Papers by Catherine Zollman
“What Should I Eat?”—Addressing Questions and Challenges Related to Nutrition in the Integrative Oncology Setting
Current Oncology Reports, Jul 5, 2022
Media review
Complementary Therapies in Medicine, Dec 1, 2000
BMJ, Sep 25, 1999
Several surveys, of varying quality, have been undertaken, but interpretation is not straightforw... more Several surveys, of varying quality, have been undertaken, but interpretation is not straightforward. Some studies targeted practitioners, whereas others surveyed patients and consumers. Different definitions of complementary medicine have been used-some include only patients consulting one of five named types of complementary practitioner, while some include up to 14 different therapies and others include complementary medicines bought over the counter. When treatments such as hypnosis are given by conventional doctors or within conventional health services, patients and surveys may not register them as "complementary." However, it is possible to make estimates from the available data, which help to chart the development of complementary practice. The most rigorous UK survey of use of complementary medicine estimated that, in 1993, 33% of the population had used some form of complementary medicine and that over 10% had consulted a complementary practitioner in the previous year. Surveys of patients with chronic and difficult to manage diseases-such as cancer, HIV infection, multiple sclerosis, psoriasis, and rheumatological conditions-give levels of use up to twice as high. Comparisons can be made with figures from other countries, although variations may be partly due to differences in survey methodology. Attempts have been made to estimate the number of complementary medicine consultations taking place in the United Kingdom. In 1993 there were about 12 million adult consultations in the six major complementary disciplines. Average consultation rates were 4.3 per patient. Estimates based on the increased number of registered complementary practitioners suggest that at least 15 million complementary medicine consultations took place in 1997, about 5% of the number of general practice consultations.
“What Should I Eat?”—Addressing Questions and Challenges Related to Nutrition in the Integrative Oncology Setting
Current Oncology Reports
Using the Patient Activation Measure to evaluate a self-management course for people with cancer
BMJ, 1993
Nearly all general practitioners meet representatives of drug companies.' The drug industry spent... more Nearly all general practitioners meet representatives of drug companies.' The drug industry spent an estimated £5000 per general practitioner promoting its products in the United Kingdom in 1985.2 Drug representatives are a crucial element in the promotion of products, and expenditure on representatives accounts for over 500/o of promotional budgets.' Information is available on the frequency and duration of meetings between general practitioners and drug companies' representatives.' I describe my meetings with representatives during one year, including the samples, gifts, and literature given to me. The study was based at my singlehanded general practice in a rural town, population 1000, in the south east of Ireland. The practice was not dispensing. For 50 of the 52 weeks between 29 August 1990 and 28 August 1991 I and two receptionists recorded details of the visits by representatives of drug companies to my surgery. We recorded each representative's name and gender, the name of the company represented, the time spent with me, the name and number of products promoted, and any samples, gifts, or literature provided. The representatives were unaware that the study was taking place. For each visit I adopted a passive role, allowing the representative to dictate its content and duration. I did not request any samples but accepted all samples and gifts that were offered. The value of the samples was calculated from the prices quoted for September 1991 in the Monthly Index of Medical Specialities. I received a total of 109 visits, a mean of 2-2 per week, from 49 representatives of 41 drug companies, a mean number of 2-7 visits per company. The visits lasted for a mean of 6-17 (range 2-16) minutes, and the sex of the representatives made no significant difference to the length of the visits (t= 1 63; df= 107; p=0-106). In each visit a mean of 3 3 (1-6) products were promoted. Data sheets were offered in 11 of the visits whereas advertising brochures were offered in 51. Two representatives offered copies of articles from peer reviewed journals. I received a gift in 64 visits: these usually displayed an advertisement for the product being promoted, and consisted of stationery, pens, diaries, calendars, or trinkets (mugs, tapes, towels, clothes brush, desk tidy, air freshener, ice scraper, and flower seeds). I was given samples of drugs in 103 of the visits and received 174 samples altogether. The table lists these samples according to the classification used in the British National Formularv. Free drug samwlples received by, a general practitioner in one year. Drugs
BMJ, 1999
Several surveys, of varying quality, have been undertaken, but interpretation is not straightforw... more Several surveys, of varying quality, have been undertaken, but interpretation is not straightforward. Some studies targeted practitioners, whereas others surveyed patients and consumers. Different definitions of complementary medicine have been used-some include only patients consulting one of five named types of complementary practitioner, while some include up to 14 different therapies and others include complementary medicines bought over the counter. When treatments such as hypnosis are given by conventional doctors or within conventional health services, patients and surveys may not register them as "complementary." However, it is possible to make estimates from the available data, which help to chart the development of complementary practice. The most rigorous UK survey of use of complementary medicine estimated that, in 1993, 33% of the population had used some form of complementary medicine and that over 10% had consulted a complementary practitioner in the previous year. Surveys of patients with chronic and difficult to manage diseases-such as cancer, HIV infection, multiple sclerosis, psoriasis, and rheumatological conditions-give levels of use up to twice as high. Comparisons can be made with figures from other countries, although variations may be partly due to differences in survey methodology. Attempts have been made to estimate the number of complementary medicine consultations taking place in the United Kingdom. In 1993 there were about 12 million adult consultations in the six major complementary disciplines. Average consultation rates were 4.3 per patient. Estimates based on the increased number of registered complementary practitioners suggest that at least 15 million complementary medicine consultations took place in 1997, about 5% of the number of general practice consultations.
