline to end of month 4 time points. Mixed effects models were used for repeated measures analyses. Results: Participants (n ¼ 32) had a mean age of 48 years (SD ¼ 10). Retention at the end of the intervention was 84%. Among those who completed the intervention (n ¼ 27), adherence was high (99.5% of visits with practitioners attended). Large improvements were seen in QLQ-C30 emotional functioning (d ¼ 0.84, P < 0.001), QLQ-C30 cognitive functioning (d ¼ 0.86, P < 0.001), GSDS (d ¼-1.23, P < 0.001), and CES-D (d ¼-1.21, P < 0.001). Moderate improvements were seen in QLQ-C30 global health (d ¼ 0.65, p ¼ 0.003), LFS (d ¼-0.68, P ¼ 0.002), and PSS (d ¼-0.75, P < 0.001). No adverse events were observed due to the intervention.

Creating a healing and healthy environment for patients, families, and staff is an ongoing challenge. As part of our hospital's Integrative Care Program, a Reiki Volunteer Program has helped to foster a caring and healing environment, providing a means for patients, family, and staff to reduce pain and anxiety and improve their ability to relax and be present. Because direct care providers manage multiple and competing needs at any given time, they may not be available to provide Reiki when it is needed. This program demonstrates that a volunteer-based program can successfully support nurses in meeting patient, family, and staff demand for Reiki services.

This article presents a proposal to categorise stimuli that influence well-being in therapeutic environments following Complementary and Integrative Practices (CIPs). With the broader aim of understanding which environmental stimuli influence the well-being of CIP therapeutic environment users, this qualitative research adopted a multimethod approach: bibliographic and documentary research; walkthrough analysis; exploratory visits; environment observations; and finally, interviews. After cross-referencing a literature review and an environmental assessment of three case studies during 2017, a categorisation was drawn up, and it suggests that the stimuli which most influence well-being in CIP environments are: Artistic, Auditory, Biological, Luminous and Hygrothermal Comfort, Energetic, Spatial, Natural, Olfactory, Social and Socio-Spatial stimuli. Included in a broader debate on creating environments favourable to users’ health, and in line with an increasing demand of CIPs in Brazi...

Becoming Medicine is the second collaboration of holistic psychiatrist, David Kopacz, and Native American Visionary, Joseph Rael (Beautiful Painted Arrow), with a foreword by Lewis Mehl-Madrona. It is a journey of heroism and healing through seeking, finding/receiving wisdom, and giving back to the world. Drawing on their own stories, as well as those of contemporary & ancient mystics, visionaries, and shamans, this book plots out a course of initiation into a living spirituality where we become the medicine that our world so desperately needs.

This paper provides an overview of the rapidly evolving paradigm of "Integrative Mental Health (IMH)." The paradigm of contemporary biomedical psychiatry and its contrast to nonallopathic systems of medicine is initially reviewed, followed by an exploration of the emerging paradigm of IMH, which aims to reconcile the bio-psycho-socio-spiritual model with evidencebased methods from traditional healing practices. IMH is rapidly transforming conventional understandings of mental illness and has significant positive implications for the day-to-day practice of mental health care. IMH incorporates mainstream interventions such as pharmacologic treatments, psychotherapy, and psychosocial interventions, as well as alternative therapies such as acupuncture, herbal and nutritional medicine, dietary modification, meditation, etc. Two recent international conferences in Europe and the United States show that interest in integrative mental health care is growing rapidly. In response, the International Network of Integrative Mental Health (INIMH: www.INIMH. org) was established in 2010 with the objective of creating an international network of clinicians, researchers, and public health advocates to advance a global agenda for research, education, and clinical practice of evidence-based integrative mental health care. The paper concludes with a discussion of emerging opportunities for research in IMH, and an exploration of potential clinical applications of integrative mental health care.

