Use of Complementary and Alternative Medicines (CAM) in the community
In 2018 alone there were a reported 17 million new cancer diagnoses and approximately 9 million cancer deaths worldwide. Given the alarming statistics and subsequent emotional toll of such a diagnosis, it’s no surprise that cancer patients are willing to do whatever it takes to gain control over their deadly disease.
The 21st century has seen an explosion of information – both good and bad. One of the largest information booms has surrounded the concept of wellness. Countless online influencers, bloggers and allied health professionals have used this movement to advertise the perceived benefits of treatments known widely as “complementary and alternative medicines” (CAMs). Complementary medicines refer to those that are used alongside conventional medical treatments. This may include acupuncture to assist with pain, or dietary supplements to restore essential nutrients. Alternative medicines are offered instead of conventional treatments. Up to 90% of cancer patients will utilise these types of treatments at some stage of their journey, and as such, it’s well worth taking the time to understand the reasons behind these choices, and the types of treatments that are being used.
Many CAM-based approaches have been proven to be very beneficial in the management of many conditions, not just cancer. Those with osteoporosis benefit demonstrably from combining modern anti-resorptive medications with calcium and vitamin D supplementation alongside a regular low-impact exercise regime. Many sources of pain are adequately managed with non-medical approaches such as massage and acupuncture and for cancer patients, complementary treatment with herbs such as ginseng and guarana have been helpful to improve symptoms of fatigue.
The role of CAM-based therapies in prevention of cancer is yet to be fully investigated and determined. At NBRI, we are currently conducting a systematic review and meta-analysis of the role of Vitamin D supplementation in preventing cancer occurrence and improving overall survival and we expect the results from our analyses available soon – so stay tuned!
Potential benefits of CAMs aside, it is also important to be aware of their shortcomings. Some therapies that might be considered ‘complementary’ can in some circumstances be harmful. For example, some dietary supplements, including megadoses of vitamins and minerals may interfere with chemotherapy.
Up to 90% of cancer patients may utilise CAMs at some stage of their therapy, backed by varying degrees of research and evidence. When patients abandon conventional, evidence-based medicines for alternative herbal or diet-based treatment, the CAM practitioner rarely discloses the fact that these regimens are largely unsupported by research and may in fact limit the activity of conventional agents.
Common diet-based treatments for cancer include the Gerson regimen and the ketogenic or macrobiotic diets. Claims of superior survival compared to conventional techniques have not been supported by randomised controlled trials in any of these diets. Furthermore, the side-effects of weight loss and the restrictive nature and unpalatability of the allowed foods on these diets make these diets intolerable to many patients.
Many CAM practitioners will prescribe unconventional supplements to their patients with a belief it will improve survival. Commonly encountered supplements include melatonin, shark and bovine cartilage and thymus extract. Again, randomised controlled trials investigating the impact of these compounds on cancer survival fail to display a benefit compared to conventional approaches.
Research surveys have suggested that 40% of patients don’t disclose CAM use to their clinicians. There are several barriers to disclosure, but given the considerable hope, time and money patients invest in these strategies plus the several reported interactions between common CAM therapies and conventional agents (chemotherapy as well as other medications), it is important that health practitioners feel comfortable discussing CAM use with their patients. While it’s not possible for most clinicians to remain up to date with the ever-changing landscape of available CAM therapies awareness that their use is extremely prevalent in patients with chronic diseases should prompt open questioning of all patients who walk through the door.