A cross-sectional study of patients of the Robert Schad Naturopathic Clinic using the Naturopathic Patient Database Christopher Habib ND (1); Stefan Podgrabinski (2), Matthew Gowan ND (1,2), Brenda Leung ND, PhD (3), Dugald Seely ND, MSc (1,4), Kieran Cooley ND, MSc (1) 1. Canadian College of Naturopathic Medicine 2. OM Corporation 3. Boucher Institute of Naturopathic Medicine 4. Ottawa Integrative Cancer Centre Integrative Background Results Table 1. Conditions Seen at RSNC 2009-2010. ICD-10 % of All % of PatientsThe Naturopathic Patient Database (NPD) is a data management tool developed Females (76%) and people in the 20-30 (31.8%) and 31-40 (18.4%) year old age Conditions Code Range Diagnoses Diagnosedby the Canadian College of Naturopathic Medicine (CCNM) to collect patient groups have the highest representation in the NPD. The pediatric population is Pregnancy-related O00-O99 0.2 0.6data from its teaching clinic, the Robert Schad Naturopathic Clinic (RSNC). This disproportionately underrepresented. Psychosocial problems, musculoskeletal Accidents, poisoning, violence S00-T98 3.0 8.2database was created in 2006 and has evolved to meet the various academic disorders, symptom-based conditions (e.g. fatigue and abnormal laboratory results), endocrine disorders, and gastrointestinal disorders were the most prevalent ICD Cardiovascular disease I00-I99 4.0 11.8and research needs of CCNM. This study describes demographics of patientsand conditions treated by student interns at the RSNC from 2009-2010. groups seen during this period. Health maintenance Z00-Z99 4.1 12.1 Infectious disease A00-B99 4.2 9.5Funding support for the development and use of the NPD was provided by a Figure 2. Conditions Seen at RSNC 2009-2010. Respiratory disorders J00-J99 4.4 12.2grant from the Lotte and John Hecht Foundation. Cancer, neoplasms, hematologic C00-D89 4.8 13.4 Pregnancy-related Methodology Accidents, poisoning, violence Nervous system, sensory organs G00-G99 5.4 14.4 Skin disorders L00-L99 7.1 20.9Fourth year naturopathic interns input data into the NPD as part of an academic Cardiovascualr disease Genitourinary disorders N00-N99 7.8 21.1requirement. Patients can only be entered into the NPD after a minimum of 3 Health maintenance Gastrointestinal disorders K00-K93 9.1 23.3visits. The majority of patients and patient visits are included in the NPD, but not Endocrine disorders E00-E90 10.6 26.8all. Thus, the NPD provides a snapshot of the data captured by interns on Infectious diseasepatients and health care services provided at the RSNC. Other medical R00-R99 10.9 28.3 Respiratory disorders Musculoskeletal disorders M00-M99 11.7 26.9All data from patient files must be entered, beginning with age and gender. The Cancer, neoplasms, hematologic Psychosocial problems F00-F99 12.6 30.0NPD is divided into sections similar to a chart: Subjective, Objective, Nervous system/sensory organsAssessment, and Plan. The NPD also contains a section for outcomes, which Figures 3. RSNC Ages. Figures 4. RSNC Genders. Skin disordersincludes data from the Measure Yourself Medical Outcome Profile (MYMOP). The Genitourinary disorders 0 to 10MYMOP is used as a universal outcome measure of effectiveness ofindividualized patient-defined symptoms. 11 to 19 Gastrointestinal disorders M 20 to 30Figure 1. Screenshot of NPD. Endocrine disorders 31 to 40 Other medical Musculoskeletal disorders 41 to 50 F 51 to 60 Psychosocial problems 61 to 100 Discussion The majority of patients seen at the RSNC are female, likely because females tend This is one of the first Canadian studies using an effective to seek complementary and alternative medicine more than males. The pediatric database tool to obtain a clinical profile of patients seen by population is possibly underrepresented in the NPD because those cases may be naturopathic doctors. Future work is needed to evaluate the more complicated and interns may choose not to select those cases for their delivery of care and utility of the NPD as an effective teaching aid academic requirements or because those patients only come to the clinic for acute and research tool. care. Selected References Acknowledgements Although a wide spectrum of diseases are treated at the RSNC, chronic diseases 1) International