Journal of Data and Information Science, 2018, 3(2): 1-19
Thematic Trends in Complementary and Alternative Medicine Applied in Cancer-Related Symptoms
Jose A. Moral-Munoz1 †, Manuel Arroyo-Morales3, Barbara F. Piper4, Antonio I. Cuesta-Vargas5, Lourdes Díaz-Rodríguez6, William C.S. Cho7, Enrique Herrera-Viedma8, Manuel J. Cobo9
1Dept. Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain;
2Institute of Research and Innovation in Biomedical Sciences of the Province of Cádiz (INiBICA), University of Cádiz, Cádiz, Spain;
3Dept. Physical Therapy, University of Granada, Granada, Spain
4Dept. Nursing, School of Health and Human Services, National University, San Diego, CA, USA
5School Clinical Science, Queensland University of Technology, Brisbane, QLD, Australia
6Instituto Biosanitario (IBS), University of Granada, Granada, Spain
7Hospital Authority, Hong Kong, China
8Dept. Computer Science and Artificial Intelligence, University of Granada, Granada, Spain
9Dept. of Computer Science and Engineering, University of Cádiz, Cádiz, Spain;
Cite this article:
Jose A. Moral-Munoz, Manuel Arroyo-Morales, Barbara F. Piper, Antonio I. Cuesta-Vargas, Lourdes Díaz-Rodríguez, William C.S. Cho, Enrique Herrera-Viedma, Manuel J. Cobo. Thematic Trends in Complementary and Alternative Medicine Applied in Cancer-Related Symptoms. Journal of Data and Information Science[J], 2018, 3(2): 1-19 doi:10.2478/jdis-2018-0006

Abstract:

Purpose: The main goal of this study is to discover the scientific evolution of Cancer-Related Symptoms in Complementary and Alternative Medicine research area, analyzing the articles indexed in the Web of Science database from 1980 to 2013.Design/methodology/approach: A co-word science mapping analysis is performed under a longitudinal framework (1980 to 2013). The documental corpus is divided into two subperiods, 1980-2008 and 2009-2013. Thus, the performance and impact rates, and conceptual evolution of the research field are shown.Findings: According to the results, the co-word analysis allows us to identify 12 main thematic areas in this emerging research field: anxiety, survivors and palliative care, meditation, treatment, symptoms and cancer types, postmenopause, cancer pain, low back pain, herbal medicine, children, depression and insomnia, inflammation mediators, and lymphedema. The different research lines are identified according to the main thematic areas, centered fundamentally on anxiety and suffering prevention. The scientific community can use this information to identify where the interest is focused and make decisions in different ways.Research limitation: Several limitations can be addressed: 1) some of the Complementary and Alternative Medicine therapies may not have been included; 2) only the documents indexed in Web of Science are analyzed; and 3) the thematic areas detected could change if another dataset was considered.Practical implications: The results obtained in the present study could be considered as an evidence-based framework in which future studies could be built.Originality/value: Currently, there are no studies that show the thematic evolution of this research area.

Key words: Cancer-related symptoms) ; Complementary and Alternative Medicine) ; Bibliometrics) ; Science mapping analysis) ; Thematic evolution) ; H-index)
1 Introduction

A dramatic increase in the number of cancer survivors in older adults is expected to occur over the coming decades (DeSantis et al., 2014). This growing group of survivors will suffer a reduction in their quality of life because of Cancer-Related Symptoms (CRS) and comorbidities and many potentially will die due to the treatment-associated side effects (Cho et al., 2013; Lötzke et al., 2015). Research directed towards clarifying the chronic effects of treatments and identifying risks of late effects during the survivorship phase of cancer is designed to prevent and reduce these late effects and reduce their impact on the continuing downward spiral of disability and decreased quality of life (Alfano et al., 2012). A new integrative evidence-based practice model for providing supportive care in this growing group of cancer survivors is urgently needed.

Complementary and Alternative Medicine (CAM) therapies are being used by approximately one-third of cancer patients (Wyatt, Sikorskii, & You, 2013). The development of an integrative model (Hu et al., 2015) using an evidence-based approach longitudinally and historically could aid scientists and healthcare providers to not only provide evidence-based care to this emerging group of cancer survivors but could also help guide studies that could be built on the model’s existing scientific evidence for the future.

The varying quality and quantity of the conducted research overtime can hamper a detailed analysis of any scientific field. While an expert in the field could develop a detailed analysis, it would nevertheless be a daunting and tedious task to undertake (Perez-Cabezas et al., 2018). For this reason, the use of scientific support tools, such as bibliometrics, can be used to facilitate the analysis of a research field by automatically classifying studies overtime into different themes and topics (Cobo et al., 2011b; Gutiérrez-Salcedo et al., 2017; Van Raan, 2005). Bibliometrics contributes to the progress of science in many different ways (Martinez et al., 2014): allowing assessing the progress made, identifying the most reliable sources of scientific publication, laying the academic basis for the evaluation of new developments, identifying major scientific actors, developing bibliometric indexes to assess academic output, etc. Thus, different actors could benefit from this kind of metrics, such as policy-makers, decision-makers, and the general public (Chinchilla-Rodrίguez, Miguel, & Moya-Anegón, 2015; Chinchilla-Rodríguez, Ocaña-Rosa, & Vargas-Quesada, 2016).

Taking into account the scientific literature, some papers analyzing the bibliometric impact of the CAM research field have been published. Danell and Danell (2009) analyzed the evolution of scientific production in academic journals from 1966 to 2007. Fu et al. (2011) analyzed the document types and the geographical and institutional distribution of the authorship from 1980 to 2009. Tam, Wong, Wong, and Cheung (2012) identified the most frequently cited articles published in the journals indexed in the Integrative and Complementary Medicine Web of Science (WoS) subject category. Moral-Munoz et al. (2014) described the thematic evolution of CAM in the Integrative and Complementary Medicine WoS subject category. Zyoud, Al-Jabi, and Sweileh (2015) analyzed the scientific production of Arab world in CAM. Huang et al. (2015) performed an analysis of the literature of traditional Chinese medicine in PubMed. Furthermore, several papers related to scientific production in cancer have been published. Ugolini et al. (2012) analyzed the scientific production in cancer rehabilitation. Hack et al. (2014) conducted a citation analysis of Canadian psycho-oncology and supportive care. Thonon et al. (2015) analyzed the trends and evolution of French cancer research. Powell et al. (2016) evaluated the 100 most influential manuscripts in gastric cancer. Singh et al. (2016) mapped the breast cancer research in India. Foley et al. (2016) performed an analysis of the 100 most cited articles in esophageal and junctional cancer. Brás et al. (2017) conducted a scientometric study of the oncology research produced by Portugal in the late twentieth century. However, a detailed scientific analysis of CRS and CAM therapies using science mapping has yet to be undertaken.

Therefore, the main aim of the present paper is to analyze the scientific evolution of CRS and CAM research area through the articles retrieved form the WoS database from 1980 to 2013. It is described how a longitudinal Science Mapping Analysis (SMA) (Cobo et al., 2011) was performed to identify the structure, conceptual evolution and future research directions of the analyzed field.

2. Methodology

In order to perform the proposed study, a bibliometric analysis is carried out. The method and software SciMAT were used to perform the SMA under a longitudinal framework.

SMA (Cobo et al., 2011) provides a spatial representation of how disciplines, scientific fields, specialties, individual documents and/or authors are related to one other (Small, 1999). It can monitor the evolution of a scientific field and delimit research areas to identify and detail its structure and development over time (Börner, Chen, & Boyack, 2003; Morris S, Van Der Veer Martens, 2008; Noyons, Moed, & Luwel, 1999).

