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The Use of Complementary and Alternative Medicine in Scandinavia ANTICANCER RESEARCH 36: 3243-3252 (2016) Review The Use of Complementary and Alternative Medicine in Scandinavia JONAS NILSSON1,3,4, MIKAEL KÄLLMAN2, ULRIKA ÖSTLUND1, GEORG HOLGERSSON1,2, MICHAEL BERGQVIST1,2,3 and STEFAN BERGSTRÖM1,2 1Centre for Research and Development, and Departments of 2Oncology, and 4Radiology, Gavle University Hospital, Gavle, Sweden; 3Department of Radiation Sciences and Oncology, Umea University Hospital, Umea, Sweden Abstract. Background: Complementary alternative attending cancer clinics in northern Europe (and especially medicine (CAM) is widely used among patients with cancer. Sweden) (2, 3). The explanation for this may be This usage may have potentially harmful effects, especially multifactorial, with both a perceived lack of interest from when combined with anticancer drugs. However, some attending healthcare professionals, as well as unease from complementary methods may benefit patients. This review patients in telling their healthcare professional about the investigated the prevalence of CAM use among patients with CAM that they are taking (4). In the present review article, cancer in Scandinavia and secondly studied the educational we compiled a comprehensive list of available studies levels of CAM users compared to non-users. Materials and investigating the usage of CAM in Scandinavian patients Methods: A systematic search of the PubMed library was with cancer with the aim of determining the percentage of carried out to locate articles published between January such patients that regularly use CAM. 2000 and October 2015 that investigated prevalence of CAM use among Scandinavian patients with cancer. Results: What is CAM? According to the United States National Twenty-two articles were found, of which nine were included Centre for Complementary and Alternative Medicine in the review. The prevalence of CAM use was 7.9% to 53%, (NCCAM), CAM is defined as healthcare outside with an average of 36.0% across all studies. Conclusion: conventional proven medicine. There is however a difference Use of CAM is widespread among patients with cancer. between 'complementary' and 'alternative' medicine. The Knowledge about CAM should be disseminated to both term 'complementary' is used when patients use non- patients and staff in order to optimise discussions about mainstream practice as a complement to conventional CAM in clinical practice. medicine. The term 'alternative medicine', on the other hand, is used when non-mainstream healthcare practice is used The role of complementary and alternative medicine (CAM) instead of proven mainstream therapies. When patients with has continuously increased in Swedish society, with an cancer choose alternative medicine instead of conventional increasing number of shops selling alternative and therapy, they risk delaying primary treatment. Consequently, complementary remedies (1). Despite this fact, the medical potentially curable early stages of cancer may progress and community has not recognised this as an important issue become fatal (5). and CAM is not a topic that is discussed with patients In recent years, the term CAM has been challenged and numerous studies suggest that it should be changed. In a review article by Cassielth et al., the following reason was cited: “This controversial term should be changed, since the This article is freely accessible online. words ‘complementary’ and ‘alternative’ have different meanings and should not be connected by ‘and’ ” (5, 6). Correspondence to: Jonas Nilsson, MD, Department of Radiology, Alternatively, when the use of conventional cancer therapy Gävle Hospital, SE-801 87 Gävle, Sweden. Tel: +46 26154000, e-mail: [email protected] combined with complementary methods aims to reduce symptoms, the term 'integrative oncology' is more adequate. Key Words: Complementary alternative medicine, CAM, The use of non-proven healthcare, regardless of being Scandinavia, review. complementary or alternative, is divided into several 0250-7005/2016 $2.00+.40 3243 ANTICANCER RESEARCH 36: 3243-3252 (2016) subcategories. The first subcategory is that of natural patients with a poorer quality of life including symptom products, such as herbs, vitamins, probiotics etc., that are progression use CAM (14, 15). Studies in the last decade often sold as healthy dietary supplements, whereas some of have shown that patients who use CAM have higher levels of these supplements may in fact be harmful (7). 