Complementary and Alternative Medicine for Patients with Cancer [Internet]
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In Norway more than a third of all patients with cancer use some form of complementary or alternative therapy (CAM). In order to support The Norwegian Cancer Society’s work with information in this field we have identified and summarized 39 systematic reviews on the efficacy and safety of some main complementary and alternative therapies for patients with cancer.The Norwegians law from 2003 gives the following definition of alternative treatment; Alternative treatment means health-related treatment as practiced outside the health service and are not performed by licensed health care professional. Treatment that is exercised in the health service or by an authorized health care providers, however, covered by the term alternative treatment when used methods which are mainly used outside the health service. When patients use alternative therapies in addition to the treatment they receive at the hospital, it is also called complementary or integrated treatment.We searched for systematic reviews documenting efficacy and safety of complementary and/or alternative therapy (CAM) used among patients with cancer. We included systematic reviews of the following methods or therapies: Vitamins and minerals, food supplements, different types of herbs (also pharmacologically produced), acupuncture, reflexology, massage, aromatherapy, hypnosis, homeopathy, traditional Chinese medicine, and various body and mind techniques.The evidence from these 39 systematic reviews, with a few exceptions, was generally of low quality, and most results are uncertain.There is a lack of evidence for the efficacy and safety for most types of alternative methods for treatment and symptom relief for patients with cancer. For some of the alternative treatment methods there is evidence of adverse events. Further research is required. When it comes to safety, it should be considered whether it is justifiable to carry out major new studies with measures that have shown serious side effects.Keywords:
Reflexology
Aromatherapy
Cancer Treatment
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Pain may be a major cause of physical and emotional distress in chronic pediatric conditions, including cancer, juvenile arthritis, and cystic fibrosis. Complementary and alternative medical (CAM) therapies have become important and frequently used modalities in treating children's pain. Yet, many practitioners have questioned whether there is sufficient evidence to support the efficacy and safety of CAM approaches for pain relief. This chapter aims to address these concerns by presenting a critical review of the available published evidence. We evaluated published studies testing CAM interventions for chronic or acute procedural pain; these study methodologies employed either controlled trials or multiple baseline studies. The evaluation criteria were developed by the American Psychological Association Division 12 Task Force on Promotion and Dissemination of Psychological Procedures to assess nonpharmacological therapies. Few of the CAM modalities qualify as empirically supported therapies under these rigorous criteria, although several met the standard for possibly efficacious or promising for pediatric pain. Our review of the published literature revealed a number of methodological flaws in existing studies. Clearly, more research on CAM therapies for children's pain is needed.
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Complementary and alternative medicine (CAM)—which is typically described as being outside of orthodox medicine—consists of a broad spectrum of interventions that aim to promote health and wellbeing and to treat illness. More than 70% of the world's populations rely on some form of CAM for health care, mainly as a compliment to standard care or as a second-line treatment after trying first-line alternatives. The use of CAM is especially common among women of reproductive age, and many of these patients seek out nonmedical treatments and interventions. There have been some benefits reported for women's use of CAM for reproductive health, and recent studies have shown that several different CAM strategies could be beneficial as adjuncts to the conventional medical management of reproductive disorders in women.
Although CAM is widely used among women, strong evidence for its effectiveness is still lacking and the underlying mechanisms behind its effects remain unsolved. The limitations of CAM studies include small sample sizes, nonrandomized or uncontrolled samples, and the self-selected nature of the participants. Thus there is only a low level of support for evidence-based applications of CAM in women with reproductive conditions, and more studies investigating the efficacy, effectiveness, and mechanisms of action of different forms of CAM are needed. We put out a call for papers, and this resulted in the six review articles included in this special issue that cover current CAM therapies for infertility, endometriosis, miscarriage, genital inflammation, and issues associated with delivery.
In this special issue, we have published two reviews describing the evidence that CAM can improve pregnancy rates in subfertile women undergoing in vitro fertilization (IVF) and can be beneficial for inducing ovulation in patients with polycystic ovary syndrome (PCOS). “The effect of complementary and alternative medicine on subfertile women with in vitro fertilization”, by Y. Zhang et al., describes the current evidence for the effects and mechanisms of Chinese herbal medicine, acupuncture, psychological therapies, temperature therapies, and other CAM therapies on improving the success rate of IVF. PCOS is the most common ovulatory disorder in reproductive-age women. “Polycystic ovary syndrome: effect and mechanisms of acupuncture for ovulation induction”, by J. Johansson et al., addresses acupuncture as a potential treatment option for reproductive and endocrine disturbances in women with PCOS. Several studies described in this review indicate that acupuncture is beneficial in treating the ovulatory dysfunction associated with PCOS.