On the other hand, co-word analysis is used in SMA to study the conceptual structure of scientific fields, by identifying the most frequent keywords used in the documents (Callon et al., 1983). The open-source software SciMAT (Cobo et al., 2012) was used to carry out the SMA analysis presented in this paper. The followed workflow is shown in Figure 1.

Figure 1.

Analysis workflow.

SciMAT is based on a bibliometric approach that establishes four phases with which to analyze the themes and thematic evolution of a research field (Cobo et al., 2015; Moral-Munoz et al., 2018):

1. Research Themes Detection. A normalized bibliometric co-word network of keyword co-occurrence is first built (Callon et al., 1983), using the equivalence index (Callon, Courtial, & Laville, 1991) as similarity measure. Then, clusters of keywords into topics/themes using a simple centers algorithm (Coulter, Monarch, & Konda, 1998) are detected. These keyword clustering correspond to centers of interest and/or research problems that are the object of significant interest among researchers.

2. Low Dimensional Space Layout of Research Themes. A spatial layout of research themes is achieved by plotting each research theme using a two-dimensional strategic diagram based on their centrality (degree of interaction of the research theme with other research themes) and density (internal strength of a research theme) rank values (Callon et al., 1991). Once the research themes are mapped into a two-dimensional space, they can be classified into four groups: motor, basic and transversal, emerging or declining, and highly developed and isolated (Cobo et al., 2011).

Themes appearing in the upper-right quadrant are classified as motor themes and are considered to be well developed and important for structuring of a research field. Themes appearing in the lower-right quadrant are classified as basic and transversal and are considered to be important for a research field but are not yet developed. Themes that appear in the lower-left quadrant are classified as emerging or declining and are considered to be weakly or marginally developed. Finally, themes that appear in the upper-left quadrant are categorized as highly developed and isolated and are considered to be well developed but with marginal importance for the field.

3. Discovery of Thematic Areas. The evolution of the previously detected research themes over a set of different time periods is then analyzed to detect the evolution areas in the research field, their origins, and their interrelationships. The evolution of the research themes over the entire study period is determined by the overlapping of clusters between two consecutive periods. To this end, the inclusion index (Sternitzke C. & Bergmann, 2009) is used to detect the conceptual nexus between research themes from different time periods. It is worth noting that the research themes and their interrelationships might indicate that a particular research theme belongs to a unique thematic area or to more than one thematic area. It could also indicate that a particular research theme cannot be associated with any of the thematic areas identified, and thus could therefore be interpreted as the origin of a new thematic area in the research field.

4. Performance Analysis. The relative contribution of the research themes and thematic areas to the whole research field is measured quantitatively and qualitatively. In this way, the most prominent, productive and highest-impact subfields may be identified. To do this, the following bibliometric indicators are applied to the different detected themes and thematic areas: number of published documents, number of received citations, and h-index (Alonso et al., 2009; Hirsch, 2005).

To carry out the analysis, the data were retrieved from WoS by using three groups of terms related to Cancer, CRS and CAM. The first group of terms referred to the main concepts of cancer and was selected from the Medical Subject Heading (MeSH) thesaurus. These terms included: neoplasm, tumor, neoplasia and cancer. The second group of terms are related to the most common CAM treatments associated with cancer according to Ernst and Casileth (1998) These included terms such as, mind-body, acupuncture, acupressure, etc. The third group of terms included typical symptoms associated with cancer according to Cleeland (2000) (e.g. insomnia, pain, fatigue, etc.). To retrieve the overall number of published documents, the following search strategy was employed:

“TS=(neoplasm\$OR tumor\$ OR neoplasia OR cancer\$) AND TS=(“complementary therap*” OR “complementary medicine” OR “alternative medicine” OR “alternative therap*” OR “integrat* medicine” OR “holistic medicine” OR mind-body OR mindbody OR acupuncture OR acupressure OR music OR massage OR laetrile OR macrobiotic* OR relaxation OR yoga OR “tai chi” OR taichi OR herb* OR beetroot OR homeopath* OR anthroposoph* OR meditation OR hypno* OR reflexology OR iscador) AND TS=(“relat* symptom$” OR insomnia OR pain OR fatigue OR depression﹩ OR anxiet﹩ OR hypervigilance OR nervousness OR dyspnea OR sleep OR appetite OR cachexia OR shoulder OR nausea OR vomit* OR lymphedema OR “arm morbidity”)”

This query retrieved an amount of 1989 documents (articles and reviews) under the period 1980 to 2013. Citation counts up to May 2014 are also used in the analysis.

The raw data was downloaded from WoS as plain text and entered into SciMAT (Cobo et al., 2012). To improve the data quality, a de-duplicating process was applied (the authors keywords and the WoS keywords plus were used as unit of analysis). Words representing the same concept were grouped. Furthermore, some meaningless keywords in this context, such as stop words or words with a very broad and general meaning were removed (e.g. disease, outcomes, system, etc.).

Next, using the SciMAT period manager, the entire study time period (1980-2013) was divided into two, three, and four subperiods, in order to test and establish the adequate number of periods to analyze. In that way, although it is common to use periods during the same time span, in the first years, there were low numbers of researchers and publications. Finally, a first subperiod of twenty-eight years (1980-2008), and a second subperiod of five years were established (2009-2013), since there was not enough document count to obtain an appropriate analysis. It allows us to have enough keywords to perform the analysis previously described.

3. Results

In order to introduce the analysis and better understand the subperiod division, the distribution of publications by year between 1980 and 2013 is shown in Figure 2. As we can observe, in the last two years, the number of documents published presents a great growth, i.e. more than 250 documents per year. Therefore, CRS and CAM therapies is a topic which is attracting an increasing interest in the scientific community.

Figure 2.

Cancer-related symptoms related to CAM research documents published from 1980 to 2013.

3.1 Analysis of the Scientific Themes

To analyze the most notable themes of the research field for each subperiod, a strategic diagram was built using SciMAT. In this diagram, the volume of the spheres is proportional to the number of documents associated with each theme. In brackets, the number of citations associated with each theme is also depicted. The strategic diagram and performance analysis are analyzed together.

3.1.1 First Period of Analysis (1980-2008)

According to the strategic diagram shown in Figure 3, some observations can should be remarked:

The motor themes Anxiety, Meditation, Postmenopausal Women and Acupressure represent the best performance rates with the highest h-index and citations count. The theme Anxiety is related to two main terms, pain and depression. This theme is composed of causes of anxiety and its related treatment (e.g. relaxation, hypnosis, aromatherapy, massage). The theme Meditation is related to the reduction of anxiety and stress. An important theme in relation to meditation is Quality of Life. Postmenopausal Women, is related to characteristic symptoms of the postmenopause (e.g. hot-flashes, vasomotor symptoms) and its therapies (e.g. hormone replacement therapy, black-cohosh). Lastly, the theme Acupressure is closely related to acupuncture and its thematic network is composed of words associated with CRS such as nausea, vomiting and morning sickness. This theme also illustrates the research interest in using acupuncture to treat these symptoms.

Figure 3.

Strategic diagram for the subperiod 1980-2008.

The motor themes Survivors and Low Back Pain, although with a fewer number of documents, present an adequate citation rates and an h-index. The theme Survivors is composed of terms related to psychological aspects and themes such as Radiotherapy or Morbidity in patients who suffer cancer and who are still alive. The theme Low Back Pain mainly addresses pain management of this body part with special attention given to acupuncture and physiotherapy.