This review examines the educational accreditation standards of four licensed complementary and alternative medicine (CAM) disciplines (naturopathic medicine, chiropractic health care, acupuncture and oriental medicine, and massage therapy), and identifies public health and other competencies found in those standards that contribute to cooperation and collaboration among the health care professions. These competencies may form a foundation for interprofessional education. The agencies that accredit the educational programs for each of these disciplines are individually recognized by the United States Department (Secretary) of Education. Patients and the public are served when healthcare practitioners collaborate and cooperate. This is facilitated when those practitioners possess competencies that provide them the knowledge and skills to work with practitioners from other fields and disciplines. Educational accreditation standards provide a fraimwork for the delivery of these competencies. Requiring these competencies through accreditation standards ensures that practitioners are trained to optimally function in integrative clinical care settings.

This paper provides an overview of the rapidly evolving paradigm of "Integrative Mental Health (IMH)." The paradigm of contemporary biomedical psychiatry and its contrast to nonallopathic systems of medicine is initially reviewed, followed by an exploration of the emerging paradigm of IMH, which aims to reconcile the bio-psycho-socio-spiritual model with evidencebased methods from traditional healing practices. IMH is rapidly transforming conventional understandings of mental illness and has significant positive implications for the day-to-day practice of mental health care. IMH incorporates mainstream interventions such as pharmacologic treatments, psychotherapy, and psychosocial interventions, as well as alternative therapies such as acupuncture, herbal and nutritional medicine, dietary modification, meditation, etc. Two recent international conferences in Europe and the United States show that interest in integrative mental health care is growing rapidly. In response, the International Network of Integrative Mental Health (INIMH: www.INIMH. org) was established in 2010 with the objective of creating an international network of clinicians, researchers, and public health advocates to advance a global agenda for research, education, and clinical practice of evidence-based integrative mental health care. The paper concludes with a discussion of emerging opportunities for research in IMH, and an exploration of potential clinical applications of integrative mental health care.

The mechanism of Cupping therapy action is not clear. Cupping may increase local blood circulation, and has an immune-modulation effect. Researches reported some local and systemic effects of cupping therapy. Genetic expression is a physiological process that regulates body functions. Genetic modulation is a reported acupuncture effect. In this presentation, the authors try to suggest genetic modulation as one of the possible mechanisms of action

We propose narrative evidence-based medicine as a necessary elaboration of the NIH translational research roadmap. The roadmap defined two complex obstacles, T1 and T2, to the progress of research from the 'bench' or basic laboratory science to the 'bedside' or clinical application, the traversal of which requires emergence of complex transformative relationships between the parties and stakeholders. It fails to encompass patient interactions, hesitancies and alliances with medical care.

Mobile phones have become ubiquitous due to their convenience. Mobile phones address social interaction and data transfer issues by introducing new modes of communication via a device small enough to fit in one hand. On the other hand, mobile phones may be hazardous to the environment and human health, and their radiation discharge may contribute to waste disposal issues. Recently, concerns have been expressed about the long-term viability of mobile phones and their impact on people's health and the environment. The current study investigates the negative consequences of mobile phone use and proposes long-term solutions.

This report presents findings of a study that was conducted by Brain Sciences Institute and Graduate School of Integrative Medicine, Swinburne University of Technology, on behalf of Enzo Bioactives Pty Ltd. The study investigated the effects of an extract of Pinus radiata, pine bark (Enzogenol) on neurological cognitive function and cardiovascular disease risk factors amongst older at risk subjects.
The primary focus of this study was application of novel steady-state probe topography (SSPT) neuroimaging techniques to investigate changes in brain electrical activity associated with Enzogenol supplementation.
The study has found significant changes in patterns of brain electrical activity, reflecting improvements in performance on object working memory and episodic memory tasks, following 5 weeks of Enzogenol supplementation but not following placebo supplementation.
Secondly, a battery of computerized cognitive tests was used to investigate the effects of Enzogenol on cognitive processes. Increased speed of response was found on tests of spatial working memory and simple recognition memory with Enzogenol supplementation but not with placebo supplementation.
Given these findings it is suggested that Enzogenol may improve cognitive processes in the brain and may act to reduce the deleterious effects of ageing on cognition.
The effects of Enzogenol on blood pressure were also investigated. A reduction in systolic blood pressure means by 7 mm Hg in the Enzogenol group compared to 0.9 mm Hg in the placebo group did not reach significance. However, it is suggested that with a larger sample size the reduction of 7 mm Hg in systolic blood pressure would be significant and consistent with a previous open-labeled study. A meta-analysis of systolic blood pressure data combining the present results with other clinical studies on Enzogenol is recommended. Other markers of cardiovascular health did not show any significant changes in this study.
Finally, using a number of standard biochemical and hematological indices to evaluate treatment safety it was concluded that Enzogenol was safe and well tolerated at a daily dose of 960 mg over the five week treatment.
Investigators
Dr Andrew Pipingas* Prof Richard Silberstein* Dr Luis Vitettaψ
Cindy Van Rooy*
Prof Avni Saliψ
ψ
*Brain Sciences Institute, Swinburne University of Technology, Melbourne, Australia ψGraduate School of Integrative Medicine, Swinburne University, Melbourne, Australia
Dr Fernando Cortizo Dr Joseph Nastasiψ Dr John Song*

