Phytotherapy known and applied by head-neck cancer patients and medical students to treat oral discomfort in Germany: an observational study.

BACKGROUND: Plant remedies are often used next to conventional standard of care by cancer patients. However, user rates are often underestimated and physicians usually feel not equipped to counsel patients. Hence, routinely recording the use of phytotherapy and sufficient knowledge on herbal medicine of the medical staff are required to improve the situation. Appraising the current state of knowledge of medical students may offer insight if education on herbals needs improvement. Here, we propose a simple anamnesis tool to assess knowledge and usage pattern of medical plants and demonstrate how to extrapolate symptom cluster participants associated with plants investigated in this study focussing on the common symptom of oral discomfort. METHODS: By screening German literature (popular science, specialist's literature, books for the interested layman) on medical plants used for treating oral discomfort, we were able to deviate a list of plants most often recommended for treating oral discomfort and to develop an anamnesis tool to assess knowledge and usage of 16 different plants. A group of 120 head-neck cancer patients (under surveillance, after receiving treatment) and 168 medical students were questioned at a collaborating out-patient clinic and via an online survey, respectively, in 2020. Students were additionally asked to write down indications of the plants they used in daily life. Knowledge and usage pattern were compared between both groups. Primary component analysis and heat-map analysis were used to visualize common and distinguishing features. Network analysis and VENN diagrams were used to extrapolate data of the medical students' cohort. RESULTS: Head-neck cancer patients and students show similar knowledge. However, students used significantly more plants in daily life than patients (p < 0.001). Overall, the user rate of patients and students were 82.50 and 93.94%, respectively. The top five most commonly known plants were similar in both groups (Marticaria recutita L., Zingiber offinicale ROSCOE, Taraxacum Wigg. Calendula officinalis L.) with the exception of Salvia officinalis L. (patients' cohort) and Carum carvi/Cuminum cyminum L. (students' cohort). Despite this slight difference, usage pattern of the top five most commonly used plants was the same between the groups. Students' indications were compared to indications found in the literature, unmasking several differences between commonly practiced and written knowledge on German phytotherapy. Network analysis revealed, that students associated certain plants with corresponding symptom clusters (e.g., coughing, oral mucositis). CONCLUSION: The majority of surveyed cancer patients as well as medical students use phytotherapy for treating oral discomfort. Both groups know and use similar plants. However, indications of written folk medicine differ from the lived and practiced tradition.

Indications of medical plants: what do medical students in Germany know? A cross-sectional study.

BACKGROUND: Patients use phytotherapy in addition to cancer therapy. Aiming to equip students with the knowledge necessary for a holistic treatment approach, the (German) national competence-based catalogue of educational objectives in medicine advises to include phytotherapy as part of the curriculum. Here, we evaluate if medical students know the official indication of herbal products as stated by the German Federal Institute for Drugs and Medical Devices (BfArM) for treating oral and abdominal discomfort. METHODS: In an online survey, students were asked to write down indications they associated with 25 plants used for treating either oral or abdominal discomfort. Students' indications were then sorted according to symptom complexes (oral discomfort, abdominal discomfort, skin care, others) and compared with the official indications stated by the BfArM. RESULTS: Of 168 participating students, 113 wrote down indications for 22 of the 25 plants surveyed. 70.80% of the students knew the correct indication for Matricaria recutita, 41.59% for Salvia officinalis, 37.17% for Foeniculum vulgare Mill. and 36.28% for Mentha piperita. Those were the highest rates of correct answers. Looking at symptom complexes (e.g., oral/ abdominal discomfort) instead of single symptoms, ≥ 10% of the students stated an indication that fell into the same symptom complex as the BfArM's indication for 10 out of 25 plants surveyed. The most well-known plants and indications were Matricaria recutita, Salvia officinalis and Mentha x piperita. CONCLUSION: Only a small minority of participating students know the official indications for specific phytotherapeutic drugs. Our study demonstrates that phytotherapy needs to be incorporated into the medical teaching curriculum.