The basic and transversal themes Palliative Care, Cancer Pain, Women and Massage present similar good performance rates. The theme Women has a higher number of citations and h-index but with fewer documents when compared to Palliative Care. The theme Palliative Care is focused on relieving and preventing patient suffering. This theme is related to music-therapy, morphine and electrical-nerve-stimulation treatments; all treatments designed to reduce pain and suffering. The theme Cancer Pain addresses painful feelings experienced by cancer patients and the medications that are designed to reduce these feelings. The theme Women is a general theme about cancers that primarily affect females and it encompasses mastectomy and exercise. Finally, the theme Massage is related to the use of this technique to alleviate selected CRS and examining its effects on immune function.

The basic and transversal theme Chemotherapy-Induced Nausea underscores the importance of this symptom. It is composed of the theme Electro-Acupuncture that suggests that this form of treatment is widely studied as a therapy for nausea.

The isolated or emerging/declining theme Herbal Medicine primarily addresses use of plants as treatment. Two herbal extracts were identified: hypericum-perforatum and mistletoe; the former is used as a depressive treatment, the latter is used in cancer treatment. Furthermore, the presence of the term rats suggests that this kind of therapy is important in experimental research conducted in animal studies.

The emerging/declining theme Imagery has a small quantity of documents but was more frequently cited than were other themes with more citations like Chemotherapy-Induced Nausea, which had twenty more citations. Imagery is a traditional mind-body technique that is considered to be a form of hypnosis and is related to behavioral treatment.

The isolated and highly developed theme Lymphedema illustrates the importance of this symptom in this research field. It is also remarkable the inclusion of evidence-based medicine.

3.1.2 Second Period of Analysis (2009-2013)

Several observations can be made about the strategic diagrams (Figure 4).

Figure 4.

Strategic diagram for the subperiod 2009-2013.

The motor themes Anxiety and Mindfulness have the highest impact rates. The theme Mindfulness is related to meditation and mind-body medicine. It appears in relationship to stress and cognitive therapy. It has a remarkable association to Quality of Life with a high volume of citations. In this capacity, Anxiety is related to stress and stress reducing forms of treatments such as massage or music-therapy. On the other hand, Hot Flashes is important in this research field and is related to similar themes such as postmenopausal women noted in the in the previous subperiod. The term Breast Cancer has a high volume of citations related to this theme.

The motor theme Fatigue is a new theme documented during this period and is related to two main concepts. One concept includes a group of citations that relate fatigue to being a physical activity consequence. The other group of citations relate fatigue to depression and sleep disturbance in cancer survivors.

The motor themes of Vomiting and Insomnia are related to these important symptoms. The theme Vomiting is closely related to nausea, specifically as it is associated with being chemotherapy- induced. It is highlighted by documents that address prevention and treatment of same (e.g. acupressure). The theme Insomnia is another symptom associated with a sleep disorder; it is related to depression and it is identified or associated with different alternative therapies (hypnotherapy, cognitive behavioral therapy).

The motor theme Low Back Pain appears in this period related to multiple sclerosis, osteoarthritis and fibromyalgia. Furthermore, it is interesting that it is also related to evidence-based medicine. Finally, the theme Cytokines, despite a low number of articles shows a remarkably high citation rate and h-index. It is mainly related to meditators involved in anti-inflammatory processes.

The basic or transversal theme Prostate Cancer is related to other kind of cancers (e.g. colorectal cancer, neck cancer) and is composed of documents that mainly focus on dietary supplements, radiotherapy, psychological distress and hospital anxiety.

The basic or transversal theme Cancer Pain appeared in the previous subperiod, but in this recent period it is related to newer concepts such as social-support and perceptions, which suggest new research interests; furthermore, the term Electro-Acupuncture seems to be an alternative therapy studied in cancer pain.

The emerging/declining theme Cortisol is an emerging theme in with adequate performance rates. It is related also to immune system and inflammation processes.

The isolated theme Herbal Medicine appears related to two specific cancers, gastric cancer and lung cancer. Also, the theme Palliative Care is present too in this period. It should be noticed its association with terms like family and family-caregivers, and documents focused in home-based care.

3.2 Thematic Evolution of the Model Over Time

The thematic evolution over time in the field of CRS and CAM can now be examined. Twelve thematic areas have been identified over these two subperiods of time (Table 1).

Table 1

Performance measures for the detected areas.

In the thematic evolution diagram shown in Figure 5, each column corresponds to a period, 1980-2008 and 2009-2013 respectively. The volume of the spheres is proportional to the number of documents associated with each theme. Solid lines mean that the linked themes share the name: both themes have the same name, or the name of one of the themes is part of the other theme. A dotted line means that the themes share elements that are not the name of the theme. The color-shadows group the themes that belong to the same thematic area. Some themes do not have a shadow, because these themes do not belong to any thematic area. In Table 1, their respective global quantitative and impact measures are provided.

Figure 5.

Thematic evolution of Cancer-related Symptoms in Complementary and Alternative Medicine (1980-2013).

To analyze the evolution of this field, Figure 5 and Table 1 show several findings that need to be highlighted to point out thematic relationships to composition, structure and impact.

Thematic Composition. The thematic area Anxiety is composed of motor and emerging/declining themes. It includes in both periods one important motor theme, called a thematic area. Also, this thematic area incorporates two new emerging themes in the second period. Survivors and Palliative Care starts with a motor and two basic themes and it develops into a motor and an isolated theme.

Three thematic areas are mainly composed by motor themes: Meditation, Postmenopause and Low Back Pain. These are consolidated into important thematic areas within the research field.

Treatment, Symptoms, and Cancer Types is the thematic area that presents the greatest number of themes. In the first subperiod it starts from a motor, a basic, an isolated and an emerging theme and it converges into a motor and two basic themes. The thematic area Cancer Pain is consolidated as a basic theme throughout the two time periods.

Two thematic areas are mainly composed by isolated themes: Herbal Medicine and Lymphedema. They are consolidated as isolated themes throughout the two time periods.

The thematic area Children starts from a motor theme and in the second subperiod it converges to a declining theme.

Two thematic areas converge to a motor theme: Depression and Insomnia and Inflammation Mediators. The former includes in its origin just an emerging theme, and it converges to a motor theme. The latter starts as an isolated theme and it develops into a motor theme.

Structural Evolution. The research field presents a great cohesion, due to the fact that the majority of detected themes are grouped into a thematic area. Furthermore, most of these evolutions are part of a thematic nexus. Some very recent themes (e.g. Coping, Alzheimer’s Disease, and Formalin Test) could not be identified with any thematic area. These could be considered to be emergent new thematic areas. In general, the thematic areas present a growing pattern of research over time. The number of documents in the second period is greater than in the period before.

Performance and Impact Indicators. Regarding the performance and impact indicators some aspects should be highlighted. The thematic area Anxiety is the most important theme in terms of the number of documents and citations, with the highest h-index and the best impact scores. On the other hand, Survivor and Palliative Care is the second thematic area with higher performance rates. The thematic areas Meditation, Treatment, Symptoms, Cancer Types, and Postmenopause also present a high citation rates and h-index. The thematic areas Menopause and Anxiety are significant, as they achieve a high growth in the second period.

4. Discussion

In this paper, a bibliometric analysis of CRS and CAM has been developed using SMA. As stated above, bibliometrics allows to analyze a research are in several ways (Santisteban-Espejo et al., 2018). Thus, in relation to the results obtained, some findings can be highlighted. The first remarkable finding is that the research field has attracted the interest of the scientific community throughout years. It is observed in the great growth of publications and citations received.