Classification This project could not have taken place withoutThe NPD was used to explore RSNC patient cases from 2009-2010. The (diabetes, mental health conditions), diseases with low perceived risk to benefit of Diseases, 10th revision. important contribution from RSNC interns and clinic supervisors from 2006-2010.assessment section of the NPD contains a column for diagnosis that uses the profiles with conventional treatment (chronic pain), and diseases that have a large, 2) Gowan et al. The NaturopathicInternational Classification of Diseases, 10th revision (ICD-10) coding system. modifiable lifestyle component to them (cardiovascular disease), are seen with high Patient Database: a Clinical Tool frequency. More research is needed to understand patient choices to receive care for Research and Education.ICD-10 codes were extracted and reviewed by an expert (CH) for accuracybefore being tabulated. from this institution and to evaluate the effectiveness of care for these disorders.
Treating Type 2 Diabetes: A cross-sectional audit of Naturopathic care within a naturopathic college teaching clinic using the Naturopathic Patient Database Christopher Habib ND (1); Stefan Podgrabinski (2), Matthew Gowan ND (1,2), Brenda Leung ND, PhD (3), Dugald Seely ND, MSc (1,4), Kieran Cooley ND, MSc (1) 1. Canadian College of Naturopathic Medicine 2. OM Corporation 3. Boucher Institute of Naturopathic Medicine 4. Ottawa Integrative Cancer Centre Integrative Background ResultsType 2 Diabetes Mellitus (T2DM) is a multi-factorial disease characterized by a The mean patient age was 60 and the female gender was more common (62%). Care Figure 3. Percentage Use of Therapies.decreased response to insulin. The Naturopathic Patient Database (NPD) is a data being provided was predominantly adjunctive care rather than primary care. Themanagement tool developed by the Canadian College of Naturopathic Medicine (CCNM) mean core audit score was 55.5 out of possible total of 90. There was no cut-off 100.0to collect patient data from its teaching clinic, the Robert Schad Naturopathic Clinic score used to determine what was considered adequate care.(RSNC). This study investigates how T2DM is managed at the RSNC from May 2009 to 75.0 PercentageFebruary 2011 for the purposes of auditing clinical supervisors and ultimately Figure 2. Audit Scores for Major Categories.improving patient care. 50.0 2.5Funding support for the use of the NPD was provided by a grant from the Lotte and 25.0John Hecht Foundation and the Diabetes Alternative Research and Healthcare 2Foundation. 0.0 1.5 Methodology Om g m e 10 M A on y ts Ch a-3 ium na a ls th in l lin m AL siu TC en ica m 1 Q- ic eg pa ne m se lem m ed ne Co an eo ro m un M ag Ph Bot Gy pp m Co Ci al M HoA core audit form was created using the American Diabetes Association 2010 Su 0.5 ic ysstandards of medical care. Multiple categories in diagnosis, physical exam, lab tests, 0and management were graded on a 0-2 scale. Criteria being assessed included: KE Tinquiring about current medications, obtaining a detailed history of complications, G S AL BS Figure 4. Relationship of Audit Score vs. NPD Visits Missing. EN IN L TA C RA LA TT EM SImeasuring blood pressure, palpating thyroid, doing a foot exam, obtaining lab results IN FE SE Y AG PH REfor HbA1c and lipid profiles, providing referrals to medical doctors, setting appropriate AL 90 AN GO Mtreatment goals, and utilizing evidence-based prescriptions. 80 Audit Score (Out of 90) Figure 3. 70Additional audit criteria were created that did not apply to all cases, since some 60guidelines only apply to specific patient populations, (eg. referring for bariatric surgery The therapy most commonly used was nutritional supplementation (93%) followed 50if Body Mass Index is over 35). Audit criteria that focused on naturopathic interventions by botanical medicine (69%). Other naturopathic modalities were rarely used to treat 40and RSNC operations were also assessed. These included the recommendations for T2DM or its complications. Of the supplements, omega-3 fatty acids (mean dose: 30various supplements, botanicals, physical medicine, homeopathy, Traditional Chinese 1818 mg daily) was the most common, followed by chromium (mean dose: 681 20Medicine, therapeutic counseling and use of the Measure Yourself Medical Outcome mcg daily). 