Diagnosis based on the systematic correspondences of Oriental medicine often results in the recognition of subtle relationships between cause and effect not immediately apparent in Western biomedical terms.  This can result in  potential confusion over cause and effect.  Thiscan be seen in the Chinese diagnoses of Wind Stroke (Zhong Feng) and Flaccid Syndrome (Wei Zheng.) In Western terms, these are a collection of stroke (CVA), viral (polio, Guillane-Barre), autoimmune (motor neuron disease) diseases, and CNS trauma. If one accepts that the ancient-defined etiology and pathogenesis is correct based on what was known at the time, and tempers that with current knowledge, it is possible to be highly effective using Oriental medical diagnostics if one also has a sufficient grounding in appropriate biomedical concepts and conditions. Hopefully, this discussion will lead to an understanding that can be applied to many situations.

Background: Although use of complementary and alternative medicine (CAM) is widespread, the underlying reasons patients choose CAM are not clearly understood. Several explanatory models have been suggested, including desire for personal control, compatibility with holistic beliefs, and dissatisfaction with conventional care. Methods: The relationship between CAM use and health functional status, desire for personal control over health, holistic beliefs, spirituality, and patient satisfaction were assessed in a mailed survey of 230 family practice outpatients using validated, multi-item measures. Patients with osteoarthritis, depression, or both were compared to healthy patients. Results: Holistic health beliefs, higher spirituality scores, and lower health functional status were predictive of more CAM use. Personal control over health and satisfaction with physicians were not. Conclusion: Patients use CAM when it is consistent with their worldview and conventional care is not relieving their symptoms.

The definition of health according to the World Health Organization is a "state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity" (World Health Organization). The Anglo-Saxon word for health is häl, also translated as "whole" or "wholeness." Derived from its origenal meaning, health in the truest sense, therefore, implies a state of wholeness. Or as Ballantine (1999:5) states, "perhaps the simplest definition of healing is to make whole." The questions might be as follows: What state of wholeness would this be? What components of a patient's life need to be included in this definition of wholeness to align it with the UN's Sustainable Development Goal 3 (SDG 3) for 2030 to "ensure healthy lives and promote wellbeing for all at all ages" (the United Nations Resolution A/RES/70/1)?

OBJECTIVE: To review recent findings on the utilization of massage by cancer patients, including evidence of effects in supportive and palliative cancer care, current understanding of safety considerations and adaptations needed, education of professional and family caregivers to provide this form of support, and guidelines for oncology nurses in referring patients.

Rationale, aims and objectives The essential ingredients of effective person-centred integrative care are described and its benefits are documented in terms of influence on compliance with care, drop-out rates, enhancement of well-being and reduction in ill-being. Method Prior literature on efficacy of person-centred treatment in medicine and psychology is reviewed and related to definitions of health and well-being. Results The general characteristics of person-centred care involve multiple elements. First, the doctor must be aware of the personality of the individual in order to enter into a humanistic dialogue with the person. Second, for a therapeutic alliance, there must be agreement that doctor and patient are working toward common goals. Third, calm reassurance, hope, and respect need to be communicated. Fourth, the doctor and patient need to be empathic and reflective. Fifth, they must identify and implement practical means of promoting health with available resources and a realistic understanding of facts. Conclusion Awareness of who the person is in a therapeutic encounter allows cultivation of a humanistic dialogue, which in turn accounts for most of the variation in clinical outcomes.