According to the analysis, it identifies for the first period twelve different main themes in CRS and CAM. All these findings are supported by the current scientific literature, which highlight the importance of these research lines. Anxiety is an important symptom as are its treatments. In the second period research is more focused on the physiological changes involved in anxiety. It is in relation to recent findings, where the repercussion of the anxiety in the emotional competences is highlighted (Balasooriya-Smeekens, Walter, & Scott, 2015; Baudry et al., 2018). Survivor and Palliative Care emphasizes healthcare that cancer patients receive following treatment and is highly focused on fatigue suffered by patients (Kassianos et al., 2018). Meditation is focused on the benefit of using this form of therapy in stressed patients and it is important to the concept of quality of life related to this thematic area (Haller et al., 2017). Treatment, Symptoms, and Cancer Types is a thematic area covering different kinds of topics: treatments (e.g. acupressure), symptoms (e.g. vomiting) and cancer types (e.g. prostate cancer). Postmenopause is mainly related to symptoms and hormonal changes that occur during postmenopause. It is also related to the term breast cancer in both periods (Rosner et al., 2015). Cancer Pain is mainly composed of themes related to treatments; in the first period it is centered on drugs and opioids, and in the second period it is focused on alternative therapies (Chiu, Hsieh, & Tsai, 2017; Kane et al., 2017). Low Back Pain is mainly focused on physiotherapy and therapies to reduce the pain in both periods (Ross & Bayer, 2005). Herbal Medicine is related to the use of herbal extracts to treat some CRS, and the presence of documents where herbal medicine is tested in animals (Lau et al., 2016). Children in the first period is related to different alternative therapies (e.g. hypnosis, imagery) and some symptoms (e.g. stress, behavior change) (Italia et al., 2015). In the second period it is less important and is related to more general terms. Depression and Insomnia is focused on those two CRS and their alternative treatments such as hypnotherapy and cognitive behavioral therapy (Cha et al., 2017). Inflammation Mediators is related to cytokines involved in immune processes, and is mainly focused on tumor necrosis factor (Fernandes et al., 2015). Lymphedema is primarily related to breast cancer and the physical treatment of this CRS (Shaitelman et al., 2015).

Regarding the thematic evolution, the thematic area Anxiety obtains the best impact index with the highest values in terms of the number of citations and h-index. This means that Anxiety is a growing research area with a good rate of published documents that captures the attention of the CRS and CAM research field. The thematic area Survivors and Palliative Care is another highly developed thematic area with a great number of documents published. The amount of documents published and the different issues related to it suggest that preventing the suffering of patients with alternative therapies is a major focus in this field.

Nevertheless, some study limitations can be highlighted. First, the most used CAM therapies, according to the literature, are analyzed, although some of them may not have been included. Second, the use of WoS as bibliographic source implies that articles not indexed in the database have not been analyzed. If they would be taken into account, the detected thematic areas could change.

5. Conclusion

Based on these study results, the following conclusions can be made. The scientific community can now identify thematic areas on which attention has been focused over time and others that are growing in terms of current research interest.
The citations and scientific production in CRS and CAM are primarily focused on two large topics, anxiety and the prevention of suffering in patients following cancer treatment. There are other thematic areas that are important in terms of research interest. These include meditation, symptoms as vomiting or nausea and postmenopause. These results suggest that this research field is growing rapidly and will continue attracting more research in the future. The study findings can be used to provide an historical perspective on research conducted in this emerging field and a scientific evidence-based practice model that could be used to develop future research.

Author Contributions

Jose A. Moral-Munoz (joseantonio.moral@uca.es) conceived and designed the analysis, contributed data or analysis tools, performed the analysis and wrote the paper. Manuel J. Cobo (manueljesus.cobo@uca.es) and Enrique Herrera-Viedma (viedma@decsai.ugr.es) conceived and designed the analysis, contributed data or analysis tools. Manuel Arroyo-Morales (marroyo@ugr.es), Barbara F. Piper (bpiper@nu.edu), Antonio I. Cuesta-Vargas (acuesta@uma.es), Lourdes Díaz-Rodríguez (cldiaz@ugr.es), and William C.S. Cho (williamcscho@gmail.com) conceived and designed the analysis.

Acknowledgements

This work has been supported by the Andalusian Excellence Project TIC-5991, and Spanish National Project TIN2016-75850-R. J.A. Moral-Munoz held an FPU scholarship (AP2012-1789) from the Spanish Ministry of Education.

The authors have declared that no competing interests exist.