10Profile (MYMOP) as a universal outcome measure of effectiveness of individualized Interns enter information into the NPD after a minimum of 3 patient visits. An 0patient-defined symptoms. analysis was done to see how audit scores compared to the number of visits that 0 2 4 6 8 10 12 14 were omitted in the NPD. There were no differences among the audit scores,One auditor (CH) conducted a search of the NPD from May 2009 to February 2011 to NPD Visits Missing indicating that the quality of care was largely determined within the first 3 visits.identify patients assessed with T2DM. The assessment section of the NPD contains acolumn for diagnosis that uses the International Classification of Diseases, 10th revision(ICD-10) coding system. The inclusion criteria were all patients assessed with T2DM, so Discussionthat the audit could also capture a realistic representation of naturopathic care for The audit scores evaluating the patient intake were high. This is likely because Feedback is key in improving audit scores and patient care. Audit findingsthose with comorbidities, as is often the case in patients with T2DM. The code for interns spend one hour per visit with patients and so have large amounts of time to were presented to clinical supervisors and to current clinic interns. They wereT2DM (E11) was employed and captured 29 patient cases. accumulate information. The audit scores for lab tests were also high and this is also integrated into the curriculum. The poorest scoring categories were likely because naturopathic doctors in Ontario cannot directly requisition lab tests, so emphasized. A checklist was created to help guide interns in their first 3 visits Figure 1. Process of Case Selection for Audit. credit was given in the audit if an intern requested lab work from the patient. with a diabetic patient. Education and creation of a naturopathic standard of care may improve audit performance and patient outcomes for patients with The three lowest scoring categories in the audit were: a thorough physical exam, 13,824 39 T2DM 37 T2DM 29 T2DM T2DM. Larger scale follow-up audits are planned to examine the impact of Cases (May Cases With referring patient care, and setting specific treatment goals. The physical exam Total NPD Cases With audit feedback and continue the process of practice improvement. Cases (2006 2009 to Feb Complete Patient File component scored poorly because there are guidelines for T2DM that fall outside of to 2011) 2011) NPD Data Identifiers the RSNC’s screening physical exam form. Referring patient care scored poorly, in Selected References Acknowledgements part, because according to the American Diabetes Association, patients must be 1) American Diabetes Association Standards 1) Robert Schad Naturopathic Clinic 13,785 Excluded 2 Excluded 8 Excluded referred to many health care practitioners who’s capabilities often overlap with those of Medical Care in Diabetes 2010. 2) OM Corporation of NDs. Setting specific treatment goals likely scored poorly because there are no 2) Bradley R, Kozura E, Buckle H, et al. 3) Lotte and John Hecht Foundation current guidelines for naturopathic standards of care for diabetes. Collection and Description of Clinical Risk Factor Changes During Naturopathic Care for Type 2 Diabetes. 4) Diabetes Alternative Research and reporting of subjective outcomes (MYMOP) could be improved. Healthcare Foundation
Evidence for the Topical Application of Castor Oil: A Systematic Review Deborah A. Kennedy ND1 and Dana Keaton ND LAC2 1Canadian College of Naturopathic Medicine 2Center for Natural Medicine Results Seventeen participants with “fatigue” were recruited to Background participate in an investigation of longer use of COPs.Castor oil, also known as Palma Christi, is derived from the Search Strategy Flow Chart Constipation Participants applied the COPs for 1.5 hours per day over thebean of the plant Ricinus communis, through cold mechanical 462 articles found Researchers Arslen and liver area for 5 days per week for 2 weeks. During the course ofpressing. Ricinus communis is native to India and during initial search Eser evaluated the treatment, the mean total lymphocyte counts normalized within (July 2009)approximately 90% of the oil is produced in Brazil and India. 