The Role of Integrative and Alternative Medicine in Cancer Care

TON - November 2017, Vol 10, No 6

New Orleans, LA—It is well known that cancer treatment is often associated with serious adverse side effects, but conventional care is often focused on cure and survival, rather than on a holistic approach to patient care, suggests Nerissa Wood, BSN, RN, OCN, Director, Tulane Comprehensive Cancer Clinic, New Orleans, LA. As a result, an increasing number of patients with cancer are turning to complementary and alternative medicine (CAM) to improve their quality of life and well-being while undergoing cancer treatment.

“People with cancer want to do everything they can to combat the disease, manage its symptoms, and cope with the side effects of treatment. Many turn to complementary health approaches—for example, herbal and other dietary supplements, acupuncture, massage, and yoga,” said Ms Wood at the 2017 Annual New Orleans Summer Cancer Meeting.

Increasingly, many cancer centers are offering their patients integrative medicine programs that include services such as acupuncture, yoga, and meditation. Nurses in your practice can play a vital role in educating patients about the risks and benefits associated with alternative medicine, and can help patients to identify complementary and safe therapies that may help in alleviating treatment side effects. The FDA considers vitamins and supplements as foods, not drugs, so they are not strictly regulated, and few supplements are tested for quality and potential adverse side effects.

“So we need to encourage patients to disclose the use of these therapies [supplements], as some may decrease the efficacy of other medications,” Ms Wood said.

Complementary versus Alternative Medicine

Many Americans—more than 30% of adults and approximately 12% of children—use healthcare approaches developed outside of mainstream Western, or conventional, medicine.1 When describing these approaches, people often use “alternative” and “complementary” interchangeably, but the 2 terms refer to different concepts, Ms Wood said. If a nonmainstream practice is used together with conventional medicine, it is considered “complementary,” whereas “alternative” refers to a nonmainstream practice used in place of conventional medicine.

Most complementary health approaches fall into 1 of 2 subgroups—natural therapies (ie, herbs, vitamins and minerals, and probiotics), or mind and body practices. According to the 2012 National Health Interview Survey, 17.7% of American adults had used a dietary supplement other than vitamins and minerals in 2012.2 The survey also revealed that yoga, chiropractic and osteopathic manipulation, meditation, and massage therapy are among the most popular mind and body practices used by adults.2

Furthermore, the 2007 National Health Interview Survey showed that approximately 38% of adults reported using CAM in the previous 12 months, and with 83 million adults spending $33.9 billion out-of-pocket on such approaches that year, those costs made up 11.2% of the total out-of-pocket expenditures on healthcare.3

Research on Integrative Medicine in Oncology

The National Center for Complementary and Integrative Health (NCCIH) was established in 1999 as the arm of the National Institutes of Health to rigorously evaluate the safety and efficacy of alternative medicine, train researchers to conduct research, and provide information to the public and healthcare professionals on such treatments. Since its inception, the organization has funded >2500 research projects focused on the safety and efficacy of nontraditional integrative medicine approaches.

NCCIH-funded research has suggested that patients with cancer who receive integrative therapies while in the hospital have less pain and anxiety.1 Their research has also shown that massage therapy can lead to short-term improvements in pain and mood in patients with advanced cancer, and yoga may alleviate the persistent fatigue that some women experience after breast cancer treatment, Ms Wood said.1

In one of the largest clinical trials to test the safety and efficacy of acupuncture, NCCIH researchers found that acupuncture significantly reduced the pain associated with osteoarthritis of the knee when used as a complement to conventional therapy.4 Other research has demonstrated that acupuncture provides relief for nausea and vomiting as well as tension headaches, and that acupuncture and simulated acupuncture can provide relief for those suffering from lower back pain.5

The Office of Cancer Complementary and Alternative Medicine is part of the National Cancer Institute (NCI) and is responsible for the NCI’s research agenda in CAM as it relates to cancer prevention, diagnosis, treatment, and symptom management.

The organization offers information to patients and healthcare providers and explains various CAM therapies and their associated benefits and risks. Its Case Review and Intramural Science Program conducts scientific studies of CAM interventions related to cancer, and facilitates prospective research with the goal of developing novel therapeutic interventions.

“For thousands of years, patients have used CAM therapy. Hopefully we can continue to further research surrounding the safety and efficacy of these therapies,” concluded Ms Wood.

1. National Center for Complementary and Integrative Health. Complementary, alternative, or integrative health: what’s in a name? Publication No. D347; June 2016. Accessed September 8, 2017.
2. Clarke TC, Black LI, Stussman BJ, et al. Trends in the use of complementary health approaches among adults: United States, 2002-2012. Natl Health Stat Report. 2015;79:1-16.
3. Nahin RL, Barnes PM, Stussman BJ, Bloom B. Costs of complementary and alternative medicine (CAM) and frequency of visits to CAM practitioners: United States, 2007. Natl Health Stat Report. 2009;18:1-14.
4. Berman BM, Lao L, Langenberg P, et al. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med. 2004;141:901-910.
5. Baxter GD, Bleakley C, McDonough S. Clinical effectiveness of laser acupuncture: a systematic review. J Acupunct Meridian Stud. 2008;1:65-82.

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