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La medicina integrata: le fonti della sicurezza

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Intervento del dott.Luca Cancian al workshop per il 30mo anniversario della nostra Associazione intitolato: "Informazione&Documentazione: un binomio per nutrire la mente". Una rassegna sulle fonti di informazione autorevole sulla medicina integrata.
Milano, Istituto di Ricerche Farmacologiche Mario Negri
20.10.2015

Veröffentlicht in: Gesundheit & Medizin
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La medicina integrata: le fonti della sicurezza

  1. 1. LA MEDICINA INTEGRATA : LE FONTI DELLA SICUREZZA LUCA CANCIAN IVANA TRUCCOLO MAURO MAZZOCUT
  2. 2. DEFINIZIONE OMS DI SALUTE “Stato di completo benessere fisico, psichico e sociale e non semplice assenza di malattia” DEFINIZIONI
  3. 3. Situazione tipo: Pz con Ca mammella in III stadio che deve intraprendere un trattamento adiuvante fa alcune domande tra le quali: - Posso iniziare una dieta alcalinizzante ? - Posso assumere la Graviola che ho sentito dire ha effetti contro il mio Tumore ? - L’ Agopuntura mi può aiutare durante la terapia? - Cosa posso fare per ridurre i rischi di una recidiva? DEFINIZIONI
  4. 4. DEFINIZIONI MEDICINA TRADIZIONALE Comprende diverse pratiche, metodi e conoscenze relative a prodotti di origine naturale, tecniche manuali, esercizi e terapie spirituali MEDICINA ALTERNATIVA Utilizzo della MT in ALTERNATIVA ai trattamenti proposti dalla medicina ufficiale
  5. 5. DEFINIZIONI MEDICINA COMPLEMENTARE E ALTERNATIVA (CAM) Le CAM sono un gruppo di diverse pratiche mediche e di sistemi di salute e di prodotti che non sono parte della Medicina Convenzionale e vengono utilizzati in ASSOCIAZIONE con i trattamento convenzionali Viene praticata da Medici, Osteopati e altre categorie di terapisti. MEDICINA INTEGRATA Approccio terapeutico integrato con utilizzo combinato della medicina ufficiale a tecniche e terapie CAM di comprovata utilità e sicurezza
  6. 6. DEFINIZIONI
  7. 7. MEDICINA INTEGRATA Uso di TERAPIE COMPLEMENTARI allo scopo di migliorare il controllo di sintomi sia FISICI che EMOTIVI per migliorare la qualità di vita durante e dopo il percorso di cura con lo scopo di un rapido recupero e di sostenere un sano proseguimento di vita dopo la malattia. La tendenza alla Medicina Integrativa è in crescita sia nei diversi singoli centri di cura sia a livello di sistemi sanitari per promuovere la salute. Mancanza di dati scientifici affidabili rende questo terreno ancora insidioso !!
