Complementary and alternative therapies for cancer

INTRODUCTION

Complementary and alternative medicine (CAM) is defined by the National Center for Complementary and Alternative Medicine as a group of diverse medical and health care systems, practices, and products that are not normally considered to be conventional medicine [1]. Included in this type of therapy are herbs, acupuncture, chiropractic, and massage, among others. Use of these therapies is common in the general population [2].

The use of CAM is widespread and increasing [3]. Multiple studies have found that within one year, up to 90 percent of patients with cancer used a CAM approach for at least a part of their therapy [4-11]. However, patients may not reveal the use of CAM unless specifically asked. In one study, disclosure of the use of these therapies increased from 7 to 43 percent when directed questions were added to standard history taking [12]. Unfortunately, communication between oncologists and patients about CAM is poor, infrequent, and mostly initiated by patients or their kin [13].

Users of CAM are generally not dissatisfied with conventional medicine but find alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life [14]. Factors reported to be associated with use of CAM therapies in cancer patients include:

• Increased psychosocial stress (eg, anxiety, depression) [15]
• Being given a less hopeful prognosis [16]
• Having the feeling of "nothing to lose" [17]
• Attending support groups [18]
• Age (younger versus older) and gender (women more than men) [11]

Despite the current popularity of CAM, most mainstream oncologists have little understanding of these therapies [19]. However, patients with cancer report feeling that their doctors "should be more interested in, more informed about, and more willing to discuss unconventional therapies" [20]. Although many patients assume that CAM is associated with beneficial effects, at least one Norwegian longitudinal study of 515 cancer patients suggests that CAM use may be associated with shorter survival [21].