'Miracle cures' anxiety, pain, depression, dissatisfaction with conventional such as amygdalin and caesium chloride have not only care and a lower quality of life than non-users (16, 17). shown lack of efficiency in clinical studies, they may also However, involvement in medical decision-making of cause cyanide toxicity and potentially lethal cardiac conventional medicine does not seem to affect the decision arrhythmia (5). to use CAM (18). Oncology health professionals may also The second subcategory is that of mind and body use CAM. Kolstad et al. showed in a national multicentre practices, such as mind-body therapies, acupuncture and survey from Norwegian health professionals that about 20% manipulative and body-based practices. of oncologists and 50% of nurses used CAM of some sort Mind-body therapies such as meditation, relaxation, (19). hypnotherapy, yoga, tai chi, music therapy and qigong have Patients using CAM do not necessarily mistrust shown beneficial effects on anxiety reduction, improvement conventional drugs. The principles of anthroposophic of quality of life and sleep. medicine are that, frequently, conventional medicine is not Acupuncture has been evaluated as a safe method of enough to reach 'true healing'. In order to achieve this, the improving symptoms such as pain, chemotherapy-induced patients must use complementary methods, such as bodily nausea, and radiation-induced xerostomia, and its inclusion practices or a variety of natural products (20). in multimodal management plans of patients with cancer has Patients, however, are not very keen to tell physicians been suggested (5). about their use. Reasons for this nondisclosure were Manipulative and body-based practices such as Swedish investigated by Eisenberg et al., and the majority of patients massage, shiatsu, tui na, reflexology, Thai massage, reported their reason for nondisclosure as “It wasn’t important Ayurvedic massage, lymphatic drainage and myofascial for the physician to know” (61%) and “The doctor never release have shown beneficial effects on pain and anxiety, asked” (60%). However, only 14% reported that they thought however, these results were based on clinical trials with poor the doctor would disapprove of or discourage their use of research methodology (5). CAM (4). Other complementary health approaches that do not fit into the subcategories listed above include traditional Use of multiple CAM therapies. Several studies have healers, homeopathy, naturopathy etc. (8). highlighted that patients using CAM often use a variety of several different CAM therapies at the same time (21, 22). This makes it difficult to evaluate both positive and adverse Are CAM therapies harmless? Not all patients are aware that effects of the diverse substances and practices. the use of non-proven therapies is not harmless. There are several potentially harmful natural products that may interact Aim of study. The aim was to characterize in a structural with anticancer drugs. For example, Sparreboom et al. manner the available literature concerning CAM-use among described how the natural products Allium sativum, Ginkgo Scandinavian cancer patients, which according to our biloba, Echinacea purpurea, Panax ginseng, Hypericum knowledge never has been done before. perforatum and Piper methysticum all had the potential to modulate the activity of drug-metabolizing enzymes such as Materials and Methods cytochrome p450 and the drug transporter P-glycoprotein, hence they can potentially have pharmacokinetic interactions Electronic database searches and article selection strategy. We with anticancer drugs (7). Furthermore, Rakovitch et al. searched for articles published from January 2000 until October 2015 in international peer-reviewed journals through a systematic conducted a study including 251 patients with breast cancer, search of PubMed. The MeSH terms used were: complementary of whom 43% used CAM. The authors showed that the alternative medicine AND patients with cancer AND survey AND patients that used CAM had a significantly higher risk of Scandinavia. We excluded all studies not written in the English cancer recurrence and death than non-users (9). It has also language. We also excluded studies based on patients without been suggested that fewer than half of all CAM users consult cancer, as well as studies that did not investigate prevalence of their healthcare professionals about their CAM use (3). CAM use among their subjects. Data extraction. For each selected article, the following data were Who uses CAM and why? Several studies have indicated that extracted: types of cancer among the subjects, number of subjects the typical CAM-users are younger, highly educated female included, gender, participation rate/response rate, use of CAM (%) individuals (10-12). CAM users have a higher income and among the subjects, median age, type of anthroposophic therapy, overall higher social status than non-users (13). More often, demography and educational levels among CAM users. 3244 Nilsson et al: Review of Complementary Alternative Medicine Use in Scandinavia (Review)
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