CAM has long been regarded as an effective and safe way to decrease the risk of miscarriage and to maintain a successful pregnancy, and Chinese herbal medicine has become a popular and common form of CAM for the prevention of miscarriages. In “Systematic review of Chinese medicine for miscarriage during early pregnancy”, L. Li et al. have identified 39,792 relevant pieces of literature for review and they summarize the clinical applications of Chinese herbal medicine during pregnancy. Based on this evidence, they suggest that Chinese herbal medicine combined with Western medicine can be effective in preventing miscarriage and relieving its clinical symptoms, but Chinese herbal medicine alone might not be effective. Rigorous scientific and clinical studies are necessary, therefore, to confirm the effectiveness of Chinese herbal medicine.
In S. Kong et al.'s review “The complementary and alternative medicine for endometriosis: a review of utilization and mechanism”, they assess the role of CAM on endometriosis and provide evidence from a number of clinical and experimental studies for both the therapeutic efficacy of CAM and possible mechanisms for these effects. The CAM therapy for endometriosis includes herbs, acupuncture, microwave-physiotherapy, Chinese herbal medicine enema, and psychological interventions. These CAM therapies are effective at relieving dysmenorrhea, shrinking adnexal masses, and improving pregnancy rates with fewer unpleasant side effects compared to standard hormonal and surgical treatments.
Genital infection is a very common gynecological condition. In “Applications and therapeutic actions of complementary and alternative medicine for women with genital infection”, C. Liu et al. review the current progress of using CAM therapies to treat genital infections such as vulvitis, vaginitis, cervicitis, and pelvic inflammatory disease. They also introduce traditional Chinese medicine, psychological intervention, and physical therapy as treatments for endometriosis.
“Analyzing the study of using acupuncture in delivery in the past ten years in China”, by Y. Chen et al., provides a review of 87 articles published from 2002 to 2012. Clinical research indicates that acupuncture relieves labor pain, induces maternal uterine contractions, shortens the birthing process, and treats postpartum complications. Preclinical research has found that acupuncture can modulate certain hormones and improve uterine contractions in late-stage pregnant rats.
Despite the evidence provided in these reviews, large, multicenter, and well-designed randomized controlled trials (RCTs) are needed to evaluate the effectiveness and safety of CAM treatments for human reproductive issues. It is important to have more RCTs that are performed following the standards for reporting interventions in clinical trials and fewer commercially driven RCTs, especially CAM clinical trials. These clinical trials should be reported in accordance to the Consolidated Standards of Reporting Trials (CONSORT) protocol in the various areas of reproduction. This would improve the reporting of RCTs and make it easier to understand a trial's design and conduct and to assess the validity of its results.
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Despite substantial progress in biomedicine, a majority of advanced cancer diseases currently cannot be cured. In addition to conventional medical symptom management (palliation) and improvement of quality of life, methods of complementary medicine and supportive psychotherapy are increasingly applied. Whereas the efficacy of biomedical and psychotherapeutic interventions has been documented, controlled investigations of complementary methods are rare and their efficacy is poorly documented or is viewed controversially. Complementary methods are defined as methods applied by conventionally trained physicians and are based on tradition, or the perspective of human arts, which are not investigated or taught at universities. As an example of the latter, anthroposophic medicine is presented. Finally, we present a project developed within the scope of NFP 34, where the efficacy of a routine biomedical treatment is compared with an additional anthroposophic and psychotherapeutic intervention respectively.