Use of complementary therapies by women in the South Thames NHS region with a diagnosis of breast cancer: a short report
Rees, Rebecca and Feigal, I. and Vickers, Andrew and Zollman, Catherine and McGurk, R. and Smith,... more Rees, Rebecca and Feigal, I. and Vickers, Andrew and Zollman, Catherine and McGurk, R. and Smith, C. (1998) Use of complementary therapies by women in the South Thames NHS region with a diagnosis of breast cancer: a short report. Project Report. Research Council for Complementary Medicine, London. ... Full text not available from this repository. ... IOE EPrints is powered by EPrints 3 and is hosted by ULCC.
Supportive care in cancer, Mar 14, 2024
Background Up-to-date recommendations for the safe practice of acupuncture in integrative oncolog... more Background Up-to-date recommendations for the safe practice of acupuncture in integrative oncology are overdue with new cancer treatments and an increase in survivors with late effects of disease; 17 years have elapsed since Filshie and Hester's 2006 guidelines. During 2022/2023 an expert panel assembled to produce updated recommendations aiming to facilitate safe and appropriate care by acupuncturists working with people with cancer. Methods A core development team comprising three integrative oncology professionals comprehensively updated pre-existing unpublished recommendations. Twelve invited international experts (senior acupuncturists with and without experience of working in oncology settings, oncologists, physicians and nurses trained in integrative oncology, researchers, academics, and professional body representatives) reviewed the recommendations. In multiple iterations, the core team harmonised comments for final ratification. To aid dissemination and uptake the panel represents national and international integrative oncology associations and major cancer treatment centres in Europe, USA, Australia, and the Middle East. Results These recommendations facilitate safe care by articulating contra-indications, cautions, and risks for patients both on and off treatment (surgery, SACT, radiotherapy). Situations where acupuncture may be contra-indicated or practices need adapting are identified. "Red and Amber Flags" highlight where urgent referral is essential. Conclusion These are the first international, multidisciplinary peer-reviewed recommendations for safe acupuncture practice in integrative oncology. Concerns about safety remain a significant barrier to appropriate referral from oncology teams, to use by acupuncturists and to uptake by patients. Disseminating trustworthy, widely accessible guidance should facilitate informed, confident practice of acupuncture in and outside of oncology healthcare settings.
Guiding patients through the maze
Integrated Cancer Care
Catherine Zollman graduated in 1989 from Oxford University and the Royal Free Hospital School of ... more Catherine Zollman graduated in 1989 from Oxford University and the Royal Free Hospital School of Medicine, London, where she developed an interest in holistic medicine by becoming a member, and then a trustee, of the British Holistic Medical Association. During her training in medical oncology, palliative care, and then general practice, she worked at the Bristol Cancer Help Centre and the Hammersmith Hospital Oncology Department, and was on the executive committee of the British Psycho-Oncology Society. Between 1996 and 1999 she was part-time director of medical education with the Research Council for Complementary Medicine, where she was involved in educating conventional healthcare professionals about complementary medicine and was co-author of an ABC of Complementary Medicine, published in journal (1999) and book (2000) form by the British Medical Journal.
approaches to nutritional medicine ABC of complementary medicine: Unconventional
BMJ Supportive & Palliative Care, 2021
BackgroundWe examine the impact of a 5-day online elective course in integrative medicine (IM) ta... more BackgroundWe examine the impact of a 5-day online elective course in integrative medicine (IM) taking place during the COVID-19 pandemic, attended by 18 medical students from two faculties of medicine in Israel.MethodsThe course curriculum addressed effectiveness and safety of IM practices highlighting supportive and palliative care, demonstrated the work of integrative physicians (IPs) in designing patient-tailored treatments and taught practical skills in communication regarding IM. Group discussions were conducted via Zoom with 32 physicians, healthcare practitioners and IM practitioners working in integrative academic, community and hospital-based settings, in Israel, Italy, UK and Germany. An 18-item questionnaire examined student attitudes and perceived acquisition of skills for implementing what was learned in clinical practice. Student narratives were analysed using ATLAS.Ti software for systematic coding, identifying barriers and advantages of the online learning methodolog...