400 articles rejected effectiveness of COPs on the group and were lower at the end of treatment vs baseline.Castor oil is composed chiefly of ricinoleic acid, which based on title review constipation in 35 elderly As an unexpected outcome, 2 participants with elevated liver 62 abstracts screenedrepresents approximately 80 - 90% of the total fatty acid for inclusion nursing home residents. enzymes and cholesterol levels normalized these variables bycontent. Castor oil has been used since the 16th century BC Constipation symptoms the end of the study.in many forms. It can be taken internally, used topically and 10 articles retrieved for were tracked for 14 daysincorporated into cosmetics and drug delivery systems. It is full analysis using the Defecation Pain Reductionthe evidence associated with the topical application of castor Search re-executed (May 2011) 2 articles Monitoring form and Viera et al compared the anti-inflammatory and antinociceptiveoil that is the focus of this review. 9 articles included in Visual Analog Scale, with effects of topical castor oil and capsaicin. Their findings systematic review COPs applied on Days 8, suggest that castor oil is devoid of irritant properties, unlike 9 capsaicin. Ricinoleic acid was found to deplete substance P. Methodology Capsaicin is used to treat neuropathic pain and the authors and 10. Findings included improvements in evacuation, fecal suggest that castor oil maybe as effective as capsaicin, withoutPubMed, Embase, Alt-Med and CINAHL databases were consistency and a reduction in straining. There were no its irritating properties.searched using the terms castor oil/therapeutic use, changes to the frequency of bowel movements nor thericinoleic acid and Ricinus communis/therapeutic use, not amount of feces evacuated. Discussionricin, from inception to July 2009 and updated May 2011. For Artifical Tears Both castor oil and its main constituent, ricinoleic acid, haveinclusion in the review, articles had to be related to the A double-blind placebo-controlled crossover study by Goto et been found to be non-toxic for both internal and external use.topical use of castor oil. Articles dealing with castor oil used al evaluated low-dose castor oil eyedrops, or artificial tears in Case reports in the literature document evidence of contactin manufacturing, as a food additive, or as a cathartic were 20 patients with obstructive meibomian gland dysfunction. dermatitis from castor oil in cosmetic products.excluded, as was the use of castor oil to aid in the delivery of Treatment with castor oil demonstrated improvement in Historically, castor oil has been reputed to provide relief forpharmaceutical drugs. symptoms and objective findings. Maissa et al also found that dermatologic conditions, contusions, inflammatory and ocular eyedrops containing castor oil produced a more stable tear disorders. This review disclosed no cohesive evidence regarding Results film and a significant decrease in ocular dry eye symptoms. the mechanism of action of castor oil or its main constituent,Nine studies investigated the topical use of castor oil ricinoleic acid. Immune and Liver functionthrough direct application of the oil or in the form of castor Preliminary evidence suggests that castor oil may modulate A double-blind controlled study of a single use of COPs vsoil packs (COPs). white blood cell count and may have a positive effect on liver paraffin oil packs in 36 healthy adults found an increase inTransdermal Absorption function and cholesterol levels; further research is needed in this total lymphocytes which peaked at 7 hours with T11 cellsMein et al conducted a small study to assess castor oil area. The topical application of castor oil has been shown to contributing to the overall increase. COPs were applied overabsorption through the skin vs oral intake. A 2-phase study reduce the pain of neurogenic inflammation, improve symptoms the liver and abdomen for 2 hours with heat. At the 24-hourcomparing abdominal COPs for 3 consecutive days versus of constipation and to lubricate the eyes as artificial tears. mark, total lymphocytes declined, although they remainedoral consumption found no significant difference in the within normal limits.urinary metabolites of castor oil pre- and post-COP while Acknowledgements.significant differences were found pre- and post-oral intake. Deborah Kennedy’s efforts on this project were supported by a career development grant from the SickKids Foundation.