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Scientometrics, 113(2), 867-888.      URL     This paper analyses the developmental dynamics of oncology research in Portugal during the second half of the twentieth century and early twenty first century. Grounding its conclusions in a scientometric analysis of a database of publications covering the period 1976 2015, the paper shows how the expansion of oncology research from the end of the 1990s through the 2000s is closely related to science and technology policy decisions in the country. The main actors of the institutional evolution of the field are public organizations, both hospital and academia/research-based, frequently working together. Portuguese oncology research focused especially on organ-based cancers, underlining the strong link between the laboratory and the clinic. Accordingly, translational research is a major trend in oncology research, as evidenced by the analysis of publications in major journals and inter-citation maps. Networks of institutional co-authorships show the importance of regional and international collaborations. The collaboration patterns over time reveal the importance of national and European collaborations during the initial years covered by our publication database, in line with the major impact of Portugal integration into the European Union, and a growing importance of regional collaborations, as well as with North and South American institutions in more recent years. Portugal provides a case study of how twentieth century policies at the national and European levels have impacted on the evolution of oncology research in countries from southern Europe. [7] Callon M., Courtial J.P., & Laville F. (1991). Co-word analysis as a tool for describing the network of interactions between basic and technological research: the case of polymer chemistry. Scientometrics, 22(1), 155-205. [Cite within: 2] [8] Callon M., Courtial J.P., Turner W.A., & Bauin S. (1983). From translation to problematic networks: An introduction to co-word analysis. Social Science Information, 22(2), 191-235.      URL     Recent empirical studies on research laboratories and the mechanism of policy elaboration in the field of science and technology have called into question some of the basic hypotheses guiding the sociology of the sciences over the past ten years. First, it now [Cite within: 2] [9] Cha K.M., Chung Y.K., Lim K.Y., Noh J.S., Chun M., Hyun S.Y., Kang D.R., Oh M.J., & Kim N.H. (2017). Depression and insomnia as mediators of the relationship between distress and quality of life in cancer patients. Journal of Affective Disorders, 217, 260-265. [Cite within: 1] [10] Chinchilla-Rodríguez Z., Ocaña-Rosa K., & Vargas-Quesada B. (2016). How to combine research guarantor and collaboration patterns to measure scientific performance of countries in scientific fields: Nanoscience and Nanotechnology as a Case Study. Frontiers in Research Metrics and Analytics, 1, 2. [Cite within: 1] [11] Chinchilla-Rodrίguez Z., Miguel S., & Moya-Anegón F. De. (2015). What factors affect the visibility of argentinean publications in humanities and social sciences in scopus? Some evidence beyond the geographic realm of research. Scientometrics, 102(1), 789-810.      URL     Argentina07s patterns of publication in the humanities and social sciences were studied for the period 2003-2012, using the Scopus database and distinguishing the geographic realm of the research. The results indicate that “topics of national scope” have grown and gained international visibility. They can be broadly characterized as having Spanish as the language of publication, and a marked preference for single authorship; in contrast, the publication of “global topics”, not geographically limited, characteristically have English as the language of divulgation, and institutional collaboration is stronger and more consolidated. Citation is apparently not determined only by the geographic realm of research, but also by language of publication, co-authorship, and the profiles of the journals where published. These results could contribute to constructive reflection upon publishing policy. The existence of a community of journals that tolerates biased patterns may make researchers echo and perpetuate poor practices, constructing or adapting the channels of communication. Such results also prove useful as a point of reference when evaluation criteria are elaborated by scientific committees, as unsupervised promotion and evaluation patterns could become based on local or overly subjective precepts, disregarding the disciplinary practices of the international scientific community. [Cite within: 1] [12] Chiu H.Y., Hsieh Y.J., & Tsai P.S. (2017). Systematic review and meta-analysis of acupuncture to reduce cancer-related pain. European Journal of Cancer Care, 26(2), 1-17.      PMID:26853524      URL     We conducted a systematic review and meta-analysis to evaluate the effects of acupuncture on malignancy-related, chemotherapy (CT)- or radiation therapy (RT)-induced, surgery-induced, and hormone therapy (HT)-induced pain. Randomised controlled trials (RCTs) examining the effects of acupuncture on cancer-related pain were reached from the EMBASE, PubMed, PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL, Airiti library, Taiwan Electrical Periodical Service, Wanfang Data (a Chinese database) and China Knowledge Resource Integrated Database from inception through June 2014. Heterogeneity, moderator analysis, publication bias and risk of bias associated with the included studies were examined. A total of 29 RCTs yielding 36 effect sizes were included. The overall effect of acupuncture on cancer-related pain was 610.45 [95% confidence interval (CI)=610.63 to 610.26]. The subanalysis indicated that acupuncture relieved malignancy-related and surgery-induced pain [effect size ( g )=610.71, and 610.40; 95% CI=610.94 to 610.48, and 610.69 to 610.10] but not CT- or RT-induced and HT-induced pain ( g =610.05, and 610.64, 95% CI=610.33 to 0.24, and 611.55 to 0.27). Acupuncture is effective in relieving cancer-related pain, particularly malignancy-related and surgery-induced pain. Our findings suggest that acupuncture can be adopted as part of a multimodal approach for reducing cancer-related pain. [Cite within: 1] [13] Cho H., Mariotto A.B., Mann B.S., Klabunde C.N., & Feuer E.J. (2013). Assessing non-cancer-related health status of US cancer patients: other-cause survival and comorbidity prevalence. American Journal of Epidemiology, 17(3), 339-349. [Cite within: 1] [14] Cleeland C.S. (2000). Cancer-Related Symptoms. Seminars in Radiation Oncology, 10(3), 175-190. [Cite within: 1] [15] Cobo M.J., López-Herrera A.G.G., Herrera-Viedma E., & Herrera F. (2012). SciMAT: A new science mapping analysis software tool. Journal of the American Society for Information Science and Technology, 63(8), 1609-1630.      Magsci     URL     This article presents a new open-source software tool, SciMAT, which performs science mapping analysis within a longitudinal framework. It provides different modules that help the analyst to carry out all the steps of the science mapping workflow. In addition, SciMAT presents three key features that are remarkable in respect to other science mapping software tools: (a) a powerful preprocessing module to clean the raw bibliographical data, (b) the use of bibliometric measures to study the impact of each studied element, and (c) a wizard to configure the analysis. [Cite within: 2] [16] Cobo M.J., López-Herrera A.G., Herrera-Viedma E., & Herrera F. (2011a). An approach for detecting, quantifying, and visualizing the evolution of a research field: A practical application to the fuzzy sets theory field. Journal of Infometrics, 5(1), 146-166. [Cite within: 3] [17] Cobo M.J., López-Herrera A.G., Herrera-Viedma E., & Herrera F. (2011b). Science mapping software tools: Review, analysis, and cooperative study among tools. Journal of the Association for Information Science and Technology, 62(7), 1382-1402.      URL     Science mapping aims to build bibliometric maps that describe how specific disciplines, scientific domains, or research fields are conceptually, intellectually, and socially structured. Different techniques and software tools have been proposed to carry out science mapping analysis. The aim of this article is to review, analyze, and compare some of these software tools, taking into account aspects such as the bibliometric techniques available and the different kinds of analysis. [Cite within: 1] [18] Cobo M.J., Martinez M.A., Gutierrez-Salcedo M., Fujita H., & Herrera-Viedma E. (2015). 25 years at knowledge-based systems: A bibliometric analysis. Knowledge-Based Systems, 80, 3-13.      URL     In commemoration of the Anniversary 25th of KnoSys we present a bibliometric analysis of the scientific content of the journal during the period 1991–2014. This analysis shows the conceptual evolution of the journal and some of its performance bibliometric indicators based on citations, as the evolution of its impact factor, its h-index, and its most cited authors/documents. [Cite within: 1] [19] Coulter N., Monarch I., & Konda S. (1998). Software engineering as seen through its research literature: A study in co-word analysis. Journal of the American Society for Information Science, 49(13), 1206-1223.      