  8. 8. TIPI DI CAM 1. TERAPIE MENTE-CORPO - Meditazione - Ipnosi - Yoga - Immaginazione - Creatività 2. MANUALI – BODY - Massaggio - Chiropratica - Reflessologia
  9. 9. TIPI DI CAM 3. MEDICINA ENERGETICA - Tai-Chi - Reiki - Tocco terapeutico 4. APPROCCI SISTEMICI - MTC (agopuntura) - Ayurveda - Omeopatia - Naturopatia
  10. 10. TIPI DI CAM 5. INTEGRATORI – NUTRIZIONE - Fitoterapia - Vitamine - Nutrizione - Diete particolari - Nutraceutici
  11. 11. I NUMERI DELLE CAM
  12. 12. I NUMERI DELLE CAM
  13. 13. I NUMERI DELLE CAM
  14. 14. I NUMERI DELLE CAM
  15. 15. I NUMERI DELLE CAM
  16. 16. I NUMERI DELLE CAM
  17. 17. I NUMERI DELLE CAM • Utilizzo molto diffuso (38%) • Prevalente in ambito di patologie minori come lombalgie e dolori muscolo-scheletrici o in ambito di prevenzione • Insufficiente o insoddisfacente risposta da parte dei Medici Curanti (60%) • Fonti informative non professionali (Familiari/Amici – Internet)
  18. 18. LE CAM IN ONCOLOGIA
  19. 19. LE CAM IN ONCOLOGIA CONSIDERAZIONI: 1.La terapia principale sono le Piante Medicinali 1.35% riporta utilizzo di CAM (40 % negli studi Americani) 3.Soddisfazione anche senza vedere un beneficio oggettivo 4. < 1% segue le raccomandazioni del Medico 5. Effetti collaterali nel 4%
  20. 20. LE CAM IN ONCOLOGIA ITALIA 22% USA 50%
  21. 21. 100 MILIONI DI PERSONE IN EU
  22. 22. THE CHALLENGES
  23. 23. CONCLUSIONI 1.Non si conosce abbastanza a fondo la prevalenza nell’uso delle CAM 2.I cittadini sono i drivers nell’uso delle CAM. I loro interessi sono i topics prioritari che ne guidano la ricerca 3.Le CAM sono considerati sicure, ancora dati deboli riguardano il rischio e il costo/beneficio 4.Serve uno sviluppo della ricerca per ottenere dati forti ma con metodica che osservi l’impatto clinico dell’efficacia 5.Valutare gli effetti specifici e non-specifici nell’uso delle CAM 6.Valutare i modelli di uso integrato delle CAM
  24. 24. RACCOMANDAZIONI IN AMBITO DELLA RICERCA 1.Scarsi dati su prevalenza, efficacia e sicurezza 2.Maggior conoscenza sull’uso delle CAM nei singoli Stati 3.Conoscenza basata sulla ricerca focalizzata nel cosi detto “real world” : una ricerca non solo dei specifici meccanismi di efficacia di una molecola ma con approccio più clinico e comparativo degli outcomes rilevanti per i pazienti. 4.Metodi di ricerca con strategia mista di efficacia comparativa e valutazione sia quantitativa che qualitativa 5.Stabilire una strategia europea con database condiviso e istituire studi osservazionali e di efficacia comparativa (CER designs) 6.Registrare case report ed effetti non-specifici 7.Valutazione di modelli di MEDICINA INTEGRATA
  25. 25. www.nccih.nih.gov
  26. 26. “REAL WORLD”
  27. 27. CHALLENGES 1.Definizione precisa della domanda della ricerca 2. Corretta definizione dello studio e dei metodi (durata sedute, “sham”, etc) 3.Valutazione effetti specifici e non-specifici nell’outcome
  28. 28. STESSI OBIETTIVI di CAMbrella
  29. 29. www.cam-europe.eu
  30. 30. 1. DATI INSODDISFACENTI 2. BISOGNO DI FONDI PER LA RICERCA NELLE CAM 3. BASSO IMPATTO ACCADEMICO 4. LA PARTE III DI HORIZON 2020 “Priority Social Challeneges” nella parte degli obbiettivi specifici “Health, Demographic Change and Well-Being” offre il supporto organizzativo per programmare e sviluppare la ricerca nelle CAM
  31. 31. SFIDE STATI MEMBRI 1.Sviluppo e applicazione politiche e regolamenti 2.Integrazione nell’assistenza sanitaria 3.Sicurezza e Qualità dei prodotti e dei professionisti 4.Criteri per la valutazione dell’eficacia 5.Ricerca e sviluppo 6.Formazione dei professionisti 7.Informazione e formazione www.who.int/medicines/publications
