Exploring complementary medicine (CAM)
October 09, 2012
Up to 80% of Canadians with cancer use complementary medicine (CAM) during their cancer experience. Yet a British Columbia study shows that only 28% of cancer patients surveyed discussed CAM with their oncology health care providers. Of those patients who had spoken about it with members of their cancer care team, only 18% received enough support to make informed decisions.
A research program called CAMEO (Complementary Medicine Education & Outcomes Program) – a collaboration of the University of British Columbia School of Nursing and the BC Cancer Agency research program – is attempting to address this gap in care.
“What we’re trying to do is find the best ways to support people to make safe and informed decisions around complementary medicine that acknowledge peoples’ values and preferences and consider the social context of CAM use,” explains Tracy Truant, a Registered Nurse and co-investigator with the CAMEO Program.
“Information about the safety, risks and benefits of CAM is increasing and becoming more complex. Health professionals need to improve their CAM knowledge and decision support skills to help patients and families make safe and informed decisions about CAM. In addition, much more research needs to be done to determine the effectiveness and safety of complementary therapies.”
The National Centre for Complementary and Alternative Medicine (NCCAM) defines CAM as “a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine.”
According to the NCCAM, CAM is divided into five categories covering a broad spectrum of therapies:
Body-based – such as massage, exercise
Mind-body – including meditation, relaxation therapies, prayer
Biologically-based – natural health products, supplements, herbs
Energy-based – such as acupuncture, therapeutic touch, Reiki
Whole medical systems – including naturopathy, traditional Chinese medicine.
The reasons for using CAM are varied. “Complementary therapies can be used for easing symptoms and improving your overall health and feeling of well-being,” according to the Canadian Cancer Society in its publication Complementary Therapies: A guide for people with cancer. “The purpose of a complementary therapy is not to treat the cancer itself. They help a person cope with cancer, its treatment or side effects, and to feel better. They take a holistic approach by focusing on the whole person.”
CAM can be referred to as complementary medicine, which is used in addition to conventional medicine, and alternative medicine, which is used in place of conventional medicine. While Canadians with cancer most commonly use complementary medicine, only 4 to 6% of Canadians leave conventional cancer care for alternative medicine. CAM can also refer to integrative medicine, which combines treatments from conventional medicine and complementary medicine for which there is evidence of safety and effectiveness.
Ideally, an integrative approach “is what we all work towards,” explains Tracy, “…it is the bringing together of evidence-based conventional and complementary therapies to promote patient centered care – it is the best of both worlds coming together in a way that addresses the unique needs, preferences and values of patients and families.”
Integrative care “offers the best of both complementary and conventional medicines,” according to the Canadian Cancer Society, noting an example of a cancer centre offering massage therapy as a standard way to help patients manage stress and create a sense of well-being during conventional cancer treatment.
The four-year CAMEO program is laying the foundation for the development of integrative cancer care by addressing these foundational goals including:
Determining how best to support people living with, through and beyond cancer in making evidence-informed CAM decisions
Evaluating how to improve health professionals’ knowledge and decision support skills related to CAM
Facilitating the development and integration of new CAM and cancer research knowledge.
The long-term goal is that the programs and materials developed by CAMEO will empower patients and families with the knowledge, skills, and resources to make safe and informed decisions about CAM that are right for them as well as enable cancer health care professionals to provide CAM education and decision support within their local communities.
One of the biggest challenges for patients and families considering CAM is to discover if therapies are safe and effective.
“Treatments that offer the best hope of success are backed up by good scientific evidence,” according to the Canadian Cancer Society. “Conventional treatments are tested and proven to be helpful in studies of large numbers of people. It’s important that complementary therapies be assessed the same way as conventional treatments, through careful scientific studies.”
Many people use more than one form of complementary therapy. It is also important to determine how these therapies work together, and if they interact with or change the effectiveness of conventional cancer treatment.
The Society for Integrative Oncology’s (SIO, 2009) evidence-based clinical guidelines for complementary therapies recommends that all cancer patients should:
Be asked about the use of CAM
Receive guidance about CAM in an open, evidence-based, and patient-centred manner by qualified personnel
Be advised to avoid therapies promoted as “alternatives” to mainstream care.
“Making a decision about CAM is more than using evidence. It’s also considering your own beliefs, values, goals, who you are in your social network and how you make decisions in that social network,” says Tracy.
“It involves your clinicians’ judgment as well – your physicians, nurses, pharmacists and other health professionals have seen many people with cancer and they have some insights into helping guide you through your complementary medicine decisions. If you take all of these things together, it’s an informed decision.”
The following links provide detailed information on specific CAM therapies, evidence-based research, information on talking to health providers about CAM, decision-making tips and more:
Deng et al., (2009). Evidence-based clinical practice guidelines for integrative oncology: Complementary therapies and botanicals. Journal of the Society for Integrative Oncology, 7(3), 85-120.
World Cancer Research Fund & American Institute for Cancer Research (WCRF & AICR). Synthesis of Food, Nutrition, & Physical Activity Research in the Prevention of Cancer (2007)
The Integrative Medicine Service – Memorial Sloan-Kettering Cancer Center
www.mskcc.org (search for integrative medicine)
Natural Medicines Comprehensive Database
US National Library of Medicine – National Institutes of Health