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Complementary and alternative medicine for cancer patients
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The popularity of complementary and alternative medicine — or CAM — has increased many-fold in recent years. As many as 7% to 54% of cancer patients in the United States are estimated to use some type of complementary or alternative therapy. As such, it is imperative for practitioners to distinguish between therapies that can be dangerous and those that are palliative and augment conventional treatment.
Complementary therapy addresses the body, mind and spirit. It is used in conjunction with mainstream allopathic medical treatment to control symptoms and enhance quality of life for patients and their families. Alternative therapies are unproven or disproven modalities, promoted as cancer therapies and cures, used as alternatives to mainstream allopathic medical treatment. The remainder of this article will focus on complementary therapies.
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Most complementary therapies are safe and have been shown to be beneficial or at least not harmful. However, there are some botanicals, nutritional supplements and vitamins that can be harmful to patients when taken in conjunction with standard medical therapy. For this reason, clinicians need to be aware of what their patients may be doing and their reasons for doing so. Motivations for cancer patients to use CAM include:
Survival
- Anticancer effect — cure the cancer, slow cancer growth, prolong survival.
- Try something else.
Relief
- Cancer symptoms.
- Side effects of conventional cancer treatments.
Repair and boost
- Detoxify the body.
- Boost immunity.
- Boost energy.
- Enhance quality of life.
Patients who seek out CAM may perceive a beneficial response, have a desire for control and/or have a strong belief in CAM. It is important to specifically ask patients about their use of CAM on a regular basis.
The National Center for Complementary and Alternative Medicine (NCCAM) was established in 1998 as one of the centers for the National Institutes of Health. The NCCAM groups CAM into five domains — whole medical systems, mind-body medicine, biologically based practices, manipulative and body-based practices and energy medicine — detailed in the accompanying table.
In addition to these five domains, patients may be using other CAM therapies, such as aromatherapy and acupuncture. Aromatherapy is the use of odorous compounds, such as essential oils, by massage, inhalation, baths or compresses, to enhance the comfort of the patient and family. It is mainly used as supportive care in cancer patients and can help with stress and anxiety.
Acupuncture is part of traditional Chinese medicine and involves applying stimulation to acupuncture points via needling, moxibustion, cupping or acupressure. Although acupuncture can be used for a myriad of conditions, its primary use in cancer patients is symptom management — pain, nausea, vomiting.
The use of CAM is very prevalent for patients with cancer. Although many interventions have little to no harm associated with them, a few can have dangerous interactions with conventional allopathic medical treatments. It is important to ask patients about their use of CAM and to have resources available to evaluate how these interventions fit into the patient’s plan of care.
Christine A. Zawistowski, MD, is an Assistant Professor of Pediatrics in the Division of Critical Care at Mount Sinai Kravis Children’s Hospital, New York.