Complementary therapy and cancer: decision making by patients and their physicians setting a research agenda

Key issues in clinical and epidemiological research in complementary and alternative medicine--a systematic literature review

BACKGROUND

In the last 2 decades there has been a large increase in publications on complementary and alternative medicine (CAM). However, CAM research methodology was heterogeneous and often of low quality. The aim of this systematic review was to investigate scientific publications with regards to general issues, concepts and strategies. We also looked at research priorities and methods employed to evaluate the clinical and epidemiological research of CAM in the past to identify the basis for consensus-based research strategies.

METHODS

We performed a systematic literature search for papers published between 1990 and 2010 in 7 electronic databases (Medline, Web of Science, PsychArticles, PsycInfo, CINAHL, EMBASE and Cochrane Library) on December 16 and 17, 2010. In addition, experts were asked to nominate relevant papers. Inclusion criteria were publications dealing with research methodology, priorities or complexities in the scientific evaluation of CAM. All references were assessed in a multistage process to identify relevant papers.

RESULTS

From the 3,279 references derived from the search and 98 references contributed by CAM experts, 170 papers fulfilled the criteria and were included in the analysis. The following key issues were identified: difficulties in past CAM research (e.g., randomisation, blinding), utility of quantitative and qualitative research methods in CAM, priority setting in CAM research and specific issues regarding various CAM modalities.

CONCLUSIONS

Most authors vote for the use of commonly accepted research methods to evaluate CAM. There was broad consensus that a mixed methods approach is the most suitable for gathering conclusive knowledge about CAM.

The use of Complementary and Alternative Medicine by cancer patients

The use of Complementary and Alternative Medicine (CAM) among cancer patients is widespread and appears to be increasing. However, it is not clear whether patients use CAM as an 'alternative' to standard oncology care or as an adjunct to the conventional treatment they receive. This study reviews the role of CAM therapies in the management of cancer, from the view of both patients and health professionals and it highlights issues relating to the efficacy of CAM used by cancer patients. Most patients use CAM to 'complement' the conventional therapies of radiotherapy, chemotherapy, hormone therapy and surgery. Health professionals in general have expressed positive views when CAM is used 'complementarily' and not as an 'Alternative'. Results so far published have shown that CAM can contribute to improving the quality of life of cancer patients and their general well-being.

Practitioners' sources of clinical information on complementary and alternative medicine in oncology

GOALS OF WORK

The use of complementary and alternative medicine (CAM) amongst oncology patients is widespread. There is little data regarding the sources of clinical information on CAM that oncology practitioners utilise. The aim of this study was to investigate the sources of clinical information on CAM utilised by Australian oncology practitioners.

METHODS

A structured self-administered questionnaire was sent to Australian oncology practitioners, defined as oncologists, oncology pharmacists and pharmacists at drug information centres (DICs). Key information was sought on their level of satisfaction with the accessibility, reliability and usefulness of this information and the frequency of, and initiating factors for, seeking this information.

MAIN RESULTS

A substantial proportion of oncologists (57.1%) reported having never sought information on CAM, compared to 27.3% of oncology pharmacists, and 18.8% of DIC pharmacists. Oncologists most commonly reported seeking information on CAM one to three times per year compared to four to ten times per year for oncology pharmacists. Databases were the most common information source used by oncologists (48.1%) and oncology pharmacists (91.7%) and the second most common information source used by DICs (92.3%). There was wide variation in the source of clinical information on CAM used by the three different professional groups.

CONCLUSION

. Oncology practitioners often seek information on CAM; however the frequency, nature and sources of information utilised varied widely. The usefulness and reliability of the sources utilised were inconsistent.

Ethical dimensions in the borderland between conventional and complementary/alternative medicine

Consumer enthusiasm for complementary and alternative medicine presents complex challenges for conventional Western biomedically dominated health care systems and for those who practice within them. In particular, this trend forces new ethical dilemmas related to how we create consensus about the nature of ethical clinical practice and what constitutes evidence sufficient for public health policy. In this paper, we examine the historical context into which complementary and alternative medicine has been introduced, and consider the ethical and scientific challenges with which it confronts mainstream health systems.

Adjustment to illness of cancer patients treated by complementary therapy along with conventional therapy

This pilot study compares the adjustment to illness, i.e. psychosocial and psychological distress, of 29 cancer patients being treated by complementary therapy along with conventional therapy, with a control group of 29 patients being treated by conventional therapy only. The findings indicate statistical differences in the brief symptom inventory scale (BSI), namely, the psychological distress of patients who received conventional therapy only was more severe than those being treated by complementary therapy with conventional therapy. No statistical differences, however, were found between the two groups in terms of psychosocial adjustment to the illness (PAIS). The findings lead to a recommendation that complementary therapy should be offered by public medical facilities as part of the standard treatment for cancer patients in order to ease psychological distress.