Complement or Alternative?

March 27, 2009

It is hard to turn on the TV or page through a magazine without seeing or hearing ads for all sorts of "optional" treatments for disorders or conditions.

It is hard to turn on the television or page through any magazine these days without seeing or hearing ads for all sorts of “optional” treatments for a variety of disorders or conditions. From plant extracts to exercise to protein supplements to music, we can cure about anything according to the advertising. So how much of this is truly effective and how much can we let go by the wayside? I think it is vitally important to not only know what is out there and being sold, but also what the research behind it is. There are many reputable resources for alternative and complementary therapies available. The Oncology Nursing Society (ONS) has published books on the subject that are easy references to a variety of therapies. So what is the difference between complementary therapies and alternative therapies? It really is very clear.

Complementary therapies are used in conjunction with or as an adjuvant to traditional therapy. Alternative therapies are used in place of traditional therapy. And there is a place for both of them in oncology and oncology nursing. I think the first thing that we have to do is look at the goals. What are the patient’s goals? I always have to remember that it is the patient’s goals and the patient’s beliefs that are paramount.

I will never forget the patient I treated several years ago who was admitted to the hospital for metastatic breast cancer. She was a young woman in her early 40’s. When she was originally diagnosed with breast cancer she had stage 1. Well that’s easy right… it’s curable. The decision should have been clear. Have surgery, do a little chemotherapy or chemotherapy and radiation, and you live a long and happy life. That would have been my choice, but not so for this woman. She was very concerned about what she put into her body. She took very little if any medications. She used herbal remedies and therapies such as yoga and acupuncture. She believed totally in the mind body connection and didn’t want to do anything to poison her body. She believed this to such a degree that she opted not to undergo any of the traditional, proven to cure therapies that were offered to her and opted to treat the curable breast cancer with herbal remedies.

Now a few years later I was seeing her with a tumor that had metastasized to her paranasal cavity to the extreme that it was pushing her right eye outward. She was basically blind in that eye. When I met with her, her friends and the attending physician it was interesting. The physician was very caring but very clear that if she did not undergo chemo and radiation at this point she would indeed die. There was no guarantee that she would recover completely with these therapies, but without them her life would come to an end. Of course her friends told her she HAD to do it. And even though she still believed that it was just not right to put “unhealthy and un-natural” things into your body, she also did not want to die. She agreed to chemo and radiation as long as she could still do acupuncture and other complementary therapies to help with the side effects. Everyone agreed. A few days after starting chemotherapy, I was taking care of the patient again. When I assessed her in the morning I found her to be somnolent almost to the point of obtunation. I had not given her any new medications or even any medication for pain for quite some time. She had been alert, but obviously depressed just moments earlier. Being the good medical professionals that we are, we were sure it was some medication and gave the narcan. Nothing. We tried everything that we had in our arsenal and could not get her to wake up. Her vital signs remained stable but she was unresponsive. Then the psych nurse stepped in. After assessment, it was determined that this young woman was now in a catatonic state. She had gone against what every fiber of her being told her was wrong in accepting the traditionally therapy that might save her life and in the process her mind could not come to terms with that. Once treated for the catatonia, she was again talking and interacting. With further psychological treatment, the “life-saving” treatments were stopped and this woman was able to truly live the remaining time that she had.

So is there a place for complementary and alternative medicine (CAM) therapies? Absolutely. We have to educate ourselves as well as our patients and be open to what may be most useful to them. If you want to know more about CAM therapies go to www.nccam.nih.gov or www.ons.org.