Xenoestrogens & Breast Cancer: Chemical Risk, Exposure and Social Determinants Sarah Young, MA (1) & Dugald Seely, ND, MSc, FABNO (1,2,3) 1. Ottawa Integrative Cancer Centre 2. Department of Research & Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto 3. Ottawa Hospital Research Institute Medicine, Background Xenoestrogens and Breast CancerIncidence of breast cancer has risen in Canada by more than 25% Table 1: Common Xenoestrogens, sources and effectsover the past twenty-five years, is the leading cause of death in Xenoestrogens are chemicals thatwomen aged 20-44, and comprises over thirty percent of all cancer mimic the effects of estrogen due to XENOESTROGENS FOUND IN EFFECTSdiagnoses in women. Nearly two-thirds of breast cancer cases result structural chemical similarities. Asfrom a combination of gene-environment interactions, lifestyle opposed to endogenous hormones, Bisphenol A (BPA) bottles, tin cans, drink containers, In vitro and animal studies: water pipes, dental composites, optical neoplastic development,factors (including lack of physical exercise, alcohol intake, and xenoestrogens come from sources lenses, adhesives, compact discs, paper proliferation of epithelial cells, coatings expression of estrogen receptorsobesity), and exposure to environmental pollutants. Exposure to external to the body. Like other (ERs) and progesterone receptors (PRs), and a decreased vaginalestrogen is the most important identifiable risk factor responsible endocrine disruptors, xenoestrogens weight, transgenerationalfor the development of breast cancer. While endogenous estrogen is can alter normal hormonal function, amplification.clearly important, the contribution that xenoestrogens have on producing adverse health effects for Polychlorinated electrical equipment, plasticizers in Human studies: high levels foundbreast cancer causation is just starting to be documented. both adults and their children. Biphenols (PCB’s) paints, plastics, and rubber products, pigments, dyes, and paper. Though in breast milk of northern communities banned in 1979 PCBs are still released PCBs are now regularly found in Mammary tissue cells express specific into the environment from hazardous waste sites. PCBs do not readily break mammals and ocean wildlife in the far north Chemicals in Our Environment receptors, known as alpha-receptors down and remain for long periods of time recycling between the air, water, that can be stimulated by estrogens to and soil.There are over 80,000 synthetic chemicals in and around us: they are induce the proliferation of end buds in Certain Pesticides used extensively in agriculture, in In vitro and animal studies:sprayed directly on our food in the form of pesticides; they get the breasts. Proliferation of these end (i.e. DDT, heptachlor, atrazine, chlordane, homes, in workplaces, and throughout cities on private and public lawns immunotoxic, mutagenic, carcinogenic, enhances thepumped into the air by diesel exhaust and industrial emissions in the buds increases the risk of breast aldrin, lindane, 2,4,5-TP and the captans) metabolism of other xenobiotic chemicalsform of polycyclic aromatic hydrocarbons (PAHs); they are used as cancer by augmenting the chance of Occupational studies: women working in agriculture 3 timesliners in tin cans, are built into plastic water bottles and are found in mutation during cell division. more likely to have breast cancerdental composites in the form of bisphenol A (BPA); are added to There are over 200 xenoestrogens used in industry, cosmetics, Cadmium from burning fossil fuels and In vitro and animal studies:personal care products in the form of parabens; leach into the soil agriculture and food processing that act as mammary carcinogens municipal waste, the smelting of zinc and copper, and tobacco smoke. induction of single-strand DNA breaks, inhibition of DNA repairand water from electronic waste in landfills in the form of cadmium, Cadmium is used in