URL     Abstract This empirical research demonstrates the effectiveness of content analysis to map the research literature of the software engineering discipline. The results suggest that certain research themes in software engineering have remained constant, but with changing thrusts. Other themes have arisen, matured, and then faded as major research topics, while still others seem transient or immature. Co-word analysis is the specific technique used. This methodology identifies associations among publication descriptors (indexing terms) from the ACM Computing Classification System and produces networks of descriptors that reveal these underlying patterns. This methodology is applicable to other domains with a supporting corpus of textual data. While this study utilizes index terms from a fixed taxonomy, that restriction is not inherent; the descriptors can be generated from the corpus. Hence, co-word analysis and the supporting software tools employed here can provide unique insights into any discipline's evolution. [Cite within: 1] [20] Danell J.A.B., & Danell, R. (2009). Publication activity in complementary and alternative medicine. Scientometrics, 80(2), 539-551.      Magsci     In this article we analyse how research on complementary and alternative medicine (CAM) break through into one established scientific arena, namely academic journals. With help from bibliometric methods we analyse publication of CAM articles, in the Medline database, during the period 1966–2007. We also analyse the general content of the articles and in what journals they get published. We conclude that the publication activity of CAM articles increases rapidly, especially in the late 1990s, and that the changing growth rate is not due to the general expansion of Medline. The character of CAM articles has changed towards more clinical oriented research, especially in subfields such as acupuncture and musculoskeletal manipulations. CAM articles are found both in core clinical journals and in specialized CAM journals. Even though a substantial part of the articles are published in CAM journals, we conclude that the increasing publication activity is not restricted to the expansion of these specialized journals. [Cite within: 1] [21] DeSantis C.E., Lin C.C., Mariotto A.B., Siegel R.L., Stein K.D., Kramer J.L., Alteri, R, Robbins A.S., & Jemal A. (2014). Cancer treatment and survivorship statistics. Cancer Journal for Clinicians, 64(4), 252-271. [Cite within: 1] [22] Ernst E., &Casileth, B.R. (1998). The Prevalence of Complementary/Alternative Medicine in Cancer. American Cancer Society, 83(4), 777-782. [Cite within: 1] [23] Fernandes J.V., Cobucci R.N.O., Jatobá C.A.N., de Medeiros Fernandes T.A.A., de Azevedo J.W.V., & de Araújo J.M.G. (2015). The role of the mediators of inflammation in cancer development. Pathology and Oncology Research, 21(3), 527-534.      PMID:25740073      URL     Abstract Epigenetic disorders such as point mutations in cellular tumor suppressor genes, DNA methylation and post-translational modifications are needed to transformation of normal cells into cancer cells. These events result in alterations in critical pathways responsible for maintaining the normal cellular homeostasis, triggering to an inflammatory response which can lead the development of cancer. The inflammatory response is a universal defense mechanism activated in response to an injury tissue, of any nature, that involves both innate and adaptive immune responses, through the collective action of a variety of soluble mediators. Many inflammatory signaling pathways are activated in several types of cancer, linking chronic inflammation to tumorigenesis process. Thus, Inflammatory responses play decisive roles at different stages of tumor development, including initiation, promotion, growth, invasion, and metastasis, affecting also the immune surveillance. Immune cells that infiltrate tumors engage in an extensive and dynamic crosstalk with cancer cells, and some of the molecular events that mediate this dialog have been revealed. A range of inflammation mediators, including cytokines, chemokines, free radicals, prostaglandins, growth and transcription factors, microRNAs, and enzymes as, cyclooxygenase and matrix metalloproteinase, collectively acts to create a favorable microenvironment for the development of tumors. In this review are presented the main mediators of the inflammatory response and discussed the likely mechanisms through which, they interact with each other to create a condition favorable to development of cancer. [Cite within: 1] [24] Foley K.G., Powell A., Lewis W.G., & Roberts S.A. (2016). The 100 most cited articles investigating the radiological staging of oesophageal and junctional cancer: a bibliometric analysis. Insights into Imaging, 7(4), 619-628.      PMID:4956630      URL     Accurate staging of oesophageal cancer (OC)02is vital. Bibliometric analysis highlights key topics and publications that have shaped understanding of a subject.02The 100 most cited articles investigating radiological staging of OC are identified. The Thomas Reuters Web of Science database with search terms including “CT, PET, EUS, oesophageal and gastro-oesophageal junction cancer” was used to identify all English language, full-script articles. The 100 most cited articles were further analysed by topic, journal, author, year and institution. A total of 5,500 eligible papers were returned. The most cited paper was Flamen et al. (n65=65306), investigating the utility of positron emission tomography (PET) for the staging of patients with potentially operable OC. The most common research topic was accuracy of staging investigations (n65=6563). The article with the highest citation rate (38.00), defined as the number of citations divided by the number of complete years published, was Tixier et al. investigating PET texture analysis to predict treatment response to neo-adjuvant chemo-radiotherapy, cited 114 times since publication in 2011. This bibliometric analysis has identified key publications regarded as important in radiological OC staging. Articles with the highest citation rates all investigated PET imaging, suggesting this modality could be the focus of future research. 61This study identifies key articles that investigate radiological staging of oesophageal cancer. 61The most common topic was accuracy of staging investigations. 61The article with the highest citation rate investigated the use of texture analysis in PET images. [Cite within: 1] [25] Fu J.Y., Zhang X., Zhao Y.H., Huang M.H., & Chen D.Z. (2011). Bibliometric analysis of complementary and alternative medicine research over three decades. Scientometrics, 88(2), 617-626.      Magsci     URL     AbstractThis study applies bibliometric analysis to investigate the quantity and citation impact of scientific papers in the field of complementary and alternative medicine (CAM). The data are collected from 19 CAM journals in the Science Citation Index Expanded (SCI-E) database during 1980鈥2009, and 17,002 papers are identified for analysis. The study analyzes the document types, geographical and institutional distribution of the authorship, including international scientific collaboration. This study suggests that the major type of document is original article. The CAM papers are mostly published by North America, East Asia, and European countries, of which publications authored in East Asia are cited most. Country-wise, major contributors of CAM papers are from USA, People Republic of China, India, England and Germany. India has the highest CPP value, attracting high attentions in CAM community. This article also finds that international co-authorship in the CAM field has increased rapidly during this period. In addition, internationally collaborated publications generate higher citation impact than papers published by authors from single country. Finally, the research identifies productive institutions in CAM, and China Medical University located in Taiwan is the most productive organization. [Cite within: 1] [26] Gutiérrez-Salcedo M., Martínez M.Á., Moral-Munoz J.A., Herrera-Viedma E., & Cobo M.J. (2017). Some bibliometric procedures for analyzing and evaluating research fields. Applied Intelligence, 48(5), 1275-1287.      URL     Nowadays, measuring the quality and quantity of the scientific production is an important necessity since almost every research assessment decision depends, to a great extent, upon the scientific... [Cite within: 1] [27] Hack T.F., Crooks D., Plohman J., & Kepron E. (2014). Citation analysis of Canadian psycho-oncology and supportive care researchers. Supportive Care in Canceri, 22, 315-324. [Cite within: 1] [28] Haller H., Winkler M.M., Klose P., Dobos G., Kümmel S., & Cramer H. (2017). Mindfulness-based interventions for women with breast cancer: An updated systematic review and meta-analysis. Acta Oncologica, 56(12), 1665-1676.      