REGARDLESS of whether doctors like it or believe in it, complementary and alternative medicine is used by more than half of all Australians each year.
Uptake among chronically ill patients is often greater, with up to 65% of Australian cancer patients using complementary and alternative medicine (CAM) to complement standard treatments rather than as an alternative to conventional treatments.
What’s worrying, though, is that many patients do not talk about their CAM use with doctors — only one-third of primary care patients consult their GP and as few as 20% of cancer patients discuss it with their specialists.
There are many stumbling blocks for patients in talking about CAM with doctors. They range from the very real prospect of receiving a negative or indifferent response, to doctors simply not asking about CAM, through to the worrying belief of many patients that CAM is entirely “natural” and safe alongside conventional treatment.
Doctors need to nurture an environment where patients can talk about their use of CAM without fear of disapproval, if for no reason other than the prospect that their use may cause serious drug interactions with conventional treatments or adverse side-effects on their own.
A recent systematic review that I carried out sheds more light on the safety risks of CAM use to cancer patients.
The safety and efficacy of over 50 individual complementary and alternative therapies were evaluated across more than 300 meta-analytic and systematic reviews. Weighing up risk versus benefit, the top 10 therapies that cancer patients should be discouraged from using are St John’s wort, laetrile/amygdalin/vitamin B17, kava, ginkgo biloba (EGb 761), lingzhi/reishi mushroom, green tea, ginseng, black cohosh, shark cartilage and garlic.
Generally, botanical agents pose the greatest risk of harm to cancer patients. In particular, their use as unproven alternative therapies (eg, laetrile/amygdalin) in place of conventional medicine should be strongly discouraged.
Some herbal medicines, dietary supplements and other “natural” therapies have toxic and potentially life-threatening effects (eg, laetrile/amygdalin can cause cyanide poisoning and death; kava and black cohosh may cause liver problems). Others interact with chemotherapy and prescription drugs (eg, St John’s wort potentially interacts with 70%–80% of all prescription medicines, and reduces the efficacy of some chemotherapy drugs). Some cause complications during radiotherapy and surgery (eg, garlic, ginkgo biloba and ginseng may increase bleeding).
That said, we shouldn’t tar all CAM interventions with the same brush as there is substantial evidence to support the safe and effective use of some interventions. Clinical trials have shown that some therapies, when used in support of conventional treatments, are beneficial in reducing symptoms or emotional distress and improving the quality of life of cancer patients.
Weighing up risk versus benefit once again, the top 10 most effective and safe therapies from my review for people with cancer are relaxation techniques, support groups led by health professionals, physical activity programs, music therapy, meditation (including mindfulness), acupuncture, massage, omega-3 fatty acids, yoga and ginger (combined with prescription antiemetics).
Generally, mind–body and manipulative/body-based therapies have the greatest potential for benefit among cancer patients. Relaxation techniques, for example, are the most effective non-pharmacological approach for the relief and prevention of depression and anxiety in patients undergoing cancer treatment.
Relaxation can also reduce nausea/vomiting, cancer-related pain and fatigue and, in respiratory cancer patients, breathing difficulties. Physical activity programs involving aerobic or resistance exercise can also be particularly beneficial for physical/emotional wellbeing and fatigue, even in metastatic cancer patients.
Patients may seek guidance about CAM therapies and medical practitioners are in the prime position to provide this. Therefore, doctors ought to be educated about CAM.
Medical schools and hospitals should integrate teaching about CAM into medical training. Doctors need to become familiar with websites and online databases that provide information about the wide range of therapies available. The Cancer Council Australia and Australasian Integrative Medicine Association are good starting points.
Cancer specialists should consider offering access to safe and effective complementary therapies (or at least safe forms of them) alongside conventional treatments through their own cancer services.
As long as complementary therapies used by cancer patients are safe and under medical supervision, where is the harm? Hippocrates once said: “As to diseases, make a habit of two things — to help, or at least, to do no harm.”
When patients don’t feel that they can talk about CAM with their doctors for fear of disapproval and doctors don’t routinely take the time to ask, is that likely to help or harm the patient with cancer? It’s certainly a question every doctor should ponder.
Carlo Pirri is a research psychologist/consultant and PhD candidate based at Murdoch University, Perth. He is a working party member of the Complementary and Integrated Therapies Interest Group established by the Clinical Oncological Society of Australia.
Posted 25 February 2013Sorry, there are no polls available at the moment.