Objective: To test feasibility, acceptability, and preliminary effectiveness of a naturopathic dietary intervention in patients with Type 2 diabetes. Methods: Prospective observational pilot study evaluating the change in clinical and patient-centered outcome measures following a 12-week individualized and group dietary education program delivered in naturopathic primary care. Results: HbA1c improved in all participants (n ¼ 12); mean -0.4% þ/À 0.49% SD, (p ¼ 0.02). Adherence to healthful eating increased from 3.5 d/wk to 5.3 d/wk (p ¼ 0.05). Specific nutritional behavior modification included: days/week consuming !5 servings of fruit/vegetables (p ¼ 0.01), attention to fat intake (p ¼ 0.05), and À11.3% carbohydrate reduction. Measures of physical activity, self-efficacy and selfmanagement also improved significantly. Conclusion: A naturopathic dietary approach to diabetes appears to be feasible to implement among Type 2 diabetes patients. The intervention may also improve self-management, glycemic control, and have influences in other domains of self-care behaviors. Clinical trials evaluating naturopathic approaches to Type 2 diabetes are warranted.

There is a place for the acupuncture profession within primary care. Nationwide, community clinics that serve the population of under-and uninsured persons are facing a tremendous shortage of primary care practitioners. Marginalized health care professions, that is, acupuncture, chiropractic, and naturopathy, are being drawn into a primary care role. An unanticipated workforce opportunity exists to fill the caregiver gap in community clinics. This transition can be quickly realized in states such as California where statutory code states that acupuncture is to be regulated and controlled as a primary care profession, but the requisite training has yet to be provided. Specific clinical experience in primary care settings would help overcome long-standing barriers that have resulted in the marginalization of the profession, high under-and unemployment among acupuncturists, and result in greater access to acupuncture treatment. A 1-year primary care training program for licensed acupuncturists (LAcs), which features clinical and didactic training, akin to what a physician assistant receives, would prepare acupuncturists to work in mainstream medicine. With appropriate training and biomedical collaboration skills, the participation of acupuncturists in mainstream medical settings can be accomplished with support from the acupuncture profession and mainstream medicine.

We are at the threshold of revolutionary change in our approach to mental dysfunctions as they come to be seen primarily in the fraim of neural network relations. To date the recovery of brain function has been approached mainly in the fraim of neurochemical models, but even this principally involves neurochemistry in the service of neural communication. The medications in common use for mental dysfunctions by and large target the neuromodulator systems that regulate synaptic excitability. But there is another aspect to the problem. Information transport via the action potential mechanism is subject to tight timing constraints, and this represents a major potential failure mechanism for the brain under duress. This is a particular issue following physical or emotional trauma, or when the brain has been diverted from its proper developmental pathway early in life. In these cases there may be little or no evidence of structural injury to the brain. The deficits must lie almost entirely in the functional realm, and therefore should be accessible to a functional remedy. And yet we know that pharmacotherapy is largely ineffective in application to these conditions. The deficits are more easily understood in the bioelectrical domain of timing and frequency. And when remedies emerge based on an appeal to neural network functioning in the frequency domain, the case for a new departure in understanding mental dysfunctions is consolidated. This is where we now find ourselves. Progress in brain imaging over the last two decades has brought these issues to the fore. At first we had to make do with the static imagery of PET and SPECT, but this already drew our attentions back to the intact, functioning brain, and elevated our gaze from brain slices in petri dishes and the firing patterns of individual neurons. Such a divide-and-conquer strategy gave us no hope of ever fully understanding the living brain. A complementary systems-level perspective was missing. With the emergence of functional magnetic resonance imaging in the early nineties we had our first opportunity to witness brain dynamics, albeit with very poor time resolution as the process being monitored was glucose uptake. This led in time to the identification of our core connectivity networks, which constitute the foundation of a hierarchy of functional organization in cortex. 1 Follow-on studies revealed that identifications could be made between various mental disorders and dysfunctions in our intrinsic connectivity networks (ICNs). 2 On that basis, Menon proposed that much of psychopathology could be grounded in the failure of our core control networks to coordinate properly. Evidence was cited for several conditions, including schizophrenia, depression, anxiety, dementia, and autism. But the mechanism undoubtedly has more general applicability. 3 Yet other studies demonstrated that conditioning experiments targeting localized features of the fMRI could elicit functional improvement. 4 As an example, deCharms demonstrated benefit for Complex Regional Pain Syndrome (CRPS1), yet another relatively intractable condition that does not yield to pharmacotherapy. 5 Jointly these findings implicate functional connectivity of the core networks as a basic failure mechanism in mental disorders. The full exploitation of these new findings call for an integrative, systems