PMID:28686520      URL     Abstract BACKGROUND: The aim of this meta-analysis was to systematically update the evidence for mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) in women with breast cancer. MATERIAL AND METHODS: In October 2016, PubMed, Scopus, and Central were searched for randomized controlled trials on MBSR/MBCT in breast cancer patients. The primary outcome was health-related quality of life. Secondary outcomes were fatigue, sleep stress, depression, anxiety, and safety. For each outcome, standardized mean differences (SMD/Hedges' g) and 95% confidence intervals (CI) were calculated. Risk of bias was assessed by the Cochrane risk of bias tool. RESULTS: The Literature search identified 14 articles on 10 studies that included 1709 participants. The overall risk of bias was unclear, except for risk of low attrition bias and low other bias. Compared to usual care, significant post-intervention effects of MBSR/MBCT were found for health-related quality of life (SMD65=65.21; 95%CI65=65[.04-.39]), fatigue (SMD65=65-.28; 95%CI65=65[-.43 to -.14]), sleep (SMD65=65-.23; 95%CI65=65[-.40 to -.05]), stress (SMD65=65-.33; 95%CI65=65[-.61 to -.05]), anxiety (SMD65=65-.28; 95%CI65=65[-.39 to -.16]), and depression (SMD65=65-.34; 95%CI65=65[-.46 to -.21]). Up to 6 months after baseline effects were significant for: anxiety (SMD65=65-.28; 95%CI65=65[-.47 to -.09]) and depression (SMD65=65-.26; 95%CI65=65[-.47 to -.04]); and significant for anxiety (SMD65=65-.21; 95%CI65=65[-.40 to -.03]) up to 12 months after baseline. Compared to other active interventions, significant effects were only found post-intervention and only for anxiety (SMD65=65-.45; 95%CI65=65[-.71 to -.18]) and depression (SMD65=65-.39; 95%CI65=65[-.65 to -.14]). However, average effects were all below the threshold of minimal clinically important differences. Effects were robust against potential methodological bias. Adverse events were insufficiently reported. CONCLUSIONS: This meta-analysis revealed evidence for the short-term effectiveness and safety of mindfulness-based interventions in women with breast cancer. However, their clinical relevance remains unclear. Further research is needed. [Cite within: 1] [29] Hirsch J. (2005). An index to quantify an individuals scientific research output. Proceeding of the National Academy of Sciences, 102, 15572-16569. [Cite within: 1] [30] Hu X.Y., Lorenc A., Kemper K., Liu J.P., Adams J., & Robinson N. (2015). Defining integrative medicine in narrative and systematic reviews: A suggested checklist for reporting. European Journal of Integrative Medicine, 7(1), 76-84. [Cite within: 1] [31] Huang Y., Zhou M., Deng Q., Zhang J., Zhou P., & Shang X. (2015). Bibliometric analysis for the literature of traditional Chinese medicine in PubMed. Scientometrics, 105(1), 557-566. [Cite within: 1] [32] Italia S., Brand H., Heinrich J., Berdel D., von Berg A., & Wolfenstetter S.B. (2015). Utilization of complementary and alternative medicine (CAM) among children from a German birth cohort (GINIplus): patterns, costs, and trends of use. BMC Complementary and Alternative Medicine, 15(1), 49.      PMID:4364567      URL     Background The use of complementary and alternative medicine (CAM) is widespread among children in Germany and other European countries. Only a few studies are available on trends in pediatric CAM use over time. The study???s objective was to present updated results for prevalence, predictors, and costs of CAM use among German children and a comparison with findings from a previous follow-up of the same birth cohort. Methods Data were collected for 3013 children on their utilization of medicinal products (during the last 4weeks) and consultation with CAM providers (in the preceding year) from a German birth cohort study (GINIplus, 15-year follow-up) using a self-administered questionnaire. The reported medicinal CAMs were classified into six categories (homeopathy, herbal drugs, nutritionals, minerals and trace elements, microorganisms, further CAM). Drug prices were traced using pharmaceutical identification numbers (PZNs), or otherwise conservatively estimated. Finally, the results were compared with data obtained from the 10-year follow-up of the same birth cohort study by adopting the identical methodology. Results In all, 26% of the reported 2489 drugs were medicinal CAM. The 4-week prevalence for homeopathy and herbal drug use was 7.5% and 5.6%, respectively. Some 13.9% of the children used at least one type of medicinal CAM in the preceding 4weeks. The 1-year prevalence for consultation with CAM providers was 10.8%. From the drugs identified as CAM, 53.7% were homeopathic remedies, and 30.8% were herbal drugs. Factors associated with higher medicinal CAM use were female gender, residing in Munich, and higher maternal education. A homeopathy user utilized on average homeopathic remedies worth EUR 15.28. The corresponding figure for herbal drug users was EUR 16.02, and EUR 18.72 for overall medicinal CAM users. Compared with the 10-year follow-up, the prevalence of homeopathy use was more than halved (???52%) and dropped substantially for herbal drug use (???36%) and overall CAM use (???38%) as well. Conclusion CAM use among 15-year-old children in the GINIplus cohort is popular, but decreased noticeably compared with children from the same cohort at the age of 10years. This is possibly mainly because German health legislation normally covers CAM for children younger than 12years only. [Cite within: 1] [33] Kane C.M., Mulvey M.R., Wright S., Craigs C., Wright J.M., & Bennett M.I. (2017). Opioids combined with antidepressants or antiepileptic drugs for cancer pain: Systematic review and meta-analysis. Palliative Medicine, 26921631771182. [Cite within: 1] [34] Kassianos A.P., Ioannou M., Koutsantoni M., & Charalambous H. (2018). The impact of specialized palliative care on cancer patients’ health-related quality of life: a systematic review and meta-analysis. Supportive Care in Cancer, 26(1), 61-79. [Cite within: 1] [35] Lau C.H.Y., Wu X., Chung V.C.H., Liu X., Hui E.P., Cramer H., Lauche R., Lau A.Y., Sit R.S., Ng B.F., & Wu J.C.Y. (2016). Acupuncture and related therapies for symptom management in palliative cancer care: Systematic review and meta-analysis. Medicine, 95(9), e2901. [Cite within: 1] [36] Lötzke D., Recchia D.R., Kröz M., Reif M., Gutenbrunner C., Zerm R., Nikolaou A., Berger B., & Büssing A. (2015). The influence of a multimodal therapy concept on health-related quality of life in breast cancer survivors with cancer-related fatigue in comparison to a standard aerobic therapy. European Journal of Integrative Medicine, 7, 14. [Cite within: 1] [37] Martinez M.A., Herrera M., Lopez-Gijon J., & Herrera-Viedma E. (2014). H-classics: Characterizing the concept of citation classics through h-index. Scientometrics, 98(3), 1971-1983.      Magsci     Citation classics identify those highly cited papers which are an important reference point in a research field. To identify a paper as a citation classic we have to fix a citation threshold value. Usually, this threshold value should not be the same for all research fields because each field presents its respective citation pattern. Studies of citation classics in the literature define particular criteria and methods to set citation thresholds, which are often set arbitrarily and designed ad-hoc, and do not allow the scientific community to validate and compare their results. In this paper we introduce the concept of H-Classics to overcome this problem and provide scientific community a standardization of key constructs. We present a new and systematic method to identify citation classics. This identification method of highly cited papers is based on the H-index and thank to the properties of H-index it is sensitive to the own characteristics of any research discipline and also its evolution. Therefore, the concept of H-Classics allows to systematize search procedure of citation classics for any field of research. [Cite within: 1] [38] Moral-Munoz J.A., Arroyo-Morales M., Herrera-Viedma E., & Cobo M.J. (2018). An overview of thematic evolution of physical therapy research area from 1951 to 2013. Frontiers in Research Metrics and Analytics, 3, 13. [Cite within: 1] [39] Moral-Munoz J.A., Cobo M.J., Peis E., Arroyo-Morales M., & Herrera-Viedma E. (2014). Analyzing the research in Integrative & Complementary Medicine by means of science mapping. Complementary Therapies in Medicine, 22(2), 409-418.      Magsci     Objectives: The research in the Complementary and Alternative Medicine (CAM) field is analyzed according to the journals indexed in ISI Web of Science. Science Mapping Analysis (SMA) is used to provide and overview of the conceptual evolution of the CAM field.
Methods: The software SciMAT is used to detect and visualize the hidden themes and their evolution over a consecutive span of years. It combines SMA and performance analysis. Twenty one journals related to CAM were analyzed, in four consecutive periods from 1974 to 2011.
Results: Strategic diagrams and the thematic evolution of CAM, together with performance indicators (h-index), were obtained. The results show that CAM research has focused on seven main thematic areas: MEDICINAL-PLANTS, CHIROPRACTIC-AND-LOW-BACK-PAIN, ACUPUNCTURE-AND-PAIN, CELL-PROCESSES-AND-DISEASES, LIPID-PEROXIDATION and DIABETES-AND-INSULIN.
