Complementary therapies: evaluating their effectiveness in cancer

https://doi.org/10.1016/S0738-3991(99)00057-9Get rights and content

Abstract

The use of complementary therapies is common among cancer patients. However, a major concern is that very few of these therapies have been appropriately evaluated and, thus, little is known about their safety and efficacy. The gold standard for evaluating cancer treatments is the randomized controlled trial (RCT). However, there are several issues inherent to the nature and practice of complementary therapies that interfere with the straightforward use of RCTs. Alternative approaches are often highly individualized and attempt to respond to patients’ needs. They are often holistic, taking into account many facets of a patient’s life. Placebo effects and the role of the provider are frequently recognized as an important part of treatment. Outcomes of complementary therapies are often subjective, rather than being more objective outcomes, such as increased survival time. Although it is important to evaluate complementary therapies, it is mandatory that studies be sensitive to these issues and that existing research methods be adjusted and modified for this purpose.

Introduction

Patients with cancer commonly use complementary therapies [1], [2]. See Table 1 in Verhoef et al. [3] for a classification of complementary therapies and some examples of specific therapies, including those used for cancer [4].

Oncologists and other physicians who care for people with cancer often express serious concerns about complementary therapies [5], [6]. Cancer physicians’ greatest concern is for the patient with a readily curable cancer, such as testicular cancer, who may reject conventional therapy in favor of an unproven one [7]. In this case, by the time a patient discovers that the complementary therapy is ineffective, the cancer may have progressed to the point where more intensive conventional therapy is necessary or even where the cancer is no longer curable [8]. Also of concern is the patient with terminal cancer who may waste thousands of dollars and may suffer significant adverse effects in a desperate and futile attempt to find a cure [9]. Physicians may also worry that the media and wide-spread availability of information about these therapies, especially from practitioners’ web-sites [10], [11], [12], may provide one-sided and overly optimistic accounts of these therapies.

Most patients seem to think that complementary therapies are natural and, thus, are not harmful. Patients and physicians probably have limited awareness of the potential for adverse interactions between conventional and complementary treatments. As many of these therapies are often only available at special clinics, patients seeking these therapies may spend a great deal of money both to reach the clinic and to pay for the treatments.

Section snippets

Differences between conventional medicine and complementary therapies

To understand the difficulties in evaluating complementary therapies with standard scientific methods, it is important to understand how the philosophical bases of complementary therapies and conventional medicine differ [13], [14]. Conventional medicine was developed within Western culture and a strong emphasis is placed on the scientific method for generating new knowledge about diseases and their treatment. Many complementary therapies are derived from traditional health care systems from a

Conventional treatments and evidence

The most consistent criticism of complementary therapies by conventional practitioners is the lack of peer-reviewed, scientifically conducted research [16]. Evidence supporting the effectiveness of an intervention is critical in the decision of government regulatory agencies to approve the use of a conventional therapy and of physicians to administer it to individual patients. Conventional medicine increasingly emphasizes the practice of evidence-based medicine, with the primary goal of

Alternative treatments and evidence

The majority of complementary therapies are not based on scientifically derived knowledge, but, rather, on the beliefs of the culture from which they were derived and a rich folk history. Testimonials and personal experience usually are the only evidence supporting purported benefits. Testimonials suffer the weaknesses of case reports but can be confounded by other factors, such as the patient also receiving conventional treatment, lack of valid and reliable outcomes measures, or even the

Discussion

Most proponents of research on complementary therapies recognize that the RCT is the prevailing standard for the evaluation of treatment effects because of the quality of evidence it provides for assessing cause–effect relationships [36]. If these therapies are to gain recognition as a valid form of treatment within the medical and scientific community, they will need to be evaluated using that methodology. Therefore, the question is not whether the RCT should be applied to complementary

Conclusions

Patients with cancer, especially those with advanced disease, are a vulnerable group. They have a life-threatening condition, for which conventional medicine often does not have an answer. They are at risk for trying expensive and potentially harmful therapies in an attempt to find a cure. They are often faced with a lack of information about alternative therapies and a hostile relationship between practitioners of conventional and alternative medicine. A perceived unwillingness of conventional

References (41)

  • M.J. Coppes et al.

    Alternative therapies for the treatment of childhood cancer

    N Engl J Med

    (1998)
  • M.J. Montbriand

    Abandoning biomedicine for alternate therapies: oncology patients’ stories

    Cancer Nurs

    (1998)
  • Gerson Institute, http://www.gerson.org/welcome.htm (accessed...
  • Original Hoxsey herbal treatment at Bio-Medical Center, http://members.tripod.com/∼hoxsey/ (accessed...
  • Burzynski Research Institute Clinical Trials Home Page http://www.cancermed.com/ (accessed...
  • M.S. Micozzi

    Characteristics of complementary and alternative medicine

  • R. Dunne et al.

    Complementary medicine — some definitions

    J Roy Soc Health

    (1997)
  • The physician and unorthodox cancer therapies

    J Clin Oncol

    (1997)
  • L.M. Friedman et al.

    Introduction to clinical trials

  • T.J. Kaptchuk et al.

    Complementary medicine: efficacy beyond the placebo effect

  • Cited by (18)

    • A community of healing: Psychosocial functions of integrative medicine perceived by oncology patients/survivors, healthcare professionals, and CAM providers

      2013, Explore: The Journal of Science and Healing
      Citation Excerpt :

      Furthermore, the integrative approach helps patients become more proactive in maintaining their health through proper diet and exercise.1 However, there are issues regarding methods of measuring the effectiveness of IM.2–7 For example, it would be difficult to measure the effects of the program as a whole with a reductionist approach, such as randomized controlled trials (RCTs), which examine a single, specific component of an intervention solely by using the tools of evaluative research in biomedicine.

    • The Marriage of Conventional Cancer Treatments and Alternative Cancer Therapies

      2008, Revista Espanola de Cirugia Ortopedica y Traumatologia
      Citation Excerpt :

      In CAM research, the goal and major challenge are the same—to ensure a methodologically meticulous trial without compromising the modality in a manner that is incomplete or inappropriate. The continued challenge is not that randomized controlled trials (RCTs) be used but rather how best to apply RCT results [40]. EBP in CAM requires a delicate and complex balance [38,39].

    • Methodological issues and complementary therapies: Researching intangibles?

      2003, Complementary Therapies in Nursing and Midwifery
    View all citing articles on Scopus
    View full text