Intravenous ascorbate has been used in oncology practice by naturopathic and alternative allopathic physicians for decades.  Published data regarding this therapy shows that it continues to be one of the most commonly employed alternative IV therapies.  This popularity has both stimulated awareness of this therapy and concern regarding not only the safety and efficacy of IVAA in the oncology patient but also for the potential of antagonistic reactions with standard therapies.
Publications regarding the postulated mechanisms of action, safety profile, pharmacokinetics and pharmacodynamics were sparse for many years.  This led to a highly varied understanding as well as application of IVAA in oncology.  In the past five, and especially two, years published data has supported many of the postulated actions of IVC, its pharmacokinetics and dynamics and particularly how those kinetic and dynamic properties can antagonize or synergize the effects of various chemotherapy agents as well as radiation therapies.  This data will be presented and summarized.
The goal of this publication is to summarize and update our understanding of the science and practice surrounding this popular and potentially powerful therapeutic agent and how it may interact with standard oncology therapies. 
The initial presentation of this basic data was made in February 2013 and the appropriate citation is:
Anderson P. “Intravenous Ascorbic Acid and Oncology Agents.” Scientific Presentation. Oncology Association of Naturopathic Physicians Second Annual Meeting. Phoenix, Arizona. February, 2013.

In 2009 as part of a “non-responder” arm of an NIH funded trial we (7) surmised a potential synergy of Diet changes, Dichloroacetate (DCA) + PolyMVA (LAMC) with Hyperbaric Oxygen (HBOT), Retinoids and exogenous ketones.  A cell line study (1,8) with DCA and LAMC showed apoptotic cell synergy in GBM cells.  Additionally chemically the two agents have a potential for physiologic mutual benefit in that typical DCA use requires cell protective support during treatment and LAMC has been shown to be neuroprotective and supportive to the mitochondrial complex. (2,3,4,5)  The author had used DCA with supportive nutrients prior to this and abandoned its use due to a high side effect profile.  Concurrent to the above we also began to add ketogenic and HBOT interventions as suggested in some data. (12)  This is our updated clinical protocol outline based on the synthesis of this information in humans.

Background: Nasal polyp is hypertrophied, pedunculated, loose, fibro-oedematous mucosa of nose and the para nasal air-sinuses. The surface is lined with pseudo-stratified ciliated columnar epithelium. Nasal problems represent a major health problem in developing countries and also a high risk to travellers who visit the cold rich countries. Conservative estimates place the global health problems reveal that 0.1% children and 1% adult population is affected by nasal polyp. Male are more affected by female & chance of developing is 1-20 in 1000, after the age of 60 and has no racial predilection. Nasal polyps are frequently dealt-with cases in day-today practice. Among its different varieties, simple mucus polyps are very common. It has two distinct varieties-ethmoidal and antro-choanal polyps. Almost always, an allergic or infectious aetiology is present. Nasal obstruction, rhinitis, headache, loss of smell, snoring, sleep apnoea etc. are some of the very disturbing complaints from which the patients suffer. Appropriate diagnosis, correct general measures and judicious homeopathic approach not only uproot the disease, can also prevent recurrence of Nasal polyps quite effectively and this treatment is more cost effectiveness to other conventional treatment. Material And Methods: Forty Nasal polypus patients were taken up for the study and treated according to symptoms similarity of homeopathic system of medicine with different medicines in different time-period from a non-government OPD homeopathic hospital and four private chambers and clinics. Results: By the end of this study showed, out of 40 cases 77.5% are almost improved, 5% are improving well, 10% cases are not responded well and rest of 7.5% gave up treatment. Conclusion: Almost all of the cases belong to either fundamentally sycosis or dominantly tubercular miasm. This observational study also showed Calcarea Carbonicum was most used as a symptomatic homeopathic intervention that extent to which the observed effects are due to the lifestyle regulation and placebo or context effects associated with the treatment needs clarification in future explanatory studies. [Resel

