Complementary therapies and cancer care: an overview
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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