Current Research in Complementary & Alternative Medicine, 2017
The phytochemicals compounds found in plants are responsible for their colour, taste, and aroma o... more The phytochemicals compounds found in plants are responsible for their colour, taste, and aroma of many foods. Over and above these attributes, emerging evidence suggests that they protect us from environmental and ingested carcinogens by arming antioxidant enzymes, enhancing DNA repair pathways, reducing chronic inflammation, and directly affecting the biological processes that underlie the fundamental hallmarks of cancer progression and metastasis. It is not a surprise, then, that the World Cancer Research Fund (WCRF) and other academic bodies report that individuals eating phytochemical-rich foods have a lower risk of cancer or relapse after treatments. The debate lies in whether concentrating these into nutritional supplements or topical creams can boost their health attributes without causing significant adverse effects. One notable randomised controlled trial has demonstrated benefits of a polyphenol-rich nutritional supplement for men with prostate cancer, another Randomised Controlled Trial (RCT) used a polyphenolic-rich topical balm to prevent distressing chemotherapy induced nail loss but, considering their potential benefits, there is a shortage of robust RCTs. This international evidence reviews highlights significant RCTs relating to cancer, their probable mechanisms of action and scope for future research.
The Journal of Alternative and Complementary Medicine, 2018
Objectives: This study evaluated the change in the concerns, wellbeing and lifestyle behaviours o... more Objectives: This study evaluated the change in the concerns, wellbeing and lifestyle behaviours of informal caregivers of people with cancer attending Penny Brohn UK's Living Well Course (LWC), a self-management education intervention. A pre-post-course design collected self-reported quantitative and qualitative data from informal caregivers attending a LWC. Setting/Location: Penny Brohn UK is a UK based charity (not-for-profit) providing specialist integrative, whole person support, free of charge, to people affected by cancer. : Informal caregivers taking part in a Penny Brohn UK LWC between June 2014 and May 2016 attending alongside the person with cancer. Intervention: The LWC is a structured 15 hour, multi-modal group self-management educational course, designed to help people affected by cancer learn tools and techniques to help build resilience. Trained facilitators deliver LWCs to around 12 people with various types and stages of cancer, and their informal caregivers. Outcome measures: MYCaW (Measure Yourself Concern and Wellbeing) completed precourse and at 6 weeks post-course; and bespoke 6 week follow up Patient Reported Experience Measure (PREM). Results: 480 informal caregivers attended a LWC June 2014 to May 2016. 118 completed a 6 week follow up MYCaW: MYCaW Concerns 1 and 2 showed statistically significant improvements (p<.0001), there was no significant improvement in wellbeing. Informal caregivers' most reported concerns relating to themselves were psychological and emotional issues (59%). The primary concern of the caregiver for the care recipient was related to the physical health of the person with cancer (40%). 87% of responding informal caregivers stated the LWC enabled health self-management. The LWC was followed by an improvement in informal caregivers' concerns, and increased self-management of their own health needs. More studies, with larger sample size, are needed to explore if better self-management by informal caregivers may also lead to improvements in patients' health and wellbeing.
JNCI Monographs, 2017
The term "whole-person cancer care"-an approach that addresses the needs of the person as well as... more The term "whole-person cancer care"-an approach that addresses the needs of the person as well as treating the disease-is more widely understood in the United Kingdom than its synonym "integrative oncology." The National Health Service (NHS) provides free access to care for all, which makes it harder to prioritize NHS funding of whole-person medicine, where interventions may be multimodal and lacking in cost-effectiveness data. Despite this, around 30% of cancer patients are known to use some form of complementary or alternative medicine (CAM). This is virtually never medically led, and usually without the support or even the knowledge of their oncology teams, with the exception of one or two large cancer centers. UK oncology services are, however, starting to be influenced from three sides; first, by well-developed and more holistic palliative care services; second, by directives from central government via the sustainable health care agenda; and third, by increasing pressure from patient-led groups and cancer charities. CAM remains unlikely to be provided through the NHS, but nutrition, physical activity, mindfulness, and stress management are already becoming a core part of the NHS "Living With and Beyond Cancer" agenda. This supports cancer survivors into stratified pathways of care, based on individual, self-reported holistic needs and risk assessments, which are shared between health care professionals and patients. Health and well-being events are being built into cancer care pathways, designed to activate patients into self-management and support positive lifestyle change. Those with greater needs can be directed toward appropriate external providers, where many examples of innovative practice exist. These changes in policy and vision for the NHS present an opportunity for integrative oncology to develop further and to reach populations who would, in many other countries, remain underserved or hard to reach by whole-person approaches.
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Papers by Catherine Zollman