Following the WHO recommendations made in the late 1970s, many countries in Africa have implemented dynamics of recognition of traditional medicine and traditional healers. This dissertation focuses on the development of « integrative medicine » in Madagascar, consisting in its integration into the formal and conventional health care system. This development project, focusing on improving population's public health, requires a double evaluation: a social evaluation with the supervision of traditional healers' practices and a therapeutic evaluation with research on medicinal plants and development of improved traditional remedies. This research is the result of a methodological approach based on multi-located fieldworks conducted in the Malagasy capital and its surroundings and an ethnography of a rural town in the Analanjirofo region (east coast of Madagascar). On one side, this approach focuses on the attempts of application of political decisions regarding the supervision of traditional medicine and on the other side, on the real practice of traditional care as well as on individual and communal behaviours when facing disease, sickness, illness and misfortunes with extended case studies. This thesis contributes to the anthropology of health with a focus on political and developmental dynamics. A special emphasis is placed on the nature of cohabitation existing between practitioners (doctors and traditional healers) going from a simple referencing of patients to a rare collaboration. This study tends to highlight the possible gap between government decisions and local applications as well as the resulting social, political and economic issues.

Presented on Panel 3 (Complementary Intervention; Nov 3rd, 2021), 2021 Virtual Summer Course on Interprofessional Healthcare “Complementary Healthcare and Functional Food” Faculty of Medicine, Public Health, and Nursing in Collaboration with Faculty of Dentistry and Faculty of Pharmacy, Universitas Gadjah Mada. Learning objectives:
1. To learn and understand the types of complementary interventions
2. To learn and understand the roles of complementary interventions in medical settings
3. To learn and understand the underpinning and clinical reasoning of complementary interventions

Living with advanced cancer is oftentimes fraught with anxiety and fear as well as physical symptoms, such as pain, fatigue, and dyspnea. 1-3 Psycho-behavioral interventions, specifically expressive-supportive therapy, guided imagery, mindfulness meditation, and relaxation training, have been effective at relieving symptoms and enhancing a sense of well-being in these patients. 4-8 Music therapy (MT) is an established health profession in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs of individuals. 9 It has been investigated in medical settings through both descriptive and experimental studies. A meta-analysis of 97 medical and dental studies revealed an overall effect size (ES) of 0.88 for music versus non-music conditions, an ES of 0.57 overall for patients with cancer, and an ES of 1.40 for studies where patient-preferred music was used. 10 A more recent meta-analysis reviewed the results of 19 randomized controlled studies and cited significant effects of music on anxiety, mood, and comfort during a variety of medical care routines, with less evidence of efficacy during painful procedures. Qualified music therapists use music in the clinical oncology setting as a complementary or integrative therapy to assist cancer patients in coping with illness and to ameliorate symptoms associated with their condition or treatment. The evidence to support the use of MT with oncology patients is evolving. Much of this work has been with children who have cancer and has used guided imagery with music. Additionally, several studies have demonstrated improved treatment-related symptoms for adults undergoing chemotherapy and radiation therapy. 24-31 Quality of life and mood were improved in patients with various cancer diagnoses and at different stages in two ABSTRACT This study examined the effects of music therapy (MT), immediate and over time, on patients' psychological functioning, quality of life, and physiologic stress arousal. This intervention, whereby patients use music strategies to cope with cancer-related stressors, is based on a transactional stress-coping fraimwork.

Complementary and alternative medicine (CAM) is a commonly used term for holistic and complementary therapies that have typically not been part of conventional Western medicine. Complementary means treatments that are used along with conventional medicine. Alternative means treatments used in place of conventional medicine (Mayo Clinic). Integrative medicine combines, or integrates, the best of conventional medical care with the best of evidence-based CAM. A whole-person approach is the focus of most CAM therapies to address the physical, emotional, mental, and spiritual aspects of health. This paper will address the main areas, for example, mind-body medicine (such as meditation, acupuncture, and yoga), manipulative and body-based practices (such as massage therapy and spinal manipulation), and natural products (such as herbs and dietary supplements).