By Kurt Ullman Complementary and alternative medicine (CAM) had a rocky start in oncology. In the 1940s, the Gerson regimen was touted by some as an alternative treatment for many cancers. Laetrile was an alternative medicine of choice in the 70s. Neither had any scientific backing, and many thought they were dangerous.
By Kurt Ullman
Complementary and alternative medicine (CAM) had a rocky start in oncology. In the 1940s, the Gerson regimen was touted by some as an alternative treatment for many cancers. Laetrile was an alternative medicine of choice in the 70s. Neither had any scientific backing, and many thought they were dangerous.
Over the years, three major distinctions have evolved. Alternative medicine was originally defined as those herbs, supplements, or interventions used instead of conventional medicine. Complementary medicine was administered in addition to conventional medicine. Finally, integrative medicine takes the best proven methods from both worlds and uses them together.
“We know from good studies that as many as 80% of our patients with cancer are using something in this realm,” says Brent Bauer, MD, director of the Complementary and Integrative Medicine Program at the Mayo Clinic in Rochester, MN. “Pretending it isn’t there may be forcing the patient to get their information from the Internet or TV.”
The outlook of conventional medicine eventually shifted from trying to discourage all patients away from the “snake oil” treatments toward scientific evaluation of which CAM treatments and regimens might actually work.
“Conventional medicine began to see the need to approach CAM in a more responsible way,” says Moshe Frenkel, MD, medical director of the integrative medicine program in the Department of Palliative Care and Rehabilitation Medicine at The University of Texas M. D. Anderson Cancer Center in Houston. “We started to advise the patient on these issues as we learned the value of these methods in cancer treatment.”
Both physicians stressed that this was not a call to include every CAM treatment for every patient. “‘First, do no harm’ is the initial screen,” says Dr. Frenkel. “Then we began looking for effectiveness and benefit as an adjunct to conventional treatments.”
As the research showing the safety and efficacy of CAM began to increase, there was a corresponding decrease in physician’s resistance to utilizing them in day-to-day treatment.
“Since we now have well-done studies, we can intelligently discuss the positive effects of yoga and other CAM interventions,” says Dr. Bauer. “As the evidence accumulates, it turns out many of these treatments fit in nicely right alongside what we are doing from a conventional standpoint. We are taking the best of conventional medicine and the best of evidence-based CAM and integrating the two to the benefit of our patients.”
This change in attitude has had some other important, if probably unintended, benefits. In the past, many physicians looked at CAM as being equivalent to the medicine shows of the Old West. They often told patients that these were not regulated and to toss them out.
“Of course this did not stop the patients from using CAM,” says Dr. Bauer. “But it did stop the patient from telling the doctor about everything they were taking. This meant that the physician was essentially prescribing in the dark, not knowing about something the patient might be taking that could interfere with the doctor’s regimen.”
He points to Saint John’s Wort (SJW), which has been shown to be effective in treating minor forms of depression. It is also established that SJW can impact the liver’s metabolism of many drugs, including chemotherapy medications. Having a patient start or stop using this supplement could result in undertreatment or overtreatment if the doctor is not told.
“While scientific and evidence-based thinking is fundamental to contemporary medical practice, patients often do not reason in this way,” says Dr. Frenkel. “A physician’s failure to recognize this interferes with his ability to address the unspoken needs of patients. In most cases, CAM users are not disappointed or dissatisfied with conventional medicine, but they want to do everything possible to regain health and to improve their quality of life. Patients may use CAM to reduce side effects and organ toxicity, to protect and stimulate immunity, or to prevent further cancers or recurrences.”
The change in how conventional medicine viewed CAM also was impacted by the advent of shared decision-making and patient-centered medicine, according to Dr. Frenkel. He says doctors should put emphasis into thinking about CAM and giving their patients sound reasons why they should or should not use that regimen.
“The physician who is receptive to patient inquiries and aware of subtle, nonverbal messages can create an environment in which a patient feels protected and can openly discuss potential CAM choices,” he continues.
Medical professionals at all levels need to assess not only what CAM interventions are being used, but also assess where the information leading to use is coming from.
“Whenever a patient’s environment finds they have cancer, they send them the latest updates from CNN, the local newspaper, their favorite internet sites, and day time TV,” says Dr. Frenkel. “They are bombarded by information, and the physician has to give direction on what constitutes a reliable website and help them avoid getting lost in this confusion.”
According to both physicians, conventional medicine is underutilizing CAM. “We have to become more proactive,” says Dr. Bauer. “Is it okay to say ‘here is the chemo, now run off and do the best you can’? If we truly care about our patients and we know there is something that might lessen the stress or decrease the nausea, I think we have to become more aggressive telling our patients about things we know will help.”
There are a number of places where the physician can go to get reliable, independent information on CAM interventions. Both MD Anderson (www.mdanderson.org/cimer) and the Mayo Clinic (http://www.mayoclinic.com/health/alternative-medicine/CM99999) maintain CAM areas on their websites for both physician and consumers. The Consortium of Academic Health Centers for Integrative Medicine (http://www.imconsortium.org/) is another resource for information and expertise on the subject.
“The emerging field of CAM use in oncology and how to integrate important aspects of CAM use into conventional cancer care is the base for this evolving new discipline of Integrative Oncology,” says Dr Frenkel. “But it is much more than that. As mentioned in the Consortium definition, integrative medicine is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals, and disciplines to achieve optimal health and healing.”