Complementary and alternative medicines for cancer: A crisis in communication
The use of Complementary and Alternative Medicines (CAMs) to treat cancer is a highly controversial topic. There are undoubtedly many advocates for CAMs who value such positive features as their “natural” properties and relative accessibility. However, there are serious concerns over whether non-traditional therapies, such as herbal medicine and nutritional supplements, are at best ineffective or at worst potentially harmful. There are also ethical considerations surrounding how “prescribing” such practices may be exploitative of vulnerable populations if the data supporting their effectiveness is not particularly convincing. With the growing use of CAMs, these concerns are becoming all the more crucial to address. A recent study published in April 2019  reported that one third of people in the USA with a cancer diagnosis use CAMs and the most common treatment was herbal supplements. Therefore, it is clear that there is a vital need for better education and effective communication between the scientific and medical community and the public on this important topic.
Disclosure rates of CAM use also reflect another worrying crisis in communication. The 2019 study reported that 29% of people who use CAMs did not tell their physicians. The authors commented that this figure was especially concerning in the case of herbal supplements, since there is not enough data to judge whether high levels of antioxidants could interfere with traditional radiation therapy. The survey respondents reported that reasons behind their nondisclosure included concern over a negative reaction and not thinking that their doctors needed to know. This result hints at complex reasons behind patients deciding to keep their CAM use private, including concerns over stigma, as well as a lack of understanding about possible interference with traditional treatments.
Understanding the motivation, perspectives, and experiences of CAM consumers is a key responsibility of the scientific community and an essential step in preventing potentially harmful outcomes. On top of this, empathy and a consideration of psychological experiences are critical in research areas as sensitive as cancer treatment. In a news article discussing the previously mentioned study , a cancer patient is quoted rationalising her use of CAMs as: “It’s what we can control – we can’t control the whole cancer.” This quote provides salient insight into the reasoning behind some CAM use; namely that it can offer a sense of agency in a situation with little control.
It is easy to imagine how alternative avenues offering structured regimes and tangible “cures” can look enticing when things may seem otherwise hopeless, and how compelling the incentive to have tried every possible treatment might be, especially ones that are marketed as “natural” and therefore potentially of low risk. With this consideration in mind, a reasonable strategy for clinicians may be to first recognise the potential emotional motivation behind CAM use so that they can promote an open and honest discussion between clinician and patient.
At NBRI, we are currently conducting a community-based survey (the “CAMPUS” study) to delve deeper into the psychology behind patients’ decision to use CAMs and their continued experiences with them. Given the perceived stigma patients face disclosing their CAM use, this study aims to collect data in a non-judgmental and open-ended manner. A failure in communication about the reality of CAMs for both clinicians and consumers is a joint responsibility, and one which we hope to work towards alleviating.
 Sanford NN, Sher DJ, Ahn C, Aizer AA, Mahal BA. Prevalence and Nondisclosure of Complementary and Alternative Medicine Use in Patients with Cancer and Cancer Survivors in the United States. JAMA Oncol. 2019;5(5):735–737. doi:10.1001/jamaoncol.2019.0349