electroplating, in by inactivation of the mismatch and have been found in over 95% of human tissue. Twenty-nine of alloys, as a de-oxidizer in nickel repair system, activation ofand are found in high amounts in the fish we eat as polycyclic plating, in Cd-Ni batteries, as oncogenes, inhibition of these compounds are produced at over a million pounds per year pigments in glazes and enamel paints, programmed cell deathbiphenols (PCBs). in plastics, and in fertilizers. Parts of (apoptosis). in the USA. North America are known to have high levels of cadmium in the soil. Occupational studies: Women working in automotive were 4Since the 1950’s more than 750 million tons of toxic chemical waste times more likely to have breast cancer.have been discarded across 50,000 hazardous waste sites in the Relevant Social DeterminantsUnited States alone. Among all North American jurisdictions, Ontario Parabens, Pthalates Personal care products, including Breast cancer rates amongst Exploring the impact of xenoestrogens from a social determinants shampoos, creams, conditioners, African American women underis the fourth highest emitter of cancer causing chemicals into the air, hairsprays, deodorants, cosmetics, and age 30 are 50% higher than white of health model, we found that early life, food security, social perfumes women and their use of estrogenicemitting over four million kilograms of reproductive toxins each year. personal care products is ten exclusion, education, working conditions, income, housing, and times higherXenoestrogens consist of a class of endocrine disrupting chemicals availability of a social safety net had a significant impact on the Polycyclic Aromatic fossil fuel combustion, diesel exhaust, In vivo, in vitro and human(EDCs) that have causative links to cancer and particularly to breast risk of exposure. These issues speak directly to breast cancer Hydrocarbons (PAH’s) consumption of smoked and grilled foods, and from cigarette smoking studies: mutagenic, increased proliferation of cells, effects oncancer. Common xenoestrogens include Bisphenol A, PCB’s, risk and chemical exposure and inequities in society as well as the estrogen receptors, enzymes of the CYP 450 family and on theCadmium, Pesticides, PAHs, Parabens and Pthalates (see table on issue of vulnerability. The timing of exposure to increased levels of tumour suppressing generight for more detail and examples). both natural and chemical xenoestrogens in a woman’s body, embryo, fetus, and infant plays a key role in the development of Acknowledgements. This review was funded by the National cancer. Network on the Environment and Women’s Health
An observational study of adjunctive cancer care at the Canadian College of Naturopathic Medicine Gillian Flower ND1, Natalie Bozinovski ND(c)1, Gabriella Chow ND1, Kieran Cooley ND1, Martha Grant ND1, Christopher Habib ND1, Daniel Lander ND, FABNO1, Tara O’Brien ND1, Jill Shainhouse ND, FABNO1, Dugald Seely ND, FABNO1,2. O’ 1. Canadian College of Naturopathic Medicine; 2. Ottawa Hospital Research Institute Table 1. Select patient characteristics by cancer type Diet, lifestyle and mind-body interventions were common, as Background was individualized homeopathy, tinctures and teas. Mean age at % reportingThe Adjunctive Cancer Care (ACC) shift provides Primary cancer Female / Number of Analysis of EORTC, MYCAW, MYMOP and KI showed that diagnosis – years conventionalnaturopathic care to patients with cancer at the Robert type male patients scores improved or were unchanged more frequently than (range) care pre-RSNCSchad Naturopathic Clinic (RSNC), the teaching clinic of the Breast 31 / 0 31 49 (30-76) 80.6 they worsened (Figure 1). This was true across all scores andCanadian College of Naturopathic Medicine (CCNM). This Digestive1 17 / 10 27 55 (2-83) 88.9 subscores in all measures used. The subset of eligiblecross-sectional, observational study summarizes Prostate 0 / 20 20 61 (48-79) 40.0 responses per tool was small (n= 11-30) although 39.1% ofdemographic, outcome and treatment data for patients all charts yielded eligible responses for at least 1tool. Hematologic 8/6 14 45 (23-63) 78.6seen on the ACC over a 13-month period. Female reproductive2 13 / 0 13 52 (26-71) 100.0 The 5 most common patient-identified concerns, elicited Neurologic 4/5 9 21 (0-67) 88.9 through MYCAW use included: references to cancer, to pain Methodology Head and neck3 5/2 7 53 (32-74) 85.7 or discomfort, to energy or fatigue, to weight or Other4 9/8 17 54 (33-83) 47.1 nutrition or to gastrointestinal symptoms. 