Expert-Guided Approaches to Complementary Interventions for Common Side Effects of Cancer Therapies: A Practice-Based Perspective from Integrative Oncology Centers in Baden-Württemberg, Germany

Marcela Winkler^1*Thomas Breitkreuz²Jürgen Brust³Stefanie Frenzel⁴Julia Gottfried⁵Wolfgang Heyl⁶Stephan HIller⁷Ralf Hofheinz⁸Meike Jocher⁵Elke Kaschdailewitsch⁹Hans Lampe¹⁰Maria Livas¹¹Heike Mönnich¹²Claudia Raichle¹³J Reuter¹³Jens-Paul Seldte¹⁴Sigune Singer-Bayrle²Theresa Wagner¹⁵Anne-Kathrin Weise¹²Klaus Kramer^16*

• ¹Robert Bosch Hospital, Department of Traditional European Naturopathic Medicine and Integrative Medicine, Auerbachstraße 110, 70376 Stuttgart, Germany, 70376 Stuttgart, Germany
• ²Paracelsus-Krankenhaus Unterlengenhardt, Germany, Unterlengenhardt, Germany
• ³Diako Krankenhaus Mannheim, Germany, Mannheim, Germany
• ⁴Kreisklinikum Heidenheim, Germany, Heideneheim, Germany
• ⁵Klinik Öschelbronn, Germany, Öschelbronn, Germany
• ⁶Universitätsfrauenklinik der Paracelsus Medizinischen Universität, Salzburg, Austria, Salzburg, Austria
• ⁷Die Filderklinik, Filderstadt, Germany, FIlderstadt, Germany
• ⁸University Medical Center Mannheim, Germany, Mannheim, Germany
• ⁹Die Filderklinik, Filderstadt, Germany, Filderklinik, Germany
• ¹⁰Rems-Murr Klinikum Winnenden, Germany, Winnenden, Germany
• ¹¹Städtisches Krankenhaus Karlsruhe, Germany, Karlsruhe, Germany
• ¹²Klinikum Esslingen, Esslingen, Germany, Esslingen, Germany
• ¹³Paul-Lechler-Krankenhaus Tübingen, Germany, Tübingen, Germany
• ¹⁴RKH Krankenhaus Bietigheim-Bissingen, Germany, Bietigheim-Bissingen, Germany
• ¹⁵Robert-Bosch-Krankenhaus GmbH, Stuttgart, Germany
• ¹⁶Dept. Integrative Medicine, University Hospital Ulm, Germany, Ulm, Germany

Introduction: Cancer patients commonly suffer from substantial side effects of oncological therapies. Therefore, the Oncology Working Group of the Competence Network for Integrative Medicine in Baden-Württemberg, Germany (KIM-BW) developed practice-oriented recommendations for the integrative treatment of chemotherapy-induced mucositis (CIM), nausea and vomiting (CINV), and cancer-related fatigue (CRF). Methods: Two expert groups of physicians and nurses developed therapeutic recommendations using an interdisciplinary expert consensus process oriented on a Delphi-methodology with a standardized scoring matrix, considering training, feasibility, time intensity, clinical effectiveness, contraindications, and interactions. The consensus process was complemented by a targeted, nonsystematic literature search conducted across the AWMF S3 Guideline on Complementary Medicine in Oncology, the KOKON knowledge database, the Working Group on Integrative Care in Oncology, and PubMed/Medline. Results: The expert panel consisted of 21 professionals (14 physicians, 7 nurses), all conventionally trained with additional qualifications in integrative disciplines. We evaluated 83 interventions. Top recommendations were identified for each symptom. For CIM: sage tea mouth rinses, ice cubes, sea buckthorn oil mouth rinses, frozen pineapple cubes, and herbal oral balm. For CRF: movement therapy, yarrow liver compresses, viscum album therapy, sleep hygiene with regular circadian rhythms, and hydrotherapy. For CINV: acupressure, ginger, aromatherapy, bitter botanicals such as gentian root, and homeopathic preparation nux vomica. Conclusions: Integrative treatment recommendations developed by the KIM Oncology Working Group provide pragmatic, clinically grounded guidance for integrative management of common treatment-related symptoms in oncology. Prospective evaluation of safety, effectiveness, and implementation across settings is warranted.