Alternative and Complementary Therapy

Alternative and Complementary Therapy Alternative and Complementary Therapy Author: Ayda G. Nambayan, DSN, RN, St. Jude Children’s Research Hospital Content Reviewed by: Emma deVilla, MA, RN, Nursing Instructor, Capital Health System School of Nursing, Trenton, New Jersey Cure4Kids Release Date: 17 February 2006 Introduction: When a child is diagnosed with cancer, it sends the life of the child and the child’s family in a new direction. A significant and growing number of patients with cancer are seeking therapies outside conventional medicine (A -1). In some cultures, non-traditional US medicine is the initial mode of therapy: patients and families seek the help of a medicine man before going to see a physician. A partner site needs survey done by St. Jude International Outreach Program, determined that approximately 70 % of the patients served by these sites use one or more form of alternative and/or complementary therapy along with their cancer treatments. The term complementary and alternative medicine (A -2 CAM) often refers to a broad and complex combination of interventions; other names used to describe these interventions include 1. Holistic 2. Unorthodox 3. Unconventional 4. Natural 5. Traditional 6. Non-traditional CAM practitioners emphasize wellness rather than treatment of disease, healing (health restoration; to return to a sound state) rather than cure (getting rid of the disease; recovery from disease), and focus on the whole person rather than the systems of the body. Complementary therapies are commonly used by cancer patients not to treat their cancer but to enhance their quality of life by reducing treatment side-effects, enabling self-care, and enhancing well-being. Patients also report increased feelings of control over their disease and self-management. Contrary to common belief that the use of CAM delays medical treatments, studies that examine cancer patients use of CAM report non-association of CAM use with perceived distress or poor compliance with medical treatment. Instead, cancer patients seem to consider CAM as supplementary to standard therapy, a way of avoiding passivity and a way of coping with feelings of hopelessness (Astin, JD 2002; Montbriand, M 1995). Module 4 - Document 9 Page 1 of 11 Alternative and Complementary Therapy This document differentiates complementary and alternative therapies. Complementary therapy is defined as one that is used in addition to conventional medical treatment. Examples of complementary therapy are massage, music, and stress reduction techniques. Alternative therapies are treatment modalities used by patients instead of the conventional treatments. Examples of these therapies include the use of snake venoms and coffee enemas. Alternative therapies are generally considered to be unproven therapies (A – 3), are considered by the medical profession to have no therapeutic value, and often reflect the fear, the patient’s hopelessness, and sense of helplessness.. A major danger of using unproven therapies is that it delays the patient’s efforts to seek conventional treatments. Further, since there are limited studies done in this area, little is known about how they actually interact with the cancer and it’s conventional treatments. Evidence of their efficacy often comes from patient and family testimonials that are not easily verified. Thus, the current thinking about alternative therapies for cancer creates divergent viewpoints, from enthusiastic acceptance to the belief that they are all “quack medicine”. This divergence can confuses the nurse, who is often the first person the patient asks about alternative therapies for cancer. Mind-Body Medicine Psychoneuroimmunology (PNI) is the study of the complex interrelationships among behavior and the neural, endocrine, and immune systems. It postulates that psychosocial interventions such as social support and reduction of hopelessness and helplessness in cancer patients is correlated with longer life and subjective report of increased quality of life. Examples of PNI: Stress Management Progressive muscle relaxation Meditation Talk therapy (including journaling) Imagery Therapeutic massage Physical Exercise The patient should consult with the health care provider before starting an exercise program. The pace of exercise should initially be slow, (walking 5 minutes twice a day) and gradually increase. Recent studies have suggested that a regular pattern of exercise in cancer patients is efficient in managing treatment-related fatigue. Nutrition and Diet Patients should investigate the credibility of any complementary nutritional program before they start it. Trustworthy nutritional programs do not claim that they cure disease. And while some dietary and nutritional supplements might benefit cancer