Conclusion: The research output could be used by the scientific community to identify thematic areas on which interest is focused. (C) 2014 Elsevier Ltd. All rights reserved. [40] Morris S.& Van Der Veer Martens B. (2008). Mapping research specialities. Annual Review of Information Science and Technology, 42(1), 213-295. [Cite within: 1] [41] Noyons E.C.M., Moed H.F., & Luwel M. (1999). Combining mapping and citation analysis for evaluative bibliometric purposes: A bibliometric study. Journal of the American Society for Information Science, 50(2), 115-131.      URL     An abstract is not available. [Cite within: 1] [42] Perez-Cabezas V., Ruiz-Molinero C., Carmona-Barrientos I., Herrera-Viedma E., Cobo M.J., & Moral-Munoz J.A. (2018). Highly cited papers in Rheumatology: Identification and conceptual analysis. Scientometrics, in press.      URL     Rheumatology is a broad research area with an extensive background in scientific publications. Thus, the present study aims to identify the highly cited papers in Rheumatology research field,... [Cite within: 1] [43] Powell A.G., Hughes D.L., Wheat J.R., & Lewis W.G. (2016). The 100 most influential manuscripts in gastric cancer: A bibliometric analysis. International Journal of Surgery (London, England), 28, 83-90. [Cite within: 1] [44] Rosner B., Eliassen A.H., Toriola A.T., Hankinson S.E., Willett W.C., Natarajan L., & Colditz G.A. (2015). Short-term weight gain and breast cancer risk by hormone receptor classification among pre- and postmenopausal women. Breast Cancer Research and Treatment, 150(3), 643-653.      PMID:4383816      URL     Obesity is well established as a cause of postmenopausal breast cancer incidence and mortality. In contrast, adiposity in early life reduces breast cancer incidence. However, whether short-term weight change influences breast cancer risk is not well known. We followed a cohort of 77,232 women from 1980 to 2006 (1,445,578 person-years), with routinely updated risk factor information, documenting 4196 incident cases of invasive breast cancer. ER and PR status were obtained from pathology reports and medical records yielding a total of 2033 ER+/PR+ tumors, 595 ER61/PR61 tumors, 512 ER+/PR61 tumors. The log incidence breast cancer model was used to assess the association of short-term weight gain (over past 402years) while controlling for average BMI before and after menopause. Short-term weight change was significantly associated with breast cancer risk (RR021.20; 9502% CI021.09–1.33) for a 4-year weight gain of ≥1502lbs versus no change (≤502lbs) ( P _trend02<020.001). The association was stronger for premenopausal women (RR021.38; 9502% CI021.13–1.69) ( P _trend02=020.004) than for postmenopausal women (RR021.10; 9502% CI020.97–1.25) ( P _trend02=020.063). Short-term weight gain during premenopause had a stronger association for ER+/PR61 (RR per 2502lb weight gain02=022.19; 9502% CI021.33–3.61, P 02=020.002) and ER61/PR61 breast cancer (RR per 2502lb weight gain02=021.61; 9502% CI021.09–2.38, P 02=020.016) than for ER+/PR+ breast cancer (RR per 2502lb weight gain02=021.13; 9502% CI020.89–1.43, P 02=020.32). There are deleterious effects of short-term weight gain, particularly during pre-menopause, even after controlling for average BMI before and after menopause. The association was stronger for ER+/PR61 and ER61/PR61 than for ER+/PR+ breast cancer. [Cite within: 2] [45] Ross M.D., & Bayer,E. (2005). Cancer as a cause of low back pain in a patietn seen in a direct access physical therapy setting. J Orthop Sports Phys Ther, 35(10), 651-658. [46] Santisteban-Espejo A., Campos F., Martin-Piedra L., Durand-Herrera D., Moral-Munoz J.A., Campos A., & Martin-Piedra M.A. (2018). Global tissue engineering trends: A scientometric and evolutive study. Tissue Engineering Part A, in press. URL     El carro de la educación médica se sustenta en cuatro ruedas o circunstancias que condicionan su excelencia y que actúan estrechamente asociadas entre sí. Las ruedas son respectivamente un paradigma médico actualizado, una docencia equilibrada, un aprendizaje autorregulado y unos entornos adecuados. En el presente artículo se identifican algunos de los componentes que en el momento actual... [Show full abstract] [Cite within: 1] [47] Shaitelman S.F., Cromwell K.D., Rasmussen J.C., Stout N.L., Armer J.M., Lasinski B.B., & Cormier J.N. (2015). Recent progress in the treatment and prevention of cancer-related lymphedema. CA: A Cancer Journal for Clinicians, 65(1), 55-81.      PMID:25410402      URL     This article provides an overview of the recent developments in the diagnosis, treatment, and prevention of cancer-related lymphedema. Lymphedema incidence by tumor site is evaluated. Measurement techniques and trends in patient education and treatment are also summarized to include current trends in therapeutic and surgical treatment options as well as longer-term management. Finally, an overview of the policies related to insurance coverage and reimbursement will give the clinician an overview of important trends in the diagnosis, treatment, and management of cancer-related lymphedema. [Cite within: 1] [48] Singh N., Handa T.S., Kumar D., & Singh G. (2016). Mapping of breast cancer research in India: a bibliometric analysis. Current Science (00113891), 110(7), 1178-1183. [Cite within: 1] [49] Small H.(1999). Visualizing science by citation mapping. Journal of the American Society for Information Science, 50, 799-813. [Cite within: 1] [50] Sternitzke C.; Bergmann I. (2009). Similarity measures for document mapping: A comparative study on the level of an individual scientist. Scientometrics, 3(4), 113-130. [Cite within: 1] [51] Tam W.W.S., Wong E.L.Y., Wong F.C.Y., & Cheung A.W.L. (2012). Citation classics in the integrative and complementary medicine literature: 50 frequently cited articles. European Journal of Integrative Medicine, 4(1), e77-e83.      Magsci     Aim of the study: The objective of the current study is to characterise the most frequently cited articles published in integrative and complementary medicine (ICM) journals.
Materials and methods: We utilised the ISI Journal Citation Reports: Science Edition 2009 database in May 2011 to determine the most frequently cited published articles. The top 50 most cited articles were selected and evaluated according to the type of journal, country of publication, topic, study design, and year of publication.
Results: The 50 selected articles were published in 7 out of 16 journals between 1980 and 2009, the majority of which originated from the US. The most common study design was literature and systematic reviews. The efficacy of ICM on pain was the most common topic, followed by the anti-inflammatory effect of ICM, prevalence of ICM utilisation, questionnaire development for pain, adverse effects of ICM, discussion of study design in ICM, chemical component of ICM, animal model testing, and obesity.
Conclusions: The findings provide a historical perspective on the scientific progress in integrative and alternative medicine. We revealed that majority papers (similar to 60%) were published between 1995 and 2004, suggesting that ICM has gained increasing attention since 1995. In terms of study design, review-type and questionnaire-related studies constituted approximately 60% of the articles. The actual number of citations from these articles was lower than the articles from the citation classics in other medical fields. The review of the articles having the greatest public recognition could help to establish and expand the role of ICM. (C) 2011 Elsevier GmbH. All rights reserved. [52] Thonon F., Saghatchian M., Nerfie A., & Delaloge S. (2015). Tendances et évolutions de la recherche française sur le cancer du sein: étude bibliométrique. Bulletin Du Cancer, 102(5), 417-427.      URL     This article presents a bibliometric study carried out in order to describe the trends and evolutions of French breast cancer research from 2003to 2013. The results show an increase in the number of publications, especially international publications coordinated by non-French institutions. The most visible topics, in terms of number of publications by keywords, are related to biology, clinical trials and genetics. Most publications are written by authors affiliated to comprehensive cancer centres, followed by universities, research centres, university hospitals and governmental agencies. The importance of publications by topic varies throughout the years: there has been an increase of the number of publications related to targeted therapies or genomics. The importance of institutions or country affiliation of authors varies with the topics. This study, especially the analysis by keywords, enables the coordinators of research programs to identify the predominant actors and themes. [Cite within: 1] [53] Ugolini D., Neri M., Cesario A., Bonassi S., Milazzo D., Bennati L., Lapenna L.M., & Pasqueletti P. (2012). Scientific production in cancer rehabilitacion grows higher: A bibliometric analysis. Supportive Care in Cancer, 20, 1629-1638.      PMID:21881910      URL     Purpose The aim of the study was to evaluate scientific production in the field of cancer rehabilitation comparing publication trends and impact factor (IF) among countries. Methods The PubMed database was searched. Publications numbers and IF were evaluated both as absolute values and after standardization by population and gross domestic product (GDP). A dedicated software was developed to create a relational database containing all information about considered publications (Research Management System). Results Some 1,743 publications were retrieved from 1967 to 2008. Cancer rehabilitation publications have grown 11.6 times, while the whole field of disease rehabilitation has grown 7.8 times. Breast neoplasms, squamous cell carcinoma, treatment outcome, endosseous dental implantation, follow-up studies, and surgical flaps were the most commonly used keywords. From 1994 to 2008, 946 citations were retrieved: 36.8% came from the European Union (EU) (Germany, the UK, and the Netherlands ranking at the top) and 36.9% from the USA. The highest mean IF was reported for the USA (3.384) followed by Canada (3.265) and Australia (2.643). The EU has a mean IF of 0.839 with the Netherlands ranking first. Canada, Australia, and the USA had the best ratio between IF (sum) and resident population or GDP. Conclusions Cancer rehabilitation is an expanding area with a growing scientific production. The rapidly ageing population, the higher number of cancer survivors, and the increasing need of resources for the after treatment of cancer patients contribute to explain the interest for this field. [Cite within: 1] [54] Van Raan,A.F. J.(2005). Handbook of quantitative science and technology research, chapter Measuring Science. Springer Netherlands, 19-50. [Cite within: 1] [55] Wyatt G., Sikorskii A., & You M. (2013). Self-reported use of complementary and alternative medicine therapies in a reflexology randomized clinical trial. Alternative Therapies in Health and Medicine, 19(5), 31-37. [Cite within: 1]
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