84.2% ofPoint-of-sale software was used to identify patients that had evaluated patients named at least one of these 5 concerns.been seen on the ACC from December 2009-December 1 – Colorectal, hepatic, pancreatic, gastric; 2 – ovarian, uterine, vaginal; 3 – salivary, oral, thyroid, sinus; 4 – includes lung, skin, testicular, osseous, diverse types not included elsewhere2010. The in-house Naturopathic Patient Database (NPD)was consulted for patient information, but a lack of 18% of patients reported a refusal of conventional treatment at some point, Discussionsufficient data led to a full patient chart review. many having tried chemotherapy or radiation previously. 9 deaths (6.5%) A diverse range of patients and cancers (type and stage) arePatients were included if they had a diagnosis of cancer and were confirmed. seen by student interns on the ACC at the RSNC. Treatmentshad >1 visit on the ACC. 35 data points were collected in include supplemental, lifestyle and dietary therapies and reflect 51% of all patients received intravenous vitamin C therapy (IVC), with use a blend of cancer-focused and individualized care.addition to scores on 4 validated assessment tools: the ranging from 45%-71% across various cancer types. Far fewer patientsKarnofsky Index (KI), the Measure Yourself Medical with neurologic cancers received IVC (11%), but only 4 patients in this Patient-defined symptoms commonly include concerns with painOutcomes Profile (MYMOP), the Measure Yourself Concerns group were eligible to receive this treatment in Ontario (>13 years old). and energy. EORTC results show fewer patients worsening inand Wellbeing scale (MYCAW) and the European these subscores than the number that maintain their currentOrganization for Research and Treatment of Cancer quality Oral supplementation was recommended in 98.5% of patients that had at status or improve. Other patient- and intern-based assessmentsof life questionnaire (EORTC). Intern prescriptions were also least 1 consult-type visit. All supplemented patients were given at least one of symptoms and function include the MYCAW, MYMOP and KI.counted. of the following 5 prescriptions: Vitamin D, curcumin, EGCG, All suggest a trend towards patient stabilization or improvement melatonin and fish oil. in evaluated outcomes. Results Figure 1. Percent of patients improving, not changing and worsening according to EORTC(1-5), MYCAW (6-7) and Karnofsky (8) results (>27 days of evaluation). Some limitations to this study include the small amount of eligible data for each tool. Responses were included if the same189 patient charts were reviewed and 138 met criteria for tool was used on more than 1 occasion and if the time elapsedinclusion. 64% of patients seen were female. Breast cancer 100% between administration was >27 days yielding as few as 11was the most common diagnosis, seen in 22.5% of all 80% responses in one instance. The original goal of using the NPD ascases. Mean age at diagnosis was lowest among neurologic Worsened a source of data could not be met, necessitating a chart review.cancers where 5/9 patients were 3 years of age or 60% Unchangedyounger. Short- and long-term naturopathic care may successfully 40% Improved address some of the most important concerns of individualsTable 1 summarizes select patient characteristics. with cancer. Further research investigating patient experiences 20% and comparative effectiveness of naturopathic treatment ofAverage duration of care was 298.4 days (range 2-2163), 0% cancer are warranted.with an average of 7.4 (0-70) consult-type visits per patient.51.5% of all patients had conventional treatment (surgery, l ky 1 ue ain g e lth na ein Acknowledgements: tiv rn fs igchemotherapy, radiation or other) during the course of their ea P io no ni ce at lb 4. ot l H Our thanks to the interns of the ACC shift 2009- og on el F arcare at the RSNC. Em ba W 3. C K 2011 and the Lotte & John Hecht Memorial C 5. 8. lo 6. 7. 1. Foundation. G 2.