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Complementary and Integrative Medicine for Cancer Patients a Purely Ideological Debate?

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Complementary and Integrative Medicine for Cancer Patients a Purely Ideological Debate? Risks & Benefits © Maddalena Carrai Complementary and integrative medicine for cancer patients A purely ideological debate? With studies showing that around half of all cancer patients use therapies that are not part of mainstream medicine, Cancer World Editor Alberto Costa explores some aspects of the discussion on what complementary and integrative medicine can offer cancer patients, and the supporting evidence behind a range of options. ancer patients have been patients using complementary or used along with standard medical turning to complementary alternative therapies in countries with treatments but are not considered to Cand integrative medicine in the lowest use, rising to three in every be standard treatments. ‘Integrative ever increasing numbers over recent four patients in countries with high use medicine’ denotes a total approach to decades. A survey published in 2005 (Ann Oncol 2005, 16:655–63). medical care that combines standard found that levels of use varied across The term ‘complementary medicine’ medicine with the complementary/ Europe, with around one in four cancer is used to denote therapies that are alternative practices that have been 34 May / July 2017 Risks & Benefits shown to be safe and effective. They Breast Cancer Specialists (EUSOMA) patients rely mainly on the advice given treat the patient’s mind, body, and published a report and recommenda- by other patients, family members and spirit. tions on the use of complementary and friends or on information extracted Integrative medicine is interdiscipli- alternative medicine (CAM) in caring from the internet.” nary, using the skills of several health- for patients with breast cancer (Eur J Clinical practice guidelines have care disciplines through referral and Cancer 2006, 42:1702–10; ibid 1711– also been published on the use of consultation. It emphasises using the 14; Eur J Cancer 2012, 48:3355–77). integrative therapies in the supportive individual’s capacity for self-healing in These recommend that all patients care of patients treated for breast cancer an approach that is personalised, col- with breast cancer should be treated (JNCI Monographs 2014, 50:346– laborative and comprehensive. by multidisciplinary teams that provide 58), on the use of complementary The National Center for Comple- the best chances of cure, palliation, and therapies and integrative medicine mentary and Integrative Medicine psychosocial and spiritual support. in lung cancer (Chest 2013, 143 (5 (NCCIM), within the US National The recommendations also suggest Suppl):e420–36) and on exercise for Institutes of Health, includes a range of that clinical case histories and ran- cancer survivors (Med Sci Sports Exerc therapeutic approaches under the head- domised trials should contain modules 2010, 42:1409–26). ing of complementary and integrative that identify patients’ belief systems medicine, many of which are listed in about complementary and alternative the table below. medicine, and establish whether it is CIM use in advanced disease: NCCIM distinguishes between being used concurrently, and support the case of pancreatic cancer natural products and mind–body open and factual discussions about it. practices, and defines its own role as A study of the use and experiences With so many new drugs being determining, “through rigorous scientific of complementary and alternative introduced into clinical practice to investigation”, the usefulness and safety medicine (CAM) among breast cancer prolong survival in advanced cancer, of complementary and integrative patients stated that the findings health interventions and their roles in “underscore the results obtained in improving health and healthcare. other studies, such as high overall Complementary and Complementary and integrative use of CAM in breast cancer patients integrative approaches* (CIM) approaches are more likely to and the association of CAM use with □ Aromatherapy be used by female patients, and those younger age, higher education and more □ Chiropratic/Osteopathy who are younger, white, more highly advanced clinical stages,” adding that, □ Hypnotherapy/Guided educated and on a higher income. “This study clearly demonstrates the Imagery Patients use these types of therapy role of information sources outside the □ Yoga/Meditation for many reasons, including improving medical system, sometimes reinforced □ Massage physical symptoms, supporting emo- by negative experiences within the □ Music and Dance therapy tional health, boosting the immune sys- oncology speciality system,” (Eur J □ Biofeedback tem and improving quality of life. Some Cancer 2012, 3133–39). □ Ayurvedic medicine patients use CIM