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Modern medicine regularly uses the products of science to improve health. Until recently, however, medicine itself has not been practiced in a scientific manner. The growth of evidence-based medicine is predicated upon the concept that insofar as possible, all aspects of medical care ought to be examined with regard to the evidence. All forms of treatments and preventive strategies should be subjected to assessments of efficacy and effectiveness. Efficacy is demonstrated in the day-to-day practice of medicine. An evaluation of effectiveness may lead to one or more randomized clinical trials, where the results of these randomized clinical trials may be necessary to maximize effectiveness. From a health care perspective, safety must be assessed, not only with regard to adverse effects of the particular intervention, but also in the context of a comparison to alternative treatments. If evidence demonstrates the efficacy and/or effectiveness of a particular intervention, it may be unsafe to select a treatment for which evidence of efficacy or effectiveness is lacking. Certainly patients should be fully informed of the evidence that is available for making rational choices. Alternative and complementary modes of medicine should be subject to these principles. The history of digitalis glycosides provides an interesting example of an important treatment arising from herbal medicine, by which many of these elements can be exemplified.
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The use of complementary and alternative medicine (CAM) by patients with inflammatory bowel disease (IBD) is common. Physicians and scientists believe that the randomized controlled trial (RCT) provides the best evidence of an intervention's efficacy. However, there are only a few controlled trials that have assessed these therapies in IBD and all contain methodological problems. The RCT does not always fit well with the underlying principles of disease causation and treatment of CAM. Many forms of CAM take a holistic approach to the diagnosis and treatment of disease, where the patient plays an active and key role in healing and treatments are often highly individualized. Therefore, the use of placebos, blinding, and random allocation to structured treatment protocols in an RCT setting is often contradictory to the principles of CAM. We still know relatively little about the use of CAM in IBD. Prior to embarking upon a program of clinical trials to evaluate these therapies, a better understanding of the specific therapies being used, reasons for their use, and their potential side effects is required. We also need to understand how the CAM practitioners use their therapies, what they view as the appropriate indications, and how treatments are best administered.
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Although extensive studies have indicated that the benefits of hormone replacement therapy outweigh the risks, many women and health care providers have concerns about safety and side effects. Many alternative therapies are popular with patients, and menopausal women in the United States spent more than $600 million in 1999 alone purchasing these therapies. Several of the more commonly used alternative therapies for the menopause are critically appraised in this article. For women who choose not to take estrogen, and for those who do, the additional benefits of calcium, vitamin D, exercise, stress reduction, and different dietary and lifestyle adaptations may enhance the quality of life as they age. Although they have the potential for being effective and safe options, there has been limited clinical research for the other alternative therapies. Gynecologists and other health care providers should be aware of the lack of evidence for the effectiveness of most of these therapies when they address patient's questions and concerns. Our information about alternative therapies will increase in the coming years. Ultimately, the growing number of available treatment choices will allow individualization of the treatment. Nevertheless, until prospective studies with prolonged follow-up are conducted to evaluate the risks and benefits of different alternative therapies, hormone replacement therapy, which is better studied, will remain the treatment of first choice, and "one size fits all" will continue to describe the management plan for most peri- and postmenopausal women at least in the near future.After completion of this article, the reader will be able to summarize the various alternatives to hormonal therapy for menopausal symptoms, describe the effects of phytoestrogens in the management of menopausal symptoms, and explain the origin and clinical use of the more common herbal therapies.
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<b><i>Background: </i></b>In total, 40-70% of cancer patients use complementary or alternative medicine (CAM). Many of them ask for advice from non-medical practitioners (NMPs). Our aim was to investigate the attitude of NMPs regarding their treatments for cancer patients. <b><i>Methods: </i></b>A survey was performed on members of NMP associations, using an online questionnaire on diagnosis and treatment, goals for using CAM, communication with the oncologist, and sources of information. <b><i>Results: </i></b>Of the 1,500 members of the NMP associations, 299 took part. The treatments were found to be heterogeneous. Homeopathy is used by 45% of the NMPs; 10% believe it to be a treatment directly against cancer. Herbal therapy, vitamins, orthomolecular medicine, ordinal therapy, mistletoe preparations, acupuncture, and cancer diets are used by more than 10% of the NMPs. None of the treatments is discussed with the respective physician on a regular basis. <b><i>Conclusions: </i></b>Many therapies provided by NMPs are biologically based and therefore may interfere with conventional cancer therapy. Thus, patients are at risk of interactions, especially as most NMPs do not adjust their therapies to those of the oncologist. Moreover, risks may arise from these CAM methods as NMPs partly believe them to be useful anticancer treatments. This may lead to the delay or even omission of effective therapies.
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