patients, these treatments should be used judiciously. Some diets, vitamins, and supplements could have both positive and negative effects in patients with certain types of cancer and its treatments. Module 4 - Document 9 Page 2 of 11 Alternative and Complementary Therapy Macrobiotic Diet This is a mostly low-calorie vegetarian diet. that may contribute to weight loss and create nutrition imbalances that can threaten the health of an already compromised patient. Vitamin and Mineral Supplements (A – 4) There is evidence that vitamin and mineral supplements might benefit cancer patients. However, it is also possible that some diets and supplements could have negative effects in some individuals with certain types of cancer. Coffee Enemas (A – 5) These treatments are believed to dilate the bile ducts, thus facilitating excretion of products caused by toxic cancer breakdowns. It is also believed that coffee enemas detoxify the liver by rapidly emptying the colon and stripping the gut of harmful bacteria and pollutants. Patients receive coffee enemas up to 2 – 4 times daily to boostthe body’s immuneresponse against cancer. A – 6 Traditional Chinese Medicine (TCM) Providers of TCM consider these treatments compatible with conventional therapies and helpful with the side-effects of chemotherapy and radiation. The aim of these treatments is to restore Qi (the vital energy) in the body. (Qi has currently has no scientific basis.. TCM reflects some of the fundamental differences that exist between the Chinese and Western medical systemsExamples of TCM are acupuncture, moxibustion and herbals. The Nurse’s Role Patients and families often ask the nurses for their opinion on a specific alternative or complementary therapy. The nurse should listen and be non-judgmental during these discussions. The role of the nurse as patient advocate is to offer to educate patients and families considering alternative or complementary therapies and to refer patients to appropriate resources. Because there are conflicting opinions about complementary therapies, nurses should have a deeper understanding of the benefits and risks of these treatments than the popular ideas held by the general public. The use of alternative and complementary therapies is generally linked to with the belief systems of patients and their families. Culture and ethnicity strongly influence an individual's interpretation or perception of health and illness; and religion, ethnicity, and culture contribute to an individual’s responses to a particular treatment. In some cultures, science-based medicine is the acceptable treatment for disease. But many patients combine science-based medicine with alternative or complementary therapies common to their own culture. Therefore, it is imperative that the nurse assess patients’ beliefs and use of non-traditional therapies. Nurses learn best from patients: simple assessments of patients’ and families’ cultural beliefs and values can provide insights into the use of alternative and/or complementary therapies. Further, developing a trusting relationship with the patients and family, and being non- judgmental toward alternative/complementary therapies often makes patients willing to share with nurses their use and experiences with these therapies. Module 4 - Document 9 Page 3 of 11 Alternative and Complementary Therapy Helpful Web Links Oncology Nursing Society Multicultural Toolkit: A hands-on product that applies the ONS multicultural guidelines. The Microsoft PowerPoint slides contained in this toolkit will help you understand the role of culture and ethnicity in health care. It will also help you to assess your cultural awareness and sensitivity. (NB: You would need Adobe Acrobat Reader to view some of the files. It is a free download from: Multicultural Toolkit http://www.ons.org/clinical/Treatment/Toolkit.shtml The University of Texas MD Anderson Cancer Center, Houston, TX This site contains definitions of terms commonly used in complementary and alternative therapies. http://www.mdanderson.org/departments/cimer/dindex.cfm?pn=7b632e4a-56b2-11d5-812100508b603a14 This MD Anderson website on Alternative and Complementary therapy provides an extensive review of: Alternative Medical Systems, Biologic/Organic/Pharmacologic, Energy Therapies, Herbal/Plant Therapies, Manipulative & Body-Based Methods, Nutrition & Special Diets http://www.mdanderson.org/departments/cimer/dindex.cfm?pn=6eb86a59-ebd9-11d4-810100508b603a14 Transcultural Nursing [email protected] This website contains information about the difference between Western traditional and non-traditional therapies and their implications in the care of the patient. http://www.culturediversity.org/healer.htm National Cancer Institute Complementary and Alternative Therapy

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