to relieve the side “Given the prevalence of CAM □ TCM [Traditional Chinese effects of conventional cancer treat- use and the restraints patients felt,” Medicine] – Acupuncture ments or to obtain a more holistic treat- the authors conclude, “every attempt □ Homeopathy ment, while others may be hoping to should be made by oncologists to □ Phytotherapy gain better control of their disease. initiate communication about CAM □ Qi gong – Tai chi pro-actively (including the provision □ Reiki of information regarding possible □ CIM use in breast cancer Reflexology supportive options and cautioning □ Diet Supplementation about the potential harm of some of Women with breast cancer have these therapies), rather than letting *Some of the treatments included in the CIM definition used by the US National particularly high rates of use of com- breast cancer patients slip into an Institutes for Health NCCIM (https:// plementary, integrative and alternative alternative world seemingly detached nccih.nih.gov/health/integrative- therapies. The European Society of from conventional medicine, where health#integrative) May / July 2017 35 Risks & Benefits 2017, states: “The use of mistletoe as Viscum album extracts in advanced pancreatic cancer a treatment for people with cancer has been investigated in clinical studies. Reports of improved survival and/ or quality of life have been common, but nearly all of the studies had major weaknesses that raise doubts about the reliability of the findings. At present, the use of mistletoe cannot be recommended outside the context Survival probability Survival of well-designed clinical trials. Such trials will be valuable to determine more clearly whether mistletoe can be useful in the treatment of specific subsets of cancer patients.” Months at risk Flashpoints in the CAM/CIM The findings of a prospective trial of 220 patients with metastatic pancreatic cancer debates randomised to Viscum album L extract or placebo VaL – Viscum album L extract Source: W Tröger et al (2013) Eur J Cancer 49:3788–97, republished with permission from Elsevier While the potential of mind–body therapies such as Tai chi, meditation and massage to improve patient wellbeing the whole perception of metastatic EORTC (European’s leading cancer attracts little controversy, the same disease is changing. From the passive clinical trials organisation), EUSOMA, cannot be said for all complementary resignation of the past, clinical oncology (the European Society of Breast Cancer and alternative therapies. is moving to a point in which the fight Specialists) and ECCO (representing against the disease continues well Europe’s professional cancer societies), Alternative or complementary? beyond the transition to the metastatic whose editor in chief, Lex Eggermont, The key message to cancer patients stage, no matter how much this will has a strong reputation for both his is that using alternatives to standard cost, both financially and emotionally rigorous scientific approach and his proven therapies to treat the cancer for patients and their caregivers. attention to the emerging field of is extremely risky – Cancer World has With the exorbitant price tag immuno-oncology in advanced disease. republished two articles by Bernhard new drugs attach to every additional The paper describes a significant Albrecht, a German doctor-journalist month of survival, it may be expected survival benefit in a prospective who investigated the tactics used by that people will increasingly turn to randomised phase III trial in 220 people who promote these sorts of alternatives in the hope of obtaining patients with locally advanced or ‘alternative anti-cancer treatments’ similar results. One potential candidate metastatic pancreatic cancer, with a (‘In the jungle of the miracle healers’, will be mistletoe which, alongside median overall survival of 4.8 months Cancer World 50 Sept–Oct 2012, other natural compounds such as for patients receiving Viscum album L ‘Dangerous healers’, Cancer World 69 curcumin, has been used medicinally extract compared with 2.7 months Nov–Dec 2015). for thousands of years and is a key part for patients on no anti-cancer therapy Complementary therapies, by of some complementary/alternative (HR 0.49, 95%CI 0.36–0.65) (Eur J contrast, taken in addition to standard practitioners’ armoury. Cancer 2013, 49:3788–97; see figure approved anti-cancer treatments, A quite surprising paper on mistletoe above). could be beneficial or ineffective, (Viscum album extract) in advanced On the other hand, a very recent but they could also be harmful if they pancreatic cancer was quietly published statement by the US National Cancer interact biologically with the standard a few years ago by the European Journal Institute’s PDQ (Physician Data treatments. The advice to patients is: of Cancer. This is the official journal of Query service), updated on February
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