Complementary therapies and cancer care: an overview

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Abstract

The use of complementary therapies by patients with cancer is increasingly common, despite limited evidence for their efficacy and safety. The widespread use of complementary therapies has major implications for research and practice. In this paper, we provide an overview of the current state of knowledge regarding issues related to the use of complementary therapies by patients with cancer. So far, complementary therapies have not been defined very well, which makes it difficult to assess the precise extent of their use. The difference in philosophy underlying conventional and complementary treatments appears to contribute to the attractiveness of complementary therapies. Conventional medical practitioners are beginning to recognize the importance of many of the elements of this philosophy, which is evidenced in the patient-centered model. Explaining how patients with cancer make the decision to use complementary therapies has been the subject of many studies. However, as yet, no formal theory of decision making has been developed. Communication between patients and physicians about complementary therapies is an important part of the patients’ decision-making process. Many gaps can be identified in knowledge of complementary therapy use by patients with cancer. Not only is there a need to increase knowledge by conducting more research and improving the research infrastructure, but attention should also be paid to information dissemination, education, and planning and development of health policies.

Introduction

The use of complementary therapies by patients with cancer is increasingly common. An expanding increasingly available body of information on complementary therapies is being accessed by patients with cancer via all means of communication. The quality of this information is a concern to many physicians who fear that one-sided and overly optimistic information leads to increased use of unproven therapies by cancer patients [1]. The use of complementary therapies by patients with cancer has major implications for research and practice. In this paper, we will review the evidence surrounding the efficacy and safety of complementary therapies in cancer care, why patients make the decision to use these therapies, the current state of knowledge regarding the use of complementary therapies by cancer patients and communication between cancer patients and their physicians. This paper will, to some degree, focus on the interest in and use of complementary therapies by patients with cancer in Canada. However, we believe that many of the issues to be discussed have much wider applicability.

Section snippets

Defining complementary therapies

There is no uniform, clear and specific definition of complementary therapies. The term complementary therapies usually refers to therapies that are used as an adjunct to conventional treatment and the term alternative therapies to those that are used as an alternative to conventional medical treatment. However, the terms are often used interchangeably. Other terms in use in the cancer literature include unproven, unorthodox, unconventional, ineffective and questionable therapies. These terms

Efficacy and safety of complementary therapies

Scientific evidence for the efficacy of complementary therapies for cancer treatment is minimal [5], [6], [7], [8]. There are a number of well-known alternative therapies specifically designed for treatment for cancer, such as hydrazine sulfate, antineoplastons, Gerson diet and Hoxsey herbal treatment. These treatments have been developed by individuals who often are charismatic physicians who are unrelenting advocates for the effectiveness and safety of their therapies [8], [9]. They often are

Attraction of patients to complementary therapies

Although it is not possible to generalize across different types of complementary therapies, most complementary therapies have a common philosophy and tenet [23], [24], [25]. This philosophy includes a focus on health and improving well-being, rather than on disease. Making a diagnosis by focusing on objective signs and subjective symptoms is replaced by evaluating the nature of physical, emotional, structural or energetic imbalance. Whereas many conventional therapies tend to be aggressive and

Making the decision to use complementary therapies

Common reasons for using complementary therapies are hope for a cure or reducing the size of the tumor, ameliorating side effects of conventional cancer treatment, strengthening the immune system, improving well-being and taking control of cancer care. Having a strong belief in the treatment, appeasing pressure from family and friends and feeling that natural therapies will not hurt contribute to this decision. How patients decide to use complementary therapies has been a subject of several

Extent of complementary therapy use by cancer patients

A systematic review of the prevalence of complementary therapies use in cancer in Western developed countries shows that it ranges from 7–64% [32]. This review also suggests that the use of complementary therapies has increased over the past years; however, increased rates may also reflect patients’ willingness to talk more openly about complementary therapy use. Bias due to willingness to report may also be related to the person or organization behind the research. In a 1992 study commissioned

Patient–physician communication about complementary therapies

In a recent pilot study, focus groups were conducted with patients with cancer to assess their expectations of the role of the family physician’s play in communication about complementary therapy use in cancer care [44]. Only a few patients indicated that their family physician was a partner in their care, who would review with them the research on specific therapies and would assist them in evaluating the appropriateness of these therapies for their care. However, all patients expressed the

Discussion

While the use of complementary therapies among patients with cancer is common, there are still many gaps in our knowledge of complementary therapies that create barriers to responsible complementary therapy use as well as to physician involvement in their patients’ use of complementary therapies.

A clear definition of complementary therapies is required to allow comparison between studies, to focus future research and to educate patients and physicians as to wise complementary therapy use. The

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