  32. 32. OBIETTIVI 1.Sfruttare il contributo della Medicina Tradizionale per il mantenimento della salute, per il benessere e per un’assistenza sanitaria incentrata sulla persona 2. Promuovere l’uso sicuro ed efficace della Medicina Tradizionale attraverso la regolamentazione, la ricerca e l’integrazione nei sistemi sanitari delle sue pratiche, dei suoi prodotti e dei professionisti. www.who.int/medicines/publications
  33. 33. LE FONTI DELLA SICUREZZA
  34. 34. LE FONTI DELLA SICUREZZA www.cancer.gov
  35. 35. LE FONTI DELLA SICUREZZA www.nccih.nih.gov
  36. 36. LE FONTI DELLA SICUREZZA www.nccih.nih.gov
  37. 37. LE FONTI DELLA SICUREZZA www.nccih.nih.gov
  38. 38. LE FONTI DELLA SICUREZZA
  39. 39. LE FONTI DELLA SICUREZZA
  40. 40. LE FONTI DELLA SICUREZZA www.integrativeonc.org
  41. 41. LE FONTI DELLA SICUREZZA www.integrativeonc.org
  42. 42. LE FONTI DELLA SICUREZZA
  43. 43. LE FONTI DELLA SICUREZZA
  44. 44. LE FONTI DELLA SICUREZZA
  45. 45. LE FONTI DELLA SICUREZZA
  46. 46. LE FONTI DELLA SICUREZZA
  47. 47. LE FONTI DELLA SICUREZZA
  48. 48. LE FONTI DELLA SICUREZZA www.mskcc.org
  49. 49. LE FONTI DELLA SICUREZZA www.mdanderosn.org
  50. 50. LE FONTI DELLA SICUREZZA CAM + ONCOLOGY
  51. 51. LE FONTI DELLA SICUREZZA INTEGRATIVE MEDICINE
  52. 52. LE FONTI DELLA SICUREZZA www.efcam.eu www.cam-europe.eu
  53. 53. ESPERIENZA DEL CRO-AVIANO o DALL’ Aprile 2014 ATTIVATA CONSULENZA SULLA MEDICINA INTEGRATA A PAZIENTI IN TRATTAMENTO PRESSO L’ISITUTO o ESEGUITE OLTRE 100 CONSULENZE CON ARGOMENTI PREVALENTI - FITOTERAPIA - INTEGRATORI - NUTRIZIONE - REFLESSOLOGI PLANTARE o PRESENTE CONSULENZA CON LA FARMACIA PER VALUTARE LE INTERAZIONI FARMACO – PRODOTTO NATURALE/INTEGRATORE
  54. 54. ESPERIENZA DEL CRO-AVIANO
  55. 55. ESPERIENZA DEL CRO-AVIANO
  56. 56. ESPERIENZA DEL CRO-AVIANO QUESTIONARIO CONOSCITIVO A PAZIENTI-VISITATORI DEL CRO 436 questionari = 80% pz in cura – 20% visitatori Il 30% dichiara di aver utilizzato almeno una CAM Nutrizione 84% Fitoterapia 80% Trattamenti Mente-Corpo 50% Terapie fisiche/massaggio 57% Terapie energetiche 35% Motivo dell’uso delle CAM Aiuto al trattamento previsto 45% Riduzione effetti collaterali 90%
  57. 57. ESPERIENZA DEL CRO-AVIANO
  58. 58. ESPERIENZA DEL CRO-AVIANO
  59. 59. CONSIDERAZIONI L’ utilizzo delle CAM è in aumento specialmente in settori delicati come l’ oncologia La Medicina Complementare si ormai deve intendere come MEDICINA INTEGRATA Appare ormai necessario dare risposte ai pazienti strutturando un modello di Medicina Integrata adeguato alla realtà contingente - incentivazione della formazione - multidisciplinarietà - inserimento nei PDTA
  60. 60. CONSIDERAZIONI Una delle sfide nello sviluppo delle CAM è la mancanza di studi clinici e dati forti che orientino il Medico e i Pazienti Organizzazioni Governative sia in ambito Europeo che del Nord America nonché la WHO indicano una roadmap da percorrere e suggeriscono un paradigma diverso nell’ambito della ricerca per le CAM, una ricerca che tenga conto dell’efficacia comparativa “CRE design” In ambito oncologico il paziente deve essere protetto da terapie alternative e pertanto una consulenza professionale in Oncologia Integrata durante il suo percorso è auspicabile L’ obiettivo è di trattare ogni paziente come una persona ammalata di cancro che curare solo in cancro in un paziente
  61. 61